Abstract Book by Sri Lanka Medical Association

THE CEYLON MEDICAL JOURNAL Established 1887 Volume 57, Supplement 1, June 2012

Sri Lanka Medical Association 125th Anniversary International Medical Congress

Abstract Book SLMA

Oral Presentations

5 13

List Abstracts

Poster Presentations

53 69

List Abstracts

Sri Lanka Medical Association 125th Anniversary International Medical Congress 2 to 6 July 2012 Bandaranaike Memorial International Conference Hall Colombo

This is a special abstract issue of the Ceylon Medical Journal Volume 57, Supplement 1, June 2012

THE SRI LANKA MEDICAL ASSOCIATION

The historic Wijerama House The Sri Lanka Medical Association (SLMA) which celebrates the 125th anniversary this year 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 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). 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. The historic Sri Lanka Medical Library, which is over 168 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 125th Anniversary International Medical Congress is the most important academic activity in the SLMAâ&#x20AC;&#x2122;s calendar this year.

The Sri Lanka Medical Association Vision To be most influential professional organisation in Sri Lanka Mission As the apex medical professional organisation in Sri Lanka, to lead the medical community to achieve the highest standards of medical professionalism and ethical conduct and to be an advisory body on health policy to the Sri Lankan government and community. General Objectives 1. Enhance the capacity as the apex professional and scientific organisation of all categories of medical doctors as defined in the constitution of the SLMA 2. Play an advocacy role towards comprehensive curative and preventive health services for the people of Sri Lanka 3. Promote professionalism, good medical practice and ethical conduct among doctors 4. Disseminate state-of the art knowledge, clinical practice, technology and emerging concepts in medical sciences among medical professionals 5. Provide opportunities for continuous professional development with particular emphasis on the National CPD programme 6. Encourage ethical medical research 7. Educate the public on health-related issue 8. Enhance closer professional and scientific links between medical doctors and professionals allied to health care

Ceylon Medical Journal website The Ceylon Medical Journal can now be read online. The full text articles of the CMJ are available free of charge at the following website. www.sljol.info/index.php/CMJ /Index OR www.sljol.info/index.php This website is maintained by the Sri Lanka Journals Online. All full text articles published since 2002 are available in the website. Please register yourself free of charge at the website, to receive e-mail alerts about new issues uploaded.

List of Oral Presentations

LIST OF ORAL PRESENTATIONS Free Paper Symposium 1: Transplant Medicine and Renal Disease OP 1: Liver transplantation - initial experience at Colombo North Liver Transplantation Service M.M.M.P.Bogamuwa, RC Siriwardana, MA Niriella, AS Dassanayake, SRE Wijesuriya, CAH Liyanage, MB Gunetilleke, HJ de Silva Faculty of Medicine, University of Kelaniya OP 2: Live donor renal transplantation in Sri Lanka - factors affecting overall outcome N Gunawansa, M Wijerathne, R Cassim, R Dissanayake, J Arudchelvam, N Senevirathne National Hospital of Sri Lanka, Colombo OP 3: Outcome of living unrelated donor renal transplantation is equivalent to those of living related donor renal transplantation UAD Wijesinghe1, MD Lamawansa1, AWM Wazil2, T Abeysekara2 1Department of Surgery, Faculty of Medicine, University of Peradeniya 2Teaching Hospital, Kandy OP 4: Arsenic Related Skin Manifestations in Patients with Chronic Kidney Disease of Unknown Aetiology (CKDu) in The North Central Province of Sri Lanka Rajeewa Dassanayake1, S Hulangamuwa1, DTDJAbeysekara2 1Teaching Hospital, Anuradhapura 2Teaching Hospital, Kandy OP 5: Histopathological changes in liver and renal tissues in Wistar rats given bore well water from CKDu endemic areas in North Central Province MG Thammitiyagodage1, C Rathnayake1, MM Gunatillaka1, N Ekanayake1, R Jayatissa1, UKSC Gunarathne2, WMMU Jayathilake1 1Medical Research Institute 2Regional Epidemiology Unit, Polonnaruwa OP 6: Renal dysfuction in patients with cirrhosis - a prospective analysis KRP Perera1, ST De Silva2, HJ De Silva2 1Colombo North Teaching Hospital, Ragama 2Faculty of Medicine, University of Kelaniya

Free Paper Symposium 2: Nutrition and Physical Activity OP 7: Vitamin D status and its association with serum parathyroid hormone in preschool children in a Sri Lankan Community E Marasinghe, S Chackrewarthy, HTCS Abeysena, S Rajindrajith University of Kelaniya OP 8: Body weight perception and weight loss practices among Sri Lankan adults R Jayawardena1, P Katulanda2, N Byrne1, M Soares3, A Hills1 1Queensland University of Technology, Brisbane, Australia 2Diabetes Research Unit, Faculty of Medicine, University of Colombo 3Curtin University, Australia OP 9: Comparison of body fat percentage of Sri Lankan National rugby players based on their playing positions SN Muthuthanthiri1, SA Pathmakanthi1, VG Arachchi1, A Pathmeswaran2, A P de Silva3 1Institute of Sports Medicine Departments of 2Public Health and 3Medicine, Faculty of Medicine, University of Kelaniya

List of Oral Presentations OP 10: Contribution of physical activity and sedentary behaviour to glycaemic status in urban women PHIU Waidyatilaka1, A de Silva2, P Lanerolle1, R Wickremasinghe3, N Somasundaram4, S Atukorala1 Departments of 1Biochemistry and Molecular Biology, 2Physiology Faculty of Medicine, University of Colombo 3Department of Community Medicine, Faculty of Medicine, University of Kelaniya 4Endocrine Unit, National Hospital of Sri Lanka, Colombo OP 11: Energy and nutrient intake - findings from a Sri Lankan adult nutrition survey R Jayawardena1, P Katulanda2, N Byrne1, M Soares3, A Hills1 1Queensland University of Technology, Brisbane, Australia 2Diabetes Research Unit, Faculty of Medicine, University of Colombo 3Curtin University, Australia OP 12: Negative health effects of coconut - are they real at the population level? LK Athauda1, B Kumarendran2, A Kasturiratne2, AR Wickremasinghe2 Departments of 1Tropical Medicine & International Health and 2Public Health, Faculty of Medicine, University of Kelaniya OP 13: Patterns and correlates of physical activity among Sri Lankan adults R Jayawardena1, P Ranasinghe2, P Katulanda3, R Sheriff 3, DR Matthews4 1Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia 2Department of Pharmacology, Faculty of Medicine, University of Colombo 3Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo 4Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, UK

List of Oral Presentations OP 19: Effects of zinc supplementation on diabetes mellitus: a systematic review and metaanalysis R Jayawardena1, P Ranasinghe2, P Galappatthy2, G R Constantine3, P Katulanda3 1Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia 2Department of Pharmacology, Faculty of Medicine, University of Colombo 3Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo OP 20: Use of alternative medicines and the factors associated with the use among diabetic patients attending the medical clinics at National Hospital of Sri Lanka PHU Cooray, DGH Damayanthi, KKS Chinthanie, N Gunawardena Faculty of Medicine, University of Colombo

List of Oral Presentations

Free Paper Symposium 5: Immunology and Genetics OP 29: Indoor aeroallergen sensitisation patterns in Sri Lankan patients with allergic rhinitis and asthma GN Malavige1, S Paranavitana2, A Fernando3 1Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura 2Central Medical Centre (PVT) Ltd, Nugegoda 3National Hospital of Sri Lanka and Central Chest Clinic, Colombo OP 30: Immunophenotype of persistent peripheral blood lymphocytosis in adults - reactive or clonal? BCM Wimalachandra1, LV Gooneratne1,2, IHDS Prabath1, R De Silva2 1Faculty of Medicine, University of Colombo 2Asiri Group of Hospitals OP 31: Prevalence of eosinophilic oesophagitis among adult Sri Lankan patients with refractory upper gastrointestinal symptoms - a prospective study CK Ranawaka1, AP de Silva2, SJ Hewavisenthi3, TMAH Jayathilake3, WRS de Alwis2, PR Waraketiya2, MA Niriella1, HJ de Silva2 1University Medical Unit, Colombo North Teaching Hospital, Ragama Departments of 2Medicine and 3Pathology Faculty of Medicine, University of Kelaniya OP 32: A candidate gene association study of preeclampsia in Sinhalese women P Andraweera1, G Dekker2, VHW Dissanayake1, S Thompson2, D Furness2, R Nowak2, A Zhou2, J Zhang2, RW Jayasekara1, C Roberts2 1Human Genetics Unit, Faculty of Medicine, University of Colombo 2University of Adelaide, Australia OP 33: Vascular disease susceptibility gene polymorphisms are associated with adverse pregnancy outcomes P Andraweera1, G Dekker2, St Thompson2, R North3, L McCowan4, C Roberts2 1Human Genetics Unit, Faculty of Medicine, University of Colombo 2University of Adelaide, Australia 3King's College, London, UK 4University of Auckland, New Zealand OP 34: Molecular diagnosis of Williams Buren syndrome in a cohort of Sri Lankan patients DM Ranaweera1, D de Silva2, D Samarasinghe3, S Perera3, N Rajapaksha2, N V Chandrasekharan4 1Post Graduate Institute of Medicine, University of Colombo 2Faculty of Medicine, University of Kelaniya 3Lady Ridgway Hospitl for Children, Colombo 4Department of Chemistry, Faculty of Science, University of Colombo OP 35: Utility of quantitative polymerase chain reaction in leptospirosis diagnosis - association between level of leptospiraemia and clinical manifestations in Sri Lanka S Agampodi1, M A Matthias2, AC Moreno2, JM Vinetz2 1 Rajarata University of Sri Lanka 2University of California San Diego, USA OP 36: PCR-enzyme linked immunoabsorbent assay as a rapid molecular method for detection of rifampicin resistant Mycobacterium tuberculosis in low resource settings CP Adikaram1, J Perera1, WSS Wijesundera2 1Department of Microbiology, Faculty of Medicine, University of Colombo 2Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo OP 37: A novel approach to understand carcinogenesis in oral submucous fibrosis RP Illeperuma1, YJ Park1, WM Tilakaratne2, J Kim3, RP Illeperuma3 1Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea 2Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya 3Modern Medicine Unit, Institute of Inediginous Medicine, University of Colombo

List of Oral Presentations

List of Oral Presentations OP 47: Life style changes among tuberculosis patients attending Central Chest Clinic Colombo MGB Senanayake1, S Samaraweera2 1Nutrition Coordination Division, Ministry of Health, Colombo 2National Programme for Tuberculosis Control and Chest Diseases, Ministry of Health, Colombo

List of Oral Presentations OP 56: Cervical cancer screening among prison inmates in two female prisons in Sri Lanka SN Perera1, J Vidanapathirana2 1National Cancer Control Programme, Ministry of Health, Colombo 2National STD & AIDS Control Programme, Ministry of Health, Colombo OP 57: Effectiveness of an educational intervention on early detection of breast cancer in the district of Gampaha PVSC Vithana1, MAY Ariyarathne2, PL Jayawardena3 1Family Heath Bureau, Colombo 2Cancer Hospital, Maharagama 3Faculty of Medicine, University of Kelaniya

Free Paper Symposium 8: Non Communicable Diseases OP 58: Incidence of hypertension in an urban population - can we modify the risk? A Kasturiratne, K Medagoda, SAF Kurukulasuriya, AR Wickremasinghe Faculty of Medicine, University of Kelaniya OP 59: Public awareness of stroke, its warning symptoms, risk factors and treatment in Sri Lanka T Chang1, S Ibrahim1, C Arambepola2, HM Ranasinghe1, AHTM Mihirini1, D Weerasinghe1, TDP Vithanage1, C Maithripala1 Departments of 1Clinical Medicine and 2Community Medicine, Faculty of Medicine, University of Colombo OP 60: Knowledge of stroke, stroke warning symptoms, stroke risk factors, antiplatelet therapy and stroke-units among general practitioners in Sri Lanka T Chang1, S Ibrahim1, C Arambepola2 Departments of 1Clinical Medicine and 2Community Medicine, Faculty of Medicine, University of Colombo OP 61: Can a composite index predict ischaemic heart disease risk? EPDS Ediriweera1, S Samita2 1Postgraduate Institute of Medicine, University of Colombo 2Board of Study of Biostatistics, Postgraduate Institute of Agriculture, University of Peradeniya OP 62: Metabolic syndrome among Sri Lankan adults - prevalence, patterns and correlates P Ranasinghe1, R Jayawardena2, P Katulanda3, R Sheriff3, DR Matthews4 1Department of Pharmacology, Faculty of Medicine, University of Colombo 2School of Human Movement Studies, Institute of Health and Biomedical Innovation, Queensland Universities, Australia 3Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo 4Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, UK OP 63: Waist-to-height ratio has the best anthropometric association with cardio-metabolic disease among Sri Lankan adults P Ranasinghe1, R Jayawardena2, WRUAS Wijesundara3,WMUA Wijetunga3, TAD Tilakaratne3, S Subasinghe3, P Katulanda3 1Department of Pharmacology, Faculty of Medicine, University of Colombo 2School of Human Movement Studies, Institute of Health and Biomedical Innovation, Queensland University, Australia 3Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo OP 64: Influence of baseline inflammatory status on dietary effects of nutrition counseling in women with and without coronary artery disease T Thoradeniya1, C Senenayake1, R Wickremasinghe2, S Mendis3, S Jayasena1, S Atukorala1, 1Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo 2Department of Public Health, Faculty of Medicine, University of Kelaniya 3Institute of Cardiology, National Hospital of Sri Lanka, Colombo OP 65: The burden of road traffic injuries in Kandy District, Sri Lanka P Nithershini1, SD Dharmaratne2 1General Hospital, Kandy 2Department of Community Medicin, Faculty of Medicine, University of Peradeniya

List of Oral Presentations

Free Paper Symposium 9: Therapeutics and Complimentary and Alternative Medicine OP 66: Atorvastatin in ulcerative colitis: A placebo controlled randomised clinical trial A Chakrabarti1, P Dhamija1, D Hota1, RK Kochar1, A Sachdeva2 1Postgraduate Institute of Medical Education and Research, Chandigarh, India 2Government Medical College, Amritsar, India OP 67: Aspirin resistance among Sri Lankan patients N Prasanna1, LV Goonaratne1, BCM Wimalachandra1, HMJP Herath2, MD Perera2, DP Suriyamudalige1, KSJ Kolambage1, SSBDP Soysa1, PC Rodrigo1, S Rajapakse1 1Faculty of Medicine, University of Colombo 2Medical Research Institute, Colombo OP 68: GSTM2 C terminal domain alters the contractility and Ca2+ transients in cultured ventricular cardiomyocytes R P Hewawasam Department of Biochemistry, Faculty of Medicine, University of Ruhuna OP 69: Effect of aqueous extract of Gmelina arborea on glucose homeostasis in alloxan induced diabetic rats AP Attanayake, KAPW Jayatilake, LKB Mudduwa, C Pathirana Faculty of Medicine, University of Ruhuna OP 70: The effect of a herbal formulation on the incidence and severity of upper respiratory symptoms in healthy volunteers: a randomised controlled clinical trial ERCS Wickramathilake1C Goonaratna2, AADCS Rupasinghe1, R Gamage1, TMSG Thennakoon1, MR Sooriyaarachchi3 1Link Natural Products (Pvt) Ltd, Colombo 2Faculty of Medicine, University of Colombo 3University of Colombo OP 71: Use of burnt paper ash as a topical haemostatic agent T Seneviratne1, K Somaratne2, K Senanayake3 1Lady Ridgeway Hospital for Children, Colombo 2Colombo South Teaching Hospital, Kalubowila 3Rajarata University of Sri Lanka OP 72: Western, Ayurvedic and plant extract pediculocides - how effective and safe are they? H Banneheke, DMDEA Gunawardane, V Jayasuriya Faculty of Medical Sciences, University of Sri Jayewardenepura OP 73: Immediate and short-term outcome of bronchial and non-bronchial systemic artery embolisation for the management of haemoptysis - a descriptive study WNDPC Appuhamy, WDUM Wijesinghe, DTD Warnakulasuriya, C Sirigampola Department of Radiology, Colombo North Teaching Hospital, Ragama OP 74: Peripheral nerve function in paraquat survivors SS Jayasinghe University of Ruhuna OP 75: The Sri Lanka Clinical Trials Registry - a 5 year audit KAG de Abrew1, UK Ranawaka2, CA Wanigatunge3, M Wimalachandra1, C Goonaratna1 1Faculty of Medicine, University of Colombo 2Faculty of Medicine, University of Kelaniya 3Faculty of Medical Sciences, University of Sri Jayewardenepura

Abstracts of Free Paper Symposium 1: Transplant Medicine and Renal Disease

ABSTRACTS OF ORAL PRESENTATIONS Free Paper Symposium 1: Transplant Medicine and Renal Disease OP 1: Liver transplantation - initial experience at Colombo North Liver Transplantation Service M.M.M.P.Bogamuwa, RC Siriwardana, MA Niriella, AS Dassanayake, SRE Wijesuriya, CAH Liyanage, MB Gunetilleke, HJ de Silva Faculty of Medicine, University of Kelaniya Introduction: Liver transplantation (LT) is the treatment of choice for end stage liver diseases. LT is still in its infancy in Sri Lanka. Aims: To describe the initial experience of the Colombo North Liver Transplantation Service (CNLTS) Methods: The study population included all patients referred for LT to CNLTS. All cases were evaluated for the indication and medical, social and psychological suitability for LT. Decision to list patients for LT was reached by a multidisciplinary team consisting of surgeons, physicians and anaesthetists. All data were collected prospectively. Results: 52 patients were referred for LT over a period of 7 months. 48/52(92.3%) were males. The median age at referral was 52(range 13-66) years. The median Child-Turcotte-Pugh(CTP) score at referral was 9/15(range 5-13/15). Median Model for End Stage Liver Disease (MELD) score at referral was 17(range 9-26). 3/52(5.8%) had hepatocellular carcinoma and 9/52(17.3%) had a low MELD score (<14) but with life threatening complications of cirrhosis as indication. 4/9(44.4%) of those being upper gastrointestinal bleeds from varices. 28/52(53.8%) of the referrals had cryptogenic cirrhosis (CC), 18/52(34.6%) had alcoholic cirrhosis, 2/52(3.8%) each had metabolic, congenital and other causes for cirrhosis. 7/52(13.5%) transplants were performed [3 Live Donor LTs(LDLT) and 4 Deceased Donor LTs(DDLT)]. 5/7(71.4%)[2 â&#x20AC;&#x201C; LDLT, 3 â&#x20AC;&#x201C;DDLT] had a successful LT outcome. 11/45(24.4%) patients died while on the LT waiting list. Conclusions: High MELD CC was the commonest reason for referral for LT in our group. There was a high waiting list mortality highlighting the need for an efficient DDLT service. OP 2: Live donor renal transplantation in Sri Lanka - factors affecting overall outcome N Gunawansa, M Wijerathne, R Cassim, R Dissanayake, J Arudchelvam, N Senevirathne National Hospital of Sri Lanka, Colombo Introduction and Aims: Patient and allograft survival following Live Donor Renal Transplants (LDRT) depend on numerous factors. We looked at our patient and graft survival along with possible predictors of allograft outcome. Methods: 415 consecutive LDRT performed between July 2006 and November 2011 were prospectively studied. Recipient age, donor age, degree of HLA mismatch, duration of pre-transplant dialysis, acute rejection in the first month and post-transplant CMV infection were studied in a multivariate logistic regression model. Results: The follow-up was complete in 397/415 (95%). Mean follow-up was 30 (3-66) months. The mean recipient and donor ages were 42 (17-72) and 39 (20-60) years respectively. Overall patient survival was 337/397 (85%). The causes of death were sepsis (n=48, 80%), myocardial ischaemia (n=4, 7%), stroke (n=4, 7%), pulmonary embolism (n=2, 3%) and others (n=2, 3%). The primary cause of sepsis was graft pyelonephritis (n=30), pneumonia (n=13) and meningitis (n=5). There were 32 (08%) graft failures (GF); 24 primary and 8 secondary (mean graft survival 10 months). Acute rejection in the first month was found to be a significant (p=0.014) independent predictor of GF while the other variables studied failed to show any statistical significance. Conclusions: Post-transplant sepsis is the commonest cause of mortality. Early acute rejection proved to be a highly significant predictor of graft failure. Both, sepsis and rejection being linked to immune suppression, advances in research in to immune tolerance is much awaited.

Abstracts of Free Paper Symposium 1: Transplant Medicine and Renal Disease OP 3: Outcome of living unrelated donor renal transplantation is equivalent to those of living related donor renal transplantation UAD Wijesinghe1, MD Lamawansa1, AWM Wazil2, T Abeysekara2 1Department of Surgery, Faculty of Medicine, University of Peradeniya 2Teaching Hospital, Kandy Introduction and Aims: Living unrelated donor (LURD) renal transplants are increasingly performed due to shortage of deceased and living related donors (LRD). This study was undertaken to evaluate the short and medium term outcome in LURD recipients and compare it with that of LRD recipients. Methods: Clinical records of consecutive 126 living donor renal transplants performed at Kandy teaching hospital from January 2007 to January 2009 were retrospectively analysed. All recipients received methyl prednisolone, cyclosporine-A and mycophenolate mofetil. Those patients with poor HLA matching received induction antibody. Delayed graft function, acute rejection, estimated GFR at last follow up and graft and patient survival were studied to measure outcome. Mean follow up period was 15.3±6.9 months. Results: Out of 126 recipients, 74 were genetically related. Mean recipient age was 38.7±11 years in LURD group and 36.1±11.6 years in LRD group, while mean age of the donors was 36.7±9.4 and 39.8±8.6 years, respectively. In both groups, males dominated as donors and recipients. The number of HLA mismatches were higher in LURD (3.9±1.5) than in LRD (2.2±1.2). Incidence of acute rejection was similar (p=0.76) in both groups (50% in LURD, 53% in LRD). Although delayed graft function was more often seen in LURD (23%) than in LRD (15%), the difference was not statistically significant (p=0.24). Estimated GFR was 68.1±17ml/min/1.73m2 in LURD and 66.5±19.3ml/min/1.73m2 in LRD (p=0.76). One year graft and patient survival were 88.5% and 90.4% for LURD and 90.5% and 90.5% for LRD, respectively (p=0.8). Conclusions: Although LURD recipients have poorer HLA matching, with modern immunosuppressive therapy, the short and medium term outcome are equivalent to those of LRD. OP 4: Arsenic Related Skin Manifestations in Patients With Chronic Kidney Disease of Unknown Aetiology (CKDu) in The North Central Province of Sri Lanka Rajeewa Dassanayake1, S Hulangamuwa1, DTDJAbeysekara2 1Teaching Hospital, Anuradhapura 2Teaching Hospital, Kandy Introduction: A recent presentation has claimed a high prevalence of arsenic (As) related skin manifestations among CKDu patients. In 12 CKDu endemic villages, almost 45% patients were thought to have As related skin manifestations. The same investigators and others, in a website by the Environmental Law Alliance Worldwide (ELAW) claim that almost 80% show the same manifestations. We studied the prevalence of As related skin manifestations in renal clinic patients with CKDu. Methods: A sample was selected from patients attending the renal clinic, teaching hospital, Anuradhapura. All patients with CKDu attending on a single day were consented, and all consenting patients were referred to a consultant dermatologist, specifically for assessment of As related skin changes. Results: 54 patients were identified and all patients gave consent. Data sheets after consultant dermatologist assessment were returned by 30. Only one had possible As related skin changes, and is planned for further investigations. Conclusions: As related skin changes are rare, if present at all, in CKDu patients in the North Central Province.

Abstracts of Free Paper Symposium 1: Transplant Medicine and Renal Disease OP 5: Histopathological changes in liver and renal tissues in Wistar rats given bore well water from CKDu endemic areas in North Central Province MG Thammitiyagodage1, C Rathnayake1, MM Gunatillaka1, N Ekanayake1, R Jayatissa1, UKSC Gunarathne2, WMMU Jayathilake1 1Medical Research Institute, Colombo 2Regional Epidemiology Unit, Polonnaruwa Introduction: Chronic kidney disease (CKD) is prevalent in North Central Province of Sri Lanka. Aims: Observe the histopathological changes in Liver and Kidney tissues after giving well water from CKD endemic areas. Methods: Three villages were selected after completing a questionnaire. Results of the questionnaire and number of CKD patients in the locality were taken as the selection criteria of wells. Well number one and two were selected from New Town Medirigiriya and Bisobandaragama from Medirigiriya division and third well was selected from Divuldamana from Dimbulagala. Ten rats were assigned to each group with equal male female ratio. Test rats were given well water from selected wells 1, 2 and 3 whilst control group was given tap water from Colombo. Experiment was conducted for fifteen months Results: Hepatocellular carcinorma developed in four rats given well water from Medirigiriya and one rat each from Bisobanadaragama and Divuldamana. Five rats from Bisobandaragama developed hepatitis. None of the animals given tap water from Colombo had malignant changes or hepatitis. Severe tubular and glomerular lesions were observed in test groups compared to control. There was a statistically significant difference between Tubular lesion index in all three test groups compared to control group (p<0.05). Significantly high Glomerular lesion index was observed in animals given well water from Divuldamana (p<0.05). Some environmental toxin in water can trigger hepatocellular carcinoma in rats. There is a strong association between consumption of bore well water from CKD endemic areas and development of CKD in rats. OP 6: Renal dysfuction in patients with cirrhosis - a prospective analysis KRP Perera1 ST De Silva2 HJ De Silva2 1Colombo North Teaching Hospital, Ragama 2Faculty of Medicine, University of Kelaniya Introduction: Renal dysfunction in cirrhosis has been shown to increase the risk of death seven-fold. Current definitions fail to detect milder degrees of renal dysfunction and exclude hepatorenal syndrome types 1 and 2 (HRS 1 and 2) in patients who have structural kidney diseases. Both have therapeutic implications; delayed diagnosis leading to a worse prognosis and withholding of treatments with potential benefit (eg. TIPPS, vasoconstrictors). Definitions that address these issues have been proposed [cirrhosis with acute kidney injury (AKI), chronic kidney disease (CKD) and acute-on-chronic kidney disease (ACKD)]. Aims: To study frequency and pattern of renal dysfunction in cirrhotic patients using the newly proposed definitions Methods: Consecutive patients with cirrhosis attending outpatient clinics were prospectively recruited from 01/08/2011 to 15/03/2012. Clinical data were obtained and renal functions were tested. Results: Of 166 patients with cirrhosis 17(10.2%) had serum creatinine >1.5 mg/dL (current cut-off), and 13/17(76.5%) fulfilled criteria of HRS 2. However, 49/166(29.5%) had eGFR <60 mg/dl (proposed cut-off), but 36/49(73.4%) did not fulfill criteria for HRS. 27/36(75%) had type II diabetes mellitus, 12/36(33.3%) had hypertension and 7/36(19.4%) had no co-morbidities. During the study period, 36/166 patients required admission; 12/36(33.3%) due to acute renal dysfunction (a rise of serum creatinine >0.3mg/dl within 48 hours). 6/12(50%) fulfilled criteria for HRS 1. Of the others, 4/6 had normal renal function and 2/6 had non-HRS CKD prior to admission. Conclusions: Our results suggest that current definitions fail to detect many cirrhotic patients with renal dysfunction. The proposed criteria seem more inclusive.

Abstracts of Free Paper Symposium 2: Nutrition and Physical Activity

Free Paper Symposium 2: Nutrition and Physical Activity OP 7: Vitamin D status and its association with serum parathyroid hormone in preschool children in a Sri Lankan Community E Marasinghe, S Chackrewarthy, HTCS Abeysena, S Rajindrajith Faculty of Medicine, University of Kelaniya Introduction: Despite increased awareness of the adverse health effects of low vitamin D status, data on serum vitamin D status of Sri Lankan preschool children is scarce. Aims: To investigate the vitamin D status and its association with serum parathyroid hormone in preschool children in a community in the Ragama MOH area. Methods: In a cross sectional study a total of 340 children (172 girls and 168 boys) aged 2-5 years were selected by random sampling. Fasting levels of serum vitamin D [as 25(OH)D] and parathyroid hormone (PTH) were determined. The anthropometric characteristics of the children were measured using calibrated equipment. Statistical analysis was performed using SPSS 16.0. Results: The mean fasting 25(OH)D and PTH concentrations were 23.47±8.9 ng/ml and 28.2±17.6 pg/ml respectively. 5.6% and 32.4% of the children had 25(OH)D concentrations indicative of vitamin D deficiency (<10 ng/ml) and insufficiency (10 - 20 ng/ml) respectively. 6% of the children were stunted and prevalence of wasting and underweight were 17% and 14% respectively. Prevalence of stunting was significantly higher in girls (p<0.05). Linear regression analysis showed a significant inverse association between serum levels of 25(OH)D and PTH (r = -0.226, p<0.02). Intake of milk and diary foods had a positive association with 25(OH)D levels although statistically insignificant (r = 0.224, p>0.05). Conclusions: This study highlights the presence of sub-optimal vitamin D status in preschool children in a tropical country. Inverse changes in PTH may deleteriously affect skeletal development and growth. The need for appropriate interventions to optimise vitamin D status is emphasized. OP 8: Body weight perception and weight loss practices among Sri Lankan adults R Jayawardena1, P Katulanda2, N Byrne1, M Soares3, A Hills1 1Queensland University of Technology, Brisbane, Australia 2Diabetes Research Unit, Faculty of Medicine, University of Colombo 3Curtin University, Australia Introduction: Obesity level has reached epidemic level in Sri Lanka. Misperception of body weight may affect obesity treatments adversely. Aims: The purpose of the present study was to evaluate the association between self-perception of body weight, waist circumference (WC) with body mass index (BMI) and WC cut-offs among Sri Lankan adults and weight loss approaches among Sri Lankan adults. Methods: A nationally representative sample of 600 adults was selected using a multi-stage random cluster sampling technique. An interviewer-administrated questionnaire was used to assess demographic characteristics, body weight perception, abdominal obesity perception and details of weight losing practices. Weight, height and WC were measured and BM) calculated defined according to Asian cut-offs. Results: body weight mis-perception was common among Sri Lankan adults. Two third of overweight males and 44.7% females considered themselves as ‘about right weight’, moreover, 4.1% and 7.6% overweight men and women reported themselves as being ‘underweight’. Over one third of both male and female obese subjects perceived themselves as ‘about right weight’ or ‘underweight’. Nearly 32% of centrally obese men and women perceived that their WC is about right. People who perceived overweight or very overweight (n=154) only 63.6% tried to loose their body weight (n=98), and quarter of adults seek advice from professionals Conclusions: Body weight misperception, was common among underweight, healthy weight, overweight, and obese adults in Sri Lanka. Over 2/3 of overweight and 1/3 of obese Sri Lankan adults believe that they are in right weight or under weight.

Abstracts of Free Paper Symposium 2: Nutrition and Physical Activity OP 9: Comparison of body fat percentage of Sri Lankan National rugby players based on their playing positions SN Muthuthanthiri1, S A Pathmakanthi1, VG Arachchi1, A Pathmeswaran2, A P de Silva3 1Institute of Sports Medicine, Colombo Departments of 2Public Health and 3Medicine, Faculty of Medicine, University of Kelaniya Introduction: Rugby is a game of physical contact that involves low-intensity, aerobic exercise, combined with periods of intermittent, intensive anaerobic exercise. The physical demands of rugby vary depending on the playing position. For example forwards require more strength and size to enable them to contest for the ball while backline players need to be more agile and have speed to carry the ball past the opposition. However, fat is useless to rugby players and they need to minimize it. Aims: To compare the Body fat% in national rugby players in Sri Lanka based on their playing position. Methods: 37 players who are the members of present Sri Lankan rugby team were included in the study (Age:25.10±5.4years). % body fat values were determined using Siri’s equation after determining the body density values relevant to age with the use of skin fold thickness values using equations suggested by Durnin & Womersley (1977). Results: The mean % body fat of forwards and backs were 24.11 and 17.45 respectively. The difference in the % of body fat between backs and forwards was significant (p < 0.05). The % body fat values of our study( 21.3  4.19 in forwards and 17.3  3.72 in backs ) is comparable with values obtained by Chong et al in 2011 in Malaysian National rugby players. Conclusions: Forwards have significantly more fat than backs. They should concentrate more on fat burning aerobic exercises to improve performance. OP 10: Contribution of physical activity and sedentary behaviour to glycaemic status in urban women PHIU Waidyatilaka1, A de Silva2, P Lanerolle1, R Wickremasinghe3, N Somasundaram4, S Atukorala1 Departments of 1Biochemistry and Molecular Biology, 2Physiology Faculty of Medicine, University of Colombo 3Department of Community Medicine, Faculty of Medicine, University of Kelaniya 4Endocrine Unit, National Hospital of Sri Lanka, Colombo Introduction: Physical activity plays a significant role in the development of Type 2 diabetes mellitus and the role of sedentary behaviour is gaining importance. This association may exist even in persons meeting exercise guidelines. Aims: To assess percentage fat mass (FM%), waist circumference (WC), physical activity (PA) and sedentary behaviour (sitting time) in relation to glycaemic status in urban women. Methods: Newly diagnosed diabetic and non diabetic urban women (30-45 years) were recruited in a community based cross sectional study following screening using fasting blood sugar (n=425). HbA1c was used to categorise women as normoglycaemic (n=182) or dysglycaemic (n=243). PA and sitting time were assessed by the International Physical Activity Questionnaire (IPAQ). WC was measured and FM% was determined by Bio-impedance analysis. Means were used to describe variables and Spearman correlation coefficients and multiple linear regression analysis were used to test for associations. Results: Mean age of women was 37.7±4.0 years. Compared with normoglycemics, dysglycaemics had significantly higher WC(70.7±7.1 vs 80.7±7.5cm), FM% (32.0±5.6 vs 37.0±4.7%), and sitting time (144±66 vs 311±120 minutes/day)(p<0.001 for each variable). PA (7252±2935 vs 2769±1762METminutes/week) was significantly lower (p<0.001) in dysglycemics. WC(rs=0.575, p<0.001), sitting time (rs=0.712, p<0.001) were significantly correlated with HbA1c. PA (r s=- 0.719, p<0.001) was negatively correlated with HbA1c. WC and sitting time were significantly associated with glycaemic status (F=69.3, p<0.001) after adjusting for PA. Conclusions: WC, sitting time and PA are significantly associated with glycaemic status. Independent of PA, WC and sedentary behaviour are associated with dysglycaemia.

Abstracts of Free Paper Symposium 2: Nutrition and Physical Activity OP 11: Energy and nutrient intake - findings from a Sri Lankan adult nutrition survey R Jayawardena1, P Katulanda2, N Byrne1, M Soares3, A Hills1 1Queensland University of Technology, Brisbane, Australia 2Diabetes Research Unit, Faculty of Medicine, University of Colombo 3Curtin University, Australia Introduction: Dietary practices are a key factor related to health status at individual and population level. Over- and under-nutrition both have the potential to contribute to serious health consequences. Sri Lanka is undergoing a rapid socioeconomic transition which is related to a significant health burden related to under-nutrition and an epidemic of non-communicable diseases. However, to-date detailed data on food consumption in the Sri Lankan population is limited. Aims: To identify major nutrient intake and food consumption patterns among Sri Lankan adults. Methods: A nationally-representative sample of adults was selected using a multi-stage random cluster sampling technique. An interviewer-administrated 24-hour dietary recall was used to obtain nutritional intake of the population. NutriSurvey® software was used to analyse nutritional composition of the meals. Results: Data from 463 participants (166 Males, 297 Females) were analysed. Total energy intake was significantly higher in males (1913±567 kcal/d) than females (1514±458 kcal/d). however, there was no significant gender differences in the percentage of energy from carbohydrate (male:72.8±6.4%, female:73.9±6.7%), fat (male:19.9±6.1%, female:18.5±5.7%) and proteins (male:10.6±2.1%, female:10.9±5.6%). The average intake of dietary fiber was 21.3 g/day and 16.3g/day for males and females respectively. There was a significant difference in nutritional intake among ethnicities, area of residence, education levels and BMI categories. Conclusions: The present study provides the first national estimates of energy and nutrient intake of the Sri Lankan adult population. Regular nutrition surveys are needed at the national level to obtain valuable information on diet and associated diseases. OP 12: Negative health effects of coconut - are they real at the population level? LK Athauda1, B Kumarendran2, A Kasturiratne2, AR Wickremasinghe2 Departments of 1Tropical Medicine & International Health and 2Public Health, Faculty of Medicine, University of Kelaniya Introduction: An ecological correlation study was carried out to assess the validity of incriminations on the effects of consumption of coconut products on deaths due to cardiovascular diseases (CVD) Aims: The aim was to evaluate the impact of consumption of coconut products on CVD death rates. Methods: Data from 1961 to 2006 were abstracted from different sources; coconut consumption from the FAO database, CVD deaths from reports of the Department of Census and Statistics, population data from the UN databases and per capita GDP from the World Bank database. Correlational and Regression analyses were carried out. Results: From 1961 to 2006, the average consumption of coconut including copra was 66.19 kg/capita/year, the average consumption of energy was 271.47 kcal/ capita/ day and the average fat supply was 24.46 g/capita/ day. There was no increase in the per capita consumption of coconut products from 1961 to 2006 in Sri Lanka (range 54.1-76.2 kg/capita/year). The CVD death rates and the proportionate mortality rate due to CVD have increased from 1961 to 2006. Consumption of coconut products was correlated with CVD death rates but no lags seen. CVD death rates were significantly associated with per capita GDP and percentage of urban population but not consumption of coconut products after adjusting for the other variables (R2=0.865). Conclusions: Mortality due to cardiovascular diseases was significantly correlated with per capita GDP and percentage of urban population after controlling for other variables. The results do not provide any evidence that consumption of coconut products increases mortality due to cardiovascular diseases at the population level.

Abstracts of Free Paper Symposium 2: Nutrition and Physical Activity OP 13: Patterns and correlates of physical activity among Sri Lankan adults R Jayawardena1, P Ranasinghe2, P Katulanda3, R Sheriff 3, DR Matthews4 1Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia 2Department of Pharmacology, Faculty of Medicine, University of Colombo 3Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo 4Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, UK Introduction: Physical inactivity levels are rising in many countries with major implications on the prevalence of non-communicable diseases. Aims: To evaluate the pattern of physical activity and its’ relationships with socio-demographic, clinical and biochemical parameters in Sri Lankans Methods: Data on physical activity were obtained from a cross-sectional survey on 5,000 Sri Lankan adults. Physical activity was assessed using, the short version of the IPAQ. A binary logistic regression analysis was performed using the dichotomous variable ‘Health Enhancing Physical Activity’ (0=’active’, 1=’inactive’). Results: Sample size was 4,485, with 39.5% males. Mean age was 46.1±15.1 years. Mean weekly total MET minutes in all adults were 4,703±4,369. Males (5,464±5452) had a significantly higher total MET minutes than females (4,205±3,394)(p<0.001). Rural adults (5,175±4,583) were significantly more physically active than urban adults (2,956±2,847)(p<0.001). Tamils had the highest mean weekly total MET minutes than other ethnicities. Those with tertiary education had the lowest mean weekly total MET minutes. In all adults 60.0% were in the ‘Highly active’ category. In the ‘Highly active’ adults 85.8% were residing in rural areas, while only 14.2% were from urban areas (p<0.001). Female gender (OR:2.1), age>70 (OR:3.8), urban living (OR:2.5), Muslim ethnicity (OR:2.7), tertiary education (OR:3.6), obesity (OR:1.8), central obesity (OR:1.5), presence of diabetes (OR:1.6), hypertension (OR:1.2) and metabolic syndrome (OR:1.3) significantly increased odds of being physically ‘inactive’. Conclusions: Female gender, older age, urban-living, Muslim ethnicity and tertiary education were all significant predictors of physical inactivity. Physical inactivity increased the risk of central obesity, diabetes, hypertension and metabolic syndrome.

Abstracts of Free Paper Symposium 3: Diabetes

Free Paper Symposium 3: Diabetes OP 14: Prevalence of diabetes mellitus and hypertension among three populations with cataract in Vavuniya and Gampaha districts in the post conflict era MS Amaratunge1, J de Silva1, IM Wasthuhewaarachchi2, SH Uyangoda1, MAJI Mallawaarachchi1,R Premarathna3, AAN Nishad4 1Vijaya Kumaratunge Memorial Hospital, Seeduwa 2Teaching Hospital, Vavuniya 3Faculty of Medicine, University of Kelaniya 4Post Graduate Institute of Medicine, University of Colombo Introduction: Identification of socio economic factors and non communicable disease profiles of patients with cataract is important to plan vision related health services. Aims: To compare prevalence of diabetes mellitus (DM) and hypertension (HT) among three groups of cataract patients. Methods: Prevalence of diabetes and hypertension was compared in groups of patients with cataracts during second quarter of 2011. Group A: a rural population in Vavuniya, B: semi-urban low socioeconomic group and C: semi-urban higher socioeconomic group in Gampaha. Standard criteria used to detect diabetes and hypertension. Results: Population in A 167(36% males), B 207(62% males) and C 407(40% males). Mean (SD) age was 65(10) years. Male diabetes prevalence (95% CI) were A 20% (9.3-28), B 30%(22.6-38.4) and C 37.9%(30.8-45.6) (p=0.009). Prevalence (95%CI) of diabetes in females were A 17.8% (11.7-26), B 19% (11.9-29) and C 33.7% (28.1-39.9) (p=0.002). Hypertension prevalence in males (95%CI) A 23.3% (1535.4), B 35.4% (27.6-44) and C 36.6% (29.6-44.3) (p=0.16) and in females A 26.2% (18.8-35.2), B 15.2% (9-24.7) and C 45.1% (39-51.4) (p=0.001). Prevalence of either diabetes or hypertension among males A 31.7% (21-44), B 54.3% (45.7-62.7) and C 56% (48.2-63.3) (p=0.001) and among females A 34.6% (2644), B 26.6% (18-37.2) and C 57.8% (51.5-63.7) (p=0.001). Conclusions: Females in higher socioeconomic group of Gampaha district had higher diabetes and hypertension prevalence than in lower socioeconomic populations. Male groups showed same pattern for diabetes but not for hypertension. Overall prevalence of hypertension and diabetes mellitus were higher than for general population in Sri Lanka. OP 15: Prevalence and predictors of high density lipoprotein levels among individuals with type 2 diabetes TP Weerarathna, HMM Herath, PGCL Liyanage, MHB Ariyaratne Faculty of Medicine, University of Ruhuna Introduction: Recognition of factors associated with low HDL level in patients with (T2DM) would enable focused interventions to reduce their cardiovascular risk. Aims: To describe prevalence and predictors of low HDL levels among T2DM subjects Methods: From an electronic data base of 2083 subjects who underwent screening, data on gender, age at onset of diabetes, waist circumference (WC) body mass index (BMI), glycosylated hemogolobin (HBA1C) and fasting lipid profile were obtained. Prevalence of low HDL (< 40 mg/dL in female and < 50 mg/ dL in females) in different categories was estimated and regression analysis was done to study the influence of each variable on HDL level. Results: There were 1348 males and 735 females with a mean age of 49yrs. Proportion of females with low HDL levels were significantly higher than males 65.6% vs 34.4%. Those with global obesity, central obesity and suboptimal glucose control had a higher proportion with low HDL (66.75 vs 33.3%, 76%vs 24% and 59.7% vs 40.3%). When HBA1c, central obesity, global obesity, duration of the disease, gender and age at diagnosis were included in the binary logistic regression model, female gender, age at diagnosis, duration of the disease were found to be a significant determinants of low HDL. Conclusions: Females with T2DM and those with both forms of obesity and suboptimal glycaemic control are at a higher risk of having lower HDL. Special attention to raise HDL level should be given to these categories of individuals with T2DM to reduce their cardiovascular risk.

Abstracts of Free Paper Symposium 3: Diabetes OP 16: Prevalence of periodontal disease in diabetic patients attending medical clinics, Teaching Hospital, Galle PLGC Liyanage1, S Lekamwasam1, S N W Abeygunawardhana2, T P Weerarathna1 1 Faculty of Medicine, University of Ruhuna 2Teaching Hospital, Galle Introduction: Periodontal disease is considered as a complication of diabetes. Aims: The purpose of the study was to see the prevalence of periodontal disease among diabetics and to assess the relationship between diabetes related factors with periodontal disease. Methods: This was a cross-sectional study with age and gender matched controls. Patients with diabetes attending medical clinics in the Teaching Hospital, Galle were randomly selected. Demographic and diabetes related information were obtained by a pretested interviewer administered questionnaire. Oral clinical evaluation included, Basic Periodontal Examination (BPE), Gingival Index (GI) and Plaque Index (PI). Presence of periodontal disease was considered as BPE > 3. Results: One hundred and fifty patients with diabetes and 53 controls were examined. The mean (SD) age of the patients and the controls were 61.4 (10.6) and 59.9 (11.6) years, respectively. Prevalence of periodontal disease among diabetics and controls were 12.7% (19/150) and 9.4% (5/53) respectively (X2 = 0.39, p = 0.5). Oral clinical evaluation showed significant higher scores in diabetics compared to the controls: BPE (2.11 vs. 1.64), GI (2.05 vs1.45), PI (2.18 vs. 1.45); (p <0.001). In regression analyses age, education level, income and duration of disease were not found to be a significant determinant of the presence of periodontal disease and scores of BPE, GI and PI were found to be significant determinants of periodontal disease (p <0.001). Conclusions: Patients with diabetes attending medical clinics have a compromised periodontal status compared with non-diabetic controls. OP 17: The prevalence, patterns and correlates of diabetic peripheral neuropathy in Sri Lanka P Ranasinghe1, R Jayawardena2, G R Constantine3, R Sheriff 3, P Katulanda3 1Department of Pharmacology, Faculty of Medicine, University of Colombo 2School of Human Movement Studies, Institute of Health and Biomedical Innovation, Queensland Universities, Australia 3Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo Introduction: Distal peripheral neuropathy (DPN) is a common yet poorly investigated complication of diabetes. Aims: To describe prevalence, patterns and correlates of DPN in patients with diabetes mellitus (DM) in Sri Lanka. Methods: Data were collected as part of a national study on DM. In new cases, DPN was assessed using the Diabetic-Neuropathy-Symptom (DNS) Score, while in established DM both DNS and Toronto-ClinicalScoring-System (TCSS) were used. A binary logistic regression was performed with ‘presence of DPN’ as the dichotomous dependent variable and other independent co-variants. Results: Sample size was 528. Mean age 55.0±12.4 years, 37.3% were males. Prevalence of DPN according to DNS score in all, established and newly diagnosed patients were 48.1% (n=254), 59.1% (n=199) and 28.8% (n=55) respectively. Prevalence of DPN in those with established DM (TCSS) was 24.0%, a majority had mild DPN (n=56, 16.6%). In males and females prevalence of DPN was 20.0% (n=25/125) and 26.4% (n=56/212) respectively. Mean age of those with and without DPN were 62.1±10.8 and 55.1±10.8 years respectively (p<0.001). Majority of those with DPN were from rural areas (75.3%) and earned a monthly income <LKR 12,000 (87.6%). In the binary logistic regression presence of foot ulcers, female gender, smoking were the strongest predictors followed by insulin treatment, diabetic retinopathy, Sulphonylureas treatment, increasing height, rural residence, higher triglycerides, lower income and longer duration of DM. Conclusions: The study defines the impact of previously known risk factors for development of DPN, while identifying several new potential risk factors in this ethnically different sub population with DM.

Abstracts of Free Paper Symposium 3: Diabetes OP 18: Variations in the modifiable cardiovascular risk factors in different phenotypes of type 2 diabetes TP Weerarathna, HMM Herath, PGCL Liyanage, MHB Ariyaratne Faculty of Medicine, University of Ruhuna Introduction: Because of the heterogenous nature of the disease, cardiovascular risk factor profiles can differ among different phenotypes of T2DM. Aims: study the prevalence and pattern of modifiable cardiovascular risk factors according to gender and age at onset of T2DM. Methods: Data on gender, age at onset, body mass index (BMI), waist circumference (WC), fasting lipid profile, albuminuria were obtained from a data base of 2082 T2DM patients who underwent single visit screening. Proportion of subjects with global (BMI > 23 kg/m2) & central obesity (WC> 90 cm in males and > 80 cm in females ), dyslipidaemia ( LDL > 100 mg/dL, TG > 150 mg/dL. HDL < 40 mg /dL in males and < 50 mg/dL in females), hypertension (SBP > 130 mm Hg,DBP> 85 mm Hg, or both) and albuminuria (urine albumin excretion > 300 mg/ dL) according to gender, age at onset of T2DM (< 30 & > 30 yrs) were analysed. Results: Mean age and duration of T2DM were 43.3 and 5.9 years. Prevalence of any type of dyslipidaemia, albuminuria, global obesity, central obesity and hypertension were 82.9%, 69.4%, 63.2%, 60.3%, 28.5% respectively. Females had significantly higher prevalence of hypertension and central obesity. Younger patients with T2DM had significantly high prevalence of dyslipidaemia. Conclusions: Significant variations exist in the prevalane of cardiovascular risk profile in different subjects with T2DM. Management protocols for individual patients with T2DM to reduce cardiovascular morbidity should give priorty to these factors to achive desirable clinical outcomes. OP 19: Effects of zinc supplementation on diabetes mellitus: a systematic review and metaanalysis R Jayawardena1, P Ranasinghe2, P Galappatthy2, G R Constantine3, P Katulanda3 1Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia 2Department of Pharmacology, Faculty of Medicine, University of Colombo 3Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo Introduction: The number of people with diabetes and pre-diabetes are exponentially increasing. Studies on humans have also shown the beneficial effects of zinc supplementation in patients with diabetes. Aims: To systematically evaluate the literature and meta-analyse the effects of zinc supplementation on diabetes. Methods: A systematic review and meta-analysis of published studies reporting the effects of zinc supplementation on diabetes mellitus was conducted in the following databases; PubMed, Web of Science and SciVerse Scopus. Results: The total number of articles included were 25 (Type-1 diabetes: 3, Type-2 diabetes: 22). There were 12 studies comparing the effects of zinc supplementation on fasting blood glucose (FBG) in patients with Type-2 diabetes. Pooled mean difference for FBG between zinc supplemented and placebo groups from random effects analysis was -18.13mg/dl (95%CI: -33.85,-2.41; p<0.05). 2-hr PPBS also shows a similar distinct reduction in (-34.87 mg/dl [95%CI: -75.44, 5.69]) the zinc treated group. The reduction in HbA1c was -0.54% (95%CI: -0.86,-0.21) in the zinc treated group. The pooled mean difference for total cholesterol between zinc supplemented and placebo groups was -32.37mg/dl (95%CI: -57.39,-7.35; p<0.05). The LDL-c also shows a similar distinct reduction in the zinc treated group, the pooled mean difference from random effects analysis was -11.19mg/dl (95%CI: -21.14,-1.25; p<0.05). Studies have also shown a significant reduction in systolic and diastolic blood pressures after zinc supplementation. Conclusions: Zinc supplementation has beneficial effects on glycaemic control and promotes healthy lipid parameters. We recommend further studies to identify exact biological mechanisms and to evaluate potential beneficial effects of zinc supplementation in prevention of diabetes.

Abstracts of Free Paper Symposium 3: Diabetes OP 20: Use of alternative medicines and the factors associated with the use among diabetic patients attending the medical clinics at National Hospital of Sri Lanka PHU Cooray, DGH Damayanthi, KKS Chinthanie, N Gunawardena Faculty of Medicine, University of Colombo Introduction: Diabetes is highly prevalent in Sri Lanka for which many tend to seek alternative treatments. Research evidence on use of alternative medicines is scarce. Aims: Objectives were to describe the use of alternative medicines, factors associated with the use, perceived effects and disclosure of use to allopathic doctors, among diabetic patients. Methods: A cross-sectional descriptive study assessed different alternative treatment methods used by 147 diabetic patients attending medical clinics at National Hospital of Sri Lanka, using an intervieweradministered questionnaire. Age, sex, race, religion, education, duration of illness, compliance to the allopathic treatment, blood glucose level, use of alternative medicines for other diseases, type of allopathic medicines, having relatives/friends or neighbours who use alternative medicines for diabetes were the factors assessed. Perceived efficacy and disclosure to allopathic doctors were also analysed. Results: Prevalence of alternative medicines use was 27.2% while 46.3% had ever used. Use of Home remedies was 100% while it was 7.4%, 2.9% and 1.5% for ‘Ayurveda’, ‘Deshiya Chikitsa’ and Homeopathy respectively. Twenty-three methods of home remedies were identified. Education level < grade 6, duration of illness >10 years and having relatives/friends or neighbours who use alternative medicines for diabetes were associated with alternative medicine use. Further, 64.7% perceived that non-western medicines were efficacious and 24.3% who used alternative medicine disclosed it to allopathic doctors. Conclusions: Prevalence of alternative medicine use among diabetics was low. Home remedies were most popular. It is recommended that effectiveness and side effects of alternative treatment methods be tested in future research.

Abstracts of Free Paper Symposium 4: Mental Health and Attitudes

Free Paper Symposium 4: Mental Health and Attitudes OP 21: A descriptive study on prevalence of gender based violence in female patients with psychiatric illnesses at the National Institute of Mental Health RMAVL Seneviratne1, MMP Devadithya1, J Mendis1, JKND Miththinda2 1National Institute of Mental Health, Angoda 2Colombo North Teaching Hospital, Ragama Introduction: Gender based violence (GBV) is any act that results in physical, sexual or psychological harm based on gender. Patients with psychiatric illness, being a marginalized group in society are at an increased risk. Aims: To assess the prevalence of GBV in female inward psychiatric patients, risk factors for it and measures taken afterwards. Method: A descriptive cross sectional study was carried out including all consenting patients fulfilling the inclusion criteria (n=32) recruited from four female wards selected by simple random sampling during the study period of one month .The data were obtained through an interviewer administered questionnaire. Results: The mean age of the study population was 41.5 years (SD 12.9 years). GBV occurred in 56% in the form of physical abuse (78%), psychological abuse (75%) and sexual abuse (17.6%). In 67% GBV occurred after the onset of psychiatric illness but no significant association was found with type of illness (p= 0.773) Married females were more likely to be abused than unmarried (p=0.002). There was no significant association between GBV and employment (p 0.542), family history of GBV (p=0.109) and presence of confiding relationships (p=0.688). Although 44% of the abused confided in someone, only 16.7% took some form of legal action. Conclusions: Gender based violence appears to be widely prevalent among female psychiatric patients, especially those who are married. OP 22: Associations between exposure to conflict, tsunami and mental disorders and school absenteeism among Sri Lankan children C Siriwardhana1, A Sumathipala2, 3S Siribaddana 1Institute for Research and Development, Institute of Psychiatry, King's College London, UK 2Institute for Research and Development, Battaramulla 3Rajarata University of Sri Lanka Introduction and Aims: Armed conflicts and natural disasters are common. Millions including children are killed, injured, disabled and displaced as a result. Effects of war and natural disaster on mental health, especially of children are well established. These events also have a detrimental effect on exposed childrenâ&#x20AC;&#x2122;s education. Exposure to three decades of war and natural disaster such as 2004 tsunami, along with mental disorders, may have a big impact of child education, especially by causing school absenteeism. This study looks at war/tsunami and mental disorder exposure and their association with absenteeism in school children. Methods: A cross sectional survey was conducted among 4000 randomly selected school children attending government schools in 17 districts. The survey included socio-demographic questions, war and tsunami exposure questionnaires and multi informant Strengths and Difficulties questionnaire and information on childrenâ&#x20AC;&#x2122;s absenteeism. Descriptive, correlation and regression analyses were carried out. Results: Results showed that all three primary exposures (war, tsunami exposure and mental disorders) were strongly associated with absenteeism among children. Also, results showed that absenteeism was widely prevalent among Sri Lankan children. Several socio-economic factors such as male gender, Tamil ethnicity, rural residency and type of school showed associations with absenteeism. Conclusions: Exposure to traumatic events such as conflicts/disasters and prevalent mental disorders along with socio-economic factors have a detrimental effect on school attendance and school achievement. These issues need further research and policy action to improve education.

Abstracts of Free Paper Symposium 4: Mental Health and Attitudes OP 23: Child abuse and abdominal pain - Is there an association? NM Devanarayana1, S Rajindrajith2, S Mettananda2, WALK Weerasooriya2, KLW Hathagoda2, BC Lakmini2, SMV Subasinghe2, DGH de Silva2 Departments of 1Physiology and 2Paediatrics, Faculty of Medicine, University of Kelaniya Introduction and Aims: It is believed that there is an association between abdominal pain and child abuse. The main objective of this study was to assess this association in Sri Lankan school children. Methods: Children aged 13-18 years were randomly selected from a semi-urban school in Gampaha district. A previously validated, self administered questionnaire was used to collect socio-demographic data and information on gastrointestinal symptoms, child abuse and exposure to other stressful events. Severity of symptoms was recorded using a validated, visual analogue scale. Children with abdominal pain were categorized into abdominal pain predominant functional gastrointestinal disorders (AP-FGD) using Rome III criteria. Results: A total of 490 children were recruited [males 254 (51.8%), mean age 15.2 years and SD 1.64 years]. Forty eight (9.8%) fulfilled Rome III criteria for AP- FGD (functional dyspepsia=3, functional abdominal pain=25, irritable bowel syndrome=15 and abdominal migraine=5). The number of children exposed to physical, emotional and sexual abuse, were respectively 119 (24.3%), 109 (22.2%) and 18 (3.8%). Prevalence of AP-FGD was significantly higher in those exposed to sexual (26.7% vs. 9.3% in controls, p=0.42) and emotional (16.5% vs. 8.3%, p=0.046) abuse, but not physical abuse (11.8% vs. 9.2%, p=0.69). AP-FGD type associated with sexual abuse was irritable bowel syndrome (15.4% vs. 2.7%, p=0.02). Mean scores obtained severity of abdominal pain were higher in children exposed to sexual (27.9 vs. 13.2, p=0.002) and emotional abuse (22.1 vs. 11.4, p<0.001). Conclusions: Chronic abdominal pain prevalence and severity were significantly higher in children exposed to sexual and emotional abuse. OP 24: Domestic violence against women in Sri Lanka - medico-legal aspects R Nananyakkara1, R Fernando2 1Faculty of Medical Sciences, University of Sri Jayewardenepura 2Faculty of Medicine, University of Colombo Introduction: One of the most common forms of violence against women is that perpetrated by husband or other intimate male partner. Intimate partner violence is a global problem. Sri Lanka also has identified the impacts of this, which affects the whole family. Aims: The objective of the study was to compare the injury pattern, causation, severity and some other aspects between female survivors of intimate partner violence (FSIPV) and female survivors of general violence (FSGV). Methods: The study population comprised of FSIPV and FSGV referred for medico-legal advice. Their injuries and other data were documented. The sample included 300 FSIPV and 300 FSGV. The severity of injuries was categorised according to the penal code of Sri Lanka. Results: There was a significant difference of age and educational level between the groups. 99% (297) of FSIPV sustained head, face and neck injuries. Upper limb injuries and chest and abdominal injuries were found in 54% and 25% respectively. 43% sustained contusions and 20% sustained lacerations. Among the FSGV, 69% (208) sustained upper limb injuries and 48% (144) sustained head and neck injuries. Higher proportion of FSIPV sustained head and neck injuries (p<0.00l), abrasions (p<0.001), contusions (p<0.001), lacerations (p<0.001) and burns (p<0.01). Significantly severe injuries were found in FSGV (p<0.01). Conclusions: FSIPV sustained significantly higher proportion of injuries in head, face, neck and abdomen. The FSGV sustained significantly higher proportion of injuries in upper limbs and chest. Contusions, abrasions, lacerations and burns were predominant in FSIPV.

Abstracts of Free Paper Symposium 4: Mental Health and Attitudes OP 25: Suicides is the commonest cause of death among pregnant women in Anuradhapura district TRN Fernando Faculty of Medical and Allied Sciences, Rajarata University of Sri Lanka Introduction and Aims: According to the WHO definition maternal death is “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes”. 1996 review of maternal deaths in Sri Lanka had shown that maternal deaths escape identification in the national statistics. Therefore this study was designed to find out the escaped deaths of pregnant mothers in Anuradhapura district. Methods: Data collected from maternal death review reports from the RDHS office in Anurdhapura district during May –July 2011. Results: Total number of maternal deaths in years 2007-2009 was 40.Suicides take the highest number among pregnancy related deaths (9/40). The time of suicide had been before the 28weeks of gestation in 66% of these women. Only 3 of them were unmarried. Second was post partum haemorrhage causing 6 deaths. Out of them 4 deaths had occurred 10 days after partus. Heart disease complicating pregnancy was 3rd with 5 maternal deaths. Only 2 deaths were due to hypertensive disorders and 1 death due to septic abortion. Conclusions: According to the WHO definition of maternal deaths suicides are categorised as “accidental or incidental cause”. Therefore suicides are not included in the MMR. However Sri Lanka has the highest suicide rate in Asia. There is a need to give more attention to prevent suicides among pregnant mothers. OP 26: Relationship between increased risk of falling and cognitive impairment in elderly people, living in an elderly home in Colombo District RS Thanthrige1, S Dassanayake1, D Dissanayake2 1Allied Health Sciences Unit, Faculty of Medicine, University of Colombo 2Department of Physiology, Faculty of Medicine, University of Colombo Introduction: Falls have become a major health care problem for older people living all over the world. Falls are not random events and may occur due to physiological impairments, such as impaired balance, muscular weakness and slow reaction time. Falls can also be associated with cognitive impairment. Aims: The purpose of this study was to compare the tendency of falling in older people with and without cognitive impairment, living in an elderly home. Methods: This was a descriptive study and the study setting was an elderly home in the Colombo district. Study population was fifty people aged 60 years to 85 years. Data collection was carried out by Montreal Cognitive Assessment (MoCA), Folstein Mini Mental State Examination (MMSE), Timed Up and Go (TUG)test, Five Times Sit to Stand Test (FTSST) and interviewing the people with an interviewer administered questionnaire. Results: Cognitive impairment was a common finding in the studied population with 66% of elders demonstrating moderate to severe cognitive deficits according to MoCA. The difference in cognitive level between fallers and non fallers was statistically significant (p=0.0001).Fallers demonstrated significantly poor lower extremity strength compared to non fallers (p=0.0001). Older people with cognitive impairment demonstrated poor functional lower extremity strength and balance than those without cognitive impairment (p=0.002).Severity of cognitive impairment increased significantly with aging (p=0.003).The difference in falling tendency between males and females was not statistically significant. Conclusions: Results suggest fall risk screening and cognitive level screening is important in elderly people. Identifying people who are at risk earlier may be a valuable window of opportunity for intervention.

Abstracts of Free Paper Symposium 4: Mental Health and Attitudes OP 27: Truth about truth telling AKP Ranaweera1, DRS Adicaram2, RD Wijesinghe3, SD Gamage, G.G Gamage4, MRM Rishad1, HM Senanayake5 1De Soysa Hospital for Women, Colombo 2Department of Parasitology, University of Peradeniya 3General Hospital, Peradeniya 4Department of Pathology, University of Peradeniya 5Department of Obstetrics and Gynaecology, University of Colombo Introduction: Truth telling is a professional obligation, norms regarding which are mainly based on data obtained from Western World. Limited data are available on patient expectations on veracity in Sri Lanka. Aims: To describe the expectations on truth telling regarding serious medical conditions and the extent to which they were met in a group of Sri Lankan patients. Methods: An interviewer administered questionnaire concerning issues on veracity were distributed to 100 patients with symptoms which may lead to a diagnosis of a serious illness at National Hospital of Sri Lanka and 50 patients diagnosed with a malignancy at Cancer Institute Maharagama. Results: In the first group, 96% wished to know their diagnosis. 91% preferred to be informed by consultant and 4% by relatives. 65% preferred to be informed in person.100% wanted to know options, success rates of treatment and its side effects.48%wanted the doctor to decide on treatment and 44% to discuss with the doctor. 8% wanted the doctor to discuss with relatives and decide. Age, gender, religion or socioeconomic status were not significantly associated with above expectations. In the second group, 92% knew the diagnosis. 74% were informed by consultant, 50% in the presence of another person. The diagnosis was divulged to relatives without their consent in 20%.72% knew about the treatment options. Side effects and success rates of treatment were known by 38% and 44% respectively. Treatment was decided by the doctor alone and after discussing with patient in 46% and 54% respectively. Conclusions: Practices regarding veracity needs to be customised according to Sri Lankan expectations because sociocultural beliefs seem not to be the actual preferrence. OP 28: Knowledge, attitudes and size of the carbon footprint among medical students CI Wijesinghe1, M Selvarajah1, D Wijesundara1, S Ranawaka1, T Chang2 1Faculty of Medicine, University of Colombo 2Department of Clinical Medicine, Faculty of Medicine, University of Colombo Introduction: Global warming is a recognised risk factor of increasing communicable and noncommunicable diseases worldwide. The ‘carbon footprint’ is a measure of the carbon dioxide emitted during daily human activities and quantifies individual and collective contributions to global warming. Aims: This study aims to measure the carbon footprint of medical students and assess their knowledge and attitudes towards it. Methods: A descriptive, cross-sectional study was conducted among 256 randomly-selected students of the Colombo Medical Faculty. Data were collected using a pre-tested, interviewer-administered questionnaire. The carbon footprint was calculated in metric tons (mt) using an online calculator. Results: One hundred and thirty-six male and 120 female medical students were interviewed; mean age 21.5 (SD 1.7) years. The mean carbon footprint of a medical student was 5.7 (SD2.8) mt of CO2/year. This is higher than the mean national carbon footprint of 1.1 mt of CO2/year (p<0.01) and resulted from lifestyle practices (67.3%), travel (25.8%) and household activities (6.9%). A household monthly income exceeding Rs 100,000 was associated with a higher carbon footprint (p=0.001). Although 82% of students knew the meaning of ‘greenhouse effect’, only 33% knew what ‘carbon footprint’ meant while only 42.3% could name 3 or more gases that contribute to climate change. About a third of students considered their carbon footprint to be negligible. However, 86.3% elected to use bicycles as transport to minimise their carbon footprint. Over 90% considered issues of climate change the responsibility of the government. Conclusions: The carbon footprint of medical students is high whilst knowledge about it is inadequate.

Abstracts of Free Paper Symposium 5: Immunology and Genetics

Free Paper Symposium 5: Immunology and Genetics OP 29: Indoor aeroallergen sensitisation patterns in Sri Lankan patients with allergic rhinitis and asthma GN Malavige1, S Paranavitana2, A Fernando3 1Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura 2Central Medical Centre (PVT) Ltd, Nugegoda 3National Hospital of Sri Lanka and Central Chest Clinic, Colombo Introduction and Aims: There is a significant increase in allergy related diseases in the whole world as well as in Sri Lanka. Data regarding indoor aeroallergen sensitisation patterns in patients with allergic rhinitis (AR) and asthma are not available in Sri Lanka. Therefore, we set out to determine the indoor aeroallergen sensitisation patterns in patients with asthma and AR in Sri Lanka. Methods: skin prick testing for common indoor aeroallergens were carried out in 102 patients with asthma and AR referred to an allergy clinic in Sri Lanka. Results: 30 (29.4%) patients had asthma and AR, 41 (40.2%) had asthma only and 31 (29.4%) had AR only. 85 (83.3%) of all patients tested positive to house dust mite (HDM), 47 (46.1%) to cockroach and 30 (29.4%) to the indoor moulds. Sensitisation to allergens in the indoor mould panel (IDM) was higher in patients who had asthma only (36.6%) when compared to those with AR (19.3%, odds ratio 2.4, confidence interval= 0.8292 to 4.309). Sensitisation to several aeroallergens was also higher in individuals aged over 12 years when compared to younger patients. Conclusions: Our data suggests that sensitisation to common indoor aeroallergens is common in patients with asthma and AR in Sri Lanka and are similar to the sensitisation patterns in other tropical countries in South East Asia. OP 30: Immunophenotype of persistent peripheral blood lymphocytosis in adults - reactive or clonal? BCM Wimalachandra1, LV Gooneratne1,2, IHDS Prabath1, R De Silva2 1Faculty of Medicine, University of Colombo 2Asiri Group of Hospitals, Colombo Introduction: Peripheral blood lymphocytosis (PBL) may be due to a variety of reactive conditions or be the presenting feature of a lymphoproliferative disorder. The morphology of peripheral blood cells alone is often inadequate to discriminate between the two. Immunophenotyping of peripheral blood lymphocytes by flowcytometry is a simple, quick and non invasive method of determining if it is reactive or clonal. We report the findings of the first such study in Sri Lanka. Aims: To describe the spectrum of diseases presenting with persistent PBL and ascertain the presence of evidence of bone marrow failure at presentation. Methods: A retrospective analysis of flowcytometry results of 75 consecutive adults referred to the flowcytometry unit at Asiri hospital, Colombo with persistent PBL (absolute lymphocyte count >5 X 109/L for at least one month). Results: Mean age of study population was 64.4%. 90% were >40 years of age. Males=52%. 94.7% were clonal while only 5.3% were reactive. Of the clonal, 95.8% were mature B-cell neoplasms and 4.2% mature T-cell neoplasms. Of the B-cell neoplasms, 48% were chronic lymphocytic leukaemia(CLL), 13.4% marginal zone lymphoma and 38.6% other types of lymphoma. 75.3% had a haemoglobin level <12g/dl at presentation. Only 15.9% had thrombocytopenia and neutropenia. Conclusions: Persistent PBL in >40 year olds is more likely to be clonal. Mature B-cell neoplasms are commoner than their T-cell counterparts. Anaemia is common at presentation. Contrary to the literature that CLL is rare in Asians, it was the commonest condition in our study.

Abstracts of Free Paper Symposium 5: Immunology and Genetics OP 31: Prevalence of eosinophilic oesophagitis among adult Sri Lankan patients with refractory upper gastrointestinal symptoms - a prospective study CK Ranawaka1, AP de Silva2, SJ Hewavisenthi3, TMAH Jayathilake3, WRS de Alwis2, PR Waraketiya2, MA Niriella1, HJ de Silva2 1University Medical Unit, Colombo North Teaching Hospital, Ragama Departments of 2Medicine and 3Pathology Faculty of Medicine, University of Kelaniya Introduction: Eosinophilic oesophagitis (EoE) is increasing in the West (community prevalence 0.021%), and is especially prevalent among patients with refractory upper gastrointestinal (UGI) symptoms (about 6.5-40%). Diagnosis is important as the treatment is with corticosteroids and other immunomodulators rather than acid suppression and prokinetics. EOE has been poorly studied in Asian populations. Aims: To study the prevalence of EoE among adult Sri Lankan patients with refractory UGI symptoms. Methods: The study was carried out in the University Medical Unit of the Colombo North Teaching Hospital, Ragama. Over a period of one year from March 2011, consecutive, consenting patients (aged 1870) referred for gastroduodenoscopy (OGD), with persistent UGI symptoms despite standard therapy for at least two months, were included. All patients underwent OGD with two biopsies each from the distal and mid oesophagus. A diagnosis of EoE was made when there were 15 or more intra-epithelial eosinophils per high-power field, according to international guidelines. Results: 106 patients (M: F= 42:64 mean age 48 yrs (SD 13.3) were recruited. Common symptoms were refractory dyspepsia, gastro-oesophageal reflux and dysphagia in74, 64, 27 patients respectively. Endoscopy was macroscopically normal in 97 patients, and suggestive of EoE in 7; concentric mucosal rings in 3 and white exudates in 4 patients. Only 2 (1.9%) patients had histological evidence of EoE, one of whom had compatible macroscopic endoscopic features. Conclusions: The prevalence of EoE in this Sri Lankan cohort of adult patients with refractory UGI symptoms was much lower than reported in western series. OP 32: A candidate gene association study of preeclampsia in Sinhalese women P Andraweera1, G Dekker2, VHW Dissanayake1, S Thompson2, D Furness2, R Nowak2, A Zhou2, J Zhang2, RW Jayasekara1, C Roberts2 1Human Genetics Unit, Faculty of Medicine, University of Colombo 2University of Adelaide, Australia Introduction and Aims: Preeclampsia complicates approximately 5% of pregnancies. Many molecular pathways are implicated in the pathogenesis of preeclampsia. We investigated the association of 100 polymorphisms in candidate genes regulating trophoblast invasion, angiogenesis, vascular integrity, one carbon metabolism, DNA damage, inflammation and renin-angiotensin system with preeclampsia. Methods: Nulliparous Sinhalese women with preeclampsia (n = 175) and normotensive pregnant women (n = 171) matched for age, ethnicity, parity and BMI were recruited from two tertiary care hospitals in Colombo. Women with a BMI > 30 kg/m2 were excluded. Preeclampsia was diagnosed using international guidelines. Early preeclampsia (n=73) was defined as early onset of preeclampsia requiring delivery before 34 weeks of gestation. A small for gestational age baby (SGA) was defined as having a birth weight below the 10th customised birth weight centile (n=102). DNA was extracted from peripheral blood collected from the participants and genotyped using the Sequenom Mass ARRAY system. Allele frequencies of cases were compared with controls using chi square analyses. Results: Placental growth factor (PGF) rs1042886 A allele (OR 1.5, 95% CI 1.1-2.1), insulin like growth factor II (IGF2) Apa1 rs680 G allele [p=0.04, OR(95% CI)=1.4 (1.0-1.9)] and mannose-binding lectin (LMAN2) G allele [p=0.04, OR(95%CI)=1.5 (1.0-2.2)] were associated with preeclampsia. The prevalence of Hypoxia inducible factor 1 (HIF1A) rs11549465 C allele was increased in preeclmptic women who developed early onset disease [p=0.003, OR(95% CI)=3.1(1.4-6.7] and in those who delivered SGA infants [p=0.02, OR(95% CI)=2.1(1.1-4.0)]. Conclusions: Polymorphisms in genes regulating angiogenesis, placental trophoblast invasion and inflammation are associated with preeclampsia in Sinhalese women.

Abstracts of Free Paper Symposium 5: Immunology and Genetics OP 33: Vascular disease susceptibility gene polymorphisms are associated with adverse pregnancy outcomes P Andraweera1, G Dekker2, St Thompson2, R North3, L McCowan4, C Roberts2 1Human Genetics Unit, Faculty of Medicine, University of Colombo 2University of Adelaide, Australia 3King's College, London, UK 4University of Auckland, New Zealand Introduction and Aims: Preeclampsia and small for gestational age (SGA) infants are risk factors for later life coronary artery disease and stroke. Common genetic factors may underlie both these pregnancy disorders and later life vascular diseases. Functional single nucleotide polymorphisms in angiogenesis regulating genes (ANGPT1 rs2507800, TSP1 rs2228262, KDR rs2071559 and KDR rs2305049) have been shown to be associated with coronary artery disease and stroke. We investigated the association of these polymorphisms with pregnancies complicated by preeclampsia and SGA infants. Methods: 3196 nulliparous pregnant women, their partners and babies were recruited in Adelaide and Auckland to a prospective multicenter cohort study. Preeclampsia was diagnosed using international guidelines. SGA was defined as birth weight <10th customised birth weight percentile adjusted for maternal height, weight, parity and ethnicity, as well as gestational age at delivery and infant sex. Uncomplicated pregnancies in the cohort served as controls. DNA was extracted from peripheral blood from couples and cord blood from babies. Genotyping was performed using the Sequenom Mass ARRAY system. Results: Maternal ANGPT rs2507800 was associated with preeclampsia (OR 0.5, 95% CI 0.3-0.9). Paternal (OR 1.4, 95% CI 1.0-2.0) and neonatal (OR 1.8, 95% CI 1.1-2) TSP1 rs2228262 was associated with SGA. Paternal and neonatal KDR rs2071559 was associated with preeclampsia (OR 1.6, 95% CI 1.0-3.0 and OR 2.2, 95% CI 1.0-4.4) and SGA (OR 1.9, 95% CI 1.1-3.3 and OR 2.2, 95% CI 1.2-3.9). Conclusions: Angiogenesis regulating gene polymorphisms may associate with the risk of vascular disorders across the life course. OP 34: Molecular diagnosis of Williams Buren syndrome in a cohort of Sri Lankan patients DM Ranaweera1, D de Silva2, D Samarasinghe3, S Perera3, N Rajapaksha2, N V Chandrasekharan4 1Post Graduate Institute of Medicine, University of Colombo 2Faculty of Medicine, University of Kelaniya 3Lady Ridgway Hospital for Children, Colombo 4Department of Chemistry, Faculty of Science, University of Colombo Introduction: Williams Bueren Syndrome (WBS) is a common genetic cause of congenital heart defects associated with developmental delay, hypercalcaemia and characteristic facial dysmorphism. It is caused by a 1.5 to 1.8 Mb deletion of chromosome 7q11.23 involving the loss of around 23 genes including the elastin (ELN) gene. This study reports the development of a semi quantitative PCR method to diagnose WBS. Aims: To establish a molecular diagnostic test for WBS and determine the frequency of ELN deletions among clinically suspected cases. Methods: Sixteen suspected WBS cases identified by two paediatric cardiologists were recruited following ethical clearance and informed consent. DNA was extracted and dosage analysis was carried out using semi-quantitative PCR. In a multiplex PCR reaction normal (N), positive control (with a confirmed deletion) and patientsâ&#x20AC;&#x2122; (P) DNA was amplified using 2 primer pairs which amplified regions within the ELN gene and the CFTR gene on chromosome 7 but outside the deleted region. Following agarose gel electrophoresis, the amplified products were quantified. A ratio of P:N of 0.5 indicated the presence of a deletion while a ratio of 1 indicated the absence of a deletion. Results: Among sixteen suspected cases, 12 (75%) had an ELN gene deletion while 4 cases did not. Conclusions: This semi-quantitative PCR method was able to distinguish ELN deleted cases from the non deleted ones. The preliminary data supports this as a useful diagnostic test for WBS but validation is required before its clinical use.

Abstracts of Free Paper Symposium 5: Immunology and Genetics OP 35: Utility of quantitative polymerase chain reaction in leptospirosis diagnosis - association between level of leptospiraemia and clinical manifestations in Sri Lanka S Agampodi1, M A Matthias2, AC Moreno2, JM Vinetz2 1Rajarata University of Sri Lanka, 2University of California San Diego, USA Introduction and Aims: Quantitative polymerase chain reaction (qPCR), has the potential to provide accurate and timely diagnosis for leptospirosis at the point-of-care in endemic areas. We studied optimal sample types for qPCR, timing of sampling, and clinical manifestations in relation to quantitative leptospiraemia. Methods: A new qPCR assay using pathogenic leptospira-specific 16S ribosomal RNA(rRNA) gene taqman primers and an optimised temperature stepdown protocol was used to analyse patient blood samples. Serum was compared with whole blood as sample source. Quantitative leptospiraemia was compared with clinical manifestations of leptospirosis and outcome. Results: The diagnostic sensitivity of qPCR of whole blood and serum was 18.4% (95%CI: 9.97%–31.4%) and 51.0% (95%CI:37.5%–64.4%) respectively. The qPCR on suspected cases confirmed infection in 58 of 381 cases (15.2%). Of these, 6 cases confirmed by nested PCR and sequencing were serologically negative using a standard but not regionally optimised microscopic agglutination test panel. The bacterial load in serum/blood ranged from 102 to 106 leptospira/ml. Median leptospiral load for uncomplicated, renal failure, myocarditis, and multi-organ failure patients were 8616, 11 007, 36 100, and 15 882 Leptospira/mL respectively. The qPCR window of positivity ranged from day 2 to day 15; sensitivity of qPCR was not affected by the length of the interval between the onset of symptoms and sample collection (p=.328). Conclusions: Quantitative PCR shows potential as a valid diagnostic test with a wider window of positivity than previously thought. Quantitative leptospiraemia in serum/whole blood samples did not directly correlate with clinical manifestations of outcome in this patient population. OP 36: PCR-enzyme linked immunoabsorbent assay as a rapid molecular method for detection of rifampicin resistant Mycobacterium tuberculosis in low resource settings CP Adikaram1, J Perera1, WSS Wijesundera2 1Department of Microbiology, Faculty of Medicine, University of Colombo 2Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo Introduction: Rifampicin resistance (RR) of M.tuberculosis (MTB) is due to point mutations in the rpoB gene. Early detection of drug resistance is important for prevention and control of tuberculosis (TB). Commercially available molecular based methods cannot be adopted in low resource settings due to high cost. Aims: The study was focused on developing a PCR-ELISA, for rapid detection of RR, a surrogate marker of multi drug resistance. Methods: Thirty RR- MTB strains with mutations at codon 526, 531 or 626 of rpoB gene, confirmed by DNA sequencing were selected for the study. 5’ biotinylated allele specific oligonucleotides corresponding to point mutations at codons 526, 531& 626 were designed as probes and were immobilized on streptavidin coated microtiter plates. Digoxigenin labeled PCR amplified fragments of the rpoB gene were hybridized with the immobilized probes and detected using peroxidase conjugated anti-Digoxigenin. The sensitivity of the PCR-ELISA was measured by a serial dilution of H37Rv DNA and the specificity was determined by using DNA of non tuberculosis Mycobacteria (NTM). Results: The PCR–ELISA was able to detected mutations in all 30 RR-MTB strains. The sensitivity of detection was 1pg of DNA for mutation at codon 531 and 626 and 100 fg for mutation at codon 526. Specificity of the PCR-ELISA was 100% against tested NTM. Conclusions: The PCR-ELISA for the detection of RR was in total agreement with DNA sequencing results (Kappa=1). Hence the developed PCR–ELISA is a rapid, sensitive and specific assay for detection of RR, suitable for low resource settings.

Abstracts of Free Paper Symposium 5: Immunology and Genetics OP 37: A novel approach to understand carcinogenesis in oral submucous fibrosis RP Illeperuma1, YJ Park1, WM Tilakaratne2, J Kim3, RP Illeperuma3 1Oral Cancer Research Institute, Yonsei University College of Dentistry, Seoul, Korea 2Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya 3Modern Medicine Unit, Institute of Indeginous Medicine, University of Colombo Introduction: Oral cancer is among the most prevalent cancers of Sri Lanka. Oral submucous fibrosis (OSF) is a premalignant condition frequently found in betel chewers due to the consumption of Areca nut. Aims: As OSF is a unique condition involves chronic inflammation and fibrosis, we hypothesised that inflammatory cytokines might have a role to play in malignant transformation of oral epithelium by DNA damage. Methods: Normal human gingival fibroblasts (hNOF) and immortalized human gingival fibroblasts (hTERT-hNOF) were used. Cytokine antibody array was utilised to screen the cytokines secreted by Areca nut extract (ANE) -stimulated fibroblasts. Cytokine secretion patterns of fibroblasts were studied using ELISA, RT-PCR and immunofluorescence. Immortalised human oral keretinocytes (IHOK) were treated with cytokines (GRO-, IL-6, and IL-8) and assessed for proliferation rate, ROS production, oxidative DNA dammage, DNA double strand breaks, cell ploidy change, motility, and epithelial mesenchymal transition (EMT) related molecules. Results: Increased secretion of GRO-, IL-6, and IL-8 were found in ANE-stimulated fibroblasts. Long term ANE exposure of hTERT-hNOF caused senescent features, but continued to secrete the cytokines. Cytokine treated IHOK caused increased aneuploid cell population, produced ROS in IHOK causing oxidative DNA damage as well as DNA double strand breaks. OSF tissues also were evident of cytokine expression, oxidative DNA damage and DNA double strand breaks in the epithelium. Cytokines induced high motility in IHOK and long-term cytokine treatment induced EMT in IHOK. Conclusions: This study provides insights to understand a contributory mechanism responsible for malignant transformation of OSF epithelium.

Free Paper Sympsoum 6: Communicable Diseases

Free Paper Symposium 6: Communicable Diseases OP 38: Predicting acute liver failure in dengue infection CK Ranawaka1, RS Kumarasena1, MA Niriella1, JKND Miththinda1, A Pathmeswaran2, AS Dassanayake3, AP de Silva4 HJ de Silva4 1University Medical Unit, Colombo North Teaching Hospital, Ragama Departments of 2Public Health, 3Pharmacology and 4 Medicine, Faculty of Medicine, University of Kelaniya Introduction: Dengue infections (DI) have a diverse clinical spectrum ranging from asymptomatic illness to severe dengue. Unusual manifestations such as encephalitis, myocarditis, and acute liver failure (ALF) are increasingly recognised. Aims: To describe the spectrum of liver dysfunction and identify possible predictors of ALF in DI Methods: Serologically confirmed patients with DI admitted to university medical unit, Ragama from January 2009 to March 2010 were included. Data were obtained from patient records. Results: Out of 240 patients (male:female 57.7%:42.5%; mean age 35.6years[SD 15.4 years]), 49(20.4%) had severe dengue, 164(68.3%) had dengue with warning signs and 27(11.2%) had dengue without warning signs. Abdominal pain, persistent nausea and vomiting (PNV), skin or mucosal bleeding, hepatomegaly and ascites was present in 52.1%, 38.3%, 16.2%, 50% and 11.7% cases respectively. Deranged AST or ALT(ASTALT), serum bilirubin(SB), alkaline phosphatase(ALP), gamma glutamyl transpeptide(GGT), and INR were observed in 86.7%, 8.3%, 7.5%, 25% and 10% of patients respectively. Of the 240 patients 41(17.1%) had ASTALT>1000 IU and 199(82.9%) had ASTALT<1000 IU. Only 16/41 patients with ASTALT>1000 IU developed ALF while none from the ASTALT<1000 IU group developed ALF. Presence of 2 or more of elevated SB, elevated ALP or PNV predicted the development of ALF with 93.8% sensitivity, 98.7% specificity, 83.3% positive predictive value and 99% negative predictive value with p<0.001. Conclusions: ASTALT<1000 IU excluded patients at risk of ALF. Presence of 2 or more of PNV, elevated SB or ALP in patients with DI may indicate impending ALF. This needs further validation in a larger population. OP 39: Association of serum IL-10 with severe clinical disease in acute dengue infections G Malavige1, L Gomes1, S Fernando2, T Chang2, C Jayasekara2, D Guruge1, SD Jayaratne1, G Ogg3 1Department of Microbiology, Faculty of Medical Science, University of Sri Jayewardenepura 2Department of Clinical Medicine, University of Colombo 3University of Oxford, UK Introduction and Aims: As it was shown that serum IL-10 were higher in a small group of patients who had fatal dengue infection we set out to investigate the possibility of using this cytokine as a biomarker to predict severe clinical disease. Methods: Serum IL-10 levels were determined by quantitative ELISA in 125 adult patients with confirmed acute dengue infection. Serial recording of all clinical features and laboratory investigations were done to determine clinical disease severity. Dengue specific IgM and IgG assays were done to confirm dengue infection. Clinical disease severity was determined by the World Health Organisation, 2009 guidelines. Accordingly, 27 (21.6%) developed shock (pulse pressure< 20mmHg). 119 (95.2%) had elevated liver enzyme levels. Results: Serum IL-10 levels were significantly higher (p=0.029) in patients with shock (median= 117, range= 24.98 to 476.1 pg/ml) when compared to those who did not develop shock (median= 70.83, range= 11.01 to 1343 pg/ml). Serum IL-10 levels showed a statistically significant and negative correlation with the total lymphocyte counts (p=0.0025, Spearmans r =-27). We did not see any association of IL-10 levels with platelet counts, neutrophil counts or with aspartate transaminase or alanine transaminase levels. There was no significant difference between serum IL-10 levels in patients with primary or secondary dengue infection. Conclusions: Serum IL-10 levels appear to be associated with severe clinical disease. The possible use of IL-10 as a biomarker needs to be evaluated in a large group of acutely infected dengue patients with varying disease severity

Free Paper Sympsoum 6: Communicable Diseases OP 40: To identify the role of haemoglobin, pack cell volume and pulse pressure in predicting fluid leakage in patients with dengue who consume adequate amounts of fluids P Ranjan1, A Ragupathy2, J K N D Miththinda2, De Silva HJ1 1Faculty of Medicine, University of Kelaniya 2 University Medical Unit, Colombo North Teaching Hospital, Ragama Introduction: Early detection of fluid leakage is important in identifying patients who are likely to develop shock syndrome in dengue. As patients are advised to consume adequate amounts of fluids such behaviours may alter the clinical and haematological parameters predicting fluid leakage. Methods: In 102 confirmed dengue patients admitted to a single medical unit, CNTH, Ragama from September 2011,quantity and quality of fluids consumed, Hb, PCV, pulse pressure(PP) and their percentage rise or decline were documented and compared between those who developed and did not develop third space fluid accumulation(TSFA) [either pleural effusions, ascites or both detected by ultrasonography]. Results: In 102 patients (52 males) with mean age 28.3(SD=11.8) years, TSFA was detected in 34/95(37%) on follow up. In those who developed TSFA and did not develop TSFA, average consumption of water 620cc/day vs 491cc/day (p=0.14); solutes 1461cc/day vs 1481cc/day (p=0.83); the mean(SD) values of highest Hb 14.66(1.82)g/dl vs 14.28(1.6)g/dl (p=0.3) and highest PCV 44.16 ( 5.19) vs 43.4 (4.5) (p=0.46); pulse pressure 29.9mmHg vs 28.4 (p=0.29); The maximum percentage rise in Hb 8%vs 4.6% (p=0.02); PCV 8.6% vs 4.5% (p=0.006); mean pulse pressure drop 6.9% vs 5.9% (p=0.84). Conclusions: In the presence of fluid consumption the quality or quantity of fluids consumed did not seems to contribute to TSFA. A single value of Hb, PCV or pulse pressure was not helpful in predicting early fluid leakage. While percentage reduction in pulse pressure was not helpful, percentage rise in Hb and PCV remained predictive of early fluid leakage in dengue. OP 41: The role of perceived self efficacy in dengue vector control activities among residents of Kundasale MOH Area DL Rangama Post Graduate Institute Medicine, University of Colombo Introduction: Dengue is a fatal vector born, viral infection endemic in Sri Lanka. Aedes aegypti and Aedes albopictus are common vectors in Sri Lanka. Public perceive changing their behaviour to control dengue vector breeding sites is a challenge. Bandura proposed that Perceived self efficacy (PSE) is an internal determinant and predictor of the human behaviour in response to challenges in life events. Aims:To determine the role of PSE in dengue vector breeding site control activities among residents in Kundsale MOH area. Methods: A descriptive cross sectional study. A sample of 600 residents was selected from households in Kundasale MOH area by cluster sampling of population proportionate to size. A questionnaire with Perceived Self-Efficacy Scale and a check list of potential dengue breeding sites in the household were completed by the respondent with the assistance of the interviewer. Results: A statistically significant negative correlation appeared between the PSE scores and container index at household level (r= -0.176). Container Index (CI) was 3.6%, House Index (HI)was 22.5% and Breteau Index(BI) was 39.3%. Median score of PSE was 64.%. PSE significantly associated with HI (p<.001), CI (p<0.001) and BI (p<0.001) religion (p=0.007), education level (p=0.016), type of occupation (p=0.003), land size (0.0001) and the number of influence types (p=0.0001).Majority was in average to high perceived self efficacy level (397/600). Conclusions: The perceived self efficacy is possibly an important determinant of dengue vector breeding site control.

Free Paper Sympsoum 6: Communicable Diseases OP 42: In-vitro erythrocyte membrane stabilization properties of Carica papaya L. leaf extracts P Ranasinghe1, P Ranasinghe2, WPKM Abeysekera2, GAS Premakumara2, YS Perera3, P Gurugama4, SB Gunatilake4 1Department of Pharmacology, Faculty of Medicine, University of Colombo 2Herbal Technology Division, Industrial Technology Institute, Colombo 3National Hospital of Sri Lanka, Colombo University Medical Unit, Colombo South Teaching Hospital, Kalubowila Introduction: Carica papaya L. fruit juice and leaf extracts are known to have many beneficial medical properties. Aims: To evaluate the membrane stabilization potential of Carica papaya L. leaf extracts using an in-vitro haemolytic assay. Methods: Fresh papaya leaves at three different maturity stages (immature, partly matured and matured) were cleaned with distilled water, crushed and the juice was extracted with 10ml of cold distilled water. Freshly prepared cold water extracts of papaya leaves (1ml containing 30μl of papaya leaf extracts, 20μl from 40% erythrocytes suspension and 950μl of phosphate buffered saline) were used in the heat-induced and hypotonic-induced haemolytic assays. In dose response experiments, six different concentrations (9.375, 18.75, 37.5, 75, 150, 300μg/ml) of freeze dried extracts of the partly matured leaves were used. Membrane stabilization properties were investigated with heat-induced and hypotonicity-induced haemolysis assays. Results: Extracts of papaya leaves of all three maturity levels showed significant reduction in heatinduced haemolysis compared to controls (p<0.05). Papaya leaf extracts of all three maturity levels showed more than 25% inhibition at concentration of 37.5μg/ml. The highest inhibition of heat-induced haemolysis was observed at 37.5 g/ml. Inhibition activity of different maturity levels was not significantly different from one another. Heat-induced haemolysis inhibition activity did not demonstrate a linear dose response relationship. At 37.5 g/ml concentration of the extract a marked inhibition of hypotonicityinduced haemolysis was observed. Conclusions: Carica papaya L. leaf extracts showed a significant inhibition of haemolysis in-vitro and could have a potential therapeutic effect in disease processes causing destabilization of biological membranes. OP 43: Study of host preference of phlebotomine sandflies (vector of leishmaniasis) in Sri Lanka SASC Senanayake1, N D Karunaweera1, E M Dotson3 1Department of Parasitology, Faculty of Medicine, University of Colombo 2Entamology Branch, Division of Parasitic Diseases, Ceners for Disease Control, Atlanta, USA Introduction: Leishmaniasis is a health concern particularly in the Southern Province of Sri Lanka. Causative agent is Leishmania parasites and transmitted by Phlebotomine sandflies. Majority of cases reported are cutaneous though a few cases have been confirmed as visceral leishmaniasis. Phlebotomus argentipes is the most probable local vector. Study of vector habits, including host preference in its biting behaviour is important in designing strategies for disease control in affected areas. Aims: This study identifies host preference in vector biting using blood meal analysis of wild caught female sandflies. Methods: Engorged sandflies were collected between 20.00 hr – 22.00 hr from likely resting places in selected sites in Dikwella, using manual aspirators at monthly intervals from November 2007 - April 2008. A total of 106 blood-fed sandflies were collected. Morphological identification made using standard keys. There were 44 Phlebotomus argentipes and 62 Sergentomiya zeylanica female sandflies. Blood meal analysis was done using established molecular-based methods that identify mammalian species specific genes. Amplified PCR products were sequenced and analysed using available gen bank data. Results: Results revealed the presence of blood from cattle (n=28), buffalo (n=6) and human (n=10) within given numbers of Phlebotomus argentipes. Majority of (46/62) S.zelanica were positive for human blood and rest were negative for mammalian blood. Conclusions: Sri Lankan P. argentipes is likely to be a zoophilic vector (unlike S.zeylanica, described as a non-vector species). Further studies are underway using both entomological and molecular-based methods in a wider group of samples to enable definite description of vector habits.

Free Paper Sympsoum 6: Communicable Diseases OP 44: Largest ever outbreak of leptospirosis in Sri Lanka: sero-molecular epidemiology and risk factors SB Agampodi1, DB Nugegoda1, V Thevanesam2, SJ Peacock3 1 Rajarata University of Sri Lanka 2University of Peradeniya 3University of Cambridge, UK Introduction: Leptospirosis is a globally widespread zoonotic disease. Sri Lanka has experienced one of the largest global leptospirosis outbreak reported in 2008. Aims: This paper presents the seroepidemiology, risk factors and predictors of 2008 outbreak of leptospirosis in Kegalle, Kandy and Matale districts. Methods: A hospital based case control study was carried out from August 2008 to January 2009 in three tertiary care hospitals. All fever patients admitted to medical wards were screened for probable leptospirosis using clinical criteria. Disease confirmation was carried out in WHO Leptospirosis reference lab in Australia and Gorge Palade laboratories of Scool of Medicine, University of California, San Diego. Age and sex matched controls were selected from the same ward for the case control study. Results: Of the 404 probable cases of leptospirosis investigated, 112 cases were confirmed using MAT and PCR. Highest titers of patient sera reacted with serovars Pyrogenes(28.7%), Hardjo(18.8%), Javanica(11.5%) and Hebdomadis(11.5%). Sequencing of the 16S rDNA gene identified 24 L.interrogans and two L.weilli infections. Exposure in paddy field (OR 3.02, 95% CI 1.684-5.410, p<.001), cattle (OR1.69, 95% CI 1.002-2.841, p=.049) or dogs (OR 1.8, 95%CI 1.107-2.914, p=.018) in home yard and paddy fields in neighborhood (OR1.77, 95%CI 1.062-2.974, p=.029) were the un-confounded risk factors significantly associated with leptospirosis. Using mainline water for drinking and other purposes had independent protective association (OR .325, 95%CI .159-.673, p=.002). Conclusions: This study provides strong evidence to suggest that large mammals play a main role as reservoir animals for human leptospirosis in Sri Lanka. Control strategies should be modified accordingly OP 45: Prophylactic doxycycline use for prevention of leptospirosis among farmers hospitalised with leptospirosis AS Dissanayake1, CL Fonseka1, J Amarasekera2, P Palihawadana2 1Faculty of Medicine, University of Ruhuna 2Epidemiology Unit, Ministry of Health, Colombo Introduction: Leptospirosis is a zoonotic disease causing substantial morbidity and mortality in Sri Lanka. Chemoprophylaxis is recommended for those with occupational exposure. Health authorities have implemented a chemoprophylaxis programme for the farming community. Whether this evidenced based preventive measure reaches those at risk is not clearly known. Aims: To assess the proportion of those with leptospirosis who had taken chemoprophylaxis and to ascertain whether those getting leptospirosis despite chemoprophylaxis use had a milder illness Methods: Demographic data, nature of exposure, clinical features and clinical outcomes in the chemoprophylaxis user and nonuser groups were ascertained from Leptospirosis surveillance data collected by the Epidemiology Unit for 2009 and 2010. Results: The case fatality rate for leptospirosis was 5.2%. Chemoprophylaxis had been taken only by 2.0% of those admitted. Occupation related exposure was recorded in 65.6%. Of them, chemoprophylaxis had been used only by 2.1%. Fulltime farmers accounted for 19.6%. The chemoprophylaxis rate for them was 3.0%. Comparative rate for part time farmers was 1.7%. The numbers using chemoprophylaxis were too small to determine whether it offered protection against life threatening complications of leptospirosis. Conclusions: Leptospirosis had a high case fatality rate. 98% of those admitted had not taken chemoprophylaxis. The target group of chemoprophylactic preventive measures, the fulltime farmers, had a low usage rate of 3%. Rate for part time farmers was even lower. Despite much morbidity and mortality the vast majority contracting leptospirosis had not used evidence based preventive measures. Determining the reasons for this phenomenon is a national health priority.

Free Paper Sympsoum 6: Communicable Diseases OP 46: Culture positive enteric fever in Colombo and Ragama 2007-2010 E Corea1, M Kamkanamge2, P Chandrasiri3, K Jayatilleke4, Dr M Dassanayake5, J Perera1 1Faculty of Medicine, University of Colombo 2Ministry of Health, Colombo 3National Hospital of Sri Lanka, Colombo 4Sri Jayewardenepura General Hospital 5Colombo North Teaching Hospital, Ragama Introduction: Enteric fever notifications from the Western Province comprise a significant proportion of the national figure, being 277/1805 (15%) in 2007, 358/1933 (18%) in 2008 and 346/2362 (15%) in 2009. Aims: To determine the aetiology of enteric fever in Colombo and Ragama between January 2007 and May 2010 Methods: Data on laboratory isolates of enteric fever pathogens from blood culture and notifications of culture positive enteric fever were collected from three state and two private hospitals. Results: 380 cases of culture positive enteric fever were collected. 352 were blood cultures from the laboratories of the study hospitals and 28 were culture positive notifications based on cultures from other laboratories (27 blood culture and one stool culture) The identity of the isolates (as recorded in the laboratory records or in the notification form) were S. typhi (54). S. paratyphi (293) while 33 isolates were not specified. The predominant isolate was S. paratyphi and the proportion increased from 2007 (48/72, 67%) to 2008 (103/133, 77%) and 2009 (126/152, 81%). In 2010, up to May, S. paratyphi comprised 15/21 isolates. Seasonal trends showed higher isolation rates from June and December. Of the 352 isolates cultured in the laboratory only 101 were subsequently notified by the wards. Conclusions: The aetiology of enteric fever has shifted from typhoid to paratyphoid fever in the Western Province. Public health initiatives, such as typhoid vaccination programmes, should note these changes in epidemiology. Notification of laboratory confirmed cases should be strengthened. OP 47: Life style changes among tuberculosis patients attending Central Chest Clinic Colombo MGB Senanayake1, S Samaraweera2 1Nutrition Coordination Division, Ministry of Health, Colombo 2National Programme for Tuberculosis Control and Chest Diseases, Ministry of Health, Colombo Introduction: Tuberculosis (TB) is a chronic disease associated with social stigma. It significantly affects patientsâ&#x20AC;&#x2122; lifestyle and also on lives of close associates. Understanding those changes helps to take remedial measures. Aims: To describe the influence of the disease on lifestyle among tuberculosis patients attending the Central Chest Clinic Colombo. Methods: Study population of this descriptive cross sectional study consisted of all tuberculosis patients aged 15 years or more and registered in the Colombo district TB register. Patients who have completed the first two months of treatment were included. Change of the job, income, family relationships and social interactions were assessed using six questions. Comparison was made by an un-weighted composite score. More than three were considered as â&#x20AC;&#x153;Considerable changeâ&#x20AC;?. Results: There were 266 respondents. Negative influence to the marital status, employment and income due to TB were seen among 71.4% (n=10), 97.1% (n=167), 98.6% (n=139) respectively. Forty-eight (21.9%) avoided social gathering to refrain from habits like smoking and alcoholism. Complete cessation of smoking and alcohol were seen in 72% (n=108), and 64.7% (n=99) respectively. Six (2.3%) have not revealed their illness to family members. Negative lifestyle changes were common among socially disadvantaged group of patients. Considerable lifestyle changes had statistically significant association with male sex, poor education, unemployment, low-income, retreatment and infectiveness of the disease, residing within Colombo Municipal Council area and alcohol, smoking, drug abuse. Conclusions: Negative lifestyle changes were commoner than positives. More attention should be paid on patients from low socio-economic groups.

Free Paper Symposium 7: Child Health, Reproductive Health and Cancer

Free Paper Symposium 7: Child Health, Reproductive Health and Cancer OP 48: Coagulation changes in hypothermia in neonatal extracorporeal membrane oxygenation (ECMO) T Harischandra1, R K Firmin2, UK J Kerslake2, A Goodall2, A Ahmed2, S Pavord3, D Field4 1Teaching Hospital, Karapitiya 2Glenfield Hospital, UK 3Leicester Royal Infirmary, UK Introduction: Hypothermia is a promising intervention for reducing cerebral ischaemic damage. Neonates who need extracorporeal membrane oxygenation (ECMO) are inherently ill and are at risk of cerebral damage. Studies have shown hypothermia to be neuroprotective, but its effect on coagulation incorporating conventional and temperature adjusted blood tests have not been studied. Aims: We aimed to look for a difference in coagulation between neonates who undergo ECMO at mild hypothermia (340C) and those at normothermia (370C). Methods: A prospective, single-centre study was done from October 2006 to November 2008: Babies were randomised to “cooled” and “non-cooled” groups. Blood sampling was done at six time points. Thromboelastography(TEG) values at 340C and 370C, routine coagulation tests and cytokines were studied. Requirements of blood products and heparin and the clinical manifestations of haemorrhage and thromboembolism were noted. Results: There were 16 neonates and eight were cooled. Mean age was 1.2 days; mean weight 3.4kg and total ECMO time 1877 (mean 117.3 hours). Eight (50%) were males. Mortality was one (6.3%). Data was analysed using the Mann-Whitney Test. Mild hypothermia caused reduced platelet count (p=0.001) and function (p=0.03) at 12 hours post- ECMO and reduced clot formation by 24 hours (p=0.02), after which differences disappeared. Heparin requirement was less in the cooled group (p=0.002). Two non- cooled babies showed cerebral infarctions. No differences in cytokines were evident. Conclusions: Transient changes in platelets occur at the onset of ECMO. There were no other changes in coagulation parameters and no adverse effects due to mild hypothermia. OP 49: The neurodevelopmental outcome at 2 years - a prospective cohort study of preterm infants S Sumanasena1, D Vipulagama1, H Wijeyasundera1, S Kuruppu1, J Weeragalle2, S Mallawarachchi2, C Jayamanne1, N Gunawardena2 1Department of Paediatrics, Faculty of Medicine, University of Colombo 2De Soysa Hospital for Women, Colombo 3Department of Community Medicine, Faculty of Medicine, University of Colombo Introduction: The advanced technologies in neonatology improve survival of preterm neonates but resulting in long term neurodevelopmental deficits. We followed up a cohort of preterms over a 2 year period and correlated their neurodevelopment with neonatal complications. Aims: To describe the neurodevelopmental outcomes at 2years of corrected gestational age (CGA) and to correlate the attainments with maturity, birth weight and complications Methods: A cohort of preterms underwent regular assessment using Bayley Scales of Infant and Toddler Development (third edition) in the domains of motor (fine and gross), language (expressive and receptive) and cognitive skills. Raw scores were converted to scaled scores and categorised into above average (14- 19), average (7-13), some delay (4-6), and severe delay (<3) in development. The scores were correlated with complications (birth weight, maturity APGAR scores, surfactant deficient respiratory distress syndrome, hypoglycaemia etc). Results: Their maturity ranged from 25- 34 (30.93+/- 2.32) weeks. The birth weight ranged from 6902070 (1400 +/- 398) g. At two years language (Receptive: 8.07 +/- 2.05, Expressive: 7.73+/- 2.66) and fine motor skills (8.54 +/- 2.67) showed average developmental scores with cognitive (6.98 +/- 2.58) and gross motor skills (6.37 +/ - 1.99) within just below average range. Birth weight correlated significantly with expressive language (p=0.029) and fine motor skills (p=0.00). Maturity correlated significantly with fine motor skills (p= 0.029). Conclusions: Maturity and birth weight significantly impact fine motor skills which will influence long term educational performance.

Free Paper Symposium 7: Child Health, Reproductive Health and Cancer OP 50: Complementary feeding practices in Infants and young children in the Medical Officer of Health area, Sandilipay D Jeyakumaran1, SSP Godakandage2 1Primary Care Service Unit, Ministry of Health, Colombo 2Research and Development Unit, Family Health Bureau, Ministry of Health, Colombo Introduction: Infancy and young childhood is a highly vulnerable period in human life. Inappropriate feeding practices are the major cause of malnutrition. A National survey done by Medical Research Institute, in 2009, revealed poor indicators on nutritional status and infants feeding in Jaffna district. Aims: To describe complementary feeding practices and factors associated with them in children aged 4 to 23 months in the Medical Officer of Health area, Sandilipay. Methods: A community based cross sectional descriptive study using an interviewer administered questionnaire. Results: Exclusive breastfeeding among children aged 4 to 6 months and continued breast feeding among children aged 12 to 15 months were 41.4% (12) and 89.8% (79) respectively. Bottle feeding was practiced in 54.1% (218) and it was 66.2% (47) among children aged 9-11 months. The minimum dietary diversity and minimum acceptable diet as per WHO indicators were 61.8% (231) and 47.3% (177) respectively. Oily food, fruits and vegetables and flesh food consumptions among children aged 6-8 months were, 15.6% (7), 22.2% (10) and 35.0% (16) respectively. bottle feeding was associated with mothers with better education (p=0.006), monthly family income more than Rs.15000/= (p=0.022). Recipient of food rations or social aids were associated with unsatisfactory minimum dietary diversity (p < 0.01) and minimum acceptable diet (p < 0.01). Conclusions: Above indicators were worse, when compared to DHS 2007 findings. Subgroups with worst indicators should be targeted for intervention; families who receive food rations or social aids, monthly income more than Rs.15000/= and mothers with better education. OP 51: Cut off value of TSH for early prediction of poor neurodevelopment of 5 to 9 year old children in Sri Lanka V Abeysuriya1, KPJ Perera2, A Kasturiratne1, AR Wickremasinghe1 1Department of Public Health, Faculty of Medicine, University of Kelaniya 2Department of Paediatrics, Faculty of Medicine, University of Kelaniya Introduction and Aims: To assess the relationship between TSH and neuro-development of children between 5- 9 years of age and to identify the cutoff value of TSH for early prediction of poor neuro developmental outcome. Methods: A descriptive cross sectional study was carried out in 20 randomly selected estates in the Ratnapura district of Sri Lanka from August to December 2010. A validated neurodevelopment assessment tool was used to assess the neuro-development of 1683 randomly selected children. Neurodevelopment was expressed as a General Quotient (GQ) score and a score <100 was identified as evidence of poor neuro-development. Of 1683 children screened, 519 were randomly selected with consent from the parents; blood was assayed for TSH using the 3rd generation TSH Chemiluminescent immunometric assay. ROC curve analysis was used to find out the cut off value of TSH that best predicts poor neurodevelopment in children. Results: Of 519 children whose TSH levels were assayed, 494 had TSH levels within the normal range between 0.60 to 5.40 μIU/ml, of whom 16% had a GQ score <100. There was a significant association between TSH levels and neuro-development (p=0.0001). The best cutoff value of TSH to predict a GQ score <100 was 1.5 μIU/ml. (Area under cure=73.4%, sensitivity= 97.0% and specificity =70.6%). Conclusions: The best cutoff value of TSH for prediction of poor neuro-development in children 5 to 9 years of age is 1.50 μIU/ml.

Free Paper Symposium 7: Child Health, Reproductive Health and Cancer OP 52: Under-nutrition, feeding practices and associated factors among pre-school children attending child welfare clinic in Passara MOH Area MMM Muzrif1, V Kumarapeli2 1Family Health Bureau, Ministry of Health, Colombo 2National Institute of Mental Health, Angoda Introduction: Under-nutrition in Sri Lanka is considerably high with marked regional and sectoral discrepancies and the highest seen in the estate sector Aims: Assess the proportion with under-nutrition, feeding practices and factors associated with undernutrition among children aged 3-5 years. Methods: A clinic based, cross sectional study was carried out among 422 children recruited using systematic sampling. Response rate: 98.13%. Data were collected using an interviewer administrated questionnaire (IAQ) and Child Health Development Record. Height and weight measured using standard methods. IAQ collected data on socio-demographic-economic characteristics, long and short term feeding practices by 24 hour dietary recall and associated factors. Individual Dietary Diversity Score (IDDS) was calculated under 8 food groups. Results: Stunting, underweight and wasting was found among 45.5%, 41.0%, 14.5% respectively. Rice was the main meal among 99.1%, Rotti and bread being 82.2% and 51.2% respectively. Snacks were: biscuits (95.0%), fruits (56.9%), yoghurt (45%), buns (42.2%). Drinks were: Milk-tea (84.6%), plain-tea (72%), milk (64.2%), Bottled drinks (25.8%), homemade fruit drinks (15.4%). Mean main meal frequency was 3.08(SD0.63), 16.6% had recommended 4 meals per day. Mean IDDS was 4.66(SD1.36); 23.2% were below recommended level of 4. Low IDDS was significantly associated with underweight, stunting and wasting (p<0.05). Average monthly income, presence of >3 children in the family and index childâ&#x20AC;&#x2122;s birth order being >2 were significantly associated with underweight (p<0.05). Conclusions: Food availability in the estate sector should be increased to achieve dietary diversity among children. Special prevention programmes are needed targeting most vulnerable groups with continuous monitoring. OP 53: National survey on tobacco use among 13 to 15 years school children in Sri Lanka AP De Silva1, IK Liyanage2, STGR De Silva3, LSomatunga1, J Bandara1, U Sooriyarachchi1, K Sooriyarachchi1 1Division of Deputy Director General (Medical Services), Ministry of Health, Colombo 2General Sir John Kotelawala Defence University 3Greater Colombo Waste Water Management Project Introduction and Aims: To describe the prevalence and correlates of smoking among 13 to 15 years old school children in Sri Lanka Methods: This cross sectional study used multi-stage cluster sampling method to randomly select thirty schools from each of the school categories of 1AB, 1C, and II. From each school a number of classes were randomly selected using probability proportionate to size model. All the students in selected classes were enrolled. From 5,891 students, 4,963 (84.2%) participated. The final sample was weighted. A pre-tested self administered, anonymous questionnaire was used to collect the data. Results: The prevalence of all time smoking was 6.5% (95%CI 4.9-8.6) (males: 11.9%, females: 1.6%). Prevalence of smoking during past 30 days was 1.5% (95%CI 1.0-2.5) and 42.5% (95%CI 39.8-45.1) was exposed to passive smoking. There were 3.4% (95%CI 2.6-4.4) of never smokers who are considering to start smoking. Majority (88.9%, 95%CI 86.8%-90.6) believe that smoking should be banned from public places. Among the current smokers 49.3% (95%CI 20.4-78.7) were not refused to sell cigarettes from the stores because of their age. Intention to quit smoking was observed among 80.6% (95%CI 55.9-93.2) of the current smokers and 79.4% (95%CI 58.0-91.5) have tried to quit during the past year. Conclusions: The prevalence of smoking was low. However exposure to passive smoking in public was high. Students who smoked have access to cigarettes from public shops in spite of being under age. Intention to quit smoking is also high.

Free Paper Symposium 7: Child Health, Reproductive Health and Cancer OP 54: Occupational and environmental exposure and semen quality of infertile men - is lead responsible? GUS Wijesekara1, DMS Fernando2, S Wijerathne3, N Bandara4 Departments of 1Medical Education and Health Sciences, 2Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura 3Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Colombo 4Department of Forestry and Environmental Sciences, Faculty of Applied sciences, University of Sri Jayewardenepura Introduction: Environmental and occupational exposures to toxic agents have deleterious effects on semen quality. Effect of lead (Pb) on semen has not been studied in Sri Lanka. Aims: To determine the association between environmental and occupational exposures and semen parameters. Methods: Data on exposures were collected from 241 infertile males using an interviewer administered questionnaire. Positive exposure was defined as environmental or occupational exposure to one or more toxicants such as pesticides, paints, solvents, metals and chemicals. Volume, count, motility, morphology and viability of semen were analysed according to the WHO guidelines. In 80 men seminal plasma lead levels were estimated by graphite furnace atomic absorption spectrophotometry after digestion with nitric acid. Comparisons between exposed and non exposed groups were done by Mann-Whitney Test. Results: The mean (SD) of age, duration of the infertility and BMI of the subjects were 34.99 (5.33) years, 45.99 (33.21) months, 24.31 (3.51) kg/m2 respectively. 57% of men were exposed to toxicants through environmental or occupational sources and 27% lived in areas with possible environmental toxicity. The mean (SD) of the sperm concentration of environmentally exposed men (56.61±53.47 million/ml) were lower than those who were not exposed (58.54±55.68 million/ml). The sperm concentration (62.30±61.13 million/ml) (64.14±63.64 million/ml), progressive motility (40.31±19.55%) (41.20±19.66%), viability (52.25±19.21%) (54.33±19.86%) and morphology(36.53±17.62%) (38.66±18.30%) of occupationally exposed group were significantly lower than men who were not exposed. (p<0.05). Lead was positive in 66% and were high in exposed men (38.04± 36.85 ug/dl) when compared to non exposed men (30.81±28.62 ug/dl). Conclusions: Occupational and environmental exposure to lead is a risk factor for poor semen quality. OP 55: Screening of female sex workers for sexually transmitted infections and HIV in the Central Province, Sri Lanka KAS Jayawardena1, TN Tennakoon1, RL Karunarathna1, JACK Jayawardena2 1STD/AIDS Control Programme, Kandy 2University of Peradeniya Introduction: Female sex workers (FSWs) are a major source of sexually transmitted infections (STIs) and HIV in South Asia. It is estimated that 35,000 – 47,000 women work as sex workers in Sri Lanka. Aims: The aim of this study is to describe the prevalence of STIs including HIV and other reproductive tract infections (RTIs) among FSWs presented to a government STD clinic in the Central province. Methods: This is a descriptive study conducted in the STD clinic Kandy. Data were collected from the clinic records of the all women identified as FSWs presented to the clinic from January 2006 to the end of 2011. Results: A total of 302 clinic records were analysed. Majority (83%) were magistrate referrals. Only 10% were self-attended. Median age of the sample was 27 years. Many (47%) were married and not living with the marital partners. Sixty eight percent reported to have used condoms with the last paying partner. Majority (79%) did not complain present or past history of having symptoms related to genital infections. However clinical examination and investigations revealed that 80% of symptomatic and 67% of asymptomatic women had either single or multiple STIs including other RTIs. None were positive for HIV. Conclusions: Many FSWs were found to have RTIs including STIs with or without symptoms. STI services should strengthen the screening of FSWs and promote correct and persistence condom use with their clients. Further, general public should be educated on risk of transmitting STIs from asymptomatic infected persons and safe sex.

Free Paper Symposium 7: Child Health, Reproductive Health and Cancer OP 56: Cervical cancer screening among prison inmates in two female prisons in Sri Lanka SN Perera1, J Vidanapathirana2 1National Cancer Control Programme, Ministry of Health, Colombo 2National STD & AIDS Control Programme, Ministory of Health, Colombo Introduction: Female prison inmates are considered as a high risk group for cervical cancer. Aims: To determine the burden of cervical cancer among prison inmates in Sri Lanka. Methods: During the months of March and April 2011, seven mobile cancer screening clinics were conducted among prison inmates in two main female prisons in Colombo and Kalutara. All female inmates were invited to attend voluntarily and pap smear tests were conducted by Public Health Nursing Sisters. Smears were analysed at the Laboratory of National STD & AIDS Control Programme. Results: 320 inmates attended the cancer screening. Out of them pap smear tests were conducted among 54% (n=173) of females. Pap smear test was not conducted among the balanced 46% (n=147) of females due to not giving consent, having menstruation during that period, undergone hysterectomy, attended cervical cancer screening within last one year etc. Among those who participated, 35% (n=61) and 30% (n=52) were between the age group of 40-49 and 30-39 respectively. One cervical cancer and three CIN stage one cases, were found. Conclusions: When compared to previous community based prevalence studies, prevalence of cervical cancer was higher in this population. Regular cervical cancer screening programmes need to be conducted among female prison inmates. OP 57: Effectiveness of an educational intervention on early detection of breast cancer in the district of Gampaha PVSC Vithana1, MAY Ariyarathne2, PL Jayawardena3 1Family Heath Bureau, Colombo 2Cancer Hospital, Maharagama 3Faculty of Medicine, University of Kelaniya Introduction and Aims: To assess the effectiveness of an educational intervention on improving knowledge, attitudes and practices (KAP) on early detection of breast cancer among Public Health Midwives (PHMs) and target group women (TGW) in the district of Gampaha. Methods: A community-based intervention was conducted in Gampaha district using two Medical Officer of Health areas selected by random sampling as intervention (IA) and control (CA). The study participants were all PHMs in IA (n=38) and CA (n=47) and 260 TGW from each area. PHMs who were exposed to the educational intervention first, conducted the same among the TGW. For PHMs, post-intervention survey was conducted at one and six months and for TGW at six months after intervention. Results: The overall median scores for KAP respectively were as follows: PHMs: Pre-intervention: IA: 58%(IQR: 53- 69%), 90%(IQR: 70-100%) and 62%(IQR: 57-70%). CA: 64%(IQR: 56-69%), 90%(IQR: 70-90%) and 62%( IQR: 50-77%). Post-intervention: six months IA: 93% (IQR: 91-93%), 100%(IQR: 90-100%), and 81%(IQR: 77-89%). CA: 67%(IQR: 58- 71%), 90%(IQR: 90-100%), and 62%( IQR: 58-73%). TGW: Pre-intervention: IA: 54%(IQR: 46-59%), 50%(IQR: 41-59%), and 0%(IQR: 0-20%). CA: 54%(IQR: 44- 59%), 50%(IQR: 36-59%), and 0%( IQR: 0-20%). Post-intervention: six months IA: 77%(IQR: 72-82%), 68%(IQR: 59- 76 %) and 40%(IQR: 20-60%). CA: 54%(IQR: 46- 59%), 50%(IQR: 36-64%), and 0%( IQR: 0-20%). All the post-intervention scores of PHMs and TGW in the IA were significantly higher in comparison to CA (p<0.001). Conclusions: This planned educational intervention had a significant impact on improving KAP of PHMs and TGW in the Gampaha district.

Free Paper Symposium 8: Non Communicable Diseases

Free Paper Symposium 8: Non Communicable Diseases OP 58: Incidence of hypertension in an urban population - can we modify the risk? A Kasturiratne, K Medagoda, SAF Kurukulasuriya, AR Wickremasinghe Faculty of Medicine, University of Kelaniya Introduction and Aims: To determine the incidence and risk factors of incident hypertension in an urban population in Sri Lanka. Methods: This study was conducted in the Ragama Health Study Cohort which consists of 2986 individuals between 35-64 years of age living in the Ragama Medical Officer of Health area in the district of Gampaha. Participants were selected using age-stratified random sampling from the electoral lists in 2007 and investigated using clinical, bio-chemical and anthropometric examinations and liver ultrasound for assessment of fatty liver. A complete follow-up assessment of the cohort was conducted in 2010. Baseline age-adjusted prevalence and three year incidence of hypertension was estimated. Independent predictors of incident hypertension were identified by Cox’s Proportional Hazards modelling. Results: Baseline age-adjusted prevalence of hypertension was 33% in males and 37% in females. Out of 1644 normotensive subjects at baseline, 407 (24.8) developed hypertension by 2010. Incidence was 80.2 per 1000 person-years of follow up. Overall incidence was higher in females. Highest incidence (111 per 1000 person-years of follow up) was seen in males in the oldest age group (55-64 years). Independent predictors of incident hypertension were low level of physical activity, presence of diabetes mellitus, a BMI over 25 kg/m2, presence of non-alcoholic fatty liver disease and older age. Conclusions: Risk of incident hypertension is largely modifiable as evident from the findings from this population with a high incidence of hypertension highlighting the need for lifestyle modifications targeting physical activity and diet at both population and individual level for prevention of hypertension. OP 59: Public awareness of stroke, its warning symptoms, risk factors and treatment in Sri Lanka T Chang1, S Ibrahim1, C Arambepola2, HM Ranasinghe1, AHTM Mihirini1, D Weerasinghe1, TDP Vithanage1, C Maithripala1 Departments of 1Clinical Medicine and 2Community Medicine, Faculty of Medicine, University of Colombo Introduction and Aims: Awareness of stroke is pivotal in reducing its burden. We evaluated knowledge on stroke, its warning symptoms and risk factors amongst general public. Methods: Relatives of non-stroke-patients admitted to medical wards of the National Hospital of Sri Lanka who did not have a personal or first-degree family history of stroke/TIA, were selected using random-systematic-sampling. Pre-intern doctors interviewed them using a pre-tested questionnaire. Results: 840 individuals (51.7% males; mean age 40.7 years; SD=12.8) from 21 of 25 districts were interviewed; 52.2% were educated ³ Ordinary levels; 62.7% were employed; and 60.6% earned >Rs 10,000/month. 48.3% had ³1 vascular risk factors. 53.2% did not know that the brain was affected in stroke. Only about a third knew that stroke could be caused by an occlusion or rupture of a brain blood vessel. In the logistic regression analysis, age <40 years, lower income and lower education were associated with a lower knowledge. Over 90% of respondents correctly identified ³3 stroke warning symptoms and ³3 stroke risk factors. Although 84.6% would seek immediate western medical treatment following a stroke warning symptom, 52.9% believed that indigenous medicine was the best treatment for stroke. 44.2% were not sure whether stroke was preventable whilst 80.1% did not know that aspirin could prevent stroke. 56.7% had learnt about stroke from friends/relatives and 45.3% from television, but only 7.8% had received information from medical staff. Conclusions: Public awareness of stroke warning symptoms and risk factors was adequate but knowledge on stroke mechanisms, treatment and prevention was lacking.

Free Paper Symposium 8: Non Communicable Diseases OP 60: Knowledge of stroke, stroke warning symptoms, stroke risk factors, antiplatelet therapy and stroke-units among general practitioners in Sri Lanka T Chang1, S Ibrahim1, C Arambepola2 Departments of 1Clinical Medicine and 2Community Medicine, Faculty of Medicine, University of Colombo Introduction and Aims: Stroke is a leading cause of death and disability. General practitioners (GPs) play a pivotal role through first-contact-care in reducing its burden. We evaluated the knowledge on stroke, warning symptoms, risk factors and treatment amongst GPs. Methods: A pre-tested questionnaire was posted to all GPs on the register of the College of General Practitioners in Sri Lanka (n=330). One-third (n=98) from 13 of 25 districts responded. Results: Mean age of GPs was 59.6 years (SD=10.3); 78% were males. 81% had a postgraduate qualification. 13% had a personal history of stroke. One-third defined stroke correctly. 82% identified ³4 of 5 stroke warning symptoms but 7-11% identified chest pain and breathlessness also as warning symptoms. 53% named hypertension as the most important modifiable risk factor. Only 12% defined TIA adequately. 24% correctly specified the stroke risk after a TIA. 39% did not know the concept of a strokeunit but 92% agreed that stroke-units reduced mortality and morbidity. Only one-fifth suggested an echocardiogram or carotid duplex after a TIA. 32% felt that a CT brain scan was not essential in stroke. 88% would immediately initiate antiplatelet therapy for hemiparesis. 40% prescribed aspirin alone for ischaemic stroke; 6% combined aspirin with dipyridamole; and 20% prescribed clopidogrel alone. 39% prescribed varying combinations of the three antiplatelet drugs whilst 4% prescribed warfarin. 60% considered thrombolysis effective beyond 4.5 hours after a stroke. Conclusions: GPs were adequately aware of stroke warning symptoms and risk factors, but knowledge on TIA, investigations and anti-platelet therapy needed improvement. OP 61: Can a composite index predict ischaemic heart disease risk? EPDS Ediriweera1, S Samita2 1Postgraduate Institute of Medicine, University of Colombo 2Board of Study of Biostatistics, Postgraduate Institute of Agriculture, University of Peradeniya Introduction: Ischaemic heart diseases (IHD) are the leading cause of death worldwide and it accounts for 12.2% of the total deaths globally. Although the individual risk factors of IHD are well understood, the possibility of predicting the risk of IHD of an individual at a given time is less understood. Aims: To develop an index to predict the risk of IHD based on individual biological parameters. Methods: Secondary data of 217 individuals were analysed. Multivariate and logistic regression techniques were used to construct a composite index (CI) based on standardised measurements of lipid profile, fasting blood sugar, systolic and diastolic blood pressure. Two sample t test and 95% confidence interval based on composite index scores were used to compare the two groups and define a cutoff point. Results: Mean [±SE] of the CI scores for undiagnosed and diagnosed IHD individuals were 0.013 [±0.014] and -0.1 [±0.041] respectively. The mean scores of the two groups were significantly different (p=0.008) and the confidence intervals for undiagnosed and diagnosed groups were –0.181 to –0.019 &–0.016 to 0.042 respectively. Accordingly, cut off point was estimated as – 0.018. Conclusions: The CI score can be used to distinguish those who are at risk from those who are risk free. Since the CI is based on several variables, the tests are more powerful compared to those based on individual variables. The CI approach has to be evaluated in several other study settings for verification. With some detailed studies, working cut off point can be established.

Free Paper Symposium 8: Non Communicable Diseases OP 62: Metabolic syndrome among Sri Lankan adults - prevalence, patterns and correlates P Ranasinghe1, R Jayawardena2, P Katulanda3, R Sheriff3, DR Matthews4 1Department of Pharmacology, Faculty of Medicine, University of Colombo 2School of Human Movement Studies, Institute of Health and Biomedical Innovation, Queensland Universities, Australia 3Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo 4Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, UK Introduction: Metabolic syndrome (MS) increases the risk for coronary artery disease and diabetes. It is common amongst south Asians. Aims: To evaluate the prevalence of MS among Sri Lankan adults and investigates its relationships with socio-demographic and clinical parameters. Methods: Data on MS and its associated details were obtained from a population-based cross-sectional study conducted between years 2005-2006. MS was defined according to the International Diabetes Federation criteria. A binary logistic regression analysis was performed using the dichotomous variable MS (0=absent, 1=present). The independent co-variants were; gender, age category, area of residence, ethnicity, level of education, income and physical activity. Results: Sample size was 4,485, 39.5% were males and mean age was 46.1±15.1 years. Crude and ageadjusted prevalence of MS was 27.1% (95% CI: 25.8–28.5) and 24.3% (95% CI: 23.0–25.6) respectively. Prevalence in males and females were 18.4% and 28.3% respectively (p<0.001). Urban adults had a significantly higher prevalence than rural adults. Among ethnicities, the highest prevalence of MS was observed in Muslims. Prevalence of MS was highest in those who were physically inactive (38.8%). The results of the binary logistic regression analysis indicates that female gender (OR:1.7), increasing age, urban living (OR:1.7), Muslim ethnicity (OR:2.6), secondary (OR:1.5) and tertiary levels of education (OR:2.3), monthly household income LKR 7,000–24,999 (OR:1.5) and >50,000 (OR:2.1), and physical inactivity (OR:1.6), all significantly increased the risk of developing MS. Conclusions: MS affects nearly one-fourth of Sri Lankan adults. Female gender, increasing age, urban living, higher socio-economical status and physical inactivity were important associated factors. OP 63: Waist-to-height ratio has the best anthropometric association with cardio-metabolic disease among Sri Lankan adults P Ranasinghe1, R Jayawardena2, WRUAS Wijesundara3,WMUA Wijetunga3, TAD Tilakaratne3, S Subasinghe3, P Katulanda3 1Department of Pharmacology, Faculty of Medicine, University of Colombo 2School of Human Movement Studies, Institute of Health and Biomedical Innovation, Queensland University, Australia 3Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo Introduction: The prevalence of non-communicable diseases has reached epidemic levels in Sri Lanka. Conventional anthropometric indices have poor sensitivity and specificity for detecting those at risk. Aims: To investigate the association of waist-to-height ratio (WHtR) and cardio-metabolic disease among Sri Lankan adults and to compare it with conventional anthropometric indices (body mass index [BMI], waist circumference [WC] and waist to hip ratio [WHR]). Methods: Five thousand adults were recruited from a nationally-representative community-based sample using multi-stage random method. Weight, height, WC and hip circumference were measured using standard techniques. Receiver-operating characteristic (ROC) curves were performed and area under the curve (AUC) was calculated for each of the anthropometricindices. Results: Sample size was 4,485, 39.5% were males and mean age was 46.1±15.1 years. The mean WHtR in all adults was 0.496±0.077. Males (0.477±0.065) had a significantly lower WHtR than females (0.508±0.081)(p<0.001). A significantly higher WHtR was observed in those with diabetes (0.547±0.068) than those without (0.489±0.075). The mean WHtR in those with and without hypertension was 0.483±0.073 and 0.529±0.076 respectively (p<0.001). Those with metabolic syndrome (MS) (0.562±0.064) had a significantly higher WHtR than those without MS (0.473±0.067)(p<0.001). WHtR had the highest correlation with blood pressure, total cholesterol and LDL-cholesterol in comparison to classical anthropometric indices. The AUC of WHtR was significantly higher than that of BMI, WC and WHR in the prediction of diabetes, pre-diabetes, hypertension, MS and hypercholesterolemia. Conclusions: Among Sri Lankan adults, WHtR had a greater association with diabetes, prediabetes, hypertension, MS and hypercholesterolemia than traditional anthropometric indices.

Free Paper Symposium 8: Non Communicable Diseases OP 64: Influence of baseline inflammatory status on dietary effects of nutrition counseling in women with and without coronary artery disease T Thoradeniya1, C Senenayake1, R Wickremasinghe2, S Mendis3, S Jayasena1, S Atukorala1, 1Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo 2Department of Public Health, Faculty of Medicine, University of Kelaniya 3Institute of Cardiology, National Hospital of Sri Lanka, Colombo Introduction: Inflammatory status influences the biochemical response to diet, suggesting an additional mechanism increasing coronary artery disease (CAD) risk. Aims: To determine the effect of baseline inflammatory status on biochemical response to nutrition counseling to reduce CAD risk. Methods: A 2x2 factorial experiment having an intervention was conducted among 40-60 year old women with (n=101) and without CAD (n=109). Intervention comprised nutrition counseling. Baseline and post-intervention data on diet, serum high sensitivity CRP (hsCRP), soluble ICAM-1 (sICAM-1), ferritin, folate, plasma total homocysteine (tHcy) concentrations and traditional CAD risk factors were assessed. Results: At baseline tHcy, sICAM-1 and hsCRP concentrations were significantly higher (p<0.05) among women with CAD than in women without CAD. Baseline sICAM-1 [OR=3.19 (95% CI, 1.65–6.17)] and tHcy concentrations [OR=1.33 (95% CI 1.1-1.61)] were independently associated with CAD after adjusting for other risk factors. Nutrition counseling significantly decreased serum total and LDL cholesterol and increased serum folate (p<0.05) in women without CAD, but not in women with CAD. Among women without CAD, nutrition counseling decreased serum total and LDL cholesterol, and increased serum folate (p<0.05) in the “low” hsCRP group (below median of controls) but not in the “high” hsCRP group (above median). Conclusions: Nutrition counseling was effective in reducing serum total and LDL cholesterol and increasing serum folate in women without CAD having a “low” baseline inflammatory status. The hindering effect of underlying inflammation, on the biochemical response to dietary modification should be considered in dietary interventions in CAD risk reduction. OP 65: The burden of road traffic injuries in Kandy District, Sri Lanka P Nithershini1, SD Dharmaratne2 1General Hospital, Kandy 2Department of Community Medicine, Faculty of Medicine, University of Peradeniya Introduction: Road traffic injuries (RTIs) are a major public health problem in Sri Lanka causing 6 fatalities daily. Traffic police records are the only available National data. Aims: To describe the burden of RTI in Kandy district. Methods: A community based cross-sectional survey was conducted in 2008 using stratified multistage cluster sampling. Data were collected using pretested structured interviewer-administered questionnaires. Individuals who had sustained an injury /or death due to a road traffic crash (RTC) in the preceding 12 months were included. Data was analysed with SPSS and reported in % with 95% CI. Results: Of 11,724 persons screened (n=3080 households), 149 had sustained RTI, including 16 fatalities. The annual RTI incidence was 12.7/ 1000 persons (95%CI=12.5-12.9), and the annual RTI fatality incidence was 1.4/1000 person(95%CI=1.3- 1.5). The case fatality rate was 10.7%. The victims had a mean age of 28.8 years (SD=16.8), and the annual incidence of RTIs among males was 19.3/1000 (95%CI=19.3- 20.3). The overall rate of RTI increased with age, peaking in the 50 - 54 year age group [35.9/1000/year (95% CI= 35.4 - 42.7)], 72.5% were employed at the time of crash. Pedestrian injuriewere the most common cause of injuries [n=51(34.2%)], and fatalities [n=9(56.2%)]. 50.0% of the deaths occurred immediately, while 22.1% of the injured had recovered with disability requiring self care. Conclusions: There is a huge burden of RTIs in Kandy district with the pedestrians, and males at higher risk. Urgent preventive measures should be implemented to reduce this serious public health problem.

Free Paper Symposium 9: Therapeutics and Complimentary and Alternative Medicine

Free Paper Symposium 9: Therapeutics and Complimentary and Alternative Medicine OP 66: Atorvastatin in ulcerative colitis: A placebo controlled randomised clinical trial A Chakrabarti1, P Dhamija1, D Hota1, RK Kochar1, A Sachdeva2 1PGIMER, India 2Government Medical College, India Introduction: Recent epidemiological studies have indicated a preventive role of statins in relapses of ulcerative colitis (UC). Additionally, statins have been demonstrated to have efficacy in Crohnâ&#x20AC;&#x2122;s disease but not studied in ulcerative Colitis (UC) in a randomised trial. Aims: To assess the efficacy and safety of add-on atorvastatin in mild to moderately severe acute exacerbations of UC. Methods: Patients with acute exacerbations of UC were randomised to receive either atorvastatin 20 mg or matching placebo once daily orally for 8 weeks. Clinical efficacy and adverse effects (ADR) were assessed at baseline, 4 weeks and 8 weeks by using Partial Mayo Score (PMS) and self reporting of ADR by patients. Compliance was assessed by pill counting. Results: Endoscopically and histologically proven sixty four diagnosed cases of UC were randomised to receive either atorvastatin 20mg (n=32) or matching placebo (n=32) for 8 weeks as add on therapy. Mean PMS was increased by 1.5 points and decreased by 0.31 points in atorvastatin and placebo groups, respectively compared to the baseline scores. Seven (21.8%) and 9 (28%) patients achieved clinical response in atorvastatin and placebo arms, respectively. Twenty (62.5%) patients in the atorvastatin group and 7 (22%) patients in the placebo group had > 1 point increase in PMS after 8 weeks (p = 0.002). Conclusions: Atorvastatin therapy in acute exacerbations of UC can possibly increase the disease severity. Hence patients of UC requiring statins may need careful monitoring. However, these findings need to be substantiated using other statins in larger studies. OP 67: Aspirin resistance among Sri Lankan patients N Prasanna1, LV Goonaratne1, BCM Wimalachandra1, HMJP Herath2, MD Perera2 DP Suriyamudalige1, KSJ Kolambage1, SSBDP Soysa1, PC Rodrigo1, S Rajapakse1 1Faculty of Medicine, University of Colombo 2Medical Research Institute, Colombo Introduction: Aspirin is an effective anti-platelet agent with proven benefit in preventing atherothrombotic complications. However, resistance to aspirin is significantly associated with increased risk of death, cerebrovascular accident or myocardial infarction compared with aspirin sensitive patients (24% vs 10%, p=0.03) and is well documented in Western literature. It has hitherto not been established in Sri Lanka. Aims: To estimate the prevalence of aspirin resistance in patients on low dose aspirin for primary or secondary prophylaxis and to ascertain if patients resistant to aspirin have detectable serum salicylic acid levels (SA). Methods: Platelet aggregometry was performed with adenosine diphosphate (ADP) and arachidonic acid (AA) in 48 patients on aspirin 150 mg daily and 12 normal controls. SA levels were also estimated using High performance liquid chromatography on the same blood sample. Aspirin resistance was defined as a mean aggregation of 70% with ADP and 20% with AA. Aspirin semi responders were those meeting only one of the above. Results: Mean age of patients was 61 years with 64% females. 24.4% were aspirin resistant, 64.5% were semi responders and 11.1% were aspirin responders. All semi responders showed normal aggregation with AA. SA were successfully performed in only 32 patients. SA >0.01g/l were detectable in 62.5% of aspirin resistant patients and 70.8% in responders. Conclusions: Aspirin resistance among Sri Lankan patients is 24.4%. These patients are at greater risk of developing recurrent vascular events in spite of being on aspirin and may benefit by a dose increment. We suggest further studies with larger numbers of patients.

Free Paper Symposium 9: Therapeutics and Complimentary and Alternative Medicine OP 68: GSTM2 C terminal domain alters the contractility and Ca2+ transients in cultured ventricular cardiomyocytes R P Hewawasam Department of Biochemistry, Faculty of Medicine, University of Ruhuna Introduction: The ryanodine receptor (RyR) functions as an ion channel that releases Ca2+ from the sarcoplasmic reticulum and is essential for excitation-contraction coupling and contraction in striated muscle. In previous studies we have shown that the human muscle specific glutathione transferase M2-2 C terminal domain (GSTM2C) is a high affinity inhibitor of cardiac muscle ryanodine receptors (RyR2). Aims: The objective of this study was to determine the effect of GSTM2C on the cardiac function. Methods: The study was performed on primary cardiomyocyte cultures from neonatal rats. Cardiomyocytes were stimulated at 1Hz, 3V for 2ms duration and cell beating was recorded in both control and 15?M GSTM2C treated cells. Contractility and Ca2+ transients were compared in cardiomyocytes treated with and without GSTM2C terminal domain using confocal microscopy. Results: Percentage shortening of field stimulated cells was not significantly different in the control group between the first (6.1±0.7%) and second (6.2±0.9%, 2 hrs later) stimulations. However, it was reduced from 7.3±0.8% to 4.1±0.6% in the GSTM2C treated cardiomyocytes (P<0.01). Ca transient profiles of GSTM2C treated cardiomyocytes were significantly different from that of normal controls where the peak intensity and the frequency were reduced significantly. Conclusions: Single channel lipid bilayer experiments and Ca2+ release assays confirmed the ability of GSTM2C to inhibit RyR2. Inhibition of RyR2 is a potential strategy for the treatment of heart failure. Our results confirms that GSTM2 C terminus also alters the cardiac function by inhibiting the RyR2 and thus reducing Ca2+ release through RyR2 in ventricular cardiomyocytes. OP 69: Effect of aqueous extract of Gmelina arborea on glucose homeostasis in alloxan induced diabetic rats AP Attanayake, KAPW Jayatilake, LKB Mudduwa, C Pathirana Faculty of Medicine, University of Ruhuna Introduction: Diabetes mellitus has been recognized as a crippling global health problem in the past few decades. Despite the great strides made in prevention and management of diabetes, disease-related complications are increasing unabated .The search for novel drugs from medicinal plants has increased due to their efficiency and recurrent drawbacks in existing antidiabetic agents. The efficacy and dose response of aqueous bark extract of Gmelina arborea(GAAq,Sinh Et-demata) in diabetic rats was determined previously. Aims: To investigate the effect of repeated administration of GAAq on glycaemic control in alloxan induced diabetic rats. Methods: Wistar rats were divided in to four groups (n=6). Group 1 and 2 served as untreated normoglycaemic and diabetic rats (150 mg kg -1i.p.). Group 3 and 4 diabetic rats were administered the GAAq (1gkg-1) and glibenclamide (0.5mg kg -1)orally for 30 days respectively. At weekly intervals, oral glucose tolerance test was performed and body weights of animals were recorded. Glycosylated haemoglobin percentage (%HbA1C) was estimated on the 30 th day. Results: The GAAq and Glibenclamide reduced the FBG by 40% and 57%, improved glucose tolerance by 46 and 53% (p=0.01) respectively in diabetic rats. The GAAq and glibenclamide reduced HbA1c to 6.74±0.02% and 6.31±0.04% respectively (p=0.001). The fasting blood glucose concentration and %HbA1Cwere increased whereas body weights were reduced in diabetic control rats as compared to normoglycaemic rats. In contrast the body weights improved periodically in GAAq treated diabetic rats. Conclusions: This study revealed that the aqueous extract of Gmelina arborea improved the glycaemic control in alloxan-diabetic rats.

Free Paper Symposium 9: Therapeutics and Complimentary and Alternative Medicine OP 70: The effect of a herbal formulation on the incidence and severity of upper respiratory symptoms in healthy volunteers: a randomised controlled clinical trial ERCS Wickramathilake1C Goonaratna2, AADCS Rupasinghe1, R Gamage1, TMSG Thennakoon1, MR Sooriyaarachchi3 1Link Natural Products (Pvt) Ltd, Colombo 2Faculty of Medicine, University of Colombo 3University of Colombo Introduction: Link Samahan 速 is a formulation containing an extract of 14 medicinal plants that have been used in various combinations to treat upper respiratory ailments for several centuries. Aims: To test the efficacy of Link Samahan 速 in reducing the incidence and severity of 15 upper respiratory symptoms. Methods: Study setting was MAS Linea Aqua, a garment factory with its own healthcare centre and high ethical standards of worker welfare. 956 healthy volunteers took daily either one sachet of Link Samahan 速 in hot water (test group n=465, mean age 29.5 + 7.7years) or plain tea (control group n=491, mean age 29.7 + 7.9) for 84 consecutive days, and recorded the incidence and severity of 15 upper respiratory symptoms in a purpose-designed form. Results: At 84 days, when compared to the control group, the average incidence of symptoms in the test group showed highly significant reductions. Conclusions: Our results indicate that Link Samahan 速 taken as one sachet daily significantly reduces average incidence, incidence over time and severity of 15 common and validated upper respiratory symptoms in healthy people. OP 71: Use of burnt paper ash as a topical haemostatic agent T Seneviratne1, K Somaratne2, K Senanayake3 1Lady Ridgeway Hospital for Children, Colombo 2Colombo South Teaching Hospital, Kalubowila 3Rajarata University of Sri Lanka Introduction: Use of burned paper ash to achieve haemostasis after leach bite is a traditional practice. We intended to compare the effectiveness of this method with regenerated oxidised cellulose (SurgicelR) which is used in modern practice of surgery as a haemostatic agent. Methods: Randomly selected twenty young individuals aged between 20-30 years were taken as samples. Blood samples of 1.5 ml were drawn from each and put into three test tubes in equal volumes of 0.5 ml. One was taken as control and to the other two were added followings respectively- 50mg of oxidised regenerated cellulose and 50mg of burned paper ash. The clotting time was measured in each. Results: Mean clotting time of control group was 7.8 min. (SD 2.142), and of the sample added with burned paper ash was 2.45 min. (SD1.145), sample added with oxidised regenerated cellulose was 4.2 min. (SD1.765). Both oxidised cellulose and burned paper ash showed a significant deference than control (p<0.001). Burned paper ash was much superior in achieving haemostasis having a mean clotting time of 2.45 min, which is nearly half the time taken by oxidised cellulose. The difference was highly significant statistically (p<0.001). Conclusions: Use of burned paper ash as a topical haemostatic agent is a successful way of achieving haemostasis. It showed a significant superiority to, when compared with modern surgical practice like use of oxidised regenerated cellulose to achieve haemostasis.

Free Paper Symposium 9: Therapeutics and Complimentary and Alternative Medicine OP 72: Western, Ayurvedic and plant extract pediculocides - how effective and safe are they? H Banneheke, DMDEA Gunawardane, V Jayasuriya Faculty of Medical Sciences, University of Sri Jayewardenepura Introduction: Pediculosis constitutes a public health problem among school children. There are many ‘pediculocides’ available but their safety and efficacy have not been evaluated. Aims: To determine the prevalence of pediculosis among school children in Western province, their practices and compare the efficacy of five ‘pediculocides’ Methods: Descriptive cross sectional study was carried out among school children in Western province giving a self administeredquestionnaire to parents. Effectiveness of five pediculocides was tested using lice repeatadly. Death confirmed by absence of peristalsis by light microscopy at regular intervals. Results: Of 598 children aged 5-17years (mean age 9.5Y, SD = 2.7) 10.1% had pediculosis. Combing (47%), manual removal (82%) and pediculocides (58.3%) were used for control. Of the pediculocides 45% used allopathic products including Lindane (3.3%) a banned product. Plant extracts and Ayurvedic products(AP) were used by 18%. Many (54.5%) reported cure using AP compared to allopathic products (22%) p<0.05. Linade and permethrin waere less effective (19%, 56%) compared to AP (p<0.001), Godapara (p<0.01) and veralu (p<0.05). At 1 hour least and best efficacy was shown by Lindane and AP (28%, 89%) (p<0.001). AP with recommended contact duration of 6-8 hours showed 100% mortality of lice at 3 hours followed by Godapara (78.9%), Veralu (74.4%), permethrin 72.5% (p>0.05) and Lindane 40.4% (p<0.001). Conclusions: Despite prohibition, Lindane continues to be used on children. AP and plant extracts were superior to allopathic products but the quality and safety standards needs to be evaluated prior to usage. OP 73: Immediate and short-term outcome of bronchial and non-bronchial systemic artery embolisation for the management of haemoptysis - a descriptive study WNDPC Appuhamy, WDUM Wijesinghe, DTD Warnakulasuriya, C Sirigampola Department of Radiology, Colombo North Teaching Hospital, Ragama Introduction and Aims: To evaluate the immediate and short-term results of arterial embolisation in the management of haemoptysis and to identify factors influencing outcome. Methods: A retrospective analysis was carried out of the medical records and angiograms of 20 patients who underwent transarterial embolisation for haemoptysis. Results: The most frequent causes of haemoptysis were tuberculosis 14 (70%) and bronchiectasis 4(20%). Out of the TB patients 4 (20%) patients had associated aspergiloma and 4 patients had associated bronchiectasis. Out of the 20 patients only 5 patients had TB alone as the etiology and one patient had aspergiloma only. There was a single case of arteriovenous malformation. A total of 44 bronchial and non-bronchial systemic arteries were embolised in 20 individuals. At follow up in one month cessation of haemoptysis was achieved in 9 patients (45%). Haemoptysis was controlled in 6 patients (30%) and no response was seen in 5 (25%). Complication rates were low which included 2 patients with transient chest pain (10%) and 2 patients with puncture site haematoma formation (10%). There were no differences in gender, age and a etiology between the re-bleeding and non-re-bleeding groups. There was no statistically significant difference in response depending on whether bronchial or systemic arteries were embolised. Conclusions: Bronchial and systemic artery embolisation is an effective and safe procedure in the management of haemoptysis.

Free Paper Symposium 9: Therapeutics and Complimentary and Alternative Medicine OP 74: Peripheral nerve function in paraquat survivors SS Jayasinghe University of Ruhuna Introduction: Neurotoxic effects of paraquat in humans have not been studied. Aims: We aimed to study the effects of paraquat on peripheral nerve function. Methods: A cohort-study was conducted with age, gender and occupation matched controls. Paraquat survivors were recruited. Nerve conduction was assessed by motor nerve conduction velocity, amplitude and area of compound muscle action potential (CMAP), sensory nerve conduction velocity and F-waves. Autonomic function tests comprised of heart rate response to standing, deep breathing, Valsalva manoeuvre and blood pressure (BP) response to standing; amplitude and latency of sympathetic skin response (SSR). Patients were assessed after one and six weeks of the exposure. Results: There were 28 (21 males) patients and 56 controls. The mean (SD) age of the patients and the controls were 29 (12) and 31(11) years respectively. None of the patients or controls had diabetes. Significant abnormality was seen in ulnar nerve CMAP-amplitude (95%CI 0.06-2.2), median nerve CMAParea (95%CI 1.4-10.4) and F-wave occurrence in median (p=0.002), ulnar (p=0.004) and tibial (p=0.002) nerves; SSR-amplitude (p<0.001), systolic (p=0.003) and diastolic (p<0.001) BP drop; and heart rate response to standing (p=0.04) in the patients vs controls at one week assessment. Other parameters were not significantly different. At the sixth week assessment no abnormalities of peripheral nerve function were observed in patients (vs controls) except diastolic BP drop and heart rate response to standing (p<0.05). Conclusions: There is evidence of autonomic nerve dysfunction following acute paraquat ingestion. OP 75: The Sri Lanka Clinical Trials Registry - a 5 year audit KAG de Abrew1, UK Ranawaka2, CA Wanigatunge3, M Wimalachandra1, C Goonaratna1 1Faculty of Medicine, University of Colombo 2Faculty of Medicine, University of Kelaniya 3Faculty of Medical Sciences, University of Sri Jayewardenepura Introduction: Prospective registration is mandatory for the conduct and publication of clinical trials. The Sri Lanka Clinical Trials Registry (SLCTR) was established in November 2006. It is a Primary Registry of the International Clinical Trials Registry Network of the WHO. Aims: To audit the process of trial registration at the SLCTR during the 5 year period from the first trial registration (February 2007-January 2012). Methods: An internal audit of the online registry and the functioning of the SLCTR was carried out. We evaluated- (1) all trial applications, including those rejected, for accuracy and completeness of the Trial Registration Data Set (TRDS), (2) all registered trials for maintenance of records and (3) in-house procedures related to trial registration. Results: Seventy trials were registered; 14 were rejected. Over half (n=37) were prospective registrations. All registrations since July 2010 (n=21) were prospective. Four were international multicentre trials; 13 were industry sponsored. Median time from submission of all relevant documentation to registration was 7 days. All applications from 2010 were registered within 7 working days. Majority (n=41) were drug trials, including herbal preparations (n=7), while 19 were for procedures. 39 trials have been completed, 8 have published their findings and 7 reported protocol changes. Eight trials (11.4%) do not have current progress reports. Conclusions: The SLCTR has provided a platform for registration of clinical trials in Sri Lanka. In-house registration processes have improved with time. There is a need to improve awareness among trial registrants regarding maintenance of trial records.

List of Poster Presentations

LIST OF POSTER PRESENTATIONS PP 1: An audit of elderly patients presenting to a primary care medical centre in urban Sri Lanka R Haniffa Family Medicine Unit, Faculty of Medicine, University of Colombo PP 2: Practice of self care for current illness episodes among undergraduates attending the University Medical Officer clinic R Haniffa1, J Jayatissa2 1Family Medicine Unit, Faculty of Medicine, University of Colombo 2UniversityMedical Officerâ&#x20AC;&#x2122;s Clinic, University of Kelaniya PP 3: Comparison of external contributory factors leading to maternal mortality in the North Central Province TRN Fernando, Faculty of Medical and Allied Sciences, Rajarata University of Sri Lanka PP 4: Knowledge and perceived barriers for application of health promotion among public health midwives KMN Perera1, N Gunawardena2, D Guruge3 1Post Graduate Institute of Medicine, University of Colombo 2Department of Community Medicine, Faculty of Medicine, University of Colombo 3Health Promotion Unit, Faculty of Applied Sciences, Rajarata University of Sri Lanka PP 5: Dental hygiene practices and the pattern of dental caries in preschool children in Ragama P Perera, N Abeweera, M Fernanado, T Warnakulasuria, N Ranathunga Faculty of Medicine, University of Kelaniya PP 6: Satisfaction with intrapartum and postpartum hospital care among mothers delivering at Colombo North Teaching Hospital KKWHP Herath1, GNL Galappaththy2, HMRP Herath3 1Medical Officer of Health Office, Kolonnawa 2Anti Malaria Campaign, Ministry of Health, Colombo 3Faculty of Medicine, University of Kelaniya PP 7: Are patients who bypass nearby hospitals more satisfied? SK Perera, MC Weerasinghe Medical Officer of Health Office, Hanwella PP 8: Awareness about HIV/AIDS among prospective Middle-East migrant workers in the Central Province, Sri Lanka KAS Jayawardena1, JACK Jayawardena2, AGS Rathnayaka2, TN Tennakoon1 1STD/AIDS Control Programme, Kandy 2University of Peradeniya PP 9: Knowledge of mothers regarding helminth infections and patterns of anthelminthic usage in children. P Perera, D Dissanayaka, M Fernando, N Ranathunga Faculty of Medicine, University of Kelaniya PP 10: Quality of breast cancer early detection services in the well women clinics in the district of Gampaha PVSC Vithana1, MAY Ariyarathne2, PL Jayawardena3 1Family Heath Bureau, Colombo 2Cancer Hospital, Maharagama 3Faculty of Medicine, University of Kelaniya

List of Poster Presentations PP 11: Prospective analysis of trauma deaths in a District General Hospital A Gunatilake, YB Koralage, S Wijayasinghe, A Danthanarayana District General Hospital, Kalutara PP 12: Outcome following reconstruction of joints with custom made prostheses for periarticular tumour resection A Gunatilake, RL Gunawardena, RM Kannangara, A Perera Sri Jayewardenepura General Hospital PP 13: Qualitative assessment of breast cancer screening services provided through well-woman clinics in the district of Gampaha PVSC Vithana1, PL Jayawardena2, DKNN Hemachandra2, MAY Ariyarathne3 1Family Heath Bureau, Colombo 2Faculty of Medicine, University of Kelaniya 3National Cancer Control Programme, Ministry of Health, Colombo PP 14: Development and validation of Sinhala version of the Chronic Liver Disease Questionnaire (CLDQ) for assessment of quality of life among cirrhotics CK Ranawaka1, A Pathmeswaran2, WRS de Alwis3, MNF Mufeena3, HS Wijewantha1, SM Senanayake1, MA Niriella1, AS Dassanayake4, AP de Silva3, HJ de Silva3 1University Medical Unit, Colombo North Teaching Hospital, Ragama Departments of 2Public Health, 3Medicine and 4Pharmacology, Faculty of Medicine, University of Kelaniy PP 15: Health seeking behaviour and myths among adults with fever, seeking medical care at Out Patient Department, National Hospital of Sri Lanka GAN Silva1, R Haniffa2, JCJ Silva1, LTK Silva1 1Faculty of Medicine, University of Colombo 2Family Medicine Unit, Faculty of Medicine, University of Colombo PP 16: Profile of paediatric respiratory diseases requiring hospital admission V Subasinghe, W Karunasekera, AD Fernando, C Lakmini, L Weerasooriya, W Hathagoda Faculty of Medicine, University of Kelaniya PP 17: Bypassing the smaller hospitals: what patients have to say SK Perera1, MC Weerasinghe2 1Medical Oficer Of Health Office, Hanwella 2Faculty of Medicine, University of Colombo PP 18: Knowledge, attitude and practice of city traffic policemen of Colombo city on health risks by vehicular air pollution N Prasanna1, S Prasath1, HM Premarathne1, B Sudasinge2 1Faculty of Medicine, University of Colombo 2Department of Community Medicine, Faculty of Medicine, University of Colombo PP 19: Profile of gastric varices among Sri Lankan cirrhotics CK Ranawaka1, KCD Mettananda2, WRS de Alwis3, JKND Miththinda1, MA Niriella1, AP de Silva3, HJ de Silva3 1University Medical Unit, Colombo North Teaching Hospital, Ragama Departments of 2Pharmacology and 3Medicine, Faculty of Medicine, University of Kelaniya PP 20: Epidemiology of stroke in the district of Colombo, Sri Lanka: a community-based study T Chang1, S Gajasinghe2, C Arambepola3 1Department of Clinical Medicine, University of Colombo 2Faculty of Medicine, University of Colombo 3Department of Community Medicine, University of Colombo PP 21: Prevalence and characteristics of selected primary headaches among medical and nonmedical students of University of Colombo HLP Amarasena, MY Amarasuriya, DDC Amarasinghe, T Chang Faculty of Medicine, University of Colombo

List of Poster Presentations PP 22: Cardiovascular risk profile of working population in Colombo District R Jayatissa Medical Research Institute, Colombo PP 23: Hazards, injuries and passenger satisfaction related to bus usage among bus commuters employed in the district of Colombo LC Devasurendra1, TWS Dananjaya1, NAB Dias1, C Arambepola2 1Faculty of Medicine, University of Colombo 2Department of Community Medicine, University of Colombo PP 24: Pattern of prescription-only medicine purchases in Colombo city AADNS Saparamadu1, S Sarangan1, S Sarathkumara1, S Wijeratne2 1Faculty of Medicine, University of Colombo 2Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Colombo PP 25: Knowledge on menstruation and menstrual practices among grade 10 students of government girlsâ&#x20AC;&#x2122; schools RJMKA Jayasundara, TAAOT Jayaweera, SD Jayawickrema, A Gamage Faculty of Medicine, University of Colombo PP 26: Is the working population vulnerable to unsafe cellular phone usage? KDT Dinesha,MDP Dilhani,MKN Dilrukshi,C Arambepola Faculty of Medicine, University of Colombo PP 27: Risk of falls among elders attending a general medical clinic K Swaminathan1, C Marasinghe2, S Gunatilake2 1Colombo South Teachung Hospital, Kalubowila 2Department of Medicine, University of Sri Jayewardenepura PP 28: Academic performance and tobacco smoking among school children in the district of Colombo IK Liyanage1,H Rathnayake1,P de Silva2,ACA Pathirana2,P Katulanda3 1General Sir John Kotelawala Defence University 2Ministry of Health, Colombo 3Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo PP 29: How young adults with thalassaemia major feel and what they want? AAN Nishad1, A Premawardhena2 1Post graduate Institute of Medicine, University of Colombo 2Faculty of Medicine, University of Kelaniya PP 30: Effect of stroke on an individualâ&#x20AC;&#x2122;s functional status, quality of life and economic status HHN Kalyani, S Dassanayake Allied Health Sciences Unit, Faculty of Medicine, University of Colombo PP 31: Prevalence of perceived stress among adolescent school children in Colombo District O de Silva1, IK Liyanage1, P de Silva2, P Katulanda3 1General Sir John Kotelawala Defence University 2Ministry of Health, Colombo 3Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo PP 32: Perceived stress, tobacco smoking, use of alcohol and illicit substances among school children in the district of Colombo IK Liyanage1, O de Silva1, I Piyadigama2, ACA Pathirana2, AKK Wickramasinghe3, TDP Withanage2, P Katulanda4 1General Sir John Kotelawala Defence University 2Ministry of Health, Colombo 3Oxford University, UK 4Diabetes Research Unit, Department of Clinical Medicine,Faculty of Medicine, University of Colombo

List of Poster Presentations PP 33: Traditional beliefs and practices during the puerperium LK Athauda1, R.Basnayake2, M Gunawardena3, MV Iyshwarya3, R S Deduwela3,URR Mendis3, WSD Lakmuthu4, AARY Siriwardhana3, MG Nadeesha3, MP Ranga3, HKT Disnani3, S Fernando3 1Department of Tropical Medicine & International Health, Faculty of Medicine, University of Kelaniya 2Ministry of Health, Colombo 3Faculty of Medical Sciences, University of Sri Jayewardenepura 4Department of Biochemistry, Faculty of Medicine, Rajarata University of Sri Lanka PP 34: Beyond “in-ward” patient care- ‘Home and Community based Care Programme (Social Medicine) RMGM Ratnayake, LP Ruwanpura, KR Atukorala, PN Weeratunga, GM Jayasena, S Jayasinghe Faculty of Medicine, University of Colombo PP 35: Health of captive elephant keepers in Sri Lanka A Dangolla1, KLTD Jayawardena1, D Dissanayaka2, DLB Dassanayake3, BMHSK Banneheka4, AD Siribaddana3, PVRK Kumarasiri2 1Faculty of Veterinary Medicine and Animal Science, University of Peradeniya 2Faculty of Medicine, Peradeniya 3Teaching Hospital, Kandy 4Faculty of Dental Sciences, Peradeniya PP 36: Is there equity in distribution of medical specialists and medical officers? NC Kariyawasam, SC Wickramasinghe Ministry of Health, Colombo PP 37: Prevalence of prediabetes among health care workers in Provincial General Hospital, Badulla CSP Sosai1, KNP Ranasighe1, MM Weerasekara2 1General Hospital, Badulla 2University of Sri Jayewardenepura PP 38: Quantity of antenatal care received by selected high risk pregnancies in Medical Officer of Health area, Imaduwa PAA Chandrasiri, S Dolamulla Medical Officer of Health Office, Imaduwa PP 39: Anaemia of pregnancy in the district of Anuradhapura - need for updating prevalence data and screening strategies U Chathurani,S Agampodi,I Dharshika,D Galgamuwa,T Agampodi Rajarata University of Sri Lanka PP 40: Diagnosis of metabolic syndrome in type 2 diabetic patients: comparison of modified NCEPATP III and International Diabetes Federation (IDF) criteria UAD Wijesinghe1, A Medagama2, NSB Dissanayake2 1Teaching Hospital, Kandy 2Department of Medicine, Faculty of Medicine, University of Peradeniya PP 41: Diabetes mellitus in South Asia - a scientific evaluation of the research output P Ranasinghe, R Jayawardena, P Katulanda Department of Pharmacology, Faculty of Medicine, University of Colombo PP 42: Geographical variations of goitre prevalence in Sri Lanka: visualisation with geographic information systems R Fernando, A Pathmeswaran, S Nandasena Faculty of Medicine, University of Kelaniya

List of Poster Presentations PP 43: Predicting free-T4 and free-T3 from TSH by statistical modeling S Namasivayam, BL Peiris Colombo North Teaching Hospital, Ragama PP 44: Usefulness of a buccal smear in a baby with a disorder of sex development KSH de Silva Department of Paediatrics, Faculty of Medicine, University of Colombo PP 45: Analysis of mitochondrial DNA recovered from old human bones in Sri Lanka KM Chandimal1, SG Yasawardene2, RJ Illeperuma3 1Department of Anatomy, Wickramarachchi Ayuruweda Institute, University of Kelaniya 2Department of Anatomy, Faculty of Medical Science, University of Sri Jayewardenapura 3Forensic Molecular Unit, Genetech, Colombo PP 46: A mutation in the growth hormone releasing hormone receptor gene identified in a child with short stature KH Tennekoon1, KSH De Silva2, D Ganihigama1, H Jayasinghe1, S Hewage1, S De Silva1 1Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo 2Department of Paediatrics, Faculty of Medicine, University of Colombo PP 47: Disruption of LyF-1 mediated transcription regulation of HBEGF expression could lead to preeclampsia GG Harendra, RW Jayasekara, VHW Dissanayake Human Genetics Unit, Faculty of Medicine, University of Colombo PP 48: Phenotypic features in a cohort of patients with 46, XY disorder of sex development (46,XY DSD) in Sri Lanka UND Sirisena1, S De Silva2, RW Jayasekara1, VHW Dissanayake1 1Human Genetics Unit, Faculty of Medicine, University of Colombo 2Department of Paediatrics, Faculty of Medicine, University of Colombo PP 49: A candidate gene association study of recurrent pregnancy loss in a Sinhalese population from Sri Lanka P Andraweera1,G Dekker2, VHW Dissanayake1, S Thompson2, D Furness2, Rl Nowak2, A Zhou2, J Zhang2, R Jayasekara1, C Roberts 2 1Human Genetics Unit, Faculty of Medicine, University of Colombo 2University of Adelaide, Australia PP 50: The spectrum of deletions and duplications in the dystrophin (DMD) gene in a cohort of patients with Duchenne muscular dystrophy in Sri Lanka N Thakur1, AGS Aeysekera1, J Wanigasinghe2, AB Padenniya3, RW Jayasekara1, VHW Dissanayake1 1Human Genetics Unit, Faculty of Medicine, University of Colombo 2Department of Paediatircs, Faculty of Medicine, University of Colombo 3Lady Ridgeway Hospital for Children, Colombo PP 51: Clinical and molecular genetic studies in a cohort of Sri Lankan patients with 46,XY disorder of sex development (46,XY DSD) UND Sirisena1, S De Silva2, AAGS Abeysekara1, RW Jayasekara1, VHW Dissanayake1 1Human Genetics Unit, Faculty of Medicine, University of Colombo 2Department of Paediatrics, Faculty of Medicine, University of Colombo PP 52: A descriptive study of alpha and beta thalassaemia mutations in Sri Lanka AGPM Padeniya1, HWW Goonasekara1, NT Hidellage2, HLV Tilakaratna2, AAGS Abeysekara2, UGAC Kariyawasam2, VHW Dissanayake1,2 1Human Genetics Unit, Faculty of Medicine,University of Colombo 2Asiri Centre for Genomic and Regenerative Medicine, Asiri Surgical Hospital

List of Poster Presentations PP 53: Hereditary thrombophilia in a cohort of patients with thromboembolism in Sri Lanka HWW Goonasekara, AI Kuruppu, RW Jayasekara, VHW Dissanayake Human Genetics Unit, Faculty of Medicine, Colombo PP 54: JAK2 mutation prevalence among patients with myeloproliferative neoplasms and thrombophilia in Sri Lanka HWW Goonasekara, AI Kuruppu, I Wijewardene, RW Jayasekara, VHW Dissanayake Human Genetics Unit, Faculty of Medicine, University of Colombo PP 55: Frequency of maternal unexpected red cell alloantibodies in early pregnancy among Sri Lankan women SMGS Manchanayake, PPK Dissanayake National Blood Centre, Colombo PP 56: Complications associated with pre-eclampsia R Amarasekara1, RW Jayasekar1, H Senanayake2, VHW Dissanayake1 1Human Genetics Unit, Faculty of Medicine, University of Colombo 2Department of Obstetrics and Gynecology, Faculty of Medicine, University of Colombo PP 57: Episiotomy rate - is it too high? TRN Fernando Faculty of Medical and Allied Sciences, Rajarata University of Sri Lanka PP 58: A rare case of tubal pregnancy - six years after subtotal hysterectomy CD Wasalthilaka, HMS Senarathne Teaching Hospital, Kandy PP 59: Vaginal birth after Caesarean section - a prospective cohort study TJ Tilakaratna1, RC Fernandopulle2 1Teaching Hospital, Kandy 2Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Sri Jayewardenepura PP 60: A study of maternal and perinatal outcome and maternal body mass index R Mohamed, MG Dhanalakshmi Sri Ramachandra Medical College and Research Institute, Chennai, India PP 61: Establishment of human endometrial stromal cell cultures as in-vitro models to test the effects of metalloestrogens in women with or without endometriosis N Silva1, K Tennekoon2, H Senanayake3, S Samarakoon2, S Fernando4, R Wickramasinghe4, RP John5 1Faculty of Medical Sciences, University of Sri Jayewardenepura 2Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo 3Faculty of Medicine, University of Colombo 4Faculty of Medicine, University of Kelaniya 5Faculty of Medical and Health Sciences, University of Auckland, New Zealand PP 62: Factors associated with high rate of caesarean section in De Soysa Hospital for Women: A case-control study AMNL De Silva, WEGKL Dayanada, GHM Dayaratne, U Senarath Faculty of Medicine, University of Colombo PP 63: The association between use of different contraceptive methods and abnormal cervical cytology among clinic attendees of Family Planning Association, Sri Lanka. AC Jayatilleke, S Thissera, U Palandage, M Wimalarathne, P Guruge Family Planning Association Sri Lanka, Colombo

List of Poster Presentations PP 64: Implications and outcomes of caesarean section - a cross sectional study in Teaching Hospital, Jaffna A Kuganananthan1, N Kiritharan1, N Rajeshkannan2, A Sritharan3 1Faculty of Medicine, University of Jaffna 2Department of Community Medicine, University of Jaffna 3Teaching Hospital, Jaffna PP 65: Identifying gene-gene interaction network in preeclampsia using text mining of PubMed abstracts HWMM Hapudeniya1, VHW Dissanayake2 1Colombo North Teaching Hospital, Ragama 2Human Genetics Unit, Faculty of Medicine, University of Colombo PP 66: A genome wide comparison of the single nucleotide (SNP) profile of the Sri Lankan Personal Genome with the SNP profiles of five other Genomes LRAB Jayaratne1, N Samaranayake2, VHW Dissanayake3 1Post Graduate Institute of Medicine, University of Colombo 2Department of Parasitology, Faculty of Medicine, University of Colombo 3Human Genetics Unit, Faculty of Medicine, University of Colombo PP 67: Identification of clinically significant single nucleotide polymorphisms (SNPs) in the Sri Lankan personal genome IRN Fernando1, N Samaranayake2, VHW Dissanayake3 1Post Graduate Institute of Medicine, University of Colombo 2Department of Parasitology, Faculty of Medicine, University of Colombo 3Human Genetics Unit, Faculty of Medicine, University of Colombo PP 68: Single nucleotide polymorphisms in the Sri Lanka personal genome: implications for aetiology of disease in the Sri Lankan population EPDS Ediriweera1, N Samaranayake2, VHW Dissanayake3 1Post Graduate Institute of Medicine, University of Colombo 2Department of Parasitology, Faculty of Medicine, University of Colombo 3Human Genetics Unit, Faculty of Medicine, University of Colombo PP 69: Creating a catalogue of disease specific micro RNAs in the Sri Lankan Human Genome MYM Ajwath1, N Samaranayake 2, VHW Dissanayake 3 1Post Graduate Institute of Medicine, University of Colombo 2Department of Parasitology, Faculty of Medicine, University of Colombo 3Human Genetics Unit, Faculty of Medicine, University of Colombo PP 70: Kidney disease in the elderly: A Sri Lankan perspective C Rodrigo1, L Samarakoon2, S Rajapakse1, R Lanerolle1, R Sheriff1 1Department of Clinical Medicine, Faculty of Medicine, University of Colombo 2University Medical Unit, National Hospital of Sri Lanka, Colombo PP 71: Vision related quality of life of patients with cataract in the conflict affected Vavuniya district and Gampaha district AAN Nishad1, J De Silva2, IM Wasthuhewaarachchi3, SH Uyangoda2, A Pathmeswaran4, S Amaratunge2 1Post graduate Institute of Medicine, University of Colombo 2Vijaya Kumaratunge Eye Hospital, Seeduwa 3Teaching Hospital, Vavuniya 4Faculty of Medicine, University of Kelaniya PP 72: Knowledge and practices regarding leptopirosis among grade 9/10 school children YM Samarakoon, N Gunawardena Medical Officer of Health Office, Biyagama

List of Poster Presentations PP 73: Precipitant profile for acute heart failure: experience of a tertiary level cardiac centre in Sri Lanka AT Matthias1, R Ekanayake2 1National Hospital of Sri Lanka, Colombo 2Institute of Cardiology, National Hospital of Sri Lanka, Colombo PP 74: Innervation and the distribution of functional nicotinic acetylcholine receptors in human lymphoid tissue M Thayabaran1, SG Yasawardene 1Department of Human Biology, Faculty of Health-Care Sciences, Eastern University of Sri Lanka PP 75: Predictors of duration and degree of third space fluid accumulation in adult patients with dengue R Premaratna1, A Ragupathy2, JKND Miththinda2, HJ de Silva1 1Faculty of Medicine, University of Kelaniya 2Professorial Medical Unit, Colombo North Teaching Hospital, Ragama PP 76: Repeated dengue shock syndrome and â&#x20AC;&#x153;Dengue myocarditisâ&#x20AC;? responding dramatically to a single dose methyl prednisolone R Premaratna1, KMD Rodrigo2, A Anuratha2, VKD de Alwis3, UDCA Perera2, HJ de Silva1 1Faculty of Medicine, University of Kelaniya 2Professorial Medical Unit, Colombo NorthTeaching Hospital, Ragama 3Medical Unit, Gampola PP 77: Low serum testosterone in Sri Lankan patients awaiting coronary artery bypass grafts CM Wickramatilake1, MR Mohideen2, C Pathirana1 Departments of 1Biochemistry and 2Medicine, Faculty of Medicine, University of Ruhuna PP 78: Developing a severity index on day 4 to predict severe dengue infection in adults HS Wijewantha1, R Premaratna1, AAN Nishad2, IDM Mabharana1, AP de Silva1, PR Waraketiya1, MA Niriella1, HJ de Silva1 1Professorial Medical Unit, Colombo North Teaching Hospital, Ragama 2Post Graduate Institute of Medicine, University of Colombo PP 79: A study to determine quantitative predictors for development of third space fluid accumulation in adult patients with dengue R Premaratna1, A Ragupathy2, JKND Miththinda2, HJ de Silva1 1Department of Medicine, Faculty of Medicine, University of Kelaniya 2Professorial Medical Unit, Colombo North Teaching Hospital, Ragama PP 80: Recurrent vs. first presentation with acute coronary syndrome in a tertiary care hospital GMTR Bandara1, VNRM Fonseka1, DST Danansuriya1, RLP Harshanie1, K Thirumavalavan2, G Premawansa2, SMSB Samarakoon2, AP De Silva1, ST De Silva1, UK Ranawaka1 1Faculty of Medicine, University of Kelaniya 2Colombo North Teaching Hospital, Ragama PP 81: Unmet needs of care and associated factors among stroke survivors followed up at the neurology clinics of National Hospital of Sri Lanka J Hamsananthy1, V Kumarapeli2, R Gamage3 1Colombo Municipality Council, Colombo 2National Institute of Mental Health, Angoda 3National Hospital of Sri Lanka, Colombo PP 82: Gait variables in patients with knee osteoarthritis at National Hospital of Sri Lanka JLR Jayalath1, MM Dissanayake2, TDMSB Dassanayake1 1Allied Health Sciences Unit, Faculty of Medicine, University of Colombo 2Faculty of Medicine, University of Colombo

List of Poster Presentations PP 83: Correlation between on admission clinical parameters and thirty day mortality rate of acute coronary syndrome DSA Wickramasinghe, GR Constantine, MHMTS Perera, RMGM Ratnayake, LP Ruwanpura Faculty of Medicine, University of Colombo PP 84: Slower platelet recovery pattern during the 2011 dengue outbreak BCM Wimalachandra, LV Goonaratne, GN Karunathunga, JK Wijerathne, S Jayasinghe Faculty of Medicine, University of Colombo PP 85: Prevalence of potential risk factors for tuberculosis patients attending Central Chest Clinic Colombo MGB Senanayake1, S Samaraweera2 1Nutrition Coordination Division Ministry of Health, Colombo 2National Programme for Tuberculosis Control and Chest Diseases, Ministry of Health, Colombo PP 86: Pattern of respiratory function among saw mill workers in selected saw mills in Wellampitiya, Sri Lanka KDL Nanayakkara, MNM Nadheem, SU Nagasinghe Faculty of Medicine, University of Colombo PP 87: Technological feasibility and patient satisfaction with wireless ECG monitor for arrhythmia detection PSA Wijewickrama1, GR Constantine1, VA Jeewagan2, AD Abeygunasekara3, BDAK Fernando3, L Samaranayake4, SN Wijesundara3 1Faculty of Medicine, University of Colombo 2National Hospita of Sri Lanka, Colombo 3Dialog Axiata PLC, Colombo 4Faculty of Engineering, University of Peradeniya PP 88: A descriptive study of patients presenting with chest pain to a general medical ward MGCP Marasinghe, NAA Weerasinghe, DMS Fernando Faculty of Medical Sciences, University of Sri Jayewardenepura PP 89: Association between diabetic peripheral neuropathy and cognitive impairment MGCP Marasinghe1, MV Iyshwarya2, AU Pathirana2, BMB Gunawardene2, U Bulugahapitiya3, SB Gunatilake1 1Department of Medicine, University of Sri Jayewardenepura 2University of Sri Jayewardenepura 3Colombo South Teaching Hospital, Kalubowila PP 90: Homicidal paraquat poisoning R Fernando Department of Forensic Medicine, Faculty of Medicine, University of Colombo PP 91: Management of severe eye injury due to paraquat R Fernando1, S Perera2 1Department of Forensic Medicine, Faculty of Medicine, University of Colombo 2Police Hospital, Colombo PP 92: Experience of abuse among Sri Lankan school children S Mettananda, DGH de Silva, T Perera, A Pathmeswaran Faculty of Medicine, University of Kelaniya PP 93: Knowledge and attitudes regarding child abuse and child rights among Sri Lankan school children S Mettananda, DGH de Silva, T Perera, A Pathmeswaran Faculty of Medicine, University of Kelaniya

List of Poster Presentations PP 94: Changing trends of poisoning in Sri Lanka R Fernando1, S de Silva2 1Faculty of Medicine, University of Colombo 2Ministry of Health PP 95: Criminal responsibility for murder among remand prisoners sent for forensic psychiatric assessment SW Kotalawala, N Fernando Forensic Psychiatry Unit, National Institute of Mental Health, Angoda PP 96: Septo-optic dysplasia: antenatal risk factors and clinical features N Atapattu1, J Ainsworth2, H Willshaw2, M Parulekar2, L MacPherson2, C Mill2, P Davies2, JMW Kirk2 1Lady Ridgeway Hospital for Children, Colombo 2Birmingham Childrenâ&#x20AC;&#x2122;s Hospital, Birmingham, UK PP 97: Sequelae of BCG vaccination and effects of cleaning vaccine site with alcohol P Perera, G Samaranayaka, R Samaranayaka, N Ranathunga Faculty of Medicine, University of Kelaniya PP 98: A comparative study on impact of surfactant therapy on neonatal respiratory distress syndrome in District General Hospital Ampara MAT Fernando1, CB Akurugoda2, MI Rifaya2 1National Hospital of Sri Lanka, Colombo 2General Hospital, Ampara PP 99: Neonatal hypothermia and associated factors in a special care baby unit S Krishnapradeep1, B Kumarendran2, S Bandara3 1Paediatric Unit, Srimavo Bandaranayake Specialised Children Hospital. Peradeniya 2Department of Public Health, Faculty of Medicine, University of Kelaniya 3Special Care Baby Unit, Teaching Hospital, Peradeniya PP 100: Correlation between anthropometric measurements and serum leptin among premenopausal women; a cross-sectional study J Nanayakkara1, S Lekamwasam2, C Liyanage3 Departments of 1Pharmacology and 2Medicine, Faculty of Medicine, University of Ruhuna 3Nuclear medicine Unit, Faculty of Medicine, University of Ruhuna PP 101: Elimination of iodine deficiency disorders (IDD) in Sri Lanka: does our salt industry comply with SLS guidelines for salt iodisation? GED De Zoysa1, M Hettiarachchi2, KAPW Jayathilaka1, C Liyanage2 1Department of Biochemistry, Faculty of Medicine, University of Ruhuna 2Nuclear Medicine Unit, Faculty of Medicine, University of Ruhuna PP 102: Physical and social environment associated with physical activity of adults in the district of Colombo AASH Weliange, DN Fernando Faculty of Medicine, University of Colombo PP 103: Knowledge, attitudes and practices on folic acid supplementation among pregnant mothers SWADA Wickramasinghe1, U Senarath2 1Medical Officer of Health Office, Mahara 2Department of Community Medicine, Faculty of Medicine, University of Colombo PP 104: Assessment of hydration status of national level athletes RP Dahanayake1, P Lanerolle2, MAHP Kumarasiri3, GLK Ekanayake1, A De Silva3 1Institute of Sports Science, Ministry of Sports, Colombo 2Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo 3Department of Physiology, Faculty of Medicine, University of Colombo

List of Poster Presentations PP 105: Ischaemic heart disease and dietary habits DJDP de Silva, LLDN Alwis, GG Abeyratne, US Molligoda, RS Nanayakkara Faculty of Medical Sciences, University of Sri Jayewardenepura PP 106: Development of a Food Frequency Questionnaire for Sri Lankan adults R Jayawardena1, P Katulanda2, M Soares3, N Byrne1, A Hills1 1Queensland University of Technology, Brisbane, Australia 2Diabetes Research Unit, Faculty of Medicine, University of Colombo 3Curtin University, Australia PP 107: Playersâ&#x20AC;&#x2122; habits on the day of competition SV Rajasinghe1, C Thurairaja2 1Sports Medicine Unit, Teaching Hospital Anuradhapura 2Oasis Hospital, Colombo PP 108: Anthropometric measurements and nutritional adequacy of Sri Lankan swimmers VG Arachchi1, S Wasalathanthri2, PTR Makuloluwa3 1Institute of Sports Medicine, Ministry of Sports, Colombo 2Department of Physiology, Faculty of Medicine, University of Colombo 3Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura PP 109: Food dependent, exercise induced anaphylaxis GN Malavige1, D Wijesekara1, R de Silva2, S Gunawardena2, D Rathnayaka2, GD Wickramasinge2 1Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura 2Medical Research Institute, Colombo PP 110: Comparison of skin fold thickness, waist circumference, waist hip ratio and BMI in predicting body fat percentage WMUA Wijetunga, TAD Tilakaratne, WRUAS Wijesundara, S Subasinghe, P Katulanda Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine,University of Colombo PP 111: Audit of anthropometric measurements in patients with non-communicable diseases SSL Kularathna, DSA Wickramasinghe, MY Amarasuriya, KLN Nanayakkara, PSA Wijewickrama, KSA Jayasinghe Faculty of Medicine, University of Colombo PP 112: Food security and nutritional status of children in Northern province R Jayatissa Medical Research Institute, Colombo PP 113: Energy drink consumption pattern in a group of medical students in Sri Lanka DPD Wijesinghe1,DRS Adicaram2,JGS Ranasinghe3,RD Wijesinghe4 1National Institute of Mental Health, Angoda Departments of 2Parasitology and 3Biochemistry, University of Peradeniya 4General Hospital, Peradeniya PP 114: Eating attitudes and behaviours among adolescent girls in the Colombo District, Sri Lanka LT Wijeratne1, KALA Kuruppuarachchi1, A Pathmeswaran2, SS Williams1 Departments of 1Psychiatry and 2Public Health Faculty of Medicine, University of Kelaniya PP 115: Arthroscopic anterior cruciate ligament reconstruction with a four-strand hamstring tendon autograft A Gunatilake,RM Kannangara, RL Gunawardene, A Perera Sri Jayewardenepura General Hospital PP 116: Long term out come of hip resurfacing arthroplasty A Gunatilake, HMP Herath, RM Kannangara, A Perera Sri Jayewardenepura General Hospital

List of Poster Presentations PP 117: Safe level of thickness of the mandibular bone graft - a preliminary study S Thilakarathne, MB Samarawickrama, BG Nanayakkara, I Ilayperuma, LBL Prabodha Department of Anatomy, Faculty of Medicine, University of Ruhuna PP 118: Iron deficiency anaemia in late infancy - who are at risk? S Mettananda, S Rajindrajith, WALK Weerasooriya, KLW Hathagoda, SMV Subasinghe, BC Lakmini Department of Paediatrics, Faculty of Medicine, University of Kelaniya PP 119: Optimum duration to place mercury in glass thermometer to check body temperature in children under 5 years P Perera, R Gamage, M Fernando, T Warnakulasuriya Faculty of Medicine, University of Kelaniya PP 120: The impact of functional constipation on quality of life in children S Rajindrajith1, S Mettananda1, BC Lakmini1, SMV Subasinghe1, WALK Weerasooriya1, KLW Hathagoda1, NM Devanarayana2 1Department of Paediatrics, Faculty of Medicine, University of Kelaniya 2Department of Physiology, Faculty of Medicine, University of Kelaniya PP 121: Assessment of the quality improvements in the best-practice immunisation clinics SC Wickramasinghe, NC Kariyawasam Ministry of Health, Colombo PP 122: Association between functional dyspepsia and gastric motility in children NM Devanarayana, S Rajindrajith, MS Perera, S Nishanthinie Faculty of Medicine, University of Kelaniya PP 123: Mothersâ&#x20AC;&#x2122; knowledge regarding managing fever and febrile convulsions at home WDMG Amarasinghe1, DNW Amarasinghe2, ALAMC Ambegoda2, KN Lankathilake2 1De Soysa Hospital for Women, Colombo 2Ministry of Health, Colombo PP 124: Depression in parents of children with congenital adrenal hyperplasia - a preliminary study from the Lady Ridgeway Hospital KSH de Silva1, P de Zoysa2 Departments of 1Paediatrics and 2Psychological Medicine, Faculty of Medicine, University of Colombo PP 125: Prevalence of depression among patients diagnosed with brain tumours SW Kotalawala, BJ Mendis, N Dolawaththa, KGCL Kapugama National Institute of Mental Health, Angoda PP 126: A descriptive study on the use of rapid tranquilization at the psychiatric intensive care unit of the National Institute of Mental Health MMP Devadithya1, RMAVL Seneviratne1, J Mendis1, JKND Miththinda2 1National Institute of Mental Health, Angoda 2Colombo North Teaching Hospital, Ragama PP 127: Recurrent urinary tract infections in females â&#x20AC;&#x201C; a prospective analysis KCD Mettananda, A Ranaweera, DSG Mettananda Faculty of Medicine, University of Kelaniya PP 128: Sexual dysfunction, practices and knowledge on reproductive health: does it differ between males and females of spinal cord injured patients S Samanmali, C Arambepola, I Sudasinghe Faculty of Medicine, University of Colombo

List of Poster Presentations PP 129: Sri Lanka in global medical research: a scientific analysis of the Sri Lankan research output P Ranasinghe1, R Jayawardena2, P Katulanda3 1Department of Pharmacology, Faculty of Medicine, University of Colombo 2School of Human Movement Studies, Institute of Health and Biomedical Innovation, Queensland Universities, Australia 3Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo PP 130: Medical student research in two Sri Lankan universities - where have all the research gone? KR Atukorala, KH Wickramasinghe, GM Rathnayake, GM Jayasena, PN Weerathunga, S Jayasinghe Department of Clinical Medicine, Faculty of Medicine, University of Colombo PP 131: An innovative short course to facilitate a smooth transition from faculty-based learning to the clinical based learning environment RMGM Ratnayake, LP Ruwanpura, KR Atukorala, PN Weeratunga, GM Jayasena, S Jayasinghe Faculty of Medicine, University of Colombo PP 132: A useful tool for a reflective approach in an undergraduate medical curriculum L Wanigabadu, V Jayasuriya, C Amarasinghe Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura PP 133: The master-apprenticeship model - medical undergraduatesâ&#x20AC;&#x2122; experiences in clinical learning settings in Western Province I Nazeer, V Jayasuriya Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura PP 134: Characteristics of health information-seeking behaviour of Suwasariya (Health Net) users GGAK Kulatunga1, GMK Perera2, RDF Kanthi2, S Amunugama3 1Post Graduate Institute of Medicine, University of Colombo 2Health Education Bureau, Colombo 3Ministry of Health, Colombo PP 135: Views of students on the use of computer aided pathology practical classes BAGG Mahendra, RMUS Rathnayake, J Hewaviisenthi Department of Pathology, Faculty of Medicine, University of Kelaniya PP 136: Awareness of clinical trial registration BCM Wimalachandra1, UK Ranawak2, KAG de Abrew1, CA Wanigatunga3, LC Rajapaksa1, C Goonaratna1 1Faculty of Medicine, University of Colombo 2Faculty of Medicine, University of Kelaniya 3Faculty of Medical Sciences, University of Sri Jayewardenepura PP 137: Knowledge and practice of research among medical officers working in rural areas S Dolamulla, N Attanayake, PK Wickramasinghe, A Chandrasiri Regional Director of Health Services Office, Hambantota PP 138: The quality of controlled clinical trial reporting in five leading Sri Lankan medical journals TI Pathirana, C Abeysena Sri Jayewardenepura General Hospital Faculty of Medicine, University of Kelaniya PP 139: Availability and distribution of infrastructure, and practice related to research in the health institutions in Hambantota district S Dolamulla1, N Attanayake2, K Wickramasingha1 1Regional Director of Health Services Office, Hambantota 2University of Colombo

List of Poster Presentations PP 140: Does Sanders-Retzlaff-Kraff (SRK-2) formula suit a Sri Lankan population in phacoemulsification cataract surgery of medium axial length? MS Amaratunge1, J De Silva1, IM Wasthuhewaarachchi2, SH Uyangoda1, MAJI Mallawaarachchi1, R Premarathna3, AAN Nishad4 1Vijaya Kumaratunge Memorial Hospital, Seeduwa 2Teaching Hospital, Vavuniya 3Faculty of Medicine, University of Kelaniya 4Post Graduate Institute of Medicine, University of Colombo PP 141: Gastric antral vascular ectasia - endoscopic patterns, aetiology and treatment options. ANR Fernandopulle, BS Sebastiampillai, AT Matthias NMM Navarathne National Hospital of Sri Lanka, Colombo PP 142: Results of endoscopic management of bleeding gastric varices with cyanoacrolate glue in a cohort of Sri Lankan patients ANR Fernandopulle, BS Sebastiampillai, AT Matthias NMM Navarathne National Hospital of Sri Lanka, Colombo PP 143: Age specific cut-off levels of serum prostate specific antigen (PSA) for symptomatic Sri Lankan men, aged 50 years and above NP Panapitiya1, U Samarasinghe2, LDJU Senarath3, MVC De Silva1, MDS Lokuhetty1 1Departments of Pathology Faculty of Medicine, University of Colombo 2Department of Radiology, Nawaloka Hospital, Colombo 3Department of Community Medicine, Faculty of Medicine, University of Colombo PP 144: Pathological significance of epidermal growth factor receptor, vascular endothelial growth factor, chemokine receptor4 and vimentin expression by colon carcinoma cells MIM De Zoysa1, DN Samarasekera1, LDJU Senarath1, CA Samarasekera2, CB Reid3, MDS Lokuhetty1 1University of Colombo 2National Hospital of Sri Lanka, Colombo 3Charles Drew Medical University, Los Angeles, USA PP 145: Liver resection and arrest of bleeding from liver trauma - a novel technique developed in a war setting K Somaratne1, T Seneviratne2 1Army Base Hospital, Palaly 2Teaching Hospital, Karapitiya PP 146: The use of degloved skin as meshed skin graft to cover the original defect in a geriatric patient K Sun1, K Rajapakse2, S J Chong2 1Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Australia 2Royal Adelaide Hospital, Australia PP 147: Longterm outcome of cardiac rehabilitation programme of National Hospital of Sri Lanka S Mendis1, Z Jamaldeen1, S Athukorala1, RBD Ranasinghe1, R Premaratne2 1Institute of Cardiology, National Hospita of Sri Lanka, Colombo 2Epidemiology Unit, Ministry of Health, Colombo PP 148: Covered stenting for coarctation of aorta - an initial experience S Mendis, G Galappatty, D Dharmawardena, D Seneviratne, C De Silva Institute of Cardiology, National Hospital of Sri Lanka, Colombo PP 149: True digital artery aneurysm â&#x20AC;&#x201C;a case report D Beneragama1, T Beneragama2 1Department of Pathology, Faculty of Medical Sciences, University of Sri Jayewardenepura 2Plastic and Reconstructive Surgery Unit, National Hospital of Sri Lanka, Colombo

List of Poster Presentations PP 150: Soft tissue reconstruction of war injuries to the hand and upper limb TS Beneragama, M K P Karunadasa, G Ekanayake Plastic and Reconstructive Surgical Unit National Hospital of Sri Lanka, Colombo PP 151: Outcome of surgically managed vascular anomalies of the upper extremity TS Beneragama1, TH Beneragama2 1Plastic and Reconstructive Surgical Unit, National Hospital of Sri Lanka, Colombo 2Department of Pathology, Faculty of Medical Sciences, University of Sri Jayewardenepura PP 152: Efficacy and safety of â&#x20AC;&#x2DC;trueâ&#x20AC;&#x2122; cinnamon (Cinnamomum zeylanicum) as a pharmaceutical agent in diabetes P Ranasinghe1, R Jayawardena2, P Galappaththy1, GR Constantine3, P Katulanda3 1Department of Pharmacology, Faculty of Medicine, University of Colombo 2School of Human Movement Studies, Institute of Health and Biomedical Innovation, Queensland Universities, Australia 3Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo PP 153: Medicinal drug use in elderly CA Wanigatunge, DS Dissanayake, UN Hewahetawatta University of Sri Jayewardenepura PP 154: Evaluation of anti-carcinogenic potential of Flueggea leucopyrus (Wild) in human hepatoma (HepG2 cells) SR Samarakoon, I Thabrew, PB Galhena, KH Tennekoon Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo PP 155: An effort to understand microbiological properties of Sri Lankan bee honey JMRWW Wadanamby, TSKRD Caldera, TLI Lankika Base Hospital, Angoda PP 156: Early bedside removal versus delayed cystoscopic removal of ureteric stents following renal transplantation N Gunawansa, M Wijerathne, R Cassim, R Dissanayake, J Arudchelvam National Hospital of Sri Lanka, Colombo PP 157: Early post-transplant urinary tract infections: impact on graft and patient survival N Gunawansa, M Wijerathne, R Cassim, R Dissanayake, J Arudchelvam National Hospital of Sri Lanka, Colombo PP 158: Diagnosis and treatment of malaria by private practitioners - findings from a post conflict district in Sri Lanka SD Fernando1, R Abeyasinghe2, J Lima3 1Department of Parasitology, Faculty of Medicine, University of Colombo 2Anti Malaria Campaign, Ministry of Health, Colombo 3Department of Public Health and Primary Care, University of Oxford, UK PP 159: Prevalence of toxoplasmosis in immunocompromised cancer patients attending a tertiary care hospital NSAR Cooray1, N Karunaweera2, N Samaranayake2 1Institute of Oral Health, Maharagama 2Faculty of Medicine, University of Colombo PP 160: Antimicrobial susceptibility and empirical prescribing practices in treating urinary tract infections CN Wijekoon1, KMMP Dassanayake2, A Pathmeswaran2 1Faculty of Medicine, University of Kelaniya 2Colombo North Teaching Hospital, Ragama

List of Poster Presentations PP 161: Laboratory based diagnosis of intestinal parasitic infections among food handlers in kitchen-canteen complexes of University of Sri Jayewardenepura KASC Jayawardena1, HMR Rathnayaka1, DMDEA Gunawardane2, MVF Jayasuriya3, LDGG De Silva2, PHKIS Ranasinghe2 1Department of Medical Laboratory Sciences, Faculty of Medical Sciences, University of Sri Jayewardenepura 2Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura 3Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura PP 162: A pilot study on comparison of rapid immunodiagnostics for confirmation of leptospirosis EJ Eugene1, SA Wickramasinghe1, TL Kalugalage1, C Rodrigo2, H Wickremesinghe3, N Dikmadugoda3, P Somaratne4, HJ de Silva5, S Rajapakse6, SM Handunnetti1 1Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo 2Department of Clinical Medicine, Faculty of Medicine, University of Colombo 3Base Hospital, Homagama, 4Department of Microbiology, Medical Research Institute, Colombo 5Department of Medicine, Faculty of Medicine, University of Kelaniya 6Department of Clinical Medicine, Faculty of Medicine, University of Colombo PP 163: Clostridium difficile infection in inflammatory bowel disease patients in Sri Lanka PR Waraketiya, AP De Silva, NT Wijesinghe, PR Waraketiya, HS Wijewantha, LG Chandrasena, A Pathmeswaran, HJ De Silva Faculty of Medicine, University of Kelaniya PP 164: Imported malaria â&#x20AC;&#x201C; is it a threat to the elimination of malaria from Sri Lanka? GNL Galappaththy1, D Fernando2, R Abeyasinghe3 1Anti Malaria Campaign, Ministry of Health, Colombo 2Department of Parasitology, Faculty of Medicine, University of Colombo 3World Health Organisation, Sri Lanka PP 165: Association of clinical and biochemical parameters of leptospirosis with leptospira specific IgM and IgG antibodies MLG Piyatissa1, G Premawansa1, SU Thrikawala2 1Colombo North Teaching Hospital, Ragama 2Department of Zoology, Faculty of Science, University of Colombo PP 166: Clostridium difficile infection in stools among patients presenting with exacerbations of inflammation ANR Fernandopulle, BS Sebastiampillai, AT Matthias, NMM Navarathne National Hospital of Sri Lanka, Colombo PP 167: Factors associated with antimicrobial susceptibility in urinary tract infections CN Wijekoon1, KMMP Dassanayake2, A Pathmeswaran1 1Faculty of Medicine, University of Kelaniya 2Colombo North Teaching Hospital, Ragama PP 168: Trends in antimicrobial resistance in urinary tract infections at De Soysa Hospital for Women MHWMN Wijayapala1,WDMG Amarasinghe1, BMR Fernandopulle2, P Chandrasiri3 1De Soysa Hospital for Women, Colombo 2Department of Pharmacology, Faculty of Medicine, Colombo 3National Hospital of Sri Lanka, Colombo PP 169: Snakebites in children- a five year retrospective review of victims admitted to two hospitals in Sri Lanka YC Jayasinghe, A Kasturiratne, SASG Samaraweera, HJ de Silva Faculty of Medicine, University of Kelaniya

Abstracts of Poster Presentations

ABSTRACTS OF POSTER PRESENTATIONS PP 1: An audit of elderly patients presenting to a primary care medical centre in urban Sri Lanka R Haniffa Family Medicine Unit, Faculty of Medicine, University of Colombo Introduction: In Sri Lanka, by the year 2031, the over-60 years age group will constitute 22% of population. This demographic transition is a challenge to the healthcare system. Aims: to identify the age composition of patients presenting to primary care and to identify common reasons for presentation to a urban primary care clinic. Methods: Using the patient register at the clinic all registered patients > 60 years who had a documented visit between 1/01/2009 and 31/12/2010 were audited. Results: Elderly patients constitute 48.6% (n=697) of the registered patients. Females accounted for 60.8% (n=424) of the elderly population. 253 (36.3%) of the elderly registrants had a documented visit during the period under audit. The commonest age group presenting for care was 60-64 years for both males and females. The mean age of the elderly clinic attendee was 69.5 years with male patients having a mean age of 71.4 years and females 68.2 years. The commonest Reason For Encounter (RFE) based on ICPC Chapter was endocrine/metabolic and nutritional reasons (39.8%, n=466), followed by musculoskeletal problems (22%, n=258) and respiratory problems (10.3%, n=120). Conclusions: The audit indicates that the elderly constitute a major proportion of patients attending primary care. The commonest RFE to this setting is the consequence of one or more "life-style" diseases. Such diseases are amendable to prevention and modification through a process of â&#x20AC;&#x2DC;healthy ageingâ&#x20AC;&#x2122;. PP 2: Practice of self care for current illness episodes among undergraduates attending the University Medical Officer clinic. R Haniffa1, J Jayatissa2 1Family Medicine Unit, Faculty of Medicine, University of Colombo 2UniversityMedical Officer Clinic, University of Kelaniya Introduction: The process of responding to illness or seeking care involves multiple steps of which self care is the beginning. Due to shifts in disease patterns, change of emphasis from cure to care, increased access to medical information and escalating cost of healthcare, self care is becoming important to both patients and doctors. Aims: To identify the common Reasons for Encounter (RFE) for which undergraduates present for care and to determine the prevalence and common methods of self care for current illness episodes. Methods: This was a descriptive cross sectional study. The calculated sample size of 427 was recruited by systematic sampling. Data was collected by using a custom designed self administered questionnaire, from February to March 2011. Results: The response rate was 96.5% (n=412); 70% (n=287) of clinic attendees were female; the sex difference was statistically significant (p<0.05) and females were 50% more likely to attend the clinic (OR=1.5). The mean age of the clinic attendees was 22.37 years (SD +/-1.93). There were 11 RFE based on ICPC Chapter. The common Chapters being Respiratory (45.15%, n=186), General and Unspecified (28.64%, n=118) and Digestive (9.22%, n=38). There were 54 RFE by ICPC Rubric. The commonest being upper respiratory tract infection - acute (37.62%, n=155). 58.5% (n=203) of the clinic attendees practiced self care for the current illness. Practice of self care based on sex was statistically not significant (p>0.05). The commonest method of self care was use of Western drugs (41.4%, n=84) followed by home remedies (32.5%, n=66). Conclusions: Self care for current illness episodes was common in the study population. University Medical Officers (UMOs) should be encouraged to document self care practices of undergraduates with a view to encouraging safe practices and discouraging the harmful ones.

Abstracts of Poster Presentations PP 3: Comparison of external contributory factors leading to maternal mortality in the North Central Province TRN Fernando, Faculty of Medical and Allied Sciences, Rajarata University of Sri Lanka Introduction: Causes for maternal death are classified as direct and indirect causes. Other than these, external factors such as failure to seek medical care, institutional failure (including lack of staff and equipment) and poor transport facilities also contribute to maternal morbidity and mortality. This study is designed to compare some external contributory factors leading to maternal mortality in the districts of Anuradhapura and Polonnaruwa during the period 2008 to 2010. Methods: Data was collected from the RDHS offices and hospitals of each district. The study was carried out from March 2011 to May 2011. Results: Anuradhapura District (AD) had a larger drainage area and higher number of eligible families compared to Polonnaruwa District (PD). The average number of pregnant mothers per PHM was 74 in AD and 64 in PD during 2008-2010. Average number of pregnant mothers per VOG was 7719 in AD and 2298 in PD. Staff in obstetrics wards: 2 VOGs, 10 doctors, 13 nurses and 12 midwives at Anuradhapura TH and 3 VOGs, 12 doctors, 23 nurses and 27 midwives at Polonnaruwa GH. Average number of deliveries per midwife was 1307 at Anuradhapura and 255 at Polonnaruwa. MMR during 2008, 2009 and 2010 in Anuradhapura District was 51, 62 and 65 respectively compared to Polonnaruwa whih was 56, 97 and 76. Conclusions: The external contributory factors compared in this study have not affected MMR adversely in NCP. Anuradhapura district with less human resources had a lower MMR compared to Polonnaruwa during 2008-2010. PP 4: Knowledge and perceived barriers for application of health promotion among public health midwives KMN Perera1, N Gunawardena2, D Guruge3 1Post Graduate Institute of Medicine, University of Colombo 2Department of Community Medicine, Faculty of Medicine, University of Colombo 3Health Promotion Unit, Faculty of Applied Sciences, Rajarata University of Sri Lanka Introduction: The Ottawa Charter (1986) defines health promotion, as the ‘process of enabling people to increase control over, and to improve, their health’. The public health midwife (PHM) is the grass-root level health worker promoting health in communities in Sri Lanka. Their knowledge regarding health promotion has not been assessed. Aims: To study knowledge on health promotion, factors associated with the level of knowledge, and perceived barriers and benefits of health promotion among PHM in the Kandy district. Methods: A descriptive study was conducted among all PHM (n=364) in the Kandy district using a selfadministered questionnaire. Level of knowledge was based on scores obtained for responses for close ended question and case scenarios. Results: Knowledge on health promotion was ‘poor’ among 65.4%. Incorrect labeling of activities as health promotional activities was common (70.6%). Training programmes (73.9%) were the commonest source of knowledge. A basic educational level of GCE A/L or higher (p=0.001), ability to read English (p=0.012), access internet (p=0.025), qualifying as a PHM in 2004 or after (p<0.001), participating in health promotion training (p=0.003) and implementing health promotional programmes (p=0.007) were associated with ‘good’ knowledge on health promotion. The commonest perceived benefit was that it makes their duties easier (27.1%). The commonest barrier was inadequate opportunities to learn health promotion. Conclusions: Knowledge on health promotion was ‘poor’ among PHM in Kandy district. Increasing learning opportunities on health promotion, improving English language skills and availability of internet facilities are recommended to improve the situation.

Abstracts of Poster Presentations PP 5: Dental hygiene practices and the pattern of dental caries in preschool children in Ragama P Perera, N Abeweera, M Fernanado, TWwarnakulasuria, N Ranathunga Faculty of Medicine, University of Kelaniya Introduction: Dental caries is a common problem among preschool children, but often neglected as deciduas teeth are replaced later by permanent teeth. However, for many reasons, protecting deciduas teeth is very important. Aims: The objectives of this study were to describe the prevalence of dental caries among preschool children and assess the utilization of dental care facilities. Methods: A descriptive cross sectional study was done between August 2010 and October 2010 at child welfare clinics held in the Ragama MOH area. Consecutive children aged between 2 and 5 years attending the clinics were recruited with the consent of parents. An interviewer administered questionnaire was used to obtain data and the mouth was examined for caries. Total decayed-missing-filled (dmft) score and significant caries index (SIC) were calculated to describe the prevalence of dental caries. Care index was calculated to describe the use of dental services. Results: Out of 410 children recruited, none had routine visits to a dentist. Though practices related to brushing teeth were satisfactory, 37.8% children in the study sample had caries. This increased to 68.8% by 5 years of age. Mean dmft score for the whole sample was 1.41 and SIC index was 4.09. The Care index was 4.72. The dmft score in girls was higher than boys. Incisors of the upper jaw were the mainly affected teeth. Conclusions: Prevalence of dental carries among this cohort of Sri Lankan preschool children is very high. The level of dental care for preschool children at present appears to be unsatisfactory. PP 6: Satisfaction with intrapartum and postpartum hospital care among mothers delivering at Colombo North Teaching Hospital KKWHP Herath1, GNL Galappaththy2, HMRP Herath3 1Medical Officer of Health Office, Kolonnawa 2Anti Malaria Campaign, Ministry of Health, Colombo 3Faculty of Medicine, University of Kelaniya Introduction: Institutional intrapartum care with skilled attendance at delivery has greatly contributed to the reduction of maternal mortality in Sri Lanka. Users’ evaluations are important for continuous quality monitoring and further improvement of maternal care services. Aims: The aims were to describe satisfaction with intrapartum and postpartum hospital care, and to determine sociodemographic and pregnancy related factors associated with satisfaction. Methods: A cross sectional analytical study was conducted in Colombo North Teaching hospital (CNTH) Ragama involving 422 postnatal mothers with uncomplicated birth outcome. Data were collected using an exit interview. Patient satisfaction with intrapartum and postpartum care was assessed using two composite scales covering five satisfaction dimensions. Sociodemographic and pregnancy related factors associated with patient satisfaction were determined by odds ratio with 95% confidence interval. Results: The majority of mothers were “satisfied” with intrapartum (90.3%) and postpartum (91%) care. Interpersonal aspects of care was the most satisfied dimension. Mothers were least satisfied with physical environment. Factors significantly associated with satistaction with both intrapartum and postpartum care were intended pregnancy, multiparity, having received field antenatal care and vaginal delivery. Age > 30 years, delivery > 40 weeks of POA and postpartum hospital stay 1 - 3 days were significantly associated with intrapartum care satisfaction. Residing within 10km of CNTH, immediate skin to skin contact and initiation of breastfeeding within 30 minutes were significantly associated with postpartum satisfaction. Conclusions: Factors associated with maternal satisfaction identified in this study should be used to deliver a more patient centered service and gain patient satisfaction.

Abstracts of Poster Presentations P 7: Do patients who bypass nearby hospitals more satisfied? SK Perera, MC Weerasinghe Medical Officer of Health Office, Hanwella Introduction: The absence of well demarcated draining areas and the lack of clear referral policies have allowed patients in rural Sri Lanka, to bypass primary care, and reach higher level of health facilities. Patients spend extra time and money, in seeking healthcare from distant facilities. It is important to find whether the patients actually meet up with their expectations by bypassing the closest hospital. Aims: To compare patient satisfaction, of patients who bypassed two selected divisional hospitals in Gampaha district, with those who did not Methods: A cross sectional analytical study design was employed. The study settings were District General Hospital â&#x20AC;&#x201C; Gampaha and two divisional hospitals that were bypassed by patients to reach it. An interviewer administered questionnaire was used. Results: Patients by-passed were significantly more satisfied (p<0.05) in comparison to non-bypassed with the cleanliness of OPD (100% vs 89.17%), seatingarrangements (100% vs 83.33%) and availability of medicines (85.73 vs 74.34%). Patients who did not bypass were significantly more satisfied (p<0.05) on accessibility to health facility compared to by-passed (97.5% vs 68.16%) and about the waiting time (86.66% vs 71.66%). Further, those who did not bypass were more satisfied (p<0.05) with the kindness and respect shown by doctors in comparison to patients bypassed (98.34% vs 87.50%) and on information received about treatment (76.66% vs56.67%). Conclusions: It is evident that improvement of basic facilities at divisional hospital could reverse the bypassing phenomenon using positive aspects of interpersonal care already in place. PP 8: Awareness about HIV/AIDS among prospective Middle-East migrant workers in the Central Province, Sri Lanka KAS Jayawardena1, JACK Jayawardena2, AGS Rathnayaka2, TN Tennakoon1 1STD/AIDS Control Programme, Kandy 2University of Peradeniya Introduction: In Sri Lanka, nearly 1500 cases of HIV infections have been reported since 1987. Among them a large number of persons are ex-migrant workers of Middle-East countries and their spouses and children. This study aimed to assess the level of awareness about HIV/AIDS among prospective MiddleEast migrant workers in the Central province. Methods: The study was conducted among non professional prospective migrant workers who attended compulsory pre-depature training on general conduct in the regional training centre of Sri Lanka foreign employment bureau in Kandy during the month of March 2011. All the new attendees were explained in groups about the study and the level of awareness about HIV/AIDS was assessed giving ten basic questions in a self-administered questionnaire. Results: The sample consisted of 317 respondents with 185 women and 132 men. The majority were Sinhalese (56%), followed by Muslims (24%), and Tamils (20%). Many (58%) had studied in schools up to GCE/OL. More men (57%) than women (46%) (p =0.05) and more Sinhalese (61%) than Tamils (52%) and Muslims (25%) (p <0.05) had correctly answered five or more questions. Knowledge gaps were mainly identified in relation to transmission of HIV, social interactions between HIV positive people and general public and treatment of HIV. Conclusions: Awareness about HIV/AIDS was minimum among non-Sinhalese female workers. Knowledge gaps indicates that the of sex education including sexually transmitted infections that are planned to different target populations have to consider their level of education, native language, social status and cultural background.

Abstracts of Poster Presentations PP 9: Knowledge of mothers regarding helminth infections and patterns of anthelminthic usage in children. P Perera, D Dissanayaka, M Fernando, N Ranathunga Faculty of Medicine, University of Kelaniya Introduction: Intestinal helminth infections are a global problem. There are lot of misbelieves among people regarding helminth infections, which often leads to inappropriate use of anthelmintics. Aims: To assess the knowledge of mothers regarding helminth infections and to describe the patterns of anthelmintic usage in children. Methods: A descriptive cross sectional study was carried out at University Paediatric unit, Teaching hospital Ragama, during September 2011 to November 2011. Two Hundred children and their mothers admitted to the Paediatrics university unit with at least one child above 18 months were recruited with informed written consent. Socio-demographic data, availability of sanitary facilities and safe drinking water, knowledge on intestinal infections and practices related to anthelmintic treatment were collected using a pretested Interviewer administered questionnaire. Results: Nearly all families had access to a safe toilet and 62% had safe drinking water. 84% of children had regular anthelmintic treatment and out of them 39.3% had 3 monthly, 55.3% six monthly and 5.3% annually. Out of them only 81.4% had risk factors to get helminth infections, while 36.9% had no evidence in the past of worm infection. There was no statistically significant association between regular anthelmintics usage and presence of risk factors (odds ratio 1.799, CI 0.849-3.815). Knowledge of mothers regarding transmission of worm infections and clinical features was poor. Conclusions: Considering the high literacy rate among Sri Lankan mothers knowledge about worm infections was surprisingly poor. A lot of children are receiving unnecessary anthelmintic treatment. Health education programs addressing these issues are indicated. PP 10: Quality of breast cancer early detection services in the well women clinics in the district of Gampaha PVSC Vithana1, MAY Ariyarathne2, PL Jayawardena3 1Family Heath Bureau, Colombo 2Cancer Hospital, Maharagama 3Faculty of Medicine, University of Kelaniya Aims: To evaluate selected aspects of breast cancer early detection services implemented through well woman clinics (WWCs) in the Gampaha District. Methods: Clinical breast-examination(CBE) coverage of target age group women(TGW) of 35-59 years was assessed in all the WWCs in Gampaha district from 2003-2007. Quality assessment of breast cancer early detection services was done using Lot Quality Assurance Sampling. The lot size and threshold value computed were twenty and six clinics respectively. Checklists were used in assessing coverage, physical facilities and clinic activities. Client-satisfaction on WWC services was assessed among 200 TGW attending 20 WWCs using an interviewer-administered questionnaires. Results: CBE coverage in the Gampaha district increased from 1.1% (3389/318711) to 2.2% (7248/326271) from 2003-2007. With regard to physical facilities, the number of clinics that were rated substandard varied between 7-18 (35% - 90%). Adequacy in relation to notice boards, stationery, furniture and linen, and cleanliness outside premises and toilets were identified as substandard. With regard to services, punctuality of staff arrival and in commencement of clinics, provision of healtheducation, availability of supervision and CBE and breast self-examination (BSE) services were observed as substandard in 7-20 clinics (35%- 100%). Median satisfaction score among TGW was 45.2% (IQR: 38.7 - 54.8%). Only 11% had a score of >70%; the threshold for satisfaction. Conclusions: Coverage of breast cancer early detection service in the Gampaha district in 2007, 11 years after commencing WWC services, was still very low (2.2%). All 20 clinics were substandard for overallCBEand BSE services.

Abstracts of Poster Presentations PP 11: Prospective analysis of trauma deaths in a District General Hospital A Gunatilake, YB Koralage, S Wijayasinghe, A Danthanarayana District General Hospital, Kalutara Introduction: Large number of trauma related deaths reported in GH Kalutara, apparently majority of them are preventable. Aims: To evaluate and describe demographic data, injury patterns, contributing factors and causes of death. Analyse the delay in transport and in hospital management To evaluate and describe better system to prevent trauma deaths Methods: Prospective analysis of all trauma related deaths reported in GH Kalutara, from 15th November 2009 to 15th February 2010, by direct interviewing witnesses, hospital staff and using BHTs, trauma surveillance records, police and JMO records. Results: Fifty one trauma related deaths reported, 82% were males and 94% were between 20 to 60 with mean of 34.5 years. Commonest were road traffic accidents (N=18) and train accidents (N=10). Commonest causes of death were craniocerebral injuries (N=13), hypovolaemic shock(N=10) and multiple injuries(N=10). Forty one victims sustained injuries not compatible with life or very poor out come. None received prehospital care. Only 10 were alive at the time of admission, out of which 4 died in the hospital due to hypovolaemic shock which were preventable. Forty six 46 (90%) were directly related to alcohol but only four were legally documented. Among road traffic accident victims (18), commonest were pedestrians(6) and vehicle passengers(5).Only 6(33%) admitted alive. There was a mean delay of 1 hour 45 minutes for mean of 6.7 km distance to hospital. Conclusions: Majority (>80%) sustained trauma not compatible with life. Unacceptable delay in transporting, and unsatisfactory pre-hospital and hospital care noted. Alcohol consumption is a major contributory factor and underreported. PP 12: Outcome following reconstruction of joints with custom made prostheses for periarticular tumour resection A Gunatilake, RL Gunawardena, RM Kannangara, A Perera Sri Jayewardenepura General Hospital Introduction: Joint reconstruction following periarticular tumour resection and mutilating trauma is difficult with regular prosthesis due to bone loss and extensive ligament damage or excision. Custom made prostheses are needed to overcome tissue loss and produce good joint function. Aims: Assess the outcome following complex arthroplasty using custom made prosthesis Methods: Five consecutive patients who were treated with custom made prostheses in Sri Jawardenapura General Hospital from 31/06/2009 to 31/06/2011 were included. Waldemar LINK速 custom made prostheses were used in all (N=5) patients. Primary pathology, preoperative functional status, operative details, and outcome and complications following surgery and insubsequent follow-ups were analyzed. Knee society knee score (KSKS) and UCLA Shoulder rating scale were used to assess the functional out come. Results: There were four total knee arthroplasties (TKA) and one shoulder hemiarthroplaty (SHA). Primary pathology for TKAs were wide local excision of lower femoral osteosarcoma (N=2), extensive knee trauma (N=1) and periprosthetic fracture of previous primary TKA (N=1), and solitary plasmacytoma for the SHA. No intra-operative or immediate post operative complications. Excellent outcome ( Knee society knee score > 80 or UCLA Shoulder rating scale > 27 ) were reported in all patients till three months follow up. The patient, who underwent TKA following extensive trauma subsequently developed flexion contracture of 200 which lead to re- exploration and contracture release to obtain satisfactory outcome. Conclusions: In patients with extensive ligament and bone loss custom made prostheses surgery can yield excellent joint function and it is a good alternative for amputation or arthrodesis.

Abstracts of Poster Presentations PP 13: Qualitative assessment of breast cancer screening services provided through well-woman clinics in the district of Gampaha PVSC Vithana1, PL Jayawardena2, DKNN Hemachandra3, MAY Ariyarathne3 1Family Heath Bureau, Colombo 2Faculty of Medicine, University of Kelaniya 3National Cancer Control Programme, Ministry of Health, Colombo Objectives: To identify Public Health Midwives’ (PHMs’) perceptions on the importance and deficiencies of the existing breast cancer early detection services provided through WWCs, and their suggestions on improving the same. Methods: A qualitative study using four focus group discussions (FGDs) consisting of 8-10 participants per each were conducted among 38 PHMs in the Gampaha district in 2008. Focus group guide included discussion points on availability of guidelines and protocols, training received, timing of clinic sessions, adequacy of resources, support from other sectors and reasons for low participation and their recommendations for improving utilization of services. Two experts conducted FGDs as moderator and data recorder. FGDs were audio-recorded, transcribed and analyzed using constant comparison and identifying themes and categories. Results were presented in narrative form. Results: All the PHMs had a firm realization on the need of breast cancer early detection. FGDs revealed non-availability of guidelines, lack of training, lack of skills and material to provide health education, inability to provide privacy during CBE, shortage of stationery and lack of community awareness and motivation. PHMs were not having sufficient confidence in their capability to detect early breast cancer. The suggestions for the improvements identified in FGDs were capacity building of PHMs, provision of guidelines, rescheduling of clinics, improved supervision, and monitoring, and coordination between clinical and preventive sectors. Conclusions: Lack of training and supervision were among those identified as deficient. Recommend training programmes at basic andpost basic levels on a regular basis and strengthening of supervision and monitoring. PP 14: Development and validation of Sinhala version of the Chronic Liver Disease Questionnaire (CLDQ) for assessment of quality of life among cirrhotics CK Ranawaka1, A Pathmeswaran2, WRS de Alwis3, MNF Mufeena3, HS Wijewantha1, SM Senanayake1, MA Niriella1, AS Dassanayake4, AP de Silva3, HJ de Silva3 1University Medical Unit, Colombo North Teaching Hospital, Ragama Departments of 2Public Health, 3Medicine and 4Pharmacology, Faculty of Medicine, University of Kelaniy Introduction: Chronic liver disease (CLD) has a negative impact on patient quality of life (QOL). The Chronic Liver Disease Questionnaire (CLDQ) is a validated tool which measures the Health Related Quality of Life (HRQL) among cirrhotics. CLDQ is easy to administer, measures six domains of QOL; abdominal symptoms, fatigue, systemic symptoms, activity, emotional functions and worry. It shows good correlation with severity of CLD. Aims: To develop and validate a Sinhala version of the CLDQ (sCLDQ). Methods: A standard method of forward and back-translation by bilingual translators was used to develop the sCLDQ. Pilot testing were done with relevant adaptations, considering differences in culture and language. The final version was self-administered to stable CLD patients without significant comorbidities, together with the WHO BREF Sinhala version (validated for patients of any disease), for comparison. sCLDQ was re-administered 4 weeks later to study its internal consistency and reliability. The sCLDQ validation was assessed by Cronabach’s alpha, intraclass correlation coefficient (ICC) and Pearson’s correlation coefficient. Results: Forty eight patients participated in the validation process. The item total correlations of sCLDQ varied from 0.30 to 0.82 (except one item number 0.15). Overall Cronabach’s alpha was 0.92. Readministration of sCLDQ to 15 patients yielded an ICC of 0.54 (p = 0.02). There was a significant correlation (Pearson’s r = 0.34; p = 0.03) between sCLDQ and WHO BREF. Conclusions: sCLDQ was reliable and valid and would be a useful tool to assess QOL of cirrhotic patients in Sri Lanka.

Abstracts of Poster Presentations PP 15: Health seeking behaviour and myths among adults with fever, seeking medical care at Out Patient Department, National Hospital of Sri Lanka GAN Silva1, R Haniffa2, JCJ Silva1, LTK Silva1 1Faculty of Medicine, University of Colombo 2Family Medicine Unit, Faculty of Medicine, University of Colombo Introduction: Fever is a common symptom for many illnesses. The manner in which patients with fever behave, may affect the outcome of it. Aims: To identify the patterns of health-seeking behaviour during a febrile illness and myths regarding fever. Methods: This is a descriptive cross-sectional study of 120 patients (age 20-50 years) with fever for 1-5 days, attending the OPD at NHSL, using an interviewer-administered questionnaire. Quantitative data are described using descriptive statistics and categorical data using proportions. Chi square test is used to determine significance. Results: The mean age was 34.98 years (SD Âą9.15). Males constituted 36.7%. Only 6.7% measured fever at home using a thermometer. Self-medication was practiced by 63.3% (male:female=81.8%:52.6%) (p=0.001). The main method of self-medication was Western drugs 67.1% (26.3%-ayurvedic medicine, 6.6%-other). Patient perception on when to start treatment was affected by their income (eg. patients with monthly income >Rs.15,000 (95.8%) started treatment within 1-3days of onset of fever compared to those with monthly income <Rs.15,000 (75.0%) (p=0.003). Common myths were; while suffering from fever should avoid consuming fatty food (71.7%), should not bathe in cool water (60%) and should not do moderate exercise (53.3%). There was a significant increase in those who believed in myths in lower educational group (p=0.009). Conclusions: Adult patients, when they have fever, rarely measure temperature at home but commonly use self-medication. Several myths are common regarding practices during a febrile illness. Patientsâ&#x20AC;&#x2122; awareness should be raised on measuring temperature, taking self medication, rest and food habits. Larger studies are needed for firmer conclusions. PP 16: Profile of paediatric respiratory diseases requiring hospital admission V Subasinghe, W Karunasekera, AD Fernando, C Lakmini, L Weerasooriya, W Hathagoda Faculty of Medicine, University of Kelaniya Introduction: Respiratory tract disorders cause significant mortality and morbidity in children worldwide. Objectives: To study the pattern of respiratory diseases and its seasonal variation among children. Methods: A descriptive study was conducted at University Paediatric Unit, Colombo North Teaching Hospital in 2010 and 2011. All children below 12 years admitted with respiratory tract diseases (ICD-10 classification) were recruited into the study. Data collection forms were filled by medical officers using patient records. Results: Total of 2651 (1370 in 2010; 1281 in 2011) were admitted with respiratory diseases. In respective years, 53% (2010) and 55%(2011) were males. Highest number of admissions was during infancy (27.2%). During consecutive years 2010 and 2011, 43.0% and 45.2% had unspecified lower respiratory tract infections (LRTI); 29.9% and 29.4% had upper respiratory tract infections (URTI); 10.7% and 12.4% had bronchial asthma; 1.8% and 2.2% had pneumonia; 5.9% and 8.9% had bronchiolitis. Stabilization at ETU was needed in 8.5%. Median duration of hospital stay was 3 (range 160) days. No follow-up was required in a majority (82.5%). Admissions due to respiratory diseases peaked in June (2010-20.1% and 2011-16.0%) and were mainly due to LRTI-52.0%, URTI-28.4%. Admissions with bronchial asthma were higher during the first half of the year (2010-86.3% and 2011-80.5%). Deaths were 18 (1.3%) in 2010 and 6 (0.5%) in 2011. Conclusions: Respiratory tract infections peak in June whereas asthma is precipitated in early months of the year. Over one-fourth of patients had URTI and was unnecessarily admitted.

Abstracts of Poster Presentations PP 17: Bypassing the smaller hospitals: what patients have to say SK Perera1, MC Weerasinghe2 1Medical Officer of Health Office, Hanwella 2Faculty of Medicine, University of Colombo Introduction: The absence of well demarcated draining areas and the lack of clear referral policies have allowed patients in rural Sri Lanka to bypass primary care to reach higher level of health facilities. Bypassing is known to reduce efficiency of health care systems. It is important to explore the reasons for bypassing to institute remedial action. Aims: To explore the reasons for patients to bypass two selected divisional hospitals in Gampaha district. Methods: A descriptive cross sectional study was conducted among patients who bypassed two selected divisional hospitals to DGH Gampaha with those who did not. Results: Patients who bypassed, in comparison those who did not were mostly married (80% vs 66.67%), permanently employed (45.83% vs 21.67%) and had monthly incomes above Rs. 20000 (28.33% vs 8.33%). All those were statistically significant at 95% level. The commonest reason for bypassing was the perception of availability of better facilities in the general hospital (75%). Other reasons were ‘satisfactory quality of care during a previous visit to the same hospital’ (61.67%), ‘unsatisfactory quality of care during a previous visit to a different hospital’ (43.33%), and ‘expectation of good quality of service as it is generally accepted a better hospital’ (45.83%). Conclusions: It was seen that patients with better social support and stable income tend to bypass the closest facility more often, expecting a better service at the bigger hospital. Hence, expectations for better facilities and quality of services when coupled with affordability of patient seem to influence the behaviour of bypassing smaller institutions in care seeking. PP 18: Knowledge, attitude and practice of city traffic policemen of Colombo city on health risks by vehicular air pollution N Prasanna1, S Prasath1, HM Premarathne1, B Sudasinge2 1Faculty of Medicine, University of Colombo 2Department of Community Medicine, Faculty of Medicine, University of Colombo Introduction: The traffic policemen of Colombo are at increased health risks posed by vehicular air pollution and this can be prevented by use of protective face masks. Aims: To assess the knowledge, attitude and practice of traffic policemen in Colombo, on health risks by vehicular air pollution and the use of protective face masks. Methods: A cross-sectional descriptive study was carried out amongst randomly selected 120 city traffic police officers, using a self-administered questionnaire, and 10% of them were observed in the field for use of facemasks. Results: 53.3% of the traffic policemen possess good knowledge regarding the health risks and facemasks, while 46.7% possess adequate knowledge. 98.3% of the group expresses a positive attitude towards using a facemask. Only 23.3% of them were using facemask at the time of study and none were observed to use them in field visit. Main causes for not using masks were difficulties in verbal communication while using a mask (50%), and lack of knowledge regarding suitable mask type (16.7%). 86.7% of the group said they would use facemasks, when provided at reduced cost or free. Conclusions: Knowledge and attitude of City traffic police officers regarding health risks by vehicular pollution and use of face mask are satisfactory, although the use of facemask in the field is very low. It is recommended to organize a health education session annually to provide further guidance and promote facemask usage and also provide facemasks for free or at a discounted price for the traffic policemen.

Abstracts of Poster Presentations PP 19: Profile of gastric varices among Sri Lankan cirrhotics CK Ranawaka1, KCD Mettananda2, WRS de Alwis3, JKND Miththinda1, MA Niriella1, AP de Silva3, HJ de Silva3 1University Medical Unit, Colombo North Teaching Hospital, Ragama Departments of 2Pharmacology and 3Medicine, Faculty of Medicine, University of Kelaniya Introduction: Gastric varices (GV) can result in life threatening bleeding. There have been no studies on the characteristics of GV among Sri Lankan cirrhotics. Aims: To perform a descriptive analysis of GV among a Sri Lankan cirrhotic population Methods: Medical records of all upper gastrointestinal endoscopies performed on cirrhotics at presentation, in the University Endoscopy Unit, Colombo North Teaching Hospital, Ragama, from 2006 to 2011 were screened. Demographics, indication and findings of endoscopy were analysed. Results: 628/641(98%) of the cirrhotic population screened had a complete data set for analysis. 70/628(11%) patients had GV[male-61(87%), female-9(13%); mean age 55(SD = +/- 10.7, range 23-81 years)]. 48/70(69%) had oesophageal varices (Gastro Oesophageal Varices (GOV1-18/48(38%), GOV230/48(62%) in addition to GV and 22/70(31%) had Isolated GV (IGV1 –10(45%), IGV2 -12(55%)). 38/70(54%) had portal hypertensive gastropathy and 3/70(4%) had gastric antral vascular ectasia in addition to GV. 51/70 (73%) were detected on initial screening of cirrhotics, while 19/70(27%)[6/22(27%) with IGV] were detected at presentation with upper gastrointestinal bleed (UGIB). 288/628(46%) had oesophageal varices (EV). 240/288(83%) had only EV without GV. 163/240(68%) were detected on initial screening of cirrhotics, while 77/240(32%) were detected at presentation with UGIB. There was no statistical significance between proportion of patients detected to have isolated EV or IGV at presentation with UGIB (p=0.64; ?2=0.2) Conclusions: The profile of GV among our patients is comparable to what is previously described elsewhere. Findings suggest in cirrhotic patients presenting with UGIB searching for presence of GV, by retroflexion at endoscopy, is as important as identifying EV. PP 20: Epidemiology of stroke in the district of Colombo, Sri Lanka: a community-based study T Chang1, S Gajasinghe2, C Arambepola3 1Department of Clinical Medicine, University of Colombo 2Faculty of Medicine, University of Colombo 3Department of Community Medicine, University of Colombo Introduction: Stroke is a leading cause of death and disability. However, community-based prevalence data in Sri Lanka is sparse. Aims: We studied the prevalence of stroke and its risk factors in an urban population. Methods: A community-based, cross-sectional study was conducted among 2313 adults currently living in the district of Colombo. A multi-stage probability-proportionate-to-size cluster sampling technique was used to select all eligible persons in 46 administrative divisions. Data were collected using an interviewer-administered-questionnaire. ‘Ever diagnosis’ of stroke was confirmed by Pre-Intern MedicalOfficers using a check list and documental evidence. Results: Of the total population (52% females; mean age 44.2 years, SD=16.6), the prevalence of stroke was 1.0% (95% CI: 0.006, 0.014) with a 2:1 male to female ratio. The prevalence increased 6-fold amongst males and two-fold amongst females over the age of 65 years. There were none 92% had developed hemi-paresis, 58.3% dysphasia and 16.7% loss of balance. 58% sought Western medical treatment, 4.2% indigenous medical treatment, and 37.5% both. Only 58.3% had CT brain scans, of whom 85.7% had ischaemic strokes. Hypertension was the commonest risk factor (62.5%) followed by smoking (50%), excess alcohol (45.8%), diabetes (33.3%), transient ischaemic attack (29.2%) and a family history (20.8%). 79.2%, mostly males, had two or more risk factors. Conclusions: The prevalence of stroke in urban Sri Lanka lies between high-income and, low- and middle-income countries. Increasing age remains the most important risk factor.

Abstracts of Poster Presentations PP 21: Prevalence and characteristics of selected primary headaches among medical and nonmedical students of University of Colombo HLP Amarasena, MY Amarasuriya, DDC Amarasinghe, T Chang Faculty of Medicine, University of Colombo Objectives: To describe the prevalence and characteristics of selected primary headaches among medical and non-medical students of the University of Colombo. Methods: A cross-sectional study was carried out recruiting 94 medical students and 91 science students using a cluster-sampling technique. Migraine and tension-type headaches were diagnosed based on criteria of the International Headache Society. The intensity of pain was assessed by a numerical scale. Impact of the headache on the studentsâ&#x20AC;&#x2122; life was evaluated using the HIT-6 (Headache Impact Test) questionnaire. Results: The three month prevalence of headaches was 77.7% among medical students and 84.6% among science-students. The prevalence of migraine was 9.6% among medical students and 7.7% among science students. The prevalence of tension-type headaches was 11.7% among medical students and 18.7% among science students. Migraines were commoner among females. Reported intensity of pain was higher among science than among medical students (p=0.01). Pain intensity and HIT scores were higher in students experiencing migraines than in those experiencing tension-type headaches (p<0.001). Only 23.3% of medical students and 34.9% of science students had sought medical advice for their headaches while 64.4% of medical students and 73% of science students reported self-medication. Use of analgesic drugs increased with the intensity of pain (p<0.001) and the impact of headaches (p=0.004). Conclusions: Headaches are common amongst University students with a notable proportion experiencing primary headache syndromes. Migraines caused a greater morbidity than tension-type headaches. Although headaches caused a substantial impact on daily activities, more students preferred to self-medicate than obtain professional medical treatment. PP 22: Cardiovascular risk profile of working population in Colombo District R Jayatissa Medical Research Institute, Colombo Introduction: Cardiovascular disease (CVD) is a major cause of disability and premature death throughout the world. Risk factor modification can reduce clinical events and premature death in people with established cardiovascular disease as well as in those who are at high cardiovascular risk due to one or more risk factors. Aims: To estimate the total cardiovascular risk of working people who have not yet developed clinically manifest cardiovascular disease for primary prevention. Methods: All the workers in 23 public institutions were screened by the Department of health, Western Province during November 2010 to September 2011. Weight, height, fasting blood sugar, fasting lipid profiles were estimated. WHO/ISH risk prediction chart was applied to identify the 10-year risk of fatal or non-fatal cardiovascular events in this population. WHO defined cut-off levels were taken to categorise body mass index and blood levels. Results: A total of 5218 adults aged 18-79 years were screened. While 64.9% were males. Among them 8.3%, 57.0%, 30.1%and 4.6% were underweight, normal, overweight and obese respectively. High systolic (>140) and diastolic (>90) was found with 6.3% and 5.4% of them respectively. Prevalence of diabetics was 22.8% and 1.7% were smokers. 10-year risk of cardiovascular event in this population is shown as30% was 97.2%, 2.1% 0.5% and 0.2% respectively. Conclusions: Majority of the working population are at low risk for developing CVDs. Only 3% of the working population need follow up. Urgent measures to be adopted on lifestyle interventions in the working population to prevent CHD risk.

Abstracts of Poster Presentations PP 23: Hazards, injuries and passenger satisfaction related to bus usage among bus commuters employed in the district of Colombo LC Devasurendra1, TWS Dananjaya1, NAB Dias1, C Arambepola2 1Faculty of Medicine, University of Colombo 2Department of Community Medicine, University of Colombo Introduction: Colombo has a predominantly road based transport system with 360,000 vehicles/day entering or leaving the city carrying 1,000,000 passengers. Aims: To describe hazards, injuries and passenger satisfaction related to bus usage and associated factors among bus commuters in the district of Colombo Methods: A cross-sectional study was conducted among 130 Employees of a Private Institution who have been bus commuters on >3 working days/week during last month. Participants were selected by random cluster sampling and given a self-administered-questionnaire to assess their characteristics, physical and social hazards, non-collision injuries and overall satisfaction of bus journey based on a score. Results: The majority were females (53.8%); mean age of 35 (SD=8.7); bus commuters for >5 years (80.6%) and >5 days/week (88.8%). Majority of injuries occurred during travelling (65.6%) involving arms and legs of contusions and lacerations. Physical hazards were: travelling in overly-packed buses (66.6%); getting pushed by other passengers (66.9%); shouting of conductor (53.1%); losing balance (50.8%); standing >30 minutes (59.2%). 22% were sexually harassed by other people. Majority were moderately satisfied of their bus journey. Satisfaction was more dependent on physical hazards (x2=13.964;df=3; p<0.05) than social hazards (x2=1.503; df=3; p>0.05). Gender and age did not act as determinants of exposure to physical hazards, but for social hazards, females were more prone (x2=23.32; df=1; p<0.05). Conclusions: Hazards and injuries were high with moderate passenger satisfaction. Gender was a determinant of social hazards. Structured bus schedules, training of bus drivers and conductors in courteous service and safe driving are recommended. PP 24: Pattern of prescription-only medicine purchases in Colombo city AADNS Saparamadu1, S Sarangan1, S Sarathkumara1, S Wijeratne2 1Faculty of Medicine, University of Colombo 2Department of Gynaecology and Obstetrics, Faculty of Medicine, University of Colombo Introduction: As medicines to cure illnesses are chemicals, they need to be prescribed by authorised medical practitioners. All medicines can be broadly categorised into prescription only medicines (POM) and over the counter medicines (OTC). Sri Lanka has a high prevalence of unauthorised purchases of POM with neither prescription for current illness nor repeat prescriptions. This is a cause for alarm. Aims: To determine purchase pattern of POM with neither prescriptions for current illnesses nor repeat prescriptions and knowledge of drug purchasers regarding OTC and POM. Methods: A descriptive cross-sectional study was conducted among 115purchasers at several pharmacies selected under systematic random sampling within Colombo city. Data was collected using a pre-tested, interviewer-administered questionnaire. Results: Of the POM purchasers, 31.3% had neither a prescription for current illness nor permitted repeat prescription. Most common POM bought without prescriptions is Metformin. Although unauthorised purchases of POM had no association with demographic factors a significant association was noted with individual pharmacies (p=0.000). Overall knowledge of purchasers of OTC and POM was more than 50% with no significant correlation with gender, residence, ethnicity, religion, occupation, income and pharmacy except for level of education (p=0.000). Conclusions: Of the study population, 27% purchased unauthorised POM demonstrating a significant association with individual pharmacies. It calls for a proper mechanism of surveillance by a competent body, in Colombo. Publishing an authoritative document of OTC and POM for end-user education and to facilitate surveillance is a remedy to alleviate this issue.

Abstracts of Poster Presentations PP 25: Knowledge on menstruation and menstrual practices among grade 10 students of government girls’ schools RJMKA Jayasundara, TAAOT Jayaweera, SD Jayawickrema, A Gamage Faculty of Medicine, University of Colombo Introduction: Knowledge on menstruation and menstrual practices are issues that are insufficiently acknowledged. Aims: To assess the knowledge on menstruation and practices adopted during menstruation among grade 10 students of government girls’ schools in Borella Educational division. Methods: A cross-sectional study was conducted among 113 participants with permission from relevant authorities. Multi-staged stratified random sampling method was used for sampling. A self-administered questionnaire gathered data on socio-demographic data, knowledge and practices during menstruation. SPSS-19 was used for data entering and analysis. Chi-squared test was used to test associations. Results: Mean age of attaining menarche was 12.17(SD±1.19) years. Only 9.7% knew about attaining menarche and 3(2.7%) defined menstruation adequately. Majority (88.5%) gained knowledge through mother. Most (96.5%) used commercially available sanitary towels, 3.5% used cleaned cloth pieces, of which 3(75.0%) reused the towels. Seventy nine percent at least bathed once during menstruation, 17.7% didn’t. Fifteen percent didn’t bathe on the first day of the period. Fifty percent changed their dietary practices during this period, of which 55(96.5%), 5(8.8%) refrained from oily foods and vegetables /fruits respectively. Two percent refrained from fish /meat and sweets/sour foods. Most(38.9%) refrained from sports, 7.1% from dancing and 4.4% from daily activities. Majority (64.6%) avoided religious places; of which 56.2% avoided ‘devala’ and 34.2% temples. Significant difference existed between level of knowledge and number of sources (p = 0.001). Conclusions: Those who had a satisfactory knowledge significantly avoided lesser socio-cultural activities (p<0.05).The study population had poor knowledge on menarche and menstruation, but satisfactory hygienic level. PP 26: Is the working population vulnerable to unsafe cellular phone usage? KDT Dinesha,MDP Dilhani,MKN Dilrukshi,C Arambepola Faculty of Medicine, University of Colombo Introduction: Guidelines for safe cellular phone use have been developed to prevent its adverse health effects. The working population is particularly vulnerable to such health hazards. Aims: To identify the unsafe practices of cellular phone usage and associated factors among a working population in the district of Colombo. Methods: A cross-sectional study was conducted among 140 bank employees currently using a cellular phone ( at least one month). Sample was selected using a random cluster sampling method. A selfadministered-questionnaire assessed safe and risky practices of cellular phone usage. Their level of knowledge on safe use was determined based on a score. Results: Majority were females (52.9%) in 20-34 year age group. Phone use included: >5 times/day (75%); > 30 minutes average caller time/day (44.3%); for > 10 years (35%). Risk behaviour included: usage in high magnetic areas (lifts, cars) (42.1%), low signal areas (45%) and in low battery mode (61.4%), and not using speaker phone mode (75%) or hands free (76.4%). Only 36.4% of males stored the phone in pant pocket while 36.4% of females in handbag. Road traffic accidents were reported among 22.3% of drivers and 5% of pedestrians. 55.7% had poor knowledge on safe phone use and was significantly associated with longer duration of use and caller time >30 minutes. Younger age (20-34) was also associated with the latter. Conclusions: Working population showed unsafe use and poor knowledge of cellular phone usage. Legislation and education in work settings are recommended for safe use of newer technology.

Abstracts of Poster Presentations PP 27: Risk of falls among elders attending a general medical clinic K Swaminathan1, C Marasinghe2, S Gunatilake2 1Colombo South Teachung Hospital, Kalubowila 2Department of Medicine, University of Sri Jayewardenepura Introduction: Falls are common in elderly. Timed Up-and-Go Test (TUG) is recommended by the American Geriatrics Society and British Geriatric Society for falls risk assessment in elders. Falls risk among Sri Lankan elders is not adequately researched. Aims: To assess the falls risk of Sri Lankan elders. Methods: 100 patients over 65 yrs, attending general medical clinic were selected. TUG, visual acuity and medical history were recorded. TUG cut of level for increased falls risk was 14 seconds. Time to complete the TUG test within 10s was considered freely mobile, 10-19s mostly independent and >20s impaired mobility. Vision >12/6 was taken as impaired. Results: Mean age was 72.14yrs (65-92yrs), 52 % females. Increased risk of falling was identified in 86% of elders. Mean TUG times were 12.95s (SD 1.4s) and 21.29s (SD 6.43s) for elders with and without falls risk. None was freely mobile, 59% mostly independent and 41% impaired mobility. Visual impairment of either eye or both eyes was found in 34% and 35% respectively. Mobility was reduced after 75yrs. TUG time was prolonged with past stoke (N-15, 23.47s, p-0.028), cardiac failure (N- 6, 22.2s, p-0.42) and bilateral visual impairment (N-35, 22.19s, p-0.048). Conclusions: Majority (86%) of elders have a risk of falls. Visual impairment, past stroke and cardiac failure were identified as main causes for reduced mobility. TUG test is useful to identify the elders at risk of falls and a cause has to be identified to prevent falls related complications. PP 28: Academic performance and tobacco smoking among school children in the district of Colombo IK Liyanage1,H Rathnayake1,P de Silva2,ACA Pathirana2,P Katulanda3 1General Sir John Kotelawala Defence University 2Ministry of Health, Colombo 3Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo Introduction: Tobacco smoking is a re-emerging problem among younger generations. Usage patterns may vary among newer users for which evidence is sparse. Aims: To study the relationship between academic performance and tobacco smoking among 15-17 year old children in Colombo District Methods: Multi-staged, stratified, cluster sampling was used to select 6000 students from 146 schools. A pre-tested, self-administered questionnaire was used for data collection. The average mark obtained in the previous term examination was used as the main indicator of academic performance. Results: Response rate was 90.7% (n=5445, males: 54%). All time smoking was reported in 27.0% males and 13.3% females. Prevalence of smoking in students with average marks >90, 80-89, 70-79, 60-69, 5059 and <49 were 20.5%, 14.5%, 18.4%, 21.2% and 30.9% respectively. With the exception of the group that obtained 90-95 marks, a rising trend of smoking when academic performance decreased was observed (P for trend>0.05). Students with marks >90 showed no significant difference in rates of smoking when compared to the rest of the population (p=0.979) or the preceding group(p=0.082). In multivariate analysis academic performance remained significant when controlled for socioeconomic determinants, parental factors and peer smoking for both genders. Having smoked>100 cigarettes was associated with getting less than 49 marks when compared to others (OR=3.4, p<0.01) Conclusions: Low academic performance was associated with smoking. However, this did not apply to the category who obtained highest marks (>90). A stronger association was observed between low academic performance and heavy smoking

Abstracts of Poster Presentations PP 29: How Young adults with Thalassaemia major feel and what they want? AAN Nishad1,A Premawardhena2 1Post Graduate Institute of Medicine, University of Colombo 2Faculty of Medicine, University of Kelaniya Introduction: During last few decades with introduction of regular blood transfusion and effective iron chelating therapy, life expectancy of Thalassaemia major patients has improved. There is little data regarding quality of life of these patients. Methods: Prospective quantitative and qualitative study was carried out at Ragama and Kurunegala with transfusion dependent patients of 16 years or older during 2011. SF-36, Becks depression inventory, GHQ-30 and in-depth interviews were used. Results: Of 37 patients (19 females) 64% had at least grade 11 education. Median age was 20(25 th=17, 75th=22) years. Forty percent girls and 33% of boys told illness had a negative impact on romantic relationships. Forty four percent boys, 10.5% girls wanted to marry. Thirty three percent boys and 5% girls wanted to have children. Seventy percent girls and 56% boys wanted to engage in an occupation. SF36 (Cronbach alpha=0.88) analysis, found that 66% thought they get sick easily and 70% thought they were not healthy. But 70% thought their health would not get worse. Limitation of activities was seen (highly active=64%, moderately active=18%). But 81% did not limit routines and 61% had no routine work difficulty. Seventy seven percent had good life satisfaction although 39% felt a great tiredness. Becks depression inventory reported 31% (95%CI=19-48) had reduced sleep and 26% (95%CI=14-42) had disturbed sleep. Mild depression was seen in 5.4%. Conclusions: Patients with thalassaemia want to live a normal life like healthy people. They seem to have a satisfactory quality of life. PP 30: Effect of stroke on an individual’s functional status, quality of life and economic status HHN Kalyani, S Dassanayake Allied Health Sciences Unit, Faculty of Medicine, University of Colombo Introduction: A stroke affects people in different ways. It may affect individual’s physical health as well as quality of life and economic status. Aims: To assess the effects of stroke on an individual’s functional status, quality of life, and family economy. Methods: This descriptive study was carried out in Institute of Neurology, National Hospital of Sri Lanka with 70 stroke patients. Results: Sample consisted of 57.14% males. . Majority (61.42%) were aged 41 to 60 years.( 78.57%). were married, (38.57% were employed and 21.42% were retired. Hemorrhagic stroke was reported in 50%, 51.42% were able to feed themselves. 34.28% were are highly dependent for toileting. Bladder and bowel management needed assistance in 57.14% and 51.42% respectively. Most individuals needed total to maximum assistance for transferring and locomotion. Indicators of quality of life showed better scores on the Social and Economic Subscale (mean=3.59) compared to Health and Functioning Subscale (mean=2.97) and Psychological/Spiritual Subscale (mean=2.75). Family expenditure had significantly increased and high (p=0.001) and income is significantly decreased less (p=0.001) after the stroke. . Conclusions: The study found that most stroke patients were aged over 40 years and were married. Hemorrhagic stroke is the commonest. Assistance was needed for functions such as bathing, toileting and locomotion. Stroke had a negative impact on physical health and level of functioning and economic status.

Abstracts of Poster Presentations PP 31: Prevalence of perceived stress among adolescent school children in Colombo District O de Silva1, IK Liyanage1, P de Silva2, P Katulanda3 1General Sir John Kotelawala Defence University 2Ministry of Health, Colombo 3Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo Introduction: High levels of perceived stress is associated with physical symptoms, psychological distress, emotional exhaustion, and burnout in students. Objectives: To study the prevalence and correlates of perceived stress among adolescents Methods: A cross sectional descriptive study was carried out among 6000 grade 10 and 12 school children, representative of Colombo District, selected by multi-staged Stratified random sampling. Students were assessed using Sheldon Cohen’s self administered “Global Measure of Perceived Stress scale”. A higher score in PSS indicates a higher degree and longer duration of self-perceived stress. Results: Response rate was 94.38% (males:53.4%). Age ranged from t 14 to 19 years. Mean PSS was 15.29 (SD=5.34) which was significantly higher (p<0.001) than the standard average PSS (13.5). PSS did not show an association with gender (p=0.95). When compared to Sinhalese, PSS was higher in students of Tamil (p=0.002) and Burger (p=0.002) ethnicities. When compared to a student in grade 10, students following Advanced Level (AL) mathematics (p<0.001) and biology (p<0.001) were less likely to have a higher PSS score. AL students following commerce, arts streams and grade 10 students had similar PSSs. Students’ participation in sports did not have a significant effect in PSS (p=0.08). Students who had 60-69 and <59 marks for the previous term test had a higher PSS when compared to students who had >90 marks. Conclusions: Higher levels of perceived stress were found in the samples of adolescents in Colombo district. In contrary to common belief, students studying science subjects showed a lesser PSS. PP 32: Perceived stress, tobacco smoking, use of alcohol and illicit substances among school children in the district of Colombo IK Liyanage1, O de Silva1, I Piyadigama2, ACA Pathirana2, AKK Wickramasinghe3, TDP Withanage2, P Katulanda4 1General Sir John Kotelawala Defence University 2Ministry of Health, Colombo 3Oxford University, UK 4Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo Introduction: Tobacco smoking, use of alcohol and illicit substances are known to be associated with higher levels of perceived stress (PS). Objectives: To study the relationship between PS and substance use behaviors among school children Methods: A sample of 6000 students from grades 10 and 12 was selected from Colombo District using multi-staged stratified random sampling. PS was assessed using Sheldon Cohen’s self administered “Global Measure of Perceived Stress scale”. A higher Perceived Stress Score (PSS) indicates a higher degree and longer duration of self-perceived stress. Students with one or more missing value for the scale were excluded from the analysis. Results: PSSs of 5040 students (84.0%) were calculated (47.9% males, mean age: 15.74 years). Mean PSS was 15.3 (SD=5.3) (maximum:40). Prevalence of substance use were; life-time smoking:19.5%, smoked >100 cigarettes:1.5%, life-time alcohol use:28.3%, cannabis use: 2.14%. Mean PSS was significantly higher among the students who smoked tobacco (16.3 against 15.1, p<0.001), smoked >100 cigarettes (17.9 against 15.3, p<0.001), used alcohol (16.4 against 14.1, p<0.001) and used cannabis (17.9 against 15.2, p<0.001). These associations remained significant in multivariate analysis when academic performance, parental factors, socioeconomic status, ethnicity, gender and age were controlled for (p<0.001). Conclusions: Higher levels of perceived stress were associated with substance use behaviors among school children in Colombo district. Helping students to refrain from these behaviors may alleviate their level of perceived stress and other related adversities.

Abstracts of Poster Presentations PP 33: Traditional beliefs and practices during the puerperium LK Athauda1, R.Basnayake2, M Gunawardena3, MV Iyshwarya3, R S Deduwela3,URR Mendis3, WSD Lakmuthu4, AARY Siriwardhana3, MG Nadeesha3, MP Ranga3, HKT Disnani3, S Fernando3 1Department of Tropical Medicine & International Health, Faculty of Medicine, University of Kelaniya 2Ministry of Health, Colombo 3Faculty of Medical Sciences, University of Sri Jayewardenepura 4Department of Biochemistry, Faculty of Medical and Allied Sciences, Rajarata University of Sri Lanka Introduction: Descriptive qualitative study was carried out to identify knowledge, attitudes and practices of women based on traditional beliefs during puerperium. Aims: To describe beliefs and practices by women during the puerperium, on hygiene, sexual practices & contraception, physical activity and food taboos. Methods: Qualitative descriptive study was conducted among Sinhalese, Buddhist women to identify beliefs and practices during puerperium following a normal vaginal delivery. Females admitted at CSTH during the months of September - December 2009 were selected. Three focus group discussions were conducted among women aged 25– 35 years, 45 – 55 years, over 65 years using a focus group study guide. Results: Women abstained from bathing up to 1 month post delivery, to avoid clotting of breast milk. Substitute for bathing is fermentation of back, abdomen & breast with leaves. Water for bath is heated with sunlight for disinfection. Breast feeding is postponed until mother’s hair dries completely after a bath. Clothes are disinfected by fumigation with herbs. Cloth straps worn around waist strengthen the abdominal muscles. Episiotomy care involves sitting in a warm salt-water tub, avoiding use of soap and fumigating the site with herbal fumes. Sexual abstinence is practiced for one to three months post partum. Strenuous activity and squatting is avoided in the peuperium. Major food taboos include coconut milk, oil, green leaves, salt water fish, and pineapple and ana-malu banana. Conclusions: Families y pressurize younger females to conform with these practices. Older women consider these beliefs and practices as traditional. The basis of these beliefs and practices need further exploration. PP 34: Beyond “in-ward” patient care- ‘Home and Community based Care Programme (Social Medicine) RMGM Ratnayake, LP Ruwanpura, KR Atukorala, PN Weeratunga, GM Jayasena, S Jayasinghe Faculty of Medicine, University of Colombo Introduction: Department of Clinical Medicine, Faculty of Medicine, Colombo introduced Home and Commnunity Care Programme (HCCP),an innovative programme years ago. It consisited of group of 810students making home-visits for patients with chronic illnesses; weeks 1-2:selecting a suitable patient for the home visit; weeks 3-7:visiting, implementing interventions and revisiting for evaluation, week8:making presentations to the entire group. Aims: To assess the student perception of the programme. Methods: Perceptions were assessed from 88 students using a self administered questionnaire distributed at the end of programme. Results: Response rate: 77/88 (87.5%). The following numbers found visiting the patient at home useful, as it helped to identify: environment factors affecting illness and recovery 69 (89.6%); impact of illness on patients’ daily life 70 (90.9%) and those of household members 66 (85.7%); factors at home and community level that would interfere with treatment which was to be continued at home 64(83.1%); non medical interventions to improve well being of patient and family 67 (87.0%). Majority had implemented simple interventions to improve well-being of patient’s and family 67 (87.0%) by utilizing resources available in community and societal level 53 (68.8%). Conclusions: Majority of students perceived HCCP as an useful learning activity. HCCP enables students to understand ‘comprehensive care of the patients. It can be improved further by making supervised visits and introducing an objective marking scheme for assessments.

Abstracts of Poster Presentations PP 35: Health of captive elephant keepers in Sri Lanka A Dangolla1, KLTD Jayawardena1, D Dissanayaka2, DLB Dassanayake3, BMHSK Banneheka4, AD Siribaddana3, PVRK Kumarasiri2 1Faculty of Veterinary Medicine and Animal Science, University of Peradeniya 2Faculty of Medicine, University of Peradeniya 3Teaching Hospital, Kandy 4Faculty of Dental Sciences, University of Peradeniya Introduction: Unacceptable social status and unhealthy lifestyles of captive elephant keepers had been described in Sri Lanka, which can affect their lives as well as elephantâ&#x20AC;&#x2122;s life. Aims: To assess the health status of elephant keepers in Sri Lanka. Methods: Captive elephant keepers were investigated in Kandy in 2010 and 2011. They were assessed clinically and were subjected to blood and urine investigations. Chest radiography, mantoux and sputum examinations were done when relevant. Results: Two thirds of the keepers regularly consumed alcohol, 60% smoked and 98% chewed beetle. Out of 78 Keepers, 20 had chest infections, only 5 turned up at hospital out of which 2 had a Mantoux reaction > 10mm(positive) and another one had clinical and radiological evidence of TB. Out of 36 keepers, 19 had pathological findings either in blood, urine or in both. Twelve keepers had elevated SGOT and SGPT, 2 had thrombocytopenia due to cirrhosis. Five urine samples had 5 pus cells/HPF and albuminuria and one had haematuria. Out of 64 keepers, 40 had carious teeth, 16 had mobile teeth, average number of missing teeth was 5.8 and one person was totally edentulous. Gross calculus was present in 33, 4 had bleeding gums and 2 had oral sub mucous fibrosis, while another 3 had Angular chelitis, glossitis and oral squamous cell carcinoma. Conclusions: Significant proportion of elephant keepers have health problems which are related to poor health habits. PP 36: Is there equity in distribution of medical specialists and medical officers? NC Kariyawasam, SC Wickramasinghe Ministry of Health, Colombo Introduction: There are 12,920 Medical Officers (MO) and 1,270 Medical Consultants (MC) working in Sri Lanka. MO is appointed to all institutions up to Primary Medical Units. MC are appointed to curative care units above Divisional Hospitals. Although it is planned to appoint MO and MC based on need, there seem to be an inequity in distribution. Aims: To describe the distribution of MC and MO in Sri Lanka Methods: Management Development and Planning Unit of Ministry of Health obtained information from all line and provincial institutions about their cadre positions including the number approved, the number in position and the number required to maintain services. This information was verified through several sources. Results: There are MC appointed to 36 Specialties in Sri Lanka and the distribution shows that 73.6% work in line ministry institutions. There are 5.9 MC per 100,000 populations in Sri Lanka. The highest ratio is in the Western Province while the lowest is in the Sabaragamuwa province. Regarding MO, 65% work at line ministry institutions. There are 62 MOâ&#x20AC;&#x2122;s/ 100,000 populations in Sri Lanka. The distribution is highest in the Western province while low ratios are seen in Northern, Sabaragamuwa and North Central provinces (34, 37 and 40 per 100,000 populations respectively). Eastern province ranks as fourth for deployment of MC while the rank goes up-to third where MO are concerned. Conclusions: It is recommended that medical officers and consultants are appointed considering the service need, population and institution density.

Abstracts of Poster Presentations PP 37: Prevalence of prediabetes among health care workers in Provincial General Hospital, Badulla CSP Sosai1, KNP Ranasighe1, MM Weerasekara2 1Provincial General Hospital, Badulla 2University of Sri Jayewardenepura Introduction: Pre-diabetes (Fasting blood glucose (FBS) of 100-125mg/dl or Impaired fasting glucose [IFG] and/or impaired glucose tolerance [IGT] level of 140-199 mg/dl after glucose tolerance test[GTT]) is a condition where blood glucose level is higher than normal but not sufficiently high to be categorized as diabetes mellitus. Persons who develop type 2 diabetes tend to go through a pre-diabetic stage. Dietary modification and medication prevent or postpone diabetes mellitus. Those with both IFG and IGT and one additional risk factor are considered as high risk pre-diabetes. Aims: To assess the prevalence of pre-diabetes in health care workers (HCW) in provincial general hospital, Badulla and identify high risk pre-diabetics. Methods: Three hundred and twenty one HCWs were included in the study with written consent. Blood pressure, body mass index (BMI) and Oral glucose tolerance test results were recorded. Other risk factors were also assessed. Results: Of the 321 HCWs 39 (12.6%) were identified as pre-diabetics. Prevalence of high risk prediabetes was 3% and there were 9%, 2%, 15%, and 21% pre diabetics in the age groups 20-29, 30-39, 4049 and 50-60 years. Prevalence of IFG was 11.6% and IGT 4%. Four percent had both IFG and IGT. Incidence of diabetes and hypertension was seen in 3.5% and 6% respectively. Conclusions: The pre diabetics rate in this study is higher than that in comparable studies. IFG is a sensitive test to detect pre-diabetic state. Majority would need dietary modifications and behavioral therapy and a few drug treatment. PP 38: Quantity of antenatal care received by selected high risk pregnancies in Medical Officer of Health area, Imaduwa PAA Chandrasiri, S Dolamulla Medical Officer of Health Office, Imaduwa Introduction: Teenage pregnancies and low body mass index (BMI) at onset of pregnancy are regarded as risk factors. They contribute to maternal and fetal morbidy and mortality So they require specialized care. Aims: To determine the quantity of antenatal care received by teenage pregnancies and low BMI mothers. Methods: Retrospective study was conducted. All pregnant mothers whose expected date of delivery fell during the year 2011 irrespective of outcome of the pregnancy in MOH area, Imaduwa were selected. Mothers whose pregnancy was terminated before 36th week of period of amenorrhoea were excluded. Data was extracted from pregnancy record part B using a check list. Results: Seven hundred and eighty pregnancy records were considered. 7.3 % (n=57) were teenage pregnancies and they received mean number of 6.95 Home Visits (HV) (SD 3.06) and 9.12 Clinic Visits (CV)(SD 1.94).Among all other pregnancies the corresponding values were 6.64 HVs (SD 3.01) and 8.22 (SD 2.25).Only 745 pregnancy records indicated BMI at registration. 195 (26.2%) had low BMI. They received mean number of 6.59 HVs (SD 3.06) and 8.52 CVs (SD 1.94). Pregnancies with normal or high BMI received 7.04 HVs (SD 4.87) and 8.35 CVs (SD 2.21). High risk pregnancies didnâ&#x20AC;&#x2122;t receive significantly different care from others. Conclusions: Quantity of antenatal care received by teenage and low BMI mothers wasnâ&#x20AC;&#x2122;t adequate. More home visits and clinic visits should be arranged for high risk pregnancies.

Abstracts of Poster Presentations PP 39: Anaemia of pregnancy in the district of Anuradhapura - need for updating prevalence data and screening strategies U Chathurani,S Agampodi,I Dharshika,D Galgamuwa,T Agampodi Rajarata University of Sri Lanka Introduction: Anemia in pregnancy is known to contribute significantly to maternal morbidity in Sri Lanka. Aims: The purpose of this study was to determine the prevalence of anemia during pregnancy in Anuradhapura district and evaluate present screening methods for anemia. Methods: Modified WHO 30 cluster sampling method was used to estimate the prevalence of anemia. Serum hemoglobin was measured using methemoglobin method. Clinical examination was carried out to evaluate conjunctival method in anemia screening. Values recorded from hemoglobin color scale method used in the field antenatal clinics were collected. Results: A total of 990 pregnant women participated in the study. In the first, second and third trimesters, prevalence of anemia was 7.6%, 19.7% and 19.3% respectively. Gestational age adjusted anemia prevalence among pregnant women in this study population was 14.1% (95%CI 12.0-16.4%). Mean and median hemoglobin concentration of the study sample was 11.8g/dL (SD 1.02g/dL and IQR 11.2-12.5g/dL). Among anemic pregnant women, average values for Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), and Mean Corpuscular Hemoglobin Concentration (MCHC) were, 82.9 fL (SD 11.5), 27.6(SD-3.6) pg/cell and 32.9g/dL (SD 1.8) respectively. Sensitivity and specificity of hemoglobin color scale method was 50% (95% CI 29.0-71.0%) and 76.3% (95% CI 66.9-83.7%) respectively. Sensitivity and specificity of conjunctival method in detecting anemia during pregnancy was 18.8% (95% CI 11.9-28.4) and 69.3 % (95% CI 58.2-78.6%). Conclusions: Prevalence of anemia in the district of Anuradhapura was less than 50% of the estimated prevalence for Sri Lanka. Both hemoglobin color scale and conjunctival method have low validity in detecting anaemia in pregnancy. PP 40: Diagnosis of metabolic syndrome in type 2 diabetic patients: comparison of modified NCEPATP III and International Diabetes Federation (IDF) criteria UAD Wijesinghe1, A Medagama2, NSB Dissanayake2 1Teaching Hospital, Kandy 2Department of Medicine, Faculty of Medicine, University of Peradeniya Introduction: The objective of this study was to compare the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) and International Diabetes Federation (IDF) criteria in determining the prevalence of metabolic syndrome (MS) in a subset of Sri Lankan patients with newly diagnosed type 2 diabetes mellitus (T2DM). Methods: 552 consecutive, newly diagnosed patients with T2DM over the age of 18 years who were referred to the diabetes clinic at Teaching Hospital, Peradeniya, from 1 January 2010 to 30 September 2011 were enrolled. MS was determined according to the modified NCEP-ATP III and IDF criteria. Cohenâ&#x20AC;&#x2122;s kappa was used to measure agreement between these two criteria. Receiver operating characteristics curves of serum triglycerides, HDL, waist circumference, systolic blood pressure and diastolic blood pressure were created for the prediction of MS and area under the corresponding curves (AUC) were used to evaluate the predictive efficiency of each MS parameter. Results: The prevalence of MS was 66.3% with the modified NCEP-ATP III and 62.9% with IDF criteria (P=0.23). The agreement between the two criteria was excellent (kappa=0.92). With both criteria females were more affected than males. Serum triglycerides had the highest predictive value with both modified NCEP-ATP III (AUCs: overall-0.754, female-0.801, male-0.758) and IDF (AUCs: overall-0.823,female0.880,male-0.821) criteria. Conclusions: The agreement between modified NCEP-ATP III and IDF criteria for diagnosis of MS in diabetic patients is excellent. Both criteria showed high prevalence of metabolic syndrome in patients with newly diagnosed T2DM. Elevated serum triglyceride was the strongest single predictor of MS.

Abstracts of Poster Presentations PP 41: Diabetes mellitus in South Asia - a scientific evaluation of the research output P Ranasinghe, R Jayawardena, P Katulanda Department of Pharmacology, Faculty of Medicine, University of Colombo Introduction: Diabetes in South Asia (SA) represents a different disease entity in onset, progression and complications. Aims: To systematically analyze medical research output on diabetes from SA. Methods: The online SciVerse Scopus® database was searched using the following search terms; ‘diabetes’ and ‘diabetes mellitus’ in the article ‘Title’, ‘Abstract’ or ‘Keywords’, in conjunction with the names of each regional country in ‘Author Affiliation’. Results: Total number of publication was 8,478. The majority was from India (85.1%) and Pakistan (9.6%). Contribution to global diabetes research output was 2.1%. Publications from SA have dramatically increased after 2007; 58.7% of publication between the years 2000-2010 were after 2007. The majority were research articles (75.9%) and reviews (12.9%), with only 90 (1.1%) clinical trials. Publications predominantly appeared in local national journals. Indian authors and institutions had the most number of articles and highest h-index. The number intra-regional collaborative studies was 136 (1.6%). Only 39 articles (0.46%) had >100 citations. Conclusions: Regional research output on diabetes mellitus is unsatisfactory, with only a minimal contribution to global research. Publications were not highly cited and there were very few RCTs. Regional scientists must collaborate and focus more on practical and culturally acceptable interventional studies in diabetes mellitus. PP 42: Geographical variations of goitre prevalence in Sri Lanka: visualisation with geographic information systems R Fernando, A Pathmeswaran, S Nandasena Faculty of Medicine, University of Kelaniya Introduction: Widely held beliefs about the geographical distribution of goiter prevalence in Sri Lanka are not based on reliable data. Geographic Information Systems provide an excellent means to visualize and present epidemiological data. Aims: To map and explore the geographical variation of goiter prevalence in Sri Lanka Methods: An island-wide representative sample of residents (n=5200) from 95 Gramasewa Niladhari (GN) divisions in 87 Divisional Secretariats (DS) were screened for goiter. A subsample was investigated for thyroiditis. Digital maps were developed to visualize the goiter and thyroiditis prevalence across the country. Maps were developed for the GN and DS level representations. Based on the data from 95 GN divisions, goiter prevalence was estimated for the un-sampled areas of the country using the interpolation techniques. ArcGIS 10.0 software was used for analysis. Results: A total of 426 goiters and 177 thyroiditis cases were identified. The male and female goiter prevalence showed similar patterns of geographical variation. The DS divisions with goiter prevalence more than 15% were seen distributed across the country without any discernible pattern. Distribution of thyroiditis exhibited a similar pattern. There was some evidence of clustering together of areas/ GN divisions with a similar prevalence of goiter but it was not possible to demarcate large contiguous areas ('zones') with a similar prevalence of goiter. Conclusions: Geographical distribution of goiter prevalence did not show any large regional or zonal variations. Areas of high and low prevalence were distributed randomly across the country.

Abstracts of Poster Presentations PP 43: Predicting free-T4 and free-T3 from TSH by statistical modeling S Namasivayam, BL Peiris Colombo North Teaching Hospital, Ragama Introduction: Thyroid function tests constitute a considerable volume in a chemicalpathologistâ&#x20AC;&#x2122;s routine workload. They are laborious to do and also expensive. Aims: We undertook this study to find the relationship between free thyroxine(FT4) and free iodothyronine(FT3) with thyroid stimulating hormone(TSH), so that the best models that enable the predictionof FT4 and FT3 for given values of TSH can be identified. Methods: The dataset consisted of 101 thyroid profile reportsobtained from a hospital laboratory. Analysis was performed using data transformation, polynomial regression and local regression(Loess procedure). Results: 40 models were produced by various combinations of transformedand untransformed variables. The best of these was,LnFT4 = 0.315 - 0.131LnTSH (R2 = 59.2%)Polynomial regression produced two quadratic and two cubic models for FT4 and FT3.Loess models for FT4 and FT3 were found using smoothing parameters 0.3 and 0.8 respectively. Smoothing parameters were found by AICCI minimization. Conclusions: FT4 and TSH were exponentially related and significantly correlated. The relationship between FT4 and TSH is best described by the equation,FT4 = b0(TSH)b1 where b 0 and b 1 are constants(b0= 0.315, b1= -0.131). This model was found suitable for predictions.FT3 and TSH were also exponentially related and significantly correlated. Data transformation for FT3 and polynomial regression did not produce models satisfactory for prediction. The Loess models found, produced good models enabling the creation of prediction charts for individual data sets. PP 44: Usefulness of a buccal smear in a baby with a disorder of sex development KSH de Silva Department of Paediatrics, Faculty of Medicine, University of Colombo Introduction: Identification of the sex of a newborn with a DSD is difficult when the external genitalia are ambiguous. Early identification is essential as some underlying conditions are fatal unless treated promptly. A karyotype is mandatory but it takes time, whereas the result of a buccal smear is available in few hours. Aims: To assess the usefulness of a buccal smear to identify the chromosomal sex of a baby with a DSD. Methods: A buccal smear and a karyotype were done on all babies with a DSD referred to a ward at LadyRidgeway Hospital over 3 years from November 2008. A smear was made from the buccal mucosa and 100 squamous cells were examined for the presence of Barr bodies. Control samples were taken from their mothers. Results: The buccal smear result corresponded to the karyotype in 23 of 33 (70%) patients. The smears were inconclusive in 5 and werenegative in 4 with 45,X/46,XY. All buccal smear results were available in 24-48 hours while in the majority (73%) the karyotype results were available after 4 weeks. Conclusions: The agreement between a buccal smear and karyotype in assessing sex was good (kappa 0.571, p=0.001). Buccal smear result is available in a few hours.Sex chromosome mosaicism cannot be identified by this method. However, it is a useful initial investigation in a baby with a DSD.by

Abstracts of Poster Presentations PP 45: Analysis of mitochondrial DNA recovered from old human bones in Sri Lanka KM Chandimal1, SG Yasawardene2, RJ Illeperuma3 1Department of Anatomy, Wickramarachchi Ayuruweda Institute, University of Kelaniya 2Department of Anatomy, Faculty of Medical Science, University of Sri Jayewardenapura 3Forensic Molecular Unit, Genetech, Colombo Introduction: Analysis of mitochondrial DNA (mtDNA) of bones has the potential to make significant and unique contribution in Forensic Medicine and Archaeology. The preservation of ancient DNA (aDNA) in human bone is reported to be very low in tropical countries like Sri Lanka due to prevailing climatic and environmental conditions such as high temperature and high humidity. We have attempted to extract mtDNA from human bones found in Sri Lanka dated 20 – 40 years BP. Aims: Analysis of mtDNA recovered from old human bones in Sri Lanka. Methods: 20 year old human humerus and 40 year old human tibia were used. The Phenol / chloroform extraction method was modified and tried out to extract DNA from the bones. The mitochondrial DNA HVS 1 region of extracted mtDNA was amplified by using overlapping 1st round primers and nested primers respectively. First round amplified PCR products were sequenced using both the reverse and forward primers by Bigdye terminator Kit. Results: mtDNA-HVS 1 region was amplified and produced the first round products: Hum1 - 378bp, Hum2 - 247, Hum3 -233bp. Nested PCR product sizes: HumF1- 247bp, Hum F2- 135bp, HumF3-161bp, HumF4 -228bp were obtained. The sequencing results of PCR amplified 1st round products were aligned with mitochondrial genome Cambridge reference and the results showed no cross contaminations or contaminations with modern DNA. Conclusions: A mtDNA extraction protocol has been successfully developed to extract and analyse mtDNA from human bones of 20 – 40 year BP found in Sri Lanka. PP 46: A mutation in the growth hormone releasing hormone receptor gene identified in a child with short stature KH Tennekoon1, KSH De Silva2, D Ganihigama1, H Jayasinghe1, S Hewage1, S De Silva1 1Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo 2Department of Paediatrics, Faculty of Medicine, University of Colombo Introduction: Mutations in the growth hormone releasing hormone receptor (GHRH-R) gene can prevent stimulation of growth hormone synthesis and secretion by the anterior pituitary. G>T transversion on codon 72 of the GHRH-R gene has been previously reported from some Asian countries and from two individuals originating from the Delft Island as a causative factor of short stature. In a preliminary study of 10 children with short stature we did not identify this mutation by Polymerase Chain reaction – Restriction Fragment Length Polymorphism method. Aims: To screen a group of children with short stature for the G>T transversion on codon 72 of the GHRHR gene by direct sequencing Methods: Peripheral venous blood samples were collected from 13 children with clinically confirmed growth hormone deficiency who were responding to growth hormone replacement. DNA was extracted, amplified by polymerase chain reaction using target specific primers and sequenced using a MegaBACE Automated DNA sequencer. Nucleotide sequences obtained were subjected to Bioinformatic analysis. Results: One child, a Muslim boy, 4 years and 5 months of age and with no family history of short stature carried the mutation G>T transversion on codon 72 of the GHRH-R gene. Conclusions: G>T transversion on codon 72 has been identified in a child with short stature. Further studies are in progress to investigate a larger group and to identify other mutations in the GHRH-R gene.

Abstracts of Poster Presentations PP 47: Disruption of LyF-1 mediated transcription regulation of HBEGF expression could lead to preeclampsia GG Harendra, RW Jayasekara, VHW Dissanayake Human Genetics Unit, Faculty of Medicine, University of Colombo Introduction: Preeclampsia is a common pregnancy complication of poorly defined etiology. Our research on contributory maternal genetic factors has shown a significant haplotype effect involving rs13385 of HBEGF gene. Specifically, haplotypes carrying rs13385T were shown to associate with preeclampsia predisposition, while rs13385C is associated with protection against preeclampsia. In-silico functional analysis has shown that rs13385 is located on a putative binding site (disrupted by rs13385T) for the regulatory protein LyF-1 (lymphoid transcription factor -1), which is implicated in migration and invasion of extravillous trophoblast in early placentation. Hence, it is possible that the observed haplotype effect is partly modulated via the disruption of this transcription factor binding site (via rs13385T) which would in turn reduce HBEGF expression. Aims: To test the LyF-1 mediated transcription regulation of rs13385 in vitro using a reporter gene assay. Methods: Recombinant experimental vectors containing rs13385T and rs13385C alleles were constructed with pGL3P vectors and were co-transfected in to JEG3 cells with renilla control vector. Normalised reporter activities were evaluated against empty pGL3P and pGL3C vectors in a dual luciferase reporter gene assay. Data were analysed using the Studentâ&#x20AC;&#x2122;s t test. Results: Compared to the empty vector, rs13385C construct increased the gene expression by 44%, while rs13385T inhibited it by 7%. Further, rs13385C allele produced a 1.56 times higher luciferase activity compared to the rs13385T allele (p<0.0001). Conclusions: Preeclampsia predisposition and protection associated with HBEGF haplotypes is transcriptionally regulated probably via the binding of LyF-1 at rs13385. This needs to be confirmed with further experimentation. PP 48: Phenotypic features in a cohort of patients with 46, XY disorder of sex development (46,XY DSD) in Sri Lanka UND Sirisena1, S De Silva2, RW Jayasekara1, VHW Dissanayake1 1Human Genetics Unit, Faculty of Medicine, University of Colombo 2Department of Paediatrics, Faculty of Medicine, University of Colombo Introduction: The etiology of 46, XY Disorder of Sex Development (DSD) is heterogeneous and results from defects in androgen production, resistance to androgen action or from abnormalities in gonadal development. The clinical spectrum varies from mild undervirilization to complete sex reversal with normal female phenotype. Aims: This study aims to describe the clinical phenotype of 46,XY DSD in Sri Lankan patients. Methods: 52 patients with clinical diagnosis of 46,XY DSD were recruited from Human Genetics Unit and Lady Ridgeway Childrenâ&#x20AC;&#x2122;s Hospital, Colombo between October 2011 and February 2012. Written informed consent was obtained from all patients and clinical history and physical features were documented. Results: Study population comprised 35 (67.3%) phenotypic males and 17 (32.7%) phenotypic females with ages ranging from 4 months to 32 years. Clinical presentation was ambiguous genitalia in 33 (63.5%), primary amenorrhoea in 12 (23.1%) and inguinal masses in 7 (13.4%). Phenotypically female patients had normal female external genitalia, absent axillary and pubic hair with breast development ranging from Tanner stages 1 to 5. Phenotypically male patients presented with external masculinization scores ranging from 2.0 to 9.5. Features of undervirilized male genitalia included micropenis (94.3%), bifid scrotum (91.4%), cryptorchidism (22.8%), hypospadias (97.1%) with perineal type hypospadias being the commonest presentation (74.3%). Genital ambiguity was associated with facial dysmorphism and cardiac anomalies in 4 (7.7%) patients. Conclusions: Common presentations of 46,XY DSD in Sri Lankan patients include genital ambiguity with undervirilized male genitalia in phenotypic males while phenotypic females presented with normal female external genitalia and primary amenorrhoea or inguinal masses.

Abstracts of Poster Presentations PP 49: A candidate gene association study of recurrent pregnancy loss in a Sinhalese population from Sri Lanka P Andraweera1, G Dekker2, VHW Dissanayake1, S Thompson2, D Furness2, Rl Nowak2, A Zhou2, J Zhang2, R Jayasekara1, C Roberts 2 1Human Genetics Unit, Faculty of Medicine, University of Colombo 2University of Adelaide, Australia Introduction: Recurrent pregnancy loss (RPL) affects 1-5% of couples. In women experiencing idiopathic RPL, genetic polymorphisms are proposed to increase the risk of pregnancy loss. We investigated the association of 100 single nucleotide polymorphisms in candidate genes regulating trophoblast invasion, angiogenesis, vascular integrity, one carbon metabolism, DNA damage, inflammation and obesity with recurrent pregnancy loss. Methods: 212 Sinhalese women with three or more recurrent pregnancy losses and no living children (cases) and 202 women who have two or more living children and no history of pregnancy loss matched for age and ethnicity (controls) were recruited at the Human Genetics unit in Colombo. Peripheral blood was collected from the participants and DNA extracted. Genotypes of 100 polymorphisms were determined by the Sequenom MassARRAY system. Allele frequencies of cases were compared with controls using chi square analyses. Results: Of the women in the RPL group, 60% had experienced only first trimester pregnancy losses. Urokinase plasminogen activator receptor (uPAR) rs4251923 A allele [P = 0.004, OR (95%CI) = 2.2 (1.33.9)], plasminogen activator inhibitor-2 (PAI-2) rs6098 A allele [P = 0.03, OR (95%CI) = 1.4 (1.0-1.8)], PAI-2 rs6103 C allele [P = 0.02, OR (95%CI) = 1.4 (1.0-1.9)], interleukin receptor antagonist (ILRN) rs454078 A allele [P = 0.04, OR (95%CI) = 1.4 (1.0-1.9)] and FTO rs9939609 A allele[P = 0.001, OR (95%CI) = 1.6 (1.2-2.3)]were associated with RPL. Conclusions: Our study demonstrates that polymorphisms in genes regulating placental trophoblast invasion, inflammation and obesity are associated with recurrent pregnancy loss in Sinhalese women. PP 50: The spectrum of deletions and duplications in the dystrophin (DMD) gene in a cohort of patients with Duchenne muscular dystrophy in Sri Lanka N Thakur1, AGS Aeysekera1, J Wanigasinghe2, AB Padenniya3, RW Jayasekara1, VHW Dissanayake1 1Human Genetics Unit, Faculty of Medicine, University of Colombo 2Department of Paediatircs, Faculty of Medicine, University of Colombo 3Lady Ridgeway Hospital for Children, Colombo Introduction: Duchenne muscular dystrophy (DMD), which affects 1 in 3500 newborn males, is the commonest fatal neurodegenerative disorders in children. Deletions and duplications in the DMD gene is the commonest underlying aetiology. Methods: 79 consecutive children with DMD were screened for deletions and duplications in the DMD gene using Multiple Ligation-binding Probe Amplification (MLPA). Results: 57 (72.2%) had deletions.7 (8.9%) had duplications. The deletions affected a singe exon in 12 (15.18%) two exons in 5 (6.32%) three exons in 4 (5.06%) four exons in 2 (2.53%) and more than four exons in56 (70.88%). The commonest deletion was the deletion spanning from exon 45 to exon 52 which was seen in 7 (8.9%). The duplications affected a singe exon in 1(14.28%) two exons in none of the patients, three exons in 3(42.85%) and more than four exons in 3 (42.85%). Conclusions: The deletion/duplication pattern seen in the Sri Lanka population was similar to that of other global populations.

Abstracts of Poster Presentations PP 51: Clinical and molecular genetic studies in a cohort of Sri Lankan patients with 46,XY disorder of sex development (46,XY DSD) UND Sirisena1, S De Silva2, AAGS Abeysekara1, RW Jayasekara1, VHW Dissanayake1 1Human Genetics Unit, Faculty of Medicine, University of Colombo 2Department of Paediatrics, Faculty of Medicine, University of Colombo Introduction: The SRY gene on chromosome Yp11.3 plays an important primary role in male sexual development by activating a cascade of genes that lead to normal male differentiation. Mutations located in the high mobility group conserved domain (HMG homeobox) of SRY gene may cause failure of testis determination or differentiation resulting in undervirilization and XY sex reversal in 10 to 15% of 46,XYDSD patients. Aims: The aim of this study was to identify mutations in SRY gene in 46,XY DSD patients and correlate them with the clinical phenotype. Methods: 52 karyotypically confirmed 46,XY DSD patients were recruited. Clinical history and physical examination findings were documented. 5ml of venous blood was drawn. DNA was extracted. The SRY gene, including HMG homeobox domain, was tested for mutations by sequencing the entire gene. Results: Phenotypically 35 (67.3%) were male and 17 (32.7%) were female. Age range in males and females was 4 months to 31 years and 19 months to 32 years respectively. Phenotypic features in males were ambiguous genitalia [33 (94.3%)] and inguinal masses [2 (5.7%)]. Phenotypic features in females were ambiguous genitalia [1 (5.9%)], primary amenorrhoea [11 (64.7%)] and inguinal masses [5 (29.4%)]. None of them had mutations in the SRY gene. Conclusions: This study shows that mutations in SRY gene do not appear to play a role in 46,XY DSD patients in Sri Lanka. Mutations in other genes, e.g. AR, SRD5A2 and 17?HSD-3, are potential aetiological factors. We plan to sequence these genes in these patients to identify mutations PP 52: A descriptive study of alpha and beta thalassaemia mutations in Sri Lanka AGPM Padeniya1, HWW Goonasekara1, NT Hidellage2, HLV Tilakaratna2, AAGS Abeysekara2, UGAC Kariyawasam2, VHW Dissanayake1,2 1Human Genetics Unit, Faculty of Medicine, University of Colombo 2Asiri Centre for Genomic and Regenerative Medicine, Asiri Surgical Hospital, Colombo Introduction: Thalassaemias are extremely heterogeneous in their phenotype, distribution and molecular mechanism. Aims: Thalassaemia causing mutations prevalent in the Sri Lankan population have been described previously in a population based study .The aim of this paper is to supplement that data with further data from a clinical genetic testing service. Methods: 47  thalassaemia patients and carriers were tested for mutations in the HBB gene by sequencing and/or by PCR for the 619bp deletion. 18  thalassaemia patients and carriers were tested by screening for - 3.7 and - 4.2 deletions in  globin gene region and by sequencing for mutations in the HBA1 and HBA2 genes. Results: In total eight pathogenic mutations were detected in HBB gene. The mutations and the mutant allele frequencies in the HBB gene were: IVS1-5G>C in 39 (53.4%), IVS1-1G>A in 17 (23.3%), CD26G>A in 5 (6.8%), CD15G>A in3 (4.1%), IVS1-129A>C in 1 (1.4%), IVSII-613C>T in 1 (1.4%), CD41/ 42-TCTT deletion in 1(1.4%), and 619bp deletion in 6(8.2%). In  thalassaemia group 9(50%) were homozygous for deletions (8 were 3.7/ 3.7, and 1 was 4.2/ 3.7), 7 (39%) were heterozygous carriers (6 were / 3.7 and 1 was / 4.2). Two patients (11.1%) with + thalassaemia had a point mutation in the HBA2 gene; HBA2c*+107A>G. Conclusions: The mutations in the HBB gene in this group are similar to that reported in the Sri Lankan population before. The non deletional  thalassaemia mutation reported here is the first to be reported in this population and is a very rare mutation reported only once before in medical literatur

Abstracts of Poster Presentations PP 53: Hereditary thrombophilia in a cohort of patients with thromboembolism in Sri Lanka HWW Goonasekara, AI Kuruppu, RW Jayasekara, VHW Dissanayake Human Genetics Unit, Faculty of Medicine, Colombo Introduction: An update on data of genetic screening for genetic thrombophilia in a single institution in Sri Lanka over six years is presented. The F5-1691G>A, F2-20210G>A and MTHFR-677C>T variants were screened. F5 and F2 variants are mainly implicated in venous thrombosis and are rare in Asians. MTHFR variant is common and is mainly associated with arterial thrombosis. However all three variants have been implicated in thrombosis in both circulations. Currently there are no defined cost effective hereditary thrombophilia screening strategies or guidelines in Sri Lanka. Aims: To determine the prevalence of the above three variant alleles in thrombophilia patients. Methods: DNA was extracted from venous blood samples after obtaining written informed consent. Genotyping was done using PCR/RFLP. Results: 765 patients, age ranging from 1-77 years, were tested from February 2006-March 2012; 42% were males. 583(76.2%) were negative. Those who tested positive; the total number for each indication and their prevalence for F5, F2 and MTHFR variants respectively were: Deep vein thrombosis(DVT)-137; 2.2%; 0.4%; 11.7%. Pulmonary embolism(PE)-30; 0%; 0%; 13.3%. Cerebrovascular accidents-320; 1.3%; 0.3%; 9.4%. Myocardial infarction-39; 2.6%; 0%; 16.6%. Abdominal vein thrombosis -50; 0%; 0%; 13%. Pregnancy complications-135; 0.4%; 0%; 9.6%. Other arterial thrombosis -13; 0%; 0%; 19.2%. Other venous thrombosis-17; 5.9%; 0%; 17.6%. DVT with PE-14; 3.6%; 0%; 17.9%. Miscellaneous indications10; 0%; 0%; 25%. Conclusions: The prevalence of the variant alleles is similar to other Asian populations and also similar to the association with the type of thrombosis in similar thrombophilic cohorts. Routine screening for all three variants for any type of thromboembolic disease cannot be recommended. PP 54: JAK2 mutation prevalence among patients with myeloproliferative neoplasms and thrombophilia in Sri Lanka HWW Goonasekara, AI Kuruppu, I Wijewardene, RW Jayasekara, VHW Dissanayake Human Genetics Unit, Faculty of Medicine, University of Colombo Introduction: JAK2 an acquired somatic mutation is found in >95% patients with Myeloproliferative Neoplasms (MPN) and approx. 50% of patients with Polycythaemia vera (PV), Myelofibrosis and Essential thrombocytaemia (ET). It helps to diagnose a MPN, and especially occult MPN which can be associated with abdominal vessel thrombosis. Presence of JAK2 in other types of thrombosis is rare, and is also not found in childhood. Aims: To report the prevalence of the JAK2 mutation in MPN and in thrombophilia in Sri Lanka. Methods: DNA was extracted from venous blood samples after obtaining written informed consent. The mutation was tested using an allele-specific PCR. Results: A total of 587 were tested. 45 (7.7%) were investigated for MPN-group-1, 542 (92.3%) had a history of thrombosis-group-2, of which 43 (7.4%) were <12 years of age-group-3. The prevalence of JAK2 was 12 (26.6%) in group-1, 2 (0.4%) in group-2 and 0(0%) in group-3. In group-1 of the total, 23 were tested for PV and JAK2 was detected in 7 (30.4%). 22 were tested for other MPN and JAK2 was detected in 5 (22.7%). In group-2 the thrombotic events had occurred in cerebral vessels, and recurrent deep vein and abdominal vessel thrombosis. None had peripheral blood counts of a MPN. Conclusions: The low prevalence of the JAK2 mutation in thrombophilia and paediatric populations is similar to other published studies. JAK2 prevalence much lower than the reported prevalence rates of other MPN cohorts. This may indicate that larger studies are needed and also stringent criteria need to be adhered to when testing for the JAK2 mutation especially in PV.

Abstracts of Poster Presentations PP 55: Frequency of maternal unexpected red cell alloantibodies in early pregnancy among Sri Lankan women SMGS Manchanayake, PPK Dissanayake National Blood Centre, Colombo Introduction: The World Health Organisation recommends antenatal antibody screening at the booking visit for all pregnant mothers for early identification of red cell alloantibodies. The frequency of clinically significant red cell alloantibodies during early pregnancy has not been reported in Sri-Lanka. Aims: To detect the frequency of maternal red cell alloantibodies in pregnant women at the booking visit. Methods: This prospective study was conducted from August to December 2011. Antenatal blood samples, which were sent for blood grouping at the booking visit were collected from the blood bank of the De Soysa Hospital for Women, Colombo. Antibody screening and identification were performed using the 370C indirect antiglobulin test. Blood group and parity of mothers were recorded from registers. Results: A total of 954 samples were analyzed. 60% of mothers were multiparous. Overall, 23% were group A, 29% group B, 6% group AB, 41% group O and 5.5% Rhesus D negative. Antibody screening was positive in 2.5% (n = 24) of samples. Among positives, the commonest antibody identified was anti-Leb (62.5%, n =15), and the others were anti-Lea (12.5%, n = 3) and anti-Lea + anti-Leb (4.2%, n = 1). Antibodies of unknown specificity were detected in 20.8 % (n =5) of the patients. Conclusions: In this study, clinically significant red cell alloantibodies were not detected during screening of mothers at the booking visit. The cost-effectiveness of a national policy of antibody screening at the booking visit for all pregnant mothers regardless of Rhesus D type should be discussed further before implementation. PP 56: Complications associated with pre-eclampsia R Amarasekara1, RW Jayasekar1, H Senanayake2, VHW Dissanayake1 1Human Genetics Unit, Faculty of Medicine, University of Colombo 2Department of Obstetrics and Gynecology, Faculty of Medicine, University of Colombo Introduction: Pre-eclampsia (PE) is one of the leading causes of maternal and infant morbidity and mortality. It is responsible for 50,000 maternal deaths and 7% of all pregnancy related complications annually worldwide. Aims: To describe the complications associated with PE in a sample of primi-parous women recruited during January 2010 to June 2011 for a meta-genomic study on PE. Methods: The phenotypic features of 60 women with PE were analyzed to describe pregnancy related complications associated with PE. Results: 56.6% (34) had systolic blood pressure over 160 mmHg, 31.6 % (19) had diastolic blood pressure over 110 mmHg, 48.3% (29) had proteinuria more than 3+, 8.3% (5) had platelet counts below 100x109/L, 13.3% (8) developed eclampsia, 3.3% (2) developed HELLP syndrome, and 46.6% (28) delivered pre-term. The birth weight of 45% (27) of babies was less than 2kg. 21.6 % (13) were admitted to the intensive care unit (ICU), 50 % (30) of babies had to be admitted either to the prenatal baby unit (PBU) or neonatal intensive care unit (NICU) and 3.3% (2) of babies died within a month of birth. Conclusions: Women with pre-eclampsia experience severe complications in pregnancy. Extensive research is required to find markers for early detection of the condition and targets for new therapies.

Abstracts of Poster Presentations PP 57: Episiotomy rate - is it too high? TRN Fernando Faculty of Medical and Allied Sciences, Rajarata University of Sri Lanka Introduction: Episiotomy rates of the world range from as low as 9.7% in Sweden to 100% in Taiwan. Episiotomy is often called the unkindest cut of all. Sri Lanka college of Sri Lanka college of obstetricians and gynaecologists (SLCOG) recommends, if an episiotomy is considered necessary a medio- lateral episiotomy is preferred and should be performed at the time of crowning of the fetal head. WHO recommend an episiotomy rate of 10%. Evidence over the last 2 decades show that many women fare better without episiotomy because the natural tears they suffer are often less severe than the episiotomy. Aims: 1. To calculate the rate of episiotomies at Anuradhapura Teaching Hospital (ATH) 2. To find out if local analgesia was given prior to episiotomy. Methods: Data were collected from the birth registry and BHTs of postnatal ward of Anuradhapura ATH. over 30days from April 21st to 20th of May 2011. Verbal consent was taken. All normal vaginal deliveries (NVD) were taken to the sample. Results: Total of 799 NVDs, with 406 Primiparas and 393 multiparas. Episiotomy rate was 85% for primiparas and 30% for multiparas. Overall rate of episiotomy was 59%. None had local analgesia prior to episiotomy. Conclusions: It is difficult to know how high is too high for episiotomy rates, because the surgery can help hasten some difficult labours. Some studies have suggested that a rate above 30% cannot be justified, while others have suggested rates of 10-20% to be appropriate. Episiotomy rate at ATH is higher than these recommendations. Should we reduce episiotomy rate and promote analgesia for episiotomies? PP 58: A rare case of tubal pregnancy - six years after subtotal hysterectomy CD Wasalthilaka, HMS Senarathne Teaching Hospital, Kandy Introduction: Ectopic Pregnancies following hysterectomies are rare. There are probably less than 60 reported cases in the entire world literature. The condition is rarely diagnosed. Delayed diagnosis and treatment are the leading causes of complications in ectopic pregnancy. This rule is equally applicable to hysterectomised patients. Case report: A 37 year old patient who had undergone subtotal hysterectomy due to postpartum haemorrhage after her 4th child birth in 2005, presented with nonspecific abdominal pain for 3 weeks and per vaginal bleeding for 3 days. Her ultrasound scan showed a right sided adnexal mass with minimal amount of free fluid in the pouch of Douglas. Her CA 125 level was slightly elevated. Explorative laparotomy was performed and a right sided tubo-ovarian mass was found with an organized blood clot. Subsequently the mass was confirmed histologically as a tubal pregnancy. Ectopic pregnancy after such a long duration following hysterectomy is very rare. Only seven cases have been reported during a five year period. This tubal pregnancy could have resulted from a communication between the vagina and peritoneal cavity through the cervical stump. In this case serum beta HCG was not assayed as the ultrasound reported a complex ovarian mass and the presentation was a long time after the hysterectomy. Conclusions: Ectopic pregnancy should be suspected in women with intact ovaries, even those with a previous hysterectomy, who present with abdominal pain.

Abstracts of Poster Presentations PP 59: Vaginal birth after Caesarean section - a prospective cohort study TJ Tilakaratna1, RC Fernandopulle2 1Teaching Hospital, Kandy 2Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Sri Jayewardenepura Introduction: Caesarean section rate is increasing globally. One of the main indications for CS is repeat caesarean delivery due to past section. Women opting for vaginal birth after caesarean section (VBAC) will be one of the strategies to reduce elective repeat LSCS rate. Aims: This study aims to determine the success rate of VBAC in a tertiary care setting in Sri Lanka and the contributory factors for the success. Methods: This prospective cohort study was conducted at ward 21 CSTH and ward 05 DSHW from July 2009 to April 2011. A total of 161 eligible pregnant women who delivered at above units with one past LSCS were recruited from 36 weeks onwards of gestation. Data were obtained by a structured data sheet before and after the delivery. Results: Out of 161 who attempted VBAC, 112 women (69.6%) achieved successful vaginal birth. 49 women (30.4%) were delivered by emergency LSCS. Factors such as indication for the previous LSCS, previous vaginal deliveries, birth weight <3000g, cervical dilatation > 2cm at admission, position of the fetal head were found to be significantly associated with the success rate of VBAC. Maternal BMI < 30 increases the success rate even though not statistically significant. Advanced maternal age, augmentation of labour are factors that decrease the likelihood of success rate. Conclusions: VBAC is an effective method to reduce rising caesarean section rate. Several antenatal and intrapartum factors associated with the success of VBAC in individual patients will be helpful in counseling and decision making. More multicenter studies are needed to see the applicability in both well resource and low resource settings. PP 60: A study of maternal and perinatal outcome and maternal body mass index R Mohamed, MG Dhanalakshmi Sri Ramachandra Medical College and Research Institute, Chennai, India Introduction: It has been observed, that mothers whose pre-pregnancy BMI was below and above ideal BMI were at increased risk of having babies with inappropriate weight for gestational age and adverse maternal and perinatal outcome. Aims: To study mothers with BMI less than and more than ideal BMI, for their maternal and perinatal outcome. Methods: In 200 mothers delivering at Ramachandra Medical college Hospital from July 2010 to August 2011, whose pre-pregnancy weights were noted and followed up till the end of their pregnancy and maternal and neonatal outcome were noted. Results: The percentage of mothers in the different BMI range were as follows : BMI < 20.9 (group A) = 19.5%, BMI 21-25(group B) = 54% BMI 25.1-30(group C) = 24.5% BMI 30.1-35(group D) = 2% BMI >35(group E) nil The following antenatal complications were noted in the study. Group C had the highest incidence of GDM - 63.15%, Preeclampsia - 75% and IUGR - 44.4%.The Maximum spontaneous vaginal deliveries were in Group B- 69.5%. Whereas maximum operative deliveries were in group C 62.5%. Anaemia was most common in group A -72.7%. Conclusions: When mothers were in either extreme of BMI their pregnancy outcome was adversely affected. Hence the need for idealising pre-pregnancy weight, before embarking on a pregnancy

Abstracts of Poster Presentations PP 61: Establishment of human endometrial stromal cell cultures as in-vitro models to test the effects of metalloestrogens in women with or without endometriosis N Silva1, K Tennekoon2, H Senanayake3, S Samarakoon2, S Fernando4, R Wickramasinghe4, RP John5 1Faculty of Medical Sciences, University of Sri Jayewardenepura 2Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo 3Faculty of Medicine, University of Colombo 4Faculty of Medicine, University of Kelaniya 5Faculty of Medical and Health Sciences, University of Auckland, New Zealand Introduction: Effects of metalloestrogens like cadmium (Cd), lead (Pb) and nickel (Ni) are difficult to demonstrate in-vivo due to toxicity and therefore requires suitable in-vitro models. Aims: To establish endometrial stromal cell(ESC) cultures as in-vitro models to demonstrate the effects of metalloestrogens in women with and without endometriosis. Methods: Stromal cells were isolated from eutopic endometrial samples from five women with endometriosis(patients) and five women without endometriosis(controls). ESC cultures were established and maintained in RPMI medium. Cultures were treated with Cd, Pb and Ni at concentrations of 10-6M, 10-9M and 10-9M respectively. At 24 h and 48 h, cell number was counted using the Neubauer haemocytometer. Sulphorhodamine(SRB) cytotoxicity assay was used to test the effect of different concentrations of metals on ESC cultures. After 24 h of treatment, caspase levels in ESC cultures were evaluated with a commercially available ELISA kit. Relative cell proliferation, SRB assay results and caspase levels were analyzed with ANOVA. Results: ESC cultures were maintained up to 30 days. In both patients and controls Cd, but not Pb or Ni increased the relative proliferation in ESC cultures (p<0.05). At 48 h, Cd induced ESC proliferation was higher in patients than in controls (p=0.02). SRB assay results and caspase levels were similar in the two groups. Conclusions: Established ESC cultures served as stable in-vitro models. Cd induced the proliferation of ESC from women with endometriosis which appears to be independent of reduced apoptosis. Similar effects of Pb and Ni could not be demonstrated in this in vitro model. PP 62: Factors associated with high rate of caesarean section in De Soysa Hospital for Women: A case-control study AMNL De Silva, WEGKL Dayanada, GHM Dayaratne, U Senarath Faculty of Medicine, University of Colombo Introduction: Rate of caesarean section has increased remarkably over last few decades in Sri Lanka. There is lack of research evidence about reasons for this trend. Aims: To determine the factors associated with delivery by caesarean section at De Soysa Hospital for Women. (DSHW). Methods: A case-control study was carried out in all obstetric wards of DSHW. Data were collected from 59 women who delivered by caesarean section (cases) and 55 women who delivered vaginally (controls). Socio-demographic data, past and current obstetric information, medical conditions, indicators of antenatal care and other related factors were compared between cases and controls using odds ratios. Results: Previous caesarean sections (OR=38.1; 95% CI=7.8-187.0) including both elective and emergency caesarean sections showed the strongest association with caesarean section. Monthly income more than Rs.25, 000 (OR=2.3; 95% CI=1-5.6), undergoing 4 or more antenatal ultra sound scans (OR=2.7; 95%CI= 1.2-5.7), hypertension during current pregnancy (OR=5.4;95% CI=1.1-25.9), maternal preference for caesarean section (OR=6.8; 95% CI=1.4-31.8) increased the likelihood of caesarean section. Mean age was higher in mothers who underwent caesarean section. Early antenatal registration (t=2.2; df=112; p<0.05), and early booking visit (t=2.2; df=112;p<0.05) were associated with high rates of caesarean section. Parity was not associated with caesarean section Conclusions: Study identified certain modifiable risk factors that can be addressed to reduce caesarean sections. Since there is a high chance of repetition of caesarean sections in a woman, preventing it at first instance would reduce her risk of having subsequent caesarean sections.

Abstracts of Poster Presentations PP 63: The association between use of different contraceptive methods and abnormal cervical cytology among clinic attendees of Family Planning Association, Sri Lanka AC Jayatilleke, S Thissera, U Palandage, M Wimalarathne, P Guruge Family Planning Association Sri Lanka, Colombo Introduction: Hormonal contraceptive methods cause changes in the cervical mucus. The copper intrauterine contraceptive device (IUCD) has a known association with bacterial vaginosis. However, the association between the contraceptive method use and cervical cytology is not well examined so far. Aims: This study aimed to examine the association between the use of different contraceptive methods and abnormal cervical cytology among clinic attendees of FPA Sri Lanka. Methods: We analyzed 1143 pap smears taken between 1st January 2007 and 31st December 2009 at the FPA Sri Lanka and were interpreted by two consultant pathologists. Using the Pearsonâ&#x20AC;&#x2122;s Chi-square test, we examined the association between contraceptive methods and cervical cytology. Results: Of the 1143 women whoâ&#x20AC;&#x2122;s pap smears were examined, 53.4% did not use any contraceptive method, 16.8% used IUCDs, 9.3% used hormonal methods, 7.6% used male condoms and 12.9% had undergone permanent sterilization. IUCD users and the users of male condoms showed significant positive associations with abnormal cervical cytology in the form of mild, moderate or severe inflammation (p<0.001 and p<0.05 consecutively). However, such a positive association was not seen with the use of hormonal contraceptive methods. Further, using any of the contraceptive methods did not show an association with the premalignant or malignant lesions of the cervix. Conclusions: Pap smear is one of the best methods to detect premalignant and malignant lesions of the cervix. Yet, routine pap smear examinations among IUCD users and male condom users will permit early detection and treatment of the infections of cervix. PP 64: Implications and outcomes of caesarean section - a cross sectional study in Teaching Hospital, Jaffna A Kuganananthan1, N Kiritharan1, N Rajeshkannan2, A Sritharan3 1Faculty of Medicine, University of Jaffna 2Department of Community Medicine, University of Jaffna 3Teaching Hospital, Jaffna Introduction: Caesarean section rates continue to increase worldwide due to the influence of many factors. It may have negative consequences on both mother and baby. Aims: To describe the implications and outcomes of caesarean section and time of initiation of breast feeding among mothers who underwent caesarean section in Teaching Hospital, Jaffna. Methods: This descriptive cross sectional study, based on interviewer-administered questionnaire, recruited all the mothers who underwent caesarean section consecutively until sample size of 310 was reached. We assessed the background details, obstetrics characteristics, indications of caesarean section, medical problems, maternal and fetal outcome and breast feeding status. Conclusions: Previous caesarean section (32.6%, 95%CI: 27.5-38.0%), fetal distress (20.0%, 95%CI:15.824.7%), abnormal fetal presentation (12.9%,95%CI:9.5-17.0%), lack of progression (11.9%,95%CI:8.715.9%), placenta previa (3.9%,95%CI:2.1-6.5%), eclampsia/ pregnancy induced hypertension (5.8%,95%CI:3.5-8.8%) and cephalopelvic disproportion (2.6%,95%CI:1.2-4.8%) were the common indications for caesarean section. In five s (1.6%, 95%CI: 0.6-3.5%) maternal preference was the only indication. Pain was the major post-operative complaint. There were no maternal deaths and 1.6% of the mothers developed postpartum hemorrhage. 313 babies were born alive and three mothers delivered twins (1%). 16.8% of the babies were admitted to premature baby unit due to low birth weight (6.1%) and fetal distress (2.6%) Two (0.6%) early neonatal deaths were recorded. 91% of mothers started breast feeding after delivery and 57.3% of them breastfed after one hour of delivery.

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Abstracts of Poster Presentations PP 65: Identifying gene-gene interaction network in preeclampsia using text mining of PubMed abstracts HWMM Hapudeniya1, VHW Dissanayake2 1Colombo North Teaching Hospital, Ragama 2Human Genetics Unit, Faculty of Medicine, University of Colombo Preeclampsia is a dangerous condition in pregnant women worldwide, which has a genetic component, several genes interact with each other to bring about preeclampsia. Much of the data on interaction can be found in a variety of interaction databases, but they are often not up to date, and most recent data can be found only in literature. However, manual reading of all the literature to find specific information is now becoming impractical due the ever expanding volume of literature. In the current study, this problem is approached by applying text mining methods on PubMed abstracts. Relevant PubMed abstracts were retrieved and sentence boundary detection was done using GeniaSS tool. Tokenizing and entity recognition was done using GeniaTagger tool. All the data was stored in a MySQL database and Perl was used as the programming language. Gene name normalization was done using a gene name dictionary created for the current work. A sentence which has more than two unique gene symbols and at least one interaction word was selected as candidate sentence for further processing. Information was extracted by manual reading and a web site was created to present the output of the work. 457 sentences were selected as candidate sentences out of 11172 sentences. 42 sentences were found to be describing genegene interactions. There were 59 genes participating in 51 interactions. Current approach has shown promising results, and it has significantly reduced the manual reading work load. PP 66: A genome wide comparison of the single nucleotide (SNP) profile of the Sri Lankan Personal Genome with the SNP profiles of five other Genomes LRAB Jayaratne1, N Samaranayake2, VHW Dissanayake3 1Post Graduate Institute of Medicine, University of Colombo 2Department of Parasitology, Faculty of Medicine, University of Colombo 3Human Genetics Unit, Faculty of Medicine, University of Colombo Introduction: The first Sri Lankan Personal Genome (SLPG) of an anonymous Sinhalese individual was sequenced in 2010. The objective of this study was to compare the single nucleotide polymorphism (SNP) profile of the SLPG to that of genomes of other populations. Methods: The SNP profile of the SLPG was compared with the SNP profiles of five genomes (SJK in Korean; Han Chinese in China; Yoruba in Nigeria, Gujarati Indian in USA, and Toscan in Italy). The first step was to update the SNP profiles to dbSNP build 135. Then the SNP profiles were compared. Results: The Sri Lankan genome shared 57.29%, 44.63%, 43.81%, 21.34% and 21.28% with SJK in Korean; Han Chinese in China; Yoruba in Nigeria, Toscan in Italy and Gujarati Indian in USA respectively. Conclusions: These results for the first time give insights to the relatedness of the Sinhalese in the Sri Lankan population to other world populations.

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Abstracts of Poster Presentations PP 67: Identification of clinically significant single nucleotide polymorphisms (SNPs) in the Sri Lankan personal genome IRN Fernando1, N Samaranayake2, VHW Dissanayake3 1Post Graduate Institute of Medicine, University of Colombo 2Department of Parasitology, Faculty of Medicine, University of Colombo 3Human Genetics Unit, Faculty of Medicine, University of Colombo Introduction: The first Sri Lankan Personal Genome (SLPG) was sequenced in 2010. We analysed the SLPG to identify clinically significant single nucleotide polymorphisms (SNPs) in the SLPG. Methods: The clinically significant SNPs associated with increased risk of diseases identified by Genome Wide Association Studies (GWAS) are found in HuGE Navigator (http://www.hugenavigator.net/HuGENavigator/downloadcentre.do). The SNP profile of the SLPG was compared with clinically significant SNPs found in the GWAS database. Results: There are 7095 SNPs in the HuGE Navigator database that are known to confer increased risk of various diseases in other populations. Of them 2396 (33.77%) were found in the SLPG. The number of SNPs related to genes involving disorders of various systems were as follows: cardio vascular system 619 (25.83%), nervous system 562 (23.45%), digestive system 399 (16.65%), endocrine system 240 (10%), reproductive system 168 (7%), respiratory system 78 (3.25%), musculoskeletal system 73 (3.05%), skin 66 (2.75%), renal system 48 (2%), eye 48 (2%), other 95 (3.96%). Conclusions: The identification of the presence and absence of SNPs associated with increased risk of various diseases in other populations, in the SLPG, point to the possibility of similarities as well as differences in the clinical picture and treatment outcome of these conditions which underscore the need for research into these conditions in our population. PP 68: Single nucleotide polymorphisms in the Sri Lanka personal genome: implications for aetiology of disease in the Sri Lankan population EPDS Ediriweera1, N Samaranayake2, VHW Dissanayake3 1Post Graduate Institute of Medicine, University of Colombo 2Department of Parasitology, Faculty of Medicine, University of Colombo 3Human Genetics Unit, Faculty of Medicine, University of Colombo Introduction: The first Sri Lankan Personal Genome (SLPG), the genome of a Sinhalese man, was sequenced in 2010. This enabled identification of single nucleotide polymorphism (SNPs) prevalent in the Sri Lankan population at genome scale. SNPs are implicated in health and disease, and identifying SNPs unique to the Sri Lankan population would enable us to gain new in sites to aetiology of disease in Sri Lankans. The aim of this work was to compare the SNPs profile of the SLPG with the SNPs deposited in the dbSNP database build 135 - the online database that catalogues all SNPs discovered in the world - at the National Center for Biotechnology Information (NCBI), USA. Methods: A newly designed SNP re-annotation tool was developed to annotate the SNP profile of the SLPG to be compatible with build 135 of the dbSNP database. The SNP profile of the SLPG was compare with that of the dbSNP build 135 using the same tool. Results: The SLPG had 2,814,051 SNPs. 214,874 (0.076%) were SNPs unique to our population. 1,058 (0.005 %) of them were in coding regions and 624 (58.97%) were non synonymous. Conclusions: SNPs located in coding regions, especially non synonymous SNPs are the ones most likely to be associated with disease. The identification such SNPs, which are unique to our population, in the SLPG, underscore the need to initiate research into the aetiology of all types of disease in our population because the clinical picture and treatment outcomes may differ in our population due to our unique genetic makeup.

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Abstracts of Poster Presentations PP 69: Creating a catalogue of disease specific micro RNAs in the Sri Lankan Human Genome MYM Ajwath1, N Samaranayake2, VHW Dissanayake2 1Post Graduate Institute of Medicine, University of Colombo 2Department of Parasitology, Faculty of Medicine, University of Colombo 3Human Genetics Unit, Faculty of Medicine, University of Colombo Introduction: The role of microRNAs (miRNA) in the control of cell growth, differentiation, apoptosis and tumorigenesis is well recognized. miRNAs exerts their effects by binding complementary to the 3’ untranslated regions (UTR) of messangerRNAs (mRNA) and interfering with their translation. A single miRNA can target many different sites on the same mRNA or on many different mRNAs. Single Neucleotide polymorphisms (SNPs) within the miRNA targets, could interfere with the activity of miRNA’s, and determine an individual’s risk of developing complex diseases. The objective of this work was to identify and catalog the SNPs located in the miRNA binding sites in the Sri Lankan Personal Genome (SLPG). Methods: Two MySQL relational tables were created. First with the updated SLPG SNP profile. Second with data of miRNA binding sites in the 3’UTR of RefSeq genes for conserved miRNA families predicted by TargetScan v5.1. Then a MySQL query was executed to select all SNPs in the SLPG which were present within the binding sites. Results: There were 85 SNPs identified in the miRNA binding sites in the SLPG. 75 were SNPs already identified in other populations. 10 were SNPs not found in other populations. An online catalogue was producedat http://bmicentral.dyndns.info:8084/lankamirnew. Conclusions: The identification of SNPs which are located in miRNA binding sites, which are unique to our population, in the SLPG, underscore the need to initiate research into the aetiology of all types of disease in our population because the clinical picture and treatment outcomes may differ in our population due to our unique genetic makeup. PP 70: Kidney disease in the elderly: A Sri Lankan perspective C Rodrigo1, L Samarakoon2, S Rajapakse1, R Lanerolle1, R Sheriff1 1Department of Clinical Medicine, Faculty of Medicine, University of Colombo 2University Medical Unit, National Hospital of Sri Lanka, Colombo Introduction: Renal disease in the elderly in Sri Lanka is a largely neglected area in the medical literature. Aims: To build a profile of elderly patients admitted to the University Medical Unit with a renal disorder. Methods: This prospective study included all patients >65 years old admitted to the University Medical Unit of NHSL over a period of one year with a primary renal related illness/cause as the reason for admission. Results: Over the study period, 86 patients (72 males and 14 females) were admitted with a primary renal disease. 45 (52%) patients had diabetes while 57 (66%) had hypertension as co-morbidities. 29 (34%) patients had acute kidney injury (AKI) while 72 (84%) had chronic kidney disease (CKD). 14 (16%) had acute kidney injury with background chronic kidney disease. Diabetes and hypertension accounted for most cases of CKD while Hump nosed viper bite was the leading cause for AKI. Of the patients with end stage CKD, only 37 (63%) were commenced on haemodialysis. A majority were inadequately dialyzed. Conclusions: We would like to make several recommendations for caring of the elderly with renal disease. a) Raising public awareness of primary, secondary and tertiary prevention of co-morbidities b) Community based studies to assess the renal disease burden of diabetes and hypertension in Sri Lanka c) A government funded (or at least subsidized) health insurance scheme to enable senior citizens with CKD to have dialysis support.

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Abstracts of Poster Presentations PP 71: Vision related quality of life of patients with cataract in the conflict affected Vavuniya district and Gampaha district AAN Nishad1, J De Silva2, IM Wasthuhewaarachchi3, SH Uyangoda2, A Pathmeswaran4, S Amaratunge2 1Post graduate Institute of Medicine, University of Colombo 2Vijaya Kumaratunge Eye Hospital, Seeduwa 3Teaching Hospital, Vavuniya 4Faculty of Medicine, University of Kelaniya Aims: To compare vision-related quality of life (VRQOL) of cataract patients living in the conflict affected Vavuniya district with cataract patients living in Gampaha district. Methods: The World Health Organization quality of life instrument (WHOQOL) was adapted as the VRQOL instrument with a ten-point visual analogue scale. VRQOL was administered and dilated ocular evaluation carried out in adults with cataract attending eye clinics in Vavuniya and Gampaha districts in May 2011. Relationships among overall VRQOL scores with sex, best corrected visual acuity (BCVA) and presence of chronic disease were compared. Less than 6/36 of visual acuity was considered low. Diabetes, hypertension or ischaemic heart disease were considered chronic diseases. Results: VRQOL had a high internal consistency (? = 0.84). Each item of the VRQOL scale had an adequate item–total correlation (range, 0.42–0.68). There were 151 participants from Gampaha district and 150 from Vavuniya, and 44.5% were males. Mean (SD) age was 63.4 (9.9) years. The mean (SD) VRQOL score was significantly lower (p=0.004) for patients with low BCVA 69.8 (18.7) than for patients with adequate BCVA 81 (16.9). Neither sex nor chronic disease showed a significant association with VRQOL score. Cataract patients from Vavuniya district had a significantly lower (p<0.001) mean (SD) VRQOL score 69.1 (16.8) than patients from Gampaha 86.4 (15.2) after adjusting for the above three factors. Conclusions: Low VRQOL score was associated with lower BCVA, but not with sex or presence of chronic disease. Participants from Vavuniya district had lower VRQOL scores than participants from the Gampaha district. PP 72: Knowledge and practices regarding leptopirosis among grade 9/10 school children YM Samarakoon, N Gunawardena Medical Officer of Health Office, Biyagama Introduction: Leptospirosis is a disease commonly affecting farmers. In farming families children are involved in agricultural activities and some will take up farming as an occupation. Aims: The aim was to describe knowledge, factors associated with knowledge and preventive practices regarding Leptospirosis among grade 9/10 students in Galgamuwa educational division in the Kurunegala district. Methods: A descriptive cross-sectional study was conducted among grade 9/10 students (n=460) using a self-administered questionnaire. Level of knowledge was based on scores obtained for responses. Results: A majority (52%) had a ‘good’ level of knowledge. Parental involvement of paddy cultivation was 70.4% among fathers and 50.4% among mothers. Of the students, 62.2% were involved in paddy cultivation and 18.2% of them used gloves/boots frequently. Handling cattle/buffaloes was reported by 9.3%; of these 60.5% washed hands and feet frequently, after handling animals. Swimming, bathing and washing in stagnant water ponds was reported by 13%. Use of prophylactic treatment against leptospirosis by family members was 60.3%. The level of knowledge regarding leptospirosis was significantly associated with the fathers (p<0.001), mothers (p=0.012) and self involvement (p=0.045) in paddy cultivation. Conclusions: Though the overall level of knowledge regarding leptospirosis was satisfactory, the study identified several gaps. Overall level of knowledge was better with the involvement of the students and their parents in paddy cultivation. Study also identified gaps in personal and household practices related to prevention of leptospirosis.

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Abstracts of Poster Presentations PP 73: Precipitant profile for acute heart failure: experience of a tertiary level cardiac centre in Sri Lanka AT Matthias1, R Ekanayake2 1National Hospital of Sri Lanka, Colombo 2Institute of Cardiology, National Hospital of Sri Lanka, Colombo Introduction: Acute Heart Failure (AHF) is a common cause of hospitalization in most countries. Data on precipitants of heart failure and hospitalization is not available in Sri Lanka. Aims: To describe the precipitants and clinical outcome of AHF. Methods A prospective study on hundred sequential admissions with AHF to the Institute of Cardiology (NHSL). Results: Fifty eight male and 42 female admissions were studied. Mean age was 60.66yrs. Mean hospital stay was 5.5 (SD 4.6) days. Sixty had denovo heart failure and forty had pre-existing heart failure. The most common identifiable precipitants were acute ischaemia 37 (37%), anaemia 41 (41%), respiratory tract infection (RTI) 10 (10%), arrhythmia 11 (11%), worsening renal function 11(11%) and alcohol 5 (5.7%). Non adherence to medication 4 (4.6%), smoking 3 (3.9%), exposure to environmental stress 3 (3.4%) and uncontrolled hypertension 1 (1%) were also observed as precipitants. Commonest arrhythmia was atrial fibrillation. The mortality rate was 8%. Those with ischaemia had a higher mortality compared to those who did not (p=0.023). Out of 34 patients in whom angiotensin-converting enzyme inhibitors or angiotensin-converting enzyme receptor blockers were indicated, 11% were not on the drug. Among 29 patients in whom spironolactone was indicated, seven patients were not on the drug. Conclusions: Most precipitating factors of AHF are preventable. Early identification and prevention of anaemia, preventing RTI by influenza vaccination, aggressive revascularization for patients with ischaemia, monitoring of renal functions and patient education regarding drug and diet compliance would reduce the number of admissions. Good patient and physician collaboration is also vital in optimizing management of AHF. PP 74: Innervation and the distribution of functional nicotinic acetylcholine receptors in human lymphoid tissue M Thayabaran1, SG Yasawardene 1Department of Human Biology, Faculty of Health-Care Sciences, Eastern University of Sri Lanka Introduction: Although immune system is known to be regulated by autonomic nerves, the neuronal control through acetylcholine receptors is not clear. Aims: To localize the neural innervation using Neuron Specific Enolase (NSE), which specify the neurons and peripheral nerves and the expression of nicotinic acetylcholine receptors in human immune tissues using immunohistochemistry. Methods: Indirect immunohistochemistry was performed on fresh human postmortem samples of immune tissues. Anti-NSE, anti-nAChR 1 and 7subunits as primary antibodies and biotinylated anti-rabbit IgG, anti-rat IgG as secondary antibody were used to labeled. The Labelled Streptavidin Biotin (LSAB) technique was used; with diaminobenzedene to detect the immunoreactivity. Intensity of immunostaining was determined based upon a score of 0, 1+(focal staining, >10%cells), 2+(focal-diffuse staining, 10-50%cells), 3+(diffuse staining, 50-100%cells) by qualitative computerized image analysis. Results: Immunoreactivity(IR) to anti-NSE was observed in splenic capsule and red pulp; capsular, subcapsular sinuses and trabeculae of lymph nodes and portaltriad of liver, while 1nAChR expression was identified in splenic capsule, red pulp and periarteriolar region. In lymph nodes the capsular, subcapsular sinuses and trabeculae showed 2+IR and diffused IR in liver. Both 1nAChR and NSE expressed 1+IR in marginal zone of Peyersâ&#x20AC;&#x2122; patches. The anti-?7nAChR was expressed in splenic red pulp and trabeculae of lymph nodes. Conclusions: Neuronal innervation of lymphoid tissue is through the supporting framework of reticulin fibres to the parenchyma. A similar distribution of 1nAChRs were seen with minimum of 7nAChR in human. This confirms the functional parasympathetic neuronal innervation of immune tissues mainly through 1nAChRs.

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Abstracts of Poster Presentations PP 75: Predictors of duration and degree of third space fluid accumulation in adult patients with dengue R Premaratna1, A Ragupathy2, JKND Miththinda2, HJ de Silva1 1Faculty of Medicine, University of Kelaniya 2Professorial Medical Unit, Colombo North Teaching Hospital, Ragama Introduction: Fluid leakage is the hallmark of dengue shock syndrome. It is important to identify clinical and biochemical parameters which predict duration and degree of fluid leakage in dengue. Methods: 102 patients with confirmed dengue were prospectively followed up for clinical, haematological and biochemical parameters, and they were correlated with ultrasonographic evidence of third space fluid accumulation (TSFA). Results: Of the 102 patients (52 males; mean age 28.3 years(SD=11.8), TSFA was detected in 34/95(36%) after hospital admission; 33/95 had pleural effusions which included all except one of 21/95 who had ascites. 72.7% pleural effusions lasted 3 or more days and 52.4% ascites lasted less than 3 days. Duration of pleural effusion showed a significant positive correlation with maximum percentage rises of PCV (r=0.526,p=0.001) and Hb(r=0.525, p=0.001) and negatively correlated with WBC count (r=-0.361, p=0.020) and platelet count (r=-0.585, p=0.000). There was no correlation with any of the other parameters. The mean lowest WBC count of 3005/mm3that was recorded for patients who developed bilateral pleural effusions (n=21) was significantly less (p=0.042) than the mean lowest WBC count of 4091/mm3 that was detected for unilateral effusions(n=12). Duration of ascites was significantly positively correlated with highest AST(r=0.598, p=0.002) and highest ALT(r=0.721, p=0.000). Conclusions: Maximum percentage rise of Hb and PCV, lower WBC and platelet counts seem to be associated TSFA. Among these, lower WBC counts appear to be more predictive of the degree of fluid leakage. Higher ALT and AST levels seem to be useful in predicting the duration of ascites. PP 76: Repeated dengue shock syndrome and “Dengue myocarditis” responding dramatically to a single dose methyl prednisolone R Premaratna1, KMD Rodrigo2, A Anuratha2, VKD de Alwis3, UDCA Perera2, HJ de Silva1 1Faculty of Medicine, University of Kelaniya 2Professorial Medical Unit, Colombo NorthTeaching Hospital, Ragama 3Medical Unit, Gampola Introduction: Place of steroids in the management of severe dengue is unclear. A retrospective observational study appeared to show benefit of methylprednisolone (MP) in a highly selected group of patients. Case report: A 14-year-old schoolboy developed “myocarditis” (4th day) and on the fifth day, he collapsed with Dengue shock syndrome DSS needing rapid resuscitation with intravenous fluid boluses and dextran. He continued to have high fever (39-410C), and pulse rate (PR)>110/min and developed two further episodes of DSS and was resuscitated with further boluses of dextran. As there was no response with temperature 40.20C, PR 160/min, mid-arm systolic BP 70 mmHg, confused, restless, respiratory rate 36/min, dropping capillary O2 saturation, moderate pleural effusions and ascites, urine output <0.2ml/kg/Hr, made it extremely difficult to select the amount and type of fluid for resuscitation. Due to rapid deterioration a single dose of methylprednisolone (MP) (500mg in 200ml saline iv over 20 minutes) was administered as a rescue medication. He had deferversence within 30 minutes, became conscious and alert in 1 hour, PR reduced to 96/minute, BP remained stable above 100/80mmHg and urine output increased to 0.8-1.4ml/Kg/Hr. His ECG became normal after 3 hours, and the echocardiogram in 12 hours (EF-55%). Conclusions: This patient with dengue developed three episodes of severe haemodynamic compromise within 12 hours while having third space fluid accumulation, “myocardits” and altered level of consciousness making it difficult to institute fluid therapy. A single dose of MP given as rescue measure resulted in a dramatic recovery suggesting a beneficial effect of MP in sever dengue.by

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Abstracts of Poster Presentations PP 77: Low serum testosterone in Sri Lankan patients awaiting coronary artery bypass grafts CM Wickramatilake1, MR Mohideen2, C Pathirana1 Departments of 1Biochemistry and 2Medicine, Faculty of Medicine, University of Ruhuna Introduction: Coronary artery disease (CAD) remains a major cause of adult mortality in Sri Lankaand worldwide. Low serum testosterone is considered a risk factor for coronary artery disease in men. The effect of magnitude of testosterone deficiency on the severity of the disease is uncertain. Aims: This study investigated the possible association of serum total testosterone (TT) concentration with the severity of coronary artery disease (CAD) in men. Methods: The morning levels of TT were estimated in 107 males with angiography- proven coronary artery CAD in the age range of 30 -70 years (mean age 57 +/- 8years) awaiting coronary artery bypass graft surgery. The severity of main coronary artery block was assessed by an angiography score. Results: There were 72.9 % (n = 78) patients with one vessel disease, 22.4 % (n = 24) with two vessel disease and 4.7 % (n = 5) with three vessel disease. The mean TT concentration was 3.388 (SD 1.026) nmol /L which is far below the low normal level of 11.0 nmol/L. All patients had values lower than the low normal limit. There was no significant difference in the means of serum testosterone and the degree of severity of the coronary artery lesions from 1-3 (3.31, 3.53, 3.84 nmol/L; p = 0.401). Conclusions: Patients with established CAD had low levels of TT, confirming the association between the two entities. Serum TT was however not significantly associated with the severity of CAD. PP 78: Developing a severity index on day 4 to predict severe dengue infection in adults HS Wijewantha1, R Premaratna1, AAN Nishad2, IDM Mabharana1, AP de Silva1, PR Waraketiya1, MA Niriella1, HJ de Silva1 1Professorial Medical Unit, Colombo North Teaching Hospital, Ragama 2Post Graduate Institute of Medicine, University of Colombo Introduction: Dengue causes high morbidity and mortality among adults in Sri Lanka. Early prediction of severe illness would help to reduce morbidity and mortality. Studies to identify predictors of severe dengue in adults are sparse. Aims: To identify predictors of severe dengue infection by the fourth day of illness. Methods: Symptoms, signs and investigation results on the 4th day of illness were compared between two groups of patients with serologically confirmed dengue over 6 months from 1st of March 2011; Group A (severe illness: evidence of fluid leakage, compensated shock, profound shock), Group B (nonsevere illness). Results: Of 117 adults 9meanage 32 yrs (SD= 13.3) and 95 males) 27 fell into Group A and 90 into group B. On day 4 of illness serum aminotransferases (AST and ALT) were significantly higher in Group A than group B [AST: 260 iu/l (SD=168.8) vs 145 iu/l(SD 135.11), p=0.005; ALT: 247 iu/l (SD= 161.5) vs 105 iu/l (SD= 91.5), p=0.002]. Overall AST (r=0.3, p=0.038) and ALT (r=0.3, p=0.045) had a positive correlation with haematocrit (PCV). An index was developed using stepwise multivariate discriminant function analysis to predict severe infection by the 4th day. A severity Index, [(0.082 x PCVD4) + (0.02 x PlateletD4) + (-0.006 x ASTD4) -3.677] of <-0.258 predicted severe infection with 73.7 % specificity, 73.8% sensitivity, 56% positive predictive value and 86% negative predictive value. Conclusions: A severity index <-0.258 calculated on the 4th day of illness may predict severe infection among adult dengue patients. This must now be validated prospectively.

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Abstracts of Poster Presentations PP 79: A study to determine quantitative predictors for development of third space fluid accumulation in adult patients with dengue R Premaratna1, A Ragupathy2, JKND Miththinda2, HJ de Silva1 1Department of Medicine, Faculty of Medicine, University of Kelaniya 2Professorial Medical Unit, Colombo North Teaching Hospital, Ragama Introduction: Prediction of severe illness remains the most important measure in preventing mortality associated with dengue. Increased vascular permeability leading to reduced intravascular volume is the hallmark of dengue shock syndrome. Third space fluid accumulation (TSFA) reflects severe vascular permeability and therefore, it is important to quantitatively identify parameters which predict the occurrence of TSFA in dengue. Methods:102 patients with confirmed dengue were prospectively followed up for clinical, haematological, biochemical parameters and for evidence of TSFA by serial utrasonography. These parameters were tested against development of TSFA using Receiver Operating Characteristic (ROC) curves to identify quantitative predictors of development of TSFA. Results: 102 patients (52 males) with mean age 28.3 years (SD 11.8), TSFA was detected in 34/95 (36%) after admission; 21/95 developed ascites at mean 5.7 days of illness (SD 1.3) and 33/95 had pleural effusion at 5.4 days (SD 1.5). Onset of TSFA could be identified using percentage rises of highest PCV (p= 0.002) where 6.5% rise of PCV predicted TSFA(sensitivity 61%, specificity 62%)], highest Hb (p=0.017) where rise of 6.1% in Hb predicted TSFA (sensitivity 55%, specificity 64%), lowest recorded platelet count (p<0.000) where platelet count of 48500/mm3 or less predicted TSFA (sensitivity of 83%, specificity 51) post-admission fluid input-output balance per day (p 0.002) where positive balance more than 777cc/day predicted TSFA (sensitivity 65%, specificity 64%). Conclusions: Rise of PCV and Hb, platelet count, WBC count and daily fluid balance appear to be useful quantitative predictors of TSFA in dengue. PP 80: Recurrent vs. first presentation with acute coronary syndrome in a tertiary care hospital GMTR Bandara1, VNRM Fonseka1, DST Danansuriya1, RLP Harshanie1, K Thirumavalavan2, G Premawansa2, SMSB Samarakoon2, AP De Silva1, ST De Silva1, UK Ranawaka1 1Faculty of Medicine, Universtiy of Kelaniya 2Colombo North Teaching Hospital, Ragama Introduction: Profile of recurrent acute coronary events may differ from first-ever events, but no data is available from South Asia where morbidity and mortality are high. Aims: To describe characteristics of patients with recurrent acute coronary syndrome (ACS) admitted to a tertiary care hospital. Methods: Data was prospectively collected from all patients admitted with ACS to the Colombo North Teaching Hospital over 18 months. Differences in demographic data, presentation, risk factors, management and early outcome between those with first and recurrent ACS were analysed. Results: Of 765 patients admitted with ACS, 501 (65.5%) presented with the first episode, while 264 (34.5%) presented with a second or subsequent episode. Those with recurrent ACS were more likely to:present with unstable angina (61.4% vs 39.5%, p<0.001), present directly to hospital instead of a primary care provider (84.1% vs 71.3%, p<0.001), have hypertension (74.1% vs 50.1%, p<0.001) and hyperlipidaemia (51.5% vs 34.3%, p<0.001), and be ex-smokers (28% vs 19.3%, p<0.001). Those with the first episode were more likely to be current smokers (23.8% vs 11%, p<0.001). No differences were noted between the two groups in:- age and sex distribution, presenting symptoms, presence of diabetes, family history of coronary artery disease, alcohol use, in-hospital management, duration of hospital stay and early outcome. Conclusions: Patients with recurrent ACS were more likely to have unstable angina than myocardial infarction. They were more likely to present directly to hospital, and to have stopped smoking. Hypertension and hyperlipidaemia were commoner among them, highlighting the need for better secondary preventive measures.

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Abstracts of Poster Presentations PP 81: Unmet needs of care and associated factors among stroke survivors followed up at the neurology clinics of National Hospital of Sri Lanka J Hamsananthy1, V Kumarapeli2, R Gamage3 1Colombo Municipality Council, Colombo 2National Institute of Mental Health, Angoda 3National Hospital of Sri Lanka, Colombo Introduction: Stroke causes long-term dependency. Assessment of unmet needs of care among stroke survivors is essential for providing a comprehensive healthcare service. Aims: To assess unmet needs of care and associated factors among stroke survivors followed up at the clinics of Neurology Departments, NHSL Methods: A hospital based descriptive cross sectional study was carried out among 270 first ever poststroke survivors, at six month follow-up. Data were collected via pre-tested interviewer administered questionnaire on socio-demographic-economic and health characteristics (cognitive status, disability, emotional status, perceptions on general health) and unmet needs of care under 5 domains (37 items): medical/clinical support, risk factor control, rehabilitation therapy, social support and emotional support. Results: Two-thirds of the stroke survivors were males (n= 179) and median age was 56 years (IQR 4864 years). Overall 98.9 % (n=267) reported having unmet needs of care (median 7.5; IQR 5.0-10.25) across all 5 domains with highest for emotional support (90.4%). Proportion of individual unmet needs was high for physiotherapy (81.2%), diet (75.9%), transport (73.8%) and stroke information (72.8%). There were statistically significant associations (p<0.05) between unmet needs of care related to medical/clinical and emotional support with ethnicity; medical/clinical support with cognitive and emotional status; risk factor control with perception on general health status; rehabilitation therapy with disability status; emotional support with emotional status. Conclusions: High proportion of unmet needs of care emphasizes need for implementation of post-stroke care strategies via a range of services. Information to patients/care givers on post-stroke care should be conveyed on discharge. PP 82: Gait variables in patients with knee osteoarthritis at National Hospital of Sri Lanka JLR Jayalath1, MM Dissanayake2, TDMSB Dassanayake1 1Allied Health Sciences Unit, Faculty of Medicine, University of Colombo 2Faculty of Medicine, University of Colombo. Sri Lanka Introduction: Osteoarthritis is one of the most common chronic diseases which increase the individualâ&#x20AC;&#x2122;s disability and affects the patients gait as the disease progress. Thus identifying the changes in gait variables in knee osteoarthritis patients is important. Aims: To compare the gait variables such as walking velocity, cadence, step length, walking base, and single support time, in both control group of people and in the disease group. Methods: This descriptive cross sectional study was conducted at physical therapy department, National Hospital of Sri Lanka. 120 participants were included for the study if they fulfilled the inclusion criteria. The participants were divided into Osteoarthritis and non osteoarthritis groups. A walk-way was used to collect data from the subjects. Participants were asked to walk once in a single direction in the walkway in their normal speed. Results: The group of females with knee osteoarthritis had significant between means of single support time, step length, walking velocity and cadence. Males with osteoarthritis showed a significant difference in walking velocity. Healthy males and females showed a significant gait variation in step length and walking velocity. Conclusions: When assessing gait parameters of females, females with osteoarthritis has reduced single support time, step length, walking velocity and cadence and increased walking base compared to healthy control group of females. In the comparison among males, males with osteoarthritis had a reduced step length, walking velocity, cadence and walking base but had same single support time, compared to healthy control group of males.

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Abstracts of Poster Presentations PP 83: Correlation between on admission clinical parameters and thirty day mortality rate of acute coronary syndrome DSA Wickramasinghe, GR Constantine, MHMTS Perera, RMGM Ratnayake, LP Ruwanpura Faculty of Medicine, University of Colombo Introduction: Acute Coronary Syndrome (ACS) is one of the leading causes of death following hospital admission. Several risk assessment models have been evaluated for risk stratification of ACS. The EMMACE (evaluation of a methods and management of acute coronary events) risk score includes age, systolic blood pressure and heart rate. However risk scores are not yet validated for Sri Lankan population. Aims: Study assessed the correlation between clinical parameters on admission and the clinical outcome of ACS. Methods: Two point cross sectional cohort study was carried out in all the medical and cardiology wards of National Hospital of Sri Lanka for a period of 6 months. Continence sampling was used. Results: of 250 participants only 157 (62.8%) was followed up due to unavailability of a means of contact. Mean age was 58.8(+/-2SD=12.5) and majority were males 128(81.5%). At presentation 79(50.3%) had shortness of breath; 122 (77.7%) had basal crepitations; 94 (59.9%) were diagnosed to have ST elevation myocardial infarction; means of pulse rate, systolic and diastolic blood pressure were 80.8bpm (+/-2SD= 20.8), 140mmHg (+/- 2SD= 36.2) and 83.2(+/-2SD= 20.8) respectively. Patient Mortality rate within 30 days of admission was 23.6%, of these 15 (40.5%) died due to complications of ACS. Mortality was associated with systolic blood pressure <100mmHg (p<0.05); pulse rate >90bpm (p<0.01) and age >58.8 years (p<0.05). Conclusions: Study results are keeping in with EMMACE risk stratification of ACS implying its use in Sri Lankan setting is acceptable. PP 84: Slower platelet recovery pattern during the 2011 dengue outbreak BCM Wimalachandra, LV Goonaratne, GN Karunathunga, JK Wijerathne, S Jayasinghe Faculty of Medicine, University of Colombo Introduction: During the 2011 outbreak of dengue fever (DF) health care providers in Colombo noticed a slower rise in platelet counts among patients when compared to the 2010 outbreak. Aims: This study was conducted to see if this observation was a significant one. Methods: A retrospective analysis of all, previously healthy patients between the ages of 12-65 years, admitted to the Central Hospital Colombo and confirmed to have DF during a three month period in 2010 and a similar period in 2011 was carried out and a simple linear regression model used to ascertain the platelet recovery rate for each patient. The two data sets were compared using the Mann Whitney test. Results: 44 patients in 2010(Group 1) and 42 patients in 2011(Group 2) fulfilled the inclusion criteria. Depending on the fitness of the regression model, recovery rates could be obtained for 25 patients in group 1 and 31 patients in group 2. The platelet recovery rate of each group was found to be different from each other (U< Critical value at 5%). The platelet recovery rate of 2010 was found to be fasters than the platelet recovery rate of 2011 (U< Critical value at 2.5%). Conclusions: While opening new windows to the changing trends of dengue fever, knowledge that a significant delay in the platelet recovery occurred during this outbreak would have had a direct impact on the cost of treatment by contributing to both direct (Investigations, hospital stay) and indirect (wages lost, travel) costs during this year.

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Abstracts of Poster Presentations PP 85: Prevalence of potential risk factors for tuberculosis patients attending Central Chest Clinic Colombo MGB Senanayake1, S Samaraweera2 1Nutrition Coordination Division, Ministry of Health, Colombo 2National Programme for Tuberculosis Control and Chest Diseases, Ministry of Health, Colombo Introduction: Tuberculosis is an infectious air borne disease and is a major global health concern. The prevention and control of tuberculosis is in cooperated into the Millennium Development Goals (MDG) and Stop TB partnership. Sri Lanka, identified as a moderate burden country with TB, the current preventive and control strategies need to be strengthened to achieve the MDG and Stop TB partnership targets. Aims: To describe the social and economic characteristics and potential risk factors among tuberculosis patients. Methods: This was a descriptive cross sectional study. The study population consisted of all tuberculosis patients, above 15 years of age and registered in the Colombo district TB register. Results: Study sample consisted of 425. There were 245 (57.6%) who were studied up to grade 8 or below. Two hundred and one (47.3%) were unemployed, 113 (50.5%) of the employed were engaged in elementary occupations. There were 63.3% (n=269) with an income below Rs. 20,000/=. The prevalence of ever smoking, current smoking, ever alcohol consumption, narcotic drug use, TB contact history, imprisonment, diabetes mellitus, bronchial asthma were 551, 151, 546, 127, 186, 52, 235, 106 per 1000 TB patients. Conclusions: The findings suggest that TB is common among people with poor education, unemployed, if employed, in elementary occupations and with low income. PP 86: Pattern of respiratory function among saw mill workers in selected saw mills in Wellampitiya, Sri Lanka KDL Nanayakkara, MNM Nadheem, SU Nagasinghe, D Samaranayaka Faculty of Medicine, University of Colombo Exposure to various types of dust has long been associated with decline in respiratory function parameters in humans. This is a descriptive cross sectional study to assess the pattern of respiratory function among saw mill workers in selected saw mills in Wellampitiya. Current study included 118 saw mill workers aged over 18 years who had been continuously exposed to saw dust for more than 3 months duration. Sample was selected by convenient sampling until the target sample size was achieved. An interviewer administered questionnaire was used to gather socio-demographic data.Anthropometric parameters were also measured. Respiratory functions were measured using a mini-spirometer after provind its accuracy prior to the study through a validation study. Lung function values were compared according to the duration of saw dust exposure. Results showed that with the duration of exposure, there was a significant decline in FVC (p=0.009), FEV1 (p=0.001) and PEFR (p=0.001) while FEV1/FVC ratio (p=0.418) showed no significance. The association of smoking and the use of protective devices also assessed and there was no significance (p=0.855) when adjusted to the duration of dust exposure. The findings suggest that there is an association between lung function deterioration with the duration of exposure.

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Abstracts of Poster Presentations PP 87: Technological feasibility and patient satisfaction with wireless ECG monitor for arrhythmia detection PSA Wijewickrama1, GR Constantine1, VA Jeewagan2, AD Abeygunasekara3, BDAK Fernando3, L Samaranayake4, SN Wijesundara3 1Faculty of Medicine, University of Colombo 2National Hospital of Sri Lanka, Colombo 3Dialog Axiata PLC, Colombo 4Faculty of Engineering, University of Peradeniya Introduction: Holter monitor is used to diagnose intermittent arrhythmias. However, they have several limitations such as restricted recording time, lack of real time data and discomfort to the patient. We developed a simple low cost wearable wireless cardiac rhythm monitor for arrhythmia detection. ECG data obtained by the sensor is transmitted to the mobile phone via Bluetooth technology. The mobile phone in turn transmits the data using GPRS network to the mHealth database where it can be viewed by qualified physicians. Our aim in this study is to evaluate the device in terms of signal clarity, acceptability to patients and physicians. Methods and Results: The device was tested in 12 volunteers for its feasibility, suitability and signal quality. Most (83.3%) reported that the device was â&#x20AC;&#x153;very easy/easy" to use and the majority (75%) of physicians were â&#x20AC;&#x153;very satisfied/satisfied" with the device. Signal and image quality was sufficient in all cases. Only problem encountered was electrode disconnection, which was overcome by contacting the relevant individual. Conclusions: Results demonstrate that the wireless ECG monitor could be used for arryhythmia detection. The signal quality of the wireless sensor system demonstrated good performance regarding signal noise and artifact disturbances. Further clinical trials should be conducted to further evaluate this wireless ECG monitor and to explore the possibility of widespread adoption of this device. PP 88: A descriptive study of patients presenting with chest pain to a general medical ward MGCP Marasinghe, NAA Weerasinghe,DMS Fernando Faculty of Medical Sciences, University of Sri Jayewardenepura Introduction: Chest pain is a common symptom with diverse etiologies. Although a large number of patients are admitted with chest pain there is little data on the outcome of these patients. Aims: To describe characteristics of patients presenting with chest pain to a general medical ward. Methods: Study sample includes all patients with chest pain (n=172) presenting to a medical ward over a period of two months. Description of the chest pain, associated symptoms, past medical history, ECGs, cardiac biomarkers and diagnosis during the admission were analyzed. Results: Of the identified patients 51.9% were males. Chest pain was central in 51%, left sided in 35.4%, tightening in 56.6%, pricking in 28% and burning in 7.9%. Diaphoresis was associated in 40.2% and dyspnoea in 35.4%. Past IHD was found in 34.4% and 28% were diagnosed diabetics. Ischemic changes in the ECGs were seen in 34% (ST elevation 10.1%, ST depression 17.5% and T inversion 23.8%) and in 19% Troponin was positive. Troponin was indicated but not done in 46.4% (21.7% had ECG changes). Radiation along left arm was significantly associated with ECG changes (p<0.001). IHD was diagnosed in 36%, out of which 26.5% had acute coronary syndrome. The diagnosis was muscular skeletal pain in 21.2 %, dyspepsia in 15.7% and 24% had no definite diagnosis. Conclusions: One third of the sample were diagnosed as having IHD. Chest pain radiating along the left arm predicted IHD. One fourth of patients did not have a diagnosis. Troponin was underused probably due to high cost.

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Abstracts of Poster Presentations PP 89: Association between diabetic peripheral neuropathy and cognitive impairment MGCP Marasinghe1, MV Iyshwarya2, AU Pathirana2, BMB Gunawardene2, U Bulugahapitiya3, SB Gunatilake1 1Department of Medicine, University of Sri Jayewardenepura 2University of Sri Jayewardenepura 3Colombo South Teaching Hospital, Kalubowila Introduction: Diabetes mellitus is associated with increased risk of developing both Alzheimerâ&#x20AC;&#x2122;s and vascular dementia. Peripheral neuropathy is one of the main complications of diabetes. Decreased cognitive function is associated with autonomic neuropathy in type 2 diabetes patients. Considering the nervous system as a unit, it might be expected that diabetic patients with peripheral neuropathy could have a central abnormality expressed as cognitive dysfunction. Aims: To assess the association between diabetic peripheral neuropathy and cognitive impairment. Methods: A randomly selected sample of 75 patients with type 2 diabetes more than five years were studied. Michigan Neuropathy Screening Instrument (MNSI) was used to diagnose peripheral neuropathy. MNSI score greater than 2 points on a 10 point scale was considered neuropathic. Patients were grouped into neuropathic and non-neuropathic. An independent researcher analyzed the cognitive function using Mini Mental State Examination (MMSE). MMSE Score below 23/30 was taken as cognitive impairment. Results: Of the 75 patients (79% females) and 49(65%) had peripheral neuropathy. Mean age of neuropathic and non-neuropathic patients were 63.6yrs (SD- 8.6) and 59.7yrs (SD- 7.7) respectively. In this group 34.2% had diabetes for 5-10yrs, 52.6% for 10-20yrs and 9.3% for more than 20yrs. Cognitive impairment was found in 5.3%. The MMSE of neuropathic and non-neuropathic patients were 26.7 and 26.9 respectively (p- 0.81). Conclusions: Prevalence of cognitive impairment among long standing type 2 diabetics was lower in this study as compared to previous studies. Diabetic peripheral neuropathy was not associated with cognitive impairment. PP 90: Homicidal paraquat poisoning R Fernando Department of Forensic Medicine, Faculty of Medicine, University of Colombo Introduction: In Sri Lanka occupational, accidental, and suicidal paraquat poisoning has been documented since 1972. An incident where three members of the same family were killed by paraquat poisoning is reported. Case report: A man, who claimed to be from the Anti-Filariasis Campaign, visited a household. He said that blood samples taken earlier showed that 5 persons were suffering from filariasis. He said he brought medicine to treat them and poured a greenish blue liquid into an empty jam bottle. The mother and one daughter drank about a quarter of the bottle that was dispensed by him. The other daughter took only a mouthful. Within 30 minutes all three developed gastro-intestinal symptoms and were admitted to a hospital. They were treated symptomatically as it was not clear as to what the poison was. On the 2 nd day the residual poison in the jam bottle was identified as paraquat in our department. The mother and daughter who drank about a quarter bottle each died within 48 hours. Autopsy findings of the mother were non-specific. The daughter had a typical paraquat tongue. The daughter who took only a mouthful died on the 13th day from typical pulmonary fibrosis. There was no prosecution in this case for over 20years, although police investigations revealed that a family member was responsible for their killing. He had managed to send another person who convincingly gave the poison as a drug for treatment of filariasis. Conclusions: These are the first cases of homicidal paraquat poisoning in Sri Lanka.

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Abstracts of Poster Presentations PP 91: Management of severe eye injury due to paraquat R Fernando1, S Perera2 1Department of Forensic Medicine, Faculty of Medicine, University of Colombo 2Police Hospital, Colombo Introduction: Paraquat eye injury is rare. We report a case of severe eye injury due to paraquat in a 32year-old lady who was admitted with acute paraquat ingestion. Case report: While she was drinking paraquat from a new 100 ml bottle, her husband had attempted to grab it resulting in paraquat splashing on to her left eye. The eye was washed immediately but she developed irritation, burning sensation and pain which became severe over the next few days. She presented on the 4th day. Her left eye had ptosis, poor vision, severe pain and difficulty in opening. Visual acuity was confined to hand movements. The conjunctiva was oedematous and hyperaemic. Fluorescein staining revealed an epithelial defect covering almost the entire cornea. The anterior chamber showed a low grade uveitis with + 2 cells. Digital intra ocular pressures in both eyes were similar. The eye was patched for 24 hours after instilling fucidic acid ointment. After 24 hours, her pain and conjunctival hyperaemia were less. The epithelial defect showed superficial healing. An area of limbal ischaemia of less than 180 degrees was visible (Grade 2 chemical injury). Chemical injury therapeutic regime was commenced with artificial tears (carboxymethyl cellulose 0.5%), ciprofloxacin eye drops, tetracycline ointment, 1% prednisolone acetate drops and vitamin C 1500 mg daily. The following day she had no ptosis or pain, the conjunctiva was minimally hyperaemic and the limbal ischaemia had reduced. On the 12th day she had no signs of eye injury. Conclusions: Timely and appropriate intervention can bring excellent recovery from paraquat eye injury. PP 92: Experience of abuse among Sri Lankan school children S Mettananda, DGH de Silva, T Perera, A Pathmeswaran Faculty of Medicine, University of Kelaniya Aims: To describe the experiences of abuse and maltreatment among children and adolescents in 3 districts in Sri Lanka. Methods: A descriptive study was conducted in Anuradapura, Monaragala and Kandy districts in JanuaryMarch 2011. Five schools were randomly selected from each district. Two primary classes [grade 4-5 (children)] and 3 senior classes [grades 9-11 (adolescents)] were randomly selected and all students in selected classes were recruited into the study after obtaining informed consent from students and staff. A self administered questionnaire given under examination conditions was used to gather data. The questionnaire contained questions regarding experiences of physical, emotional and sexual abuse. Results: The study population comprised 739 children (Anuradapura-279, Moneragala-207, Kandy-253) and 1091 adolescents (Anuradapura-327, Moneragala-387, Kandy-377). Male: female ratio was 49:51. 75% children and 91% adolescents claimed that they are physically punished when they misbehave in school, whereas 79% and 97% respectively, agreed that they are shouted at. 28% adolescents (Male-49%, Female-10%) had performed life endangering tasks, and in 43% the caretaker/adult had requested it of them. Part-time child labour was reported by 2.7% children and 1.6% adolescents. 2.6% children (Male3.6%, Female-1.7%) and 1.7% adolescents (Male-2%, Female-1.4%) had experienced incidents of sexual abuse. 14% children and 7% adolescents were staying alone at home whereas 37% children and 49% adolescents travelled alone. Conclusions: Corporal punishment, although banned, is still being widely used as a disciplinary method. About 2% of school children had experienced sexual abuse. Significant proportions of school children were either living alone or going out alone, and are therefore at risk of abuse.

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Abstracts of Poster Presentations PP 93: Knowledge and attitudes regarding child abuse and child rights among Sri Lankan school children S Mettananda, DGH de Silva, T Perera, A Pathmeswaran Faculty of Medicine, University of Kelaniya Aims: To describe knowledge and attitudes regarding child abuse and child rights among school children in 3 districts in Sri Lanka. Methods: A descriptive study was conducted in Anuradapura, Monaragala and Kandy districts in 2011. Five schools were randomly selected from each district. Three classes of grades 9-11 were randomly selected and all students in selected classes were recruited into the study after obtaining informed consent. A self-administered questionnaire given under examination conditions was used to gather data. The questionnaire contained questions to assess knowledge/attitudes regarding child abuse and rights. Subjects were assigned a mark (range 0-5) on their answers to questions in different aspects of child abuse and higher marks signify better knowledge. Results: The study population comprised 1091 adolescents (Anuradapura-30%, Moneragala-35%, Kandy-34%). Mean age was 14.2 (SD±1.23) years and 48% were males. The majority of boys (85%) and girls (78%) were unaware of the child rights convention. A higher percentage of girls (10.1%) than boys (5.2%) answered the question on child rights satisfactorily [p=0.003]. Corporal punishment in schools was recommended by 38%, whereas 42% suggested positive disciplinary methods. On other’s request, 29% boys and 6% girls would do life-endangering tasks. Marks for the question regarding ability to handle/avoid sexual abuse were- 0 in 7%, 1-3 in 51% and 4-5 in 42%. Girls scored significantly higher than boys [p<0.001]. Conclusions: Knowledge regarding child rights among Sri Lankan children was unsatisfactory. A high proportion acknowledged corporal punishment as a disciplinary method. Girls had a better knowledge regarding child rights and are better aware of how to handle situations of sexual abuse. PP 94: Changing trends of poisoning in Sri Lanka R Fernando1, S de Silva2 1Faculty of Medicine, University of Colombo 2Ministry of Health, Colombo Aims: To analyse the trends of poisoning in Sri Lanka with a view to identifying future strategies for prevention and management. Methods: Retrospective analysis of data on poisoning was performed in the Indoor Morbidity and Mortality Returns and Annual Reports of the Medical Statistics Unit of the Ministry of Health from 1989 to 2008. The toxic agents were classified as ‘Drugs and medicaments’, ‘Pesticides’ (Organophosphates and carbamates – OP/CB), ‘Other pesticides’, ‘Toxic effects of other substances (Plants, household chemicals etc.)’ and ‘Snakebites’. Results: The highest recorded admissions from poisoning were 102,048 in 2008. Of all admissions from chemical poisonings, drugs accounted for 10.3%, pesticides for 52.2% and other substances for 37% in 1989, compared to 36.6%, 28.2% and 35%respectively in 2008. Admissions from drug poisoning have increased by 26.3% and snakebites by 23%. A reduction of admissions was observed in poisoning by ‘other toxic substances’ (2%) and due to pesticides (24%). Case fatality of poisoning has reduced significantly from 8 in 1989 to 2 in 2008. Conclusions: Pesticide poisoning which was the main agent responsible for poisoning in Sri Lanka during the past few decades has been replaced by drugs in 2008. Drugs, other toxic substances and snakebites will be the major causes of poisoning in future. This trend introduces challenges for providing improved services and funds for the management of acute poisoning and prevention. Therefore, new strategies have to be adopted to institute policy into practice to reduce morbidity and mortality from poisoning in the future.

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Abstracts of Poster Presentations PP 95: Criminal responsibility for murder among remand prisoners sent for forensic psychiatric assessment SW Kotalawala, N Fernando Forensic Psychiatry Unit, National Institute of Mental Health, Angoda Introduction: There is lack of research on criminal responsibility among offenders with mental illness inSri Lanka. ‘Unsound mind’, defined in penal code of Sri Lanka, excludes persons from responsibility for acts of crime. Psychiatric diagnosis does not always exclude those of criminal responsibility. A forensic psychiatric assessment is used to judge responsibility for a crime. Psychiatrists are requested by courts to give opinions on such matters. Aims: To describe proportions of those who were deemed to not responsible for the crime of murder due to insanity. Methods: Retrospective study, of hospital records and court reports of persons charged with ‘murder’ and were admitted for psychiatric assessment in year 2011, maintained by the forensic psychiatry unit at the National Institute of Mental Health, were analyzed. Results: 42 were admitted (38 males, 4 females). 37 (88%) of them had a mental illness. Out them 13(35%) were deemed to be having an ‘unsound mind’ at the time of the alleged offence. 12 (32%), were found to be of ‘sound mind’ thus responsible for the charge of murder, despite having identified mental illnesses. In 13(31%) the mental state could not be reconstructed due to lack of information. Most common diagnosis was schizophrenia. Conclusions: Penal code in Sri Lanka is flexible enough for psychiatrist to give expert opinion on offenders’ criminal responsibility for their alleged offence of murder despite having an identified mental illness. PP 96: Septo-optic dysplasia: antenatal risk factors and clinical features N Atapattu1, J Ainsworth2, H Willshaw2, M Parulekar2, L MacPherson2, C Mill2, P Davies2, JMW Kirk2 1Lady Ridgeway Hospital for Children, Colombo 2Birmingham Children’s Hospital, Birmingham, UK Introduction: Septo-optic dysplasia (SOD) is a disorder in which both environmental and genetic aetiological factors are implicated. Aims: We aimed to delineate potential perinatal environmental factors and clinical features in children with SOD within a defined area. Methods: Systematic assessment of patients with hypopituitarism and/or optic nerve hypoplasia (ONH) plus SOD in the UK West Midlands region identified from 1998-2009. Results: 88 patients [46 (52%) males] had SOD (i.e. 2/3 features of the triad). Median age of the population was 12.42 years (range 36.79- 0.31). Median gestation was 40 weeks and birth weight was 2.915 kg. 21 (24%) had all SOD triad features, with anterior pituitary hormone deficiency seen in 54 (61%). 19/88 (21.5%) had diabetes insipidus, 47% had absent septum pellucidum and 84/88 (95.4%) had ONH. Learning disability was seen in 22 patients. Median maternal age was 21 years, lower than the mean UK age (29.3 years) (p<0.001), as was median paternal age [23.5 years compared to 32.4 years (p<0.001)]. 71.1% were primigravida births. 8% were Afro-Caribbean, 9% were mixed ethnic origin, 3% were South Asian origin while 80% were Caucasian groups. First trimester bleeding occurred in 25%, (background UK rate = 0.07%, (p<0.001)). 39% mothers admitted to smoking, 21% to drinking alcohol and 4.3% to taking cocaine during pregnancy. Conclusions: We have confirmed that SOD is associated with younger maternal age and primigravida births, but have also demonstrated younger paternal age and ethnic differences. Increased first trimester bleeding supports the hypothesis that SOD is a vascular disruption sequence.

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Abstracts of Poster Presentations PP 97: Sequelae of BCG vaccination and effects of cleaning vaccine site with alcohol P Perera, G Samaranayaka, R Samaranayaka, N Ranathunga Faculty of Medicine, University of Kelaniya Introduction: In Sri Lanka, BCG vaccine is given during neonatal period. There are many myths regarding BCG vaccine among general public and sequelae of vaccination is not well documented in medical literature. Aims: Objectives of this study were to describe the sequelae of BCG vaccination when given at neonatal period and to find out whether cleaning the vaccine site with 70% alcohol, affect its potency. Methods: A prospective observational study was carried out at Ragama teaching hospital and 2 private hospitals in Gampaha district. 125 babies each from government and private sector were recruited for the study with the consent from parents. Vaccine was administered in the morning as well as evening, as required by the patient, by a consultant Paediatrician. Vaccine site was cleaned with 70 % alcohol and allowed to dry before vaccination. All babies were bathed on same day. Babies were followed up periodically until a scar was detected. Results: 182 babies completed the follow up and all babies developed a scar. Time taken for a reaction varied but all babies had a reaction by 8 weeks and a scar by 14 weeks. 6 babies had fever within one week of vaccination but it was due to feeding failure or sepsis. None had adverse reactions attributable to the vaccine. Conclusions: Cleaning the vaccine site with alcohol does not affect the potency of BCG vaccine. Proper technique of administration is important for successful vaccination. Time of vaccination and bathing had no effect on efficacy or side effects. PP 98: A comparative study on impact of surfactant therapy on neonatal respiratory distress syndrome in District General Hospital Ampara MAT Fernando1, CB Akurugoda2, MI Rifaya2 1National Hospital of Sri Lanka, Colombo 2General Hospital Ampara Introduction: Respiratory distress syndrome (RDS) due to lack of surfactant is a major cause of morbidity and mortality in premature babies. Surfactant therapy was introduced to General Hospital Ampara (GHA) in November 2010. Aims: To determine the impact of surfactant therapy on RDS by comparing the morbidity and mortality of preterm babies diagnosed with RDS who received surfactant with those who did not receive surfactant. Methods: Retrospective study at Neonatal intensive care unit at GHA. Babies, gestational age (GA) < 32weeks, who fulfilled ‘Medscape RDS work up’ criteria admitted 9 months before surfactant became available were compared with those admitted 9 months after introduction of surfactant. Results: Seventeen babies before the availability of surfactant (group A) and twenty babies after surfactant became available (group B) formed the study population and all in group B received surfactant as rescue therapy. In group B, 80% with GA 27-29 weeks, survived but in group A 100% with same GA died (P=< 0.005). 58% in each group, GA 30-32weeks, Survived (p=< 0.05).In 55% and75% of group B the Oxygen requirement reduced in 6hours and 12 hours of surfactant therapy respectively. In group B 35% and in group A 52% required ventilator care after surfactant administration. 35% in group B developed surfactant related complication. In group A 84% needed increased oxygen at 12hours of age and 52% required ventilator care. Conclusions: Surfactant therapy significantly reduced the mortality in babies GA 29 – 32weeks. 35% developed surfactant related complications.

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Abstracts of Poster Presentations PP 99: Neonatal hypothermia and associated factors in a special care baby unit S Krishnapradeep1, B Kumarendran2, S Bandara3 1Paediatric Unit, Srimavo Bandaranayake Specialised Children Hospital. Peradeniya 2Department of Public Health, Faculty of Medicine, University of Ragama 3Special Care Baby Unit, Teaching Hospital, Peradeniya Introduction: Neonatal hypothermia is known to result in many adverse consequences. Aims: To estimate the incidence and associated factors of neonatal hypothermia Methods: This cohort study followed up 125 neonates consecutively admitted to Special Care Baby Unit of Teaching Hospital, Peradeniya from November 2011 to January 2012. A paediatric registrar interviewed parents using a structured-questionnaire and direct observation using a check list. On admission, axillary body temperature was measured and graded using WHO classification. Results: Of the 125 neonates, 96 were admitted within first day of birth (78.6%) and 72 had low birth weight (57.6%). Neonates were admitted from operation theater (58, 46.4%), postnatal ward (34, 27.2%) and labour room (23, 18.4%). Median temperature on admission was 36.2 째C with 38.4% having moderate hypothermia (n=48), 19.2% cold-stress (n=24) and none with severe hypothermia. Risk of hypothermia was increased by prematurity (OR = 9.9, 95% CI: 4.2 - 23), low birth weight (OR= 6.8, 3.1 15.1), being delivered by caesarean section (OR=4, 1.8 - 9.1), admission from operation theatre or labour room (OR =9.1, 3.9 - 21.4) and cold delivery room ( p < 0.001). Caesarean rate was higher among neonates admitted to PBU than all the children delivered (OR = 3.35, 2.2 - 5.1). Hypothermia increases risk of poor activity (OR =1.8, 1.4 - 2.4), poor feeding (OR= 7.2, 1.5 - 34.9), poor cry (OR = 1.9, 1.5 - 2.4), respiratory distress (OR= 1.5, 1.1 - 2.0) and hypoglycemia (OR = 1.6, 1.2 - 2.0). PP 100: Correlation between anthropometric measurements and serum leptin among premenopausal women; a cross-sectional study J Nanayakkara1, S Lekamwasam2, C Liyanage3 Departments of 1Pharmacology and 2Medicine, Faculty of Medicine, University of Ruhuna 3Nuclear medicine Unit, Faculty of Medicine, University of Ruhuna Introduction: Serum leptin is incriminated in the regulation of many bodily functions such as appetite, sympathetic nervous system, immune system, obesity and metabolic diseases. Aims: There is uncertainty as to what anthropometric measurements would best predict the serum leptin level in the body. We conducted a cross-sectional study to investigate the association between serum lepin level and anthropometric measurements. Methods: A group 128 healthy premenopausal females, selected randomly, aged 25-50 years were stratified into four equal groups according to their BMI. Body weight, height, waist and hip circumferences were measured according to standard protocols. Serum leptin was measured in venous blood after 12 hrs of fasting using the ELISA method. Results: Serum leptin significantly correlated with BMI, waist circumference, hip circumference, weight and waist hip ratio. Corresponding r values were 0.42, 0.41, 0.39, 0.37, 0.23 respectively (for all P<0.001). Adjusting these correlations for age did not change the results materially and BMI was the strongest predictor of the serum leptin level. Unit change in BMI wouldchange leptin level by 0.38 ng/L and BMI explained 18% variation of serum leptin in this study. When women were categorized according to their BMI, the highest mean serum leptin was found in the highest BMI category while the lowest serum leptin level found in the lowest BMI category. Conclusions: Serum leptin correlate with all the selected anthropometric measures except height, BMI has the strongest correlation and can be used as a surrogate to predict serum leptin level in premenopausal females, aged 25-50 years.

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Abstracts of Poster Presentations PP 101: Elimination of iodine deficiency disorders (IDD) in Sri Lanka: does our salt industry comply with SLS guidelines for salt iodisation? GED De Zoysa1, M Hettiarachchi2, KAPW Jayathilaka1, C Liyanage2 1Department of Biochemistry, Faculty of Medicine, University of Ruhuna 2Nuclear Medicine Unit, Faculty of Medicine, University of Ruhuna Introduction: IDD refers to all the consequences of iodine deficiency in a population. In 1993, WHO/UNICEF recommended universal salt iodization (USI) as the main strategy to achieve elimination of IDD. The USI programme was implemented in Sri Lanka in 1995. Assessment of the iodine content of commercially available salt products is important for proper programme monitoring. The iodine content of edible common salt must be within 15 – 30 mg/ kg (SLS 79). Aims: To assess the quality of salt products that are currently available in Bope-Poddala health division inGalle. Methods: Samples were randomly purchased from boutiques, supermarkets and fairs. Total of 86 salt samples from 42 brands (2 from different batches) were purchased during July 2011 to August 2011. Samples were analyzed in triplicate for iodine content using iodometric titration method. Details on each packet of salt were recorded. Results: Only 64% of samples had iodine content in the legal range whereas, 23% had lower and 13% had higher values. Iodine content was indicated in 78% and ingredients indicated in 57% of salt packets. 9% of samples were sold in fairs under direct sun light and only 2% had the SLS certificate. Conclusions: Findings highlighted that standardization of salt industry appears questionable inSri Lanka and establishing a proper mechanism to improve the quality of salt products to achieve the goal of elimination of IDD is urgent. PP 102: Physical and social environment associated with physical activity of adults in the district of Colombo AASH Weliange, DN Fernando Faculty of Medicine, University of Colombo Introduction: Physical inactivity is the fourth leading risk factor for non communicable disease mortality, which is on the rise in Sri Lanka. Physical activity is the interaction of the individual, and the physical and social environment. These environmental factors in Sri Lanka are not the same as in the western world and need to be explored. Aims: To identify the items in the physical and social environment that are associated with physical activity among adults in Sri Lanka. Methods: After defining the construct, item generation was carried out through review of literature, key informant interviews with experts and through in-depth interviews with the general public between the ages of 20-59 years in the district of Colombo. To select the most appropriate and culture specific items, the item pool was rated by 18 experts. Results: The definition used was “external context consisting of the characteristics of the natural and built environment and the characteristics of the people in the neighborhood which influences participation in physical activity”. Thirty six items falling into the broad categories of residential density, condition of the streets and pavements, pleasantness, access to places, vehicular traffic, facilities for engaging in physical activity, safety, land use diversity, social cohesion and social acceptance of physical activity were selected as important environment factors associated with physical activity. Conclusions: These were used to develop a tool to measure the physical and social environment associated with physical activity of adults in Sri Lanka.

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Abstracts of Poster Presentations PP 103: Knowledge, attitudes and practices on folic acid supplementation among pregnant mothers SWADA Wickramasinghe1, U Senarath2 1Office of the Medical Officer of Health, Mahara 2Department of Community Medicine, Faculty of Medicine, University of Colombo Introduction: Folic acid supplementation programme is in existence in Sri Lanka to prevent neural tube defects of foetuses and anaemia of women of childbearing age. After several years of implementing the programme we still lack reliable data on its progress and outcome. Aims: Aim of this study was to describe knowledge, attitudes and practices on folic acid supplementation and associated factors among pregnant mothers and the relevant services provided by Public Health Midwives (PHMM). Methods: A descriptive cross-sectional study was carried out in Kegalle Medical Officer of Health (MOH) area in 2011. Data were collected from a systematic random sample of 524 pregnant mothers representing all antenatal clinics and 25 PHMM. Results: Overall knowledge on folic acid was â&#x20AC;&#x2DC;poorâ&#x20AC;&#x2122; in 84.9% (n=445). Ninety-six percent (n=503) have used folic acid at some stage of pregnancy, but only 46% (n=241) have used it before conception. Poor knowledge on folic acid supplementation was associated with lower age, belonging to an ethnicity other than Sinhalese, living in urban area or estates and low education. A lower rate of utilization of folic acid before and during pregnancy was associated with low education, unplanned pregnancies and not receiving advice from healthcare workers. Parity 2nd or higher, belonging to an ethnicity other than Sinhalese and living in estates were also predictors of poor pre-conceptional folic acid use. Conclusions: Planned health promotion campaigns, preventing unplanned and teenage pregnancies, distributing folic acid through government clinics during pre-conceptional period and developing monitoring systems for folic acid supplementation programme are recommended. PP 104: Assessment of hydration status of national level athletes RP Dahanayake1, P Lanerolle2, MAHP Kumarasiri3, GLK Ekanayake1, A De Silva3 1Institute of Sports Science, Ministry of Sports, Colombo 2Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Colombo 3Department of Physiology, Faculty of Medicine, University of Colombo Introduction: No data is available regarding hydration status of athletes in Sri Lanka, despite hydration being a significant factor influencing performance. Aims: To assess hydration status through assessment of urine osmolality and specific gravity (SG) in national level Sri Lankan athletes. Methods: National athletes (n=101); [basketball (n=29), football (n=18), athletics (n=28) and swimming (n=26)], were assessed during a regular training session. Urine osmolality and SG were measured in preand post-session urine samples using an osmometer and refractometer. Athletes were categorized as euhydrated or hypohydrated (euhydration: osmolality< 900mOsm/kg and SG< 1.020, hypohydration: osmolality >900mOsm/kg and SG >1.020). Fluid intake was assessed by an interviewer administered questionnaire. Environmental temperature and relative humidity were recorded. Results: Mean age of athletes was 20.4Âą4.9 years, 65.3% were male and 34.7% were female. Pre-session fluid intake was practiced by 100 athletes (99%) and post-session fluid intake by 89 athletes (88.1%). At start of training, 66 athletes were euhydrated and 57 athletes maintained hydration. However, 35 athletes were hypohydrated at the start of training, and 20subjects remained hypohydrated at the end. Of the 20 hypohydrated athletes, 70% were basketball players, 25% were football players and 5% were track and field athletes. Conclusions: One third of national level athletes were in a poorly hydrated state at the beginning of training. It is of concern that one fifth remained poorly hydrated throughout training, indicating the need for greater attention to hydration status.

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Abstracts of Poster Presentations PP 105: Ischaemic heart disease and dietary habits DJDP de Silva, LLDN Alwis, GG Abeyratne, US Molligoda, RS Nanayakkara Faculty of Medical Sciences, University of Sri Jayewardenepura Introduction: Ischaemic heart disease (IHD) is the commonest cause of death in Sri Lanka. Although diet is an established risk factor, studies on effect of Sri Lankan diet on IHD are scarce. Identifying harmful and protective dietary habits would aid in prevention of IHD. Aims: To describe the association of IHD with Sri Lankan food types and frequencies of their consumption. Methods: A case-control study was conducted in Colombo South Teaching Hospital and Sri Jayewardenepura General Hospital. Cases (n=147) were inward patients who have had an episode of stable angina (SA) or acute coronary syndrome (ACS) for first time during last six months. Controls (n=147) were inward patients who had never had SA or ACS. Risk factor assessment (including dietary factors) was conducted using an interviewer-administered questionnaire. Anthropometric measurements were recorded using standard methods. Chi-square test was used to compare two groups and odds ratio was used to check magnitude of IHD risk of dietary components Results: Compared to controls, the cases consumed, in significantly higher frequency, fried-food (OR=2.1, p=0.001), fast-food (OR=1.9, p<0.05) and coconut-oil (OR=1.8, p<0.05). Controlsâ&#x20AC;&#x2122; frequency of consumption was significantly higher for pulses (OR=2.3, P<0.05), green leaves (OR=1.4, p<0.05) and plain milk (OR=2.2, p<0.05,) compared to cases. Proportion of patients with body mass index >25 and females with waist-hip ratio >0.85 was significantly higher among cases than controls (OR=2.2, p<0.01 and OR=4.8, p=0.001 respectively). Conclusions: National level interventions to reduce disease burden due to IHD in Sri Lanka must target dietary modifications of people. PP 106: Development of a Food Frequency Questionnaire for Sri Lankan adults R Jayawardena1, P Katulanda2, M Soares3, N Byrne1, A Hills1 1Queensland University of Technology, Brisbane, Australia 2Diabetes Research Unit, Faculty of Medicine, University of Colombo, 3Curtin University, Australia Introduction: Sri Lanka is facing an epidemic of non-communicable diseases (NCD). Despite Sri Lanka having a very high level of prevalence of NCDs and associated mortality, there is little known about the causative factors for this burden. It is widely believed that the global NCD epidemic is associated with recent human lifestyle changes such as dietary habits. However, currently there is no Food Frequency Questionnaire (FFQ) available to assess dietary patterns in the Sri Lankan population. Aims: The main aim of this study was to develop a FFQ for Sri Lankan adults. Methods: We conducted a nutritional survey among 600 adults using a random 24-hour recall questionnaire. Contribution analysis and a multiple regression analysis were used to select food items. In addition, to improve the quantification of food intake, the questionnaire contained color photographs of 3 differently sized portions. Results: We obtained a total of 490 adultâ&#x20AC;&#x2122;s dietary data (321 females and 169 males). Collected food items were divided into eight food groups by two independent nutritionists. In total, 110 food items were included in the developed FFQ in order to explain at least 80% of the variance in the consumption of energy, carbohydrate, protein, fat and dietary fibers. For portion size clarifications, four main food items were displayed in series of photographs. Conclusions: In the Sri Lankan population with diverse dietary habits, using standard methods to develop a FFQ can capture dietary intakes adequately. The next step involves the verification of reproducibility and validity of the FFQ.

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Abstracts of Poster Presentations PP 107: Players’ habits on the day of competition SV Rajasinghe1, C Thurairaja2 1Sports Medicine Unit, Teaching Hospital, Anuradhapura 2Oasis Hospital, Colombo Introduction: Every player needs proper training, skills and several other factors for his success, but optimal performance will depend on his behavior on the day of competition. Aims: To assess the habits and practices which negatively affect the performance of the players during the competition. Methods: 50 players aged 16-40 years were assessed by an interviewer administered questionnaire during the North central provincial meet 2011. Results: Majority of players (36%, n=18) between 21-25 years of age and 60% (n=30) overall had not had their breakfast. 19 (38%) players consumed simple carbohydrate like glucose before their event. Majority of players 22 (44%) reported to the venue before 15-30 minutes before and 72% (n=36) of players didn’t do a proper warm-up before their event. 29 (58%) players sustained some kind of injury during the event and 94% of the players did not do any type of cooling down. 60% have not had postevent meal and only 10% had it within 1 hour. 88% players consumed fluids after the event but pre-event fluid consumption was only 40%. 54% of players experienced sleep disturbances day before the night. Conclusions: Majority of players paid less attention to essential factors like pre-event meal, warm-up and cooling down during the competition day, though they have done those during their training. Players, coaches as well as parents should be educated regarding this in order to gain better outcome. PP 108: Anthropometric measurements and nutritional adequacy of Sri Lankan swimmers VG Arachchi1, S Wasalathanthri2, PTR Makuloluwa3 1Institute of Sports Medicine, Ministry of Sports, Colombo 2Department of Physiology, Faculty of Medicine, University of Colombo 3Department of Physiology, Faculty of Medical Sciences, University of Sri Jayewardenepura Introduction: Research has shown that nutrition plays a significant role in successful sports performance. The objective of this study was to assess anthropometric measurements and nutrient intake in competitive swimmers. Methods: The sample consisted of 36 national and international level swimmers. Data were collected 3 months prior to 10th South Asian Games held in Colombo. Dietary history was obtained by the 24 hour dietary recall method using an interviewer administered questionnaire. Nutrient intake was calculated using diet analysis software. Height, weight and skin fold measurements were taken, BMI and percentage of body fat calculated. Results: All swimmers except for one male were in the recommended BMI range (18.5-24.9kg/m2). Mean percentage of body fat (mean±SD) was 12.07±3.6 in males and 20.90±5.4 in females. Around 80% of swimmers have consumed >50% of the recommended calorie intake. Although none of the swimmers have consumed the recommended amount of proteins, all have consumed between 50-99.9% of the recommended amount. The dietary intake of calcium, riboflavin, thiamin and ascorbic acid were more than the RDA in more than 75% of swimmers but iron intake was adequate only in 47%. Conclusions: Although iron intake is not satisfactory, the overall results show that the swimmers have chosen nutrient dense foods (foods rich in nutrients when compared to their calorie content). These findings suggest that sports authorities should plan and recommend optimum dietary schedules and appropriate nutritional counseling, and supervise meals in competitive sports personnel.

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Abstracts of Poster Presentations PP 109: Food dependant, exercise induced anaphylaxis GN Malavige1, D Wijesekara1, R de Silva2, S Gunawardena2, D Rathnayaka2, GD Wickramasinge2 1Department of Microbiology, Faculty of Medical Sciences, University of Sri Jayewardenepura 2Medical Research Institute, Colombo Aims: Exercise induced anaphylaxis (EIA) and food dependent exercise induced anaphylaxis (FDEIA) are life threatening disorders in which anaphylaxis occurs in response to physical exertion. We describe 5 individuals who suffer from FDEIA following wheat ingestion in Sri Lanka. Methods: 5 individuals who were referred for investigation of anaphylaxis were included in the study. Detailed clinical histories and food diaries were maintained to determine causes of anaphylaxis. Once FDEIA (due to wheat) was identified as the cause of anaphylaxis in these individuals from the history, wheat specific IgE antibody levels were measured by the Immunocap method. Results: Exercise was identified as a trigger in all 5 patients and all 5 patients reported the ingestion of wheat containing products 1 hour before exercise. All individuals had reported generalised urticaria, abdominal pain, which rapidly progressed to difficulty in breathing and loss of consciousness. All individuals had high wheat specific IgE antibody levels when measured by the immunocap method. None of them reported any symptoms of anaphylaxis, urticaria or other allergy symptoms when ingesting wheat unrelated to exercise. Conclusions: Although FDEIA has been widely reported in many countries, it has not been reported in Sri Lanka. We wish to report these 5 cases in order to create awareness among health care professionals in Sri Lanka, regarding its existence here. PP 110: Comparison of skin fold thickness, waist circumference, waist hip ratio and BMI in predicting body fat percentage WMUA Wijetunga, TAD Tilakaratne, WRUAS Wijesundara, S Subasinghe, P Katulanda Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine,University of Colombo Introduction: Body fat percentage (BFP) is a risk factor for many non communicable diseases including diabetes, hypertension and cardiovascular disease. Bio impedance analysis (BIA) provides an accurate way of measuring BFP but it is associated with a high initial cost. If anthropometric indices are predictive of BFP, they can be used for clinical work with less cost. Aims: To compare skin fold thickness (SFT), waist circumference (WC), waist hip ratio (WHR) and BMI in predicting BFP in adults. Methods: A sample of 1007 adult diabetic patients (age 20- 45 years) were randomly selected and their anthropometric measurements were obtained. BFP was measured using single frequency BIA. The association between anthropometric measurements and BFP was determined using the Pearson test and linear regression analysis. Results: Out of the 1007 patients, 42.3% were males. Mean age was 36.6(+11.17) years. The mean WC, WHR and BMI were 87.2 cm, 0.92 and 24.6 kg/m2 respectively. BFP showed significant correlation with BMI (r=0.4, p <0.01) and SFT at triceps (r=0.67, p <0.01) but not with the WC and the WHR. SFT in the triceps (r=0.67, p <0.01) and biceps (r=0.61, p <0.01) regions showed the strongest correlation followed by SFT in the suprailiac (r=0.42, p <0.01) and subscapular (r=0.4, p <0.01) regions. Conclusions: SFT is a better indicator of BFP than BMI, WC and WHR. SFT in the triceps and biceps regions is superior to subscapular and suprailiac regions in predicting BFP.

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Abstracts of Poster Presentations PP 111: Audit of anthropometric measurements in patients with non-communicable diseases SSL Kularathna, DSA Wickramasinghe, MY Amarasuriya, KLN Nanayakkara, PSA Wijewickrama, KSA Jayasinghe Faculty of Medicine, University of Colombo Introduction: Sri Lanka is currently facing an epidemic of non communicable diseases (NCDs). As obesity increases the morbidity and mortality associated with NCDs, management of such patients should include regular monitoring of anthropometric measurements. Aims: To evaluate the regularity of monitoring of weight, height and waist circumference of patients with NCDs at the University Medical Unit of the National Hospital of Sri Lanka. Methods: The audit involved 105 consecutive patients diagnosed to have diabetes mellitus, hypertension, ischaemic heart disease and dyslipidaemia, managed at the University Medical Unit. An interviewer administered questionnaire was used to gather data regarding monitoring of the patientsâ&#x20AC;&#x2122; weight, height and waist circumference. Results: The weight and height of patients had been measured in the health care sector at least once in 57.14% of the sample. Of this, the height had been measured in 42.86%, weight in 52.38% and waist circumference in 5.71%. Anthropometric measurements had been taken at least once in the past year in 41.9%. 18.09% of the sample was aware of the concept of body mass index (BMI) and the ideal weight they should achieve. Conclusions: Despite the fact that obesity has been shown to increase the morbidity and mortality of non communicable diseases, the monitoring of anthropometric measurements in these patients is poor. Measurement of waist circumference, in particular was suboptimal. Only a small proportion of the patients were aware of the concept of BMI and the ideal weight they should achieve. PP 112: Food security and nutritional status of children in Northern province R Jayatissa Medical Research Institute, Colombo Introduction: With the resettlement process nearing completion, it was considered relevant to make an assessment of the status of nutrition and food security among the resettled population in particular and the host population in general and make comparisons with the data obtained during the previous year, to fulfill the information needs for planing health, nutrition and food aid programs for the Northern Province. Aims: To identify the factors associated with nutritional status of children in relation to food security. Methods: Randomly selected 80 Grama Niladarai (GN) Divisions and 15 randomly selected households from each GN were studied to represent the Northern province. Data were collected by an interviewer administered questionnaire. Results: Of the total group 22.8%, 18.3% and 29.2% were stunted, wasted and underweight respectively. The prevalence of all three indicators of nutritional status was much higher among the children in the resident families and those who were resettled. Nearly a third of the sample, had received humanitarian assistance within the preceding three months, with this percentage being higher among the resettled households. The percentage of households that had poor, borderline food consumption patterns and the severely food insecure category as well as the moderately food insecure category, has shown a decline from October 2010 to October 2011. Conclusions: Continued support to treatment of Acute Malnutrition and enhanced targeted programmes for children with moderately acute undernutrition have to be considered as a priority intervention aimed at all children in Northern Province. It should include targeted effective supplementation programmes with proper monitoring.

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Abstracts of Poster Presentations PP 113: Energy drink consumption pattern in a group of medical students in Sri Lanka DPD Wijesinghe1,DRS Adicaram2,JGS Ranasinghe3,RD Wijesinghe4 1National Institute of Mental Health, Angoda Departments of 2Parasitology and 3Biochemistry, University of Peradeniya 4General Hospital, Peradeniya Introduction: Energy drinks are designed to give a "jolt" of energy and are targeted to 18 to 35 year old consumers. There has been little research regarding consumption patterns among young adults in Sri Lanka. Aims: To study the pattern of energy drink consumption throughout the undergraduate period namely from first to final year. Results: From the total number of students only 31.4% had consumed the drink and preference was higher in males (52.2%) than females (12.7%) which was statistically significant (p=0.000). From all consumers, 45.9% had consumed for examination purposes,42.6%expected to gain energy and 13.1% with alcohol during partying. Only 26.2% believed that they achieved the expected effect and 44.3% were uncertain about the effect the rest of the consumers considered that there was no effect. Following consumption11.5%experienced nausea and 8.2%palpitations. Half (49.2%)of students who consumed recommend it to a close friend. Consumers had got the information from TV advertisements (60.7%), from friends (54.1%) and a few from supermarket (8.2%). Statistically significant increase in consumption was observed during final year comparedto1st, 2ndand 4thyears. (p=0.01, p=0.002, p=0.005)respectively. Conclusions: The results indicated that 1/3rd of the total population had preferred the commercial product irrespective of their educational level .TV advertisements, friends and promotion at supermarkets had a strong influence on consumption. Based on this study energy drink consumption can be considered as a waste of money and the study can be improved if the performances after the energy drink are measured. Significant increase in final year may be due to the heavy schedule and gender difference should be further investigated in a larger group. PP 114: Eating attitudes and behaviours among adolescent girls in the Colombo District, Sri Lanka LT Wijeratne1, KALA Kuruppuarachchi1, A Pathmeswaran2, SS Williams1 Departments of 1Psychiatry and 2Public Health Faculty of Medicine, University of Kelaniya Introduction: Eating disorders are considered by some to be a culture bound phenomena confined to the west. Its prevalence among young adolescents in Sri Lanka is not known. Aims: To describe the concerns and attitudes regarding weight and body shape among adolescent school girls in the Colombo district. Methods: A descriptive cross sectional study was conducted in selected National, type 1AB, type 1C and type 2 schools in the Colombo district, using a self administered questionnaire that included demographic data and the Eating Attitude Questionnaire ( EAT26 ). The EAT 26 was translated to Sinhalese and validated using the Delphi technique. Results: The study population consisted of 1564 adolescent school girls from 18 schools. A high risk for developing an eating disorder in terms of the EAT 26 questionnaire was seen in 217 ( 14%) and a moderate risk in 554 ( 36%). 14% believed they were fatter than their peers. Of those who believed they were fatter than others, 25% had an EAT 26 score indicating a high risk for developing an eating disorder. Dieting was undertaken by 34% to lose weight. Conclusions: Risk for eating disorders is present in adolescent girls in Sri Lanka. Clinicians need to consider this differential diagnosis in young females presenting with weight loss.

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Abstracts of Poster Presentations PP 115: Arthroscopic anterior cruciate ligament reconstruction with a four-strand hamstring tendon autograft A Gunatilake,RM Kannangara, RL Gunawardena, A Perera Sri Jayewardenepura General Hospital Introduction: Anterior cruciate ligament (ACL) injury is commonly encountered entity which seriously affects the performance and later results in osteoarthritis. Proper reconstruction and functional restoration is essential for favourable long term outcome. Aims: Assess the outcome following arthrocopic assisted ACL reconstruction with four strand hamstring tendon autograft. Methods: Sixty consecutive patients who had isolated ACL rupture, treated with reconstruction, with four-strand hamstring tendon autograft were included in the sample. Surgeries were performed at Sri Jayewardenepura General Hospital during one year (01/06/2010 â&#x20AC;&#x201C; 31/05/2011) and followed by structured physiotherapy programme. Demographic data, operative details, and clinical data were analysed and Lysholm score was utilized to ascertain functional out come. Results: Fourty two patients (31 males, 11 females) were available for the follow up. Age ranges from 17 to 48 years (mean 29.5). Majority (N=23 ) sustained sports injury. Sixteen patients had associated meniscal injury. All patients achived stability and full extension, without impingement on table. All patients achieved painless stable knee with full extension, and flexion more than 900 at the end of the physiotherapy programme. None got rupture or laxityof the autograft, implant failure or surgical site complications. Thirty eight (>90%) patients achieved excellent outcome (Lysholm score > 90 ) at the end of three week physiotherapy and 4 had limitation in flexion which improved with further physiotherapy. Mean Lysholm score improved from 55 points preoperatively to 92 points at the follow-up. Conclusions: ACL reconstruction with a four-strand hamstring tendon autograft is a safe procedure with excellent outcome. PP 116: Long term out come of hip resurfacing arthroplasty A Gunatilake, HMP Herath, RM Kannangara, A Perera Sri Jayewardenepura General Hospital Introduction: Hip resurfacing arthroplasty (HRA) is a metal-on-metalprosthesis, analternative to stemmed prostheses for younger patients. It preserves the femoral head and neck bone stock, so the revision surgery will be easier. Aims: Asses the long term functional status, complications and patient satisfaction following HRA Methods: Data from 11 consecutive HRA (nine patients) performed from 31/03/2007 to 31/03/2009 were analysed retrospectively using clinical and operative records, direct interviewing and physical examination. Follow up was for 3 to 5 years. Functional status was assessed objectively with Oxford hip score and UCLA activity score. Results: Nine hips of seven patients were available for the follow up. Age ranged from 31 years to 53 years (mean age 40 years). Main aetiological factor was osteonecrosis ( N=6). None of the patients got intra-operative complications. Two patients got superficial surgical site complications managed successfully with secondary suturing. All patients were discharged within two weeks(mean=6.4 days). None got late complications such as femoral neck factures, dislocations, osteonecrosis of the remaining head, complications due to metal ions or deep seated infection. No additional surgical procedures were needed. All patients had Oxford hip score > 50 (mean = 90) UCLA activity score > 6 indicating satisfactory joint function. Conclusions: HRA is a safe, useful alternative for young people who otherwise need THR. It gives excellent outcome with no other surgical interventions at long term follow up, while preserving femoral bone mass making revision surgery less complicated.

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Abstracts of Poster Presentations PP 117: Safe level of thickness of the mandibular bone graft - a preliminary study S Thilakarathne, MB Samarawickrama, BG Nanayakkara, I Ilayperuma, LBL Prabodha Department of Anatomy, Faculty of Medicine, University of Ruhuna Introduction: The body of the mandible is commonly used for obtaining cortical bone for maxillofacial reconstructive surgeries. Aims: The aim of this study was to assess the safe level of thickness of the cortical bone of the body of the dentulous mandibles by harvesting the bone graft in a group of Sri Lankan subjects. Methods: Eighteen dentulous hemi mandibles of human cadavers were used in this study. The block graft was obtained extending from the External Oblique Ridge (EOR) to 1.5cm inferiorly towards the Inferior Border of the Mandible (IBM) and width of the graft extending from mid buccal aspect of the first molar to the mid buccal aspect of the third molar teeth. The distance from the Cemento-Enamel Junction (CEJ) to the EOR, IBM, Inferior Alveolar Nerve (IAN) and cortical bone thickness of the harvested block graft were obtained by using a Vernier Caliper. (Mitutoyo, Japan). Results: The mean distance from CEJ to the EOR was 4.47 +/- 2.01mm and CEJ to IBM was 24.17mm +/3.43. The mean distance from CEJ to IAN was 14.20 +/- 3.75mm and the mean buccal cortical bone thickness of the harvested block graft was 2.64 +/- 0.52mm. Conclusions: The safe height of the block graft was determined to be less than 14.20mm (Range 10.4517.95mm) and the safe level of thickness of the graft was shown to be less than 2.64mm (Range 2.123.16mm) in dentulous mandibles of Sri Lankan subjects. PP 118: Iron deficiency anaemia in late infancy - who are at risk? S Mettananda, S Rajindrajith, WALK Weerasooriya, KLW Hathagoda, SMV Subasinghe, BC Lakmini Department of Paediatrics, Faculty of Medicine, University of Kelaniya Aims: To identify risk factors for iron deficiency anaemia (IDA) in infants between 6-12 months old in a tertiary referral centre in Sri Lanka. Methods: A case-controlled study was conducted in the University Paediatric Unit, Colombo North Teaching Hospital, Ragama, in June-December 2011. All infants aged between 6-12 months diagnosed to have IDA (haemoglobin <11.0g/dl + hypochromic microcytic red cells in the blood film + serum ferritin <12μg/dl) were recruited as ‘cases’ after obtaining informed consent from the mother. An equal number of age and sex matched controls were also recruited. Data were collected using an interviewer schedule and analysed using SPSS 16.0. Results: Fifty cases (male:female = 31:19) and an equal number of controls were recruited. Haemoglobin levels in cases were 9-11g/dl – 66%, 7-9g/dl – 28%, <7 g/dl – 6%. Mean value of mean corpuscular volume was 68.2fl (SD±8.2). Among cases, 15 (30%) mothers had tertiary education compared to 24 (48%) controls [p=0.06]. Of the cases 16 (32%) mothers were employed compared to 7 (14%) in the controls [p=0.03]. Low maternal weight (<45kg) at the booking visit was significantly associated with IDA in infancy [OR=2.6, 95%CI=1.01-6.71] but maternal anaemia was not a significant risk factor. Exclusive breast feeding beyond 5 months of age was also associated with increased risk of IDA [OR=2.5, 95%CI=1.11-5.74] whereas introduction of iron fortified food was a protective factor [OR=0.4, 95%CI=0.18-0.91]. Conclusions: Maternal employment, low maternal weight during early pregnancy and exclusive breast feeding beyond 5 months were significantly associated with IDA in late infancy.

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Abstracts of Poster Presentations PP 119: Optimum duration to place mercury in glass thermometer to check body temperature in children under 5 years P Perera, R Gamage, M Fernando, T Warnakulasuriya Faculty of Medicine, University of Kelaniya Introduction: Measuring axillary temperature using mercury in glass thermometer is the main method of measuring temperature in most of the households and hospitals of Sri Lanka. However, there is no agreement about the duration to keep the thermometer in axilla in order to record the temperature. Aims :To describe the optimum duration to place mercury in glass thermometer in axilla to check body temperature and its correlates. Methods: Cross sectional observational study was carried out at University Paediatric unit of Teaching Hospital Ragama during August 2011 and September 2011. All children less than 5 years of age, admitted during this period were recruited, on all inclusive consecutive basis, provided their mothers gave informed written consent. Using pretested mercury in glass thermometers, axillary temperature was recorded at 30 seconds intervals, while the thermometer was remaining in the axilla, until 3 stable recordings were obtained. Very ill and uncooperative children were excluded. Results: Temperatures of 264 children were recorded. Minimum duration to get a stable temperature was 1 minute and maximum duration was 6 minutes. Mean duration for stabilization was 2.98 minutes. There was no association between duration taken for stabilization and age, sex or BMI. Conclusions: Duration taken for stabilization has a wide variation. In an uncooperative child placing a thermometer in the axilla for 6 minutes is not possible. Measuring axillary temperature using mercury in glass thermometers can lead to underestimation of fever. Digital thermometers may be a better option as they indicate when final temperature has reached. PP 120: The impact of functional constipation on quality of life in children S Rajindrajith1, S Mettananda1, BC Lakmini1, SMV Subasinghe1, WALK Weerasooriya1, KLW Hathagoda1, NM Devanarayana2 1Department of Paediatrics, Faculty of Medicine, University of Kelaniya Sri Lanka Sri Lanka 2Department of Physiology, Faculty of Medicine, University of Kelaniya Aims: Chronic constipation is a common problem among Sri Lankan school children affecting approximately 10%. Previous hospital based studies from western countries have shown poor quality of life in affected children. In this study we assessed the quality of life of Sri Lankan school children with constipation and factors influencing it. Methods: This cross sectional survey was conducted in children aged 13-18 years, in a semi-urban school in Gampaha district. Data was collected using a pretested, self administered questionnaire with questions on bowel habits, healthcare consultation and quality of life (QOL). Constipation was diagnosed using Rome III criteria. Results: A total of 490 children were included in the study [males 254 (51.8%), mean age 15.2 years and SD 1.64 years]. Forty (8.2%) fulfilled Rome III criteria for constipation. Children with constipation had lower QOL scores for physical (84.1 vs. 90.0 in controls, p<0.001), social (85.9 vs. 92.4, p=0.001) and mental (75.4 vs. 80.9, p=0.05) domains, and lower overall scores (80.2 vs. 86.3, p=0.001). QOL scores were lower in girls with constipation than in boys (73.5 vs. 82.7, p <0.001), those with faecal incontinence (67.9 vs. 83.6, p<0.001) and in those who have seek medical care for their symptoms (71.5 vs. 83.4, p=0.25). None of the other symptoms had such significant difference. Conclusions: Children with constipation have lower quality of life, especially in social and physical domains. High degree of awareness among parents and clinicians and early detection and treatment, will be helpful to improve quality of life.

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Abstracts of Poster Presentations PP 121: Assessment of the quality improvements in the best-practice immunisation clinics SC Wickramasinghe, NC Kariyawasam Ministry of Health, Colombo Introduction: Improving the quality of immunisation has been focused in the World Bank Project. All the immunisation clinics in the country were assessed to select the best practicing immunisation clinic (BPIC) in each MOH area and funds were released to improve the clinic as a model clinic. This is an evaluation of the project. Aims: To compare pre and post status of BPIC and t assess the customer satisfaction in BPIC compared to other clinics Methods: A descriptive cross sectional study was conducted consisting of two components. That is, pre and post assessment of a randomly selected sample of 103 BPIC using a check list and assessment of client satisfaction of 100 mothers attending BPIC and 100 mothers from comparison clinics using an interviewer administered questionnaire. Results: In the pre and post assessment there was significant improvement in the Clinic site and preparation, AEFI/ Injection safety and waste disposal, Record keeping and follow up and screening and health education. Improvement was not seen in the areas of Vaccine and cold chain management and Procedures/ Injection techniques. Mothers attending BPIC were significantly more satisfied about improvements made in the clinic, skills of staff, waiting time in the clinics and availability of water, electricity and toilets. Conclusions: Training in Vaccine cold chain management and injection technique recommended. PP 122: Association between functional dyspepsia and gastric motility in children NM Devanarayana, S Rajindrajith, MS Perera, S Nishanthinie Faculty of Medicine, University of Kelaniya Introduction: Functional dyspepsia (FD) is an important gastrointestinal problem with obscure aetiology. Abnormal gastric motility is suggested as a possible pathophysiological mechanism for symptoms. The main objective of this study was to assess gastric motility in children with FD. Methods: 41 consecutive children [19 (46.3%) males, age 4-14 years, mean 7.5 years, SD 2.6 years) referred to Gastroenterology Research Laboratory, Faculty of Medicine, University of Kelaniya, from 1st January 2007 to 31st December 2011 for gastric motility assessment, were screened and those fulfilling Rome III criteria for FD were recruited. None had clinical or laboratory evidence of organic disorders. Twenty healthy children were recruited as controls [8 (40%) males, age 4-14 years, mean 8.4 years, SD 3.0 years]. Liquid gastric emptying rate (GER) and antral motility parameters were assessed using an ultrasound method. Results: Average GER (45.6 vs. 66.2% in controls), amplitude of antral contractions (58.2 vs. 89%) and antral motility index (5.1 vs. 8.3) were lower and fasting antral area (1.5cm2 vs. 0.6cm2) was higher in patients with FD (p<0.01). Frequency of antral contractions (8.8 vs. 9.3) did not show a significant difference (p=0.07). Scores obtained for severity of abdominal pain had negative correlation with GER (r=-0.35, p=0.25). Children exposed to stressful events had higher fasting antral area (1.9cm2) than those not exposed to stress (1.0cm2) (p=0.02). Conclusions: GER and antral motility parameters were significantly impaired in children with FD compared to controls. GER negatively correlated with severity of symptoms. This study highlights the importance of gastric motility in developing FD in children.

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Abstracts of Poster Presentations PP 123: Mothers’ knowledge regarding managing fever and febrile convulsions at home WDMG Amarasinghe1, DNW Amarasinghe2, ALAMC Ambegoda2, KN Lankathilake2 1De Soysa Hospital for Women, Colombo 2Ministry of Health, Colombo Introduction: Fever is one of the commonest presentations to paediatric wards, which can easily proceed to a febrile convulsion causing great parental anxiety. Aims: To determine the knowledge on managing fever and febrile convulsions at home among mothers. Methods: Four wards at LRH were selected by simple random sampling. From each ward, 25 mothers who are having at least one living child aged below 6 years were selected by simple random sampling. A pre-tested interviewer administered questionnaire was used. Statistical significance was tested with Chi square test. Results: 41 mothers (41%) knew the correct normal body temperature. 34 mothers (34%) had poor knowledge regarding use of thermometer. Only 49 mothers (49%) had adequate knowledge on management of fever at home. 82 mothers (82%) had an adequate knowledge regarding symptoms of febrile convulsions. 48 mothers (48%) had good knowledge on management of febrile convulsions. Regarding prognosis of febrile fits, 38 mothers (38%) thought that child’s intellect will be retarded and 41 thought (41%) it will lead to future epilepsy. Although, there was a statistically significant association between past experience of febrile convulsion, with knowledge regarding management of febrile convulsions (P<0.05); maternal age and parity did not. Commonest method of gaining education regarding febrile convulsions is through mass media (n=46). Conclusions: Education regarding correct methods of temperature reduction in a febrile child is important to prevent febrile fits. Mothers should be educated more on management and prognosis of febrile convulsions focusing on existing myths and incorrect life threatening practices. PP 124: Depression in parents of children with congenital adrenal hyperplasia - a preliminary study from the Lady Ridgeway Hospital KSH de Silva1, P de Zoysa2 Departments of 1Paediatrics and 2Psychological Medicine, Faculty of Medicine, University of Colombo Introduction: The nature and long-term implications of having a child with Congenital Adrenal Hyperplasia (CAH) could have a negative psychological impact on parents. Aims: To assess the prevalence of depression in parents of children with CAH. Methods: The study consisted of a convenience sample of 11 fathers and 26 mothers of children diagnosed as having CAH and receiving treatment in a ward at the Lady Ridgeway Hospital. The Sinhala, Tamil and English translations of the self-administered 20-item Centre for Epidemiological StudiesDepression (CES-D) scale was used to measure depression. The parents had already been informed about the condition at the time of administering the CES-D. Results: The CES-D classified 45% of fathers and 65% of mothers as being depressed. Conclusions: The finding that mothers, more than fathers, are impacted by their child’s diagnosis is not an unusual finding as females report a higher prevalence of depression. Being more closely involved in the life of a child, mothers may be more affected. Depression rates in the general public vary. The USA reports it as 19.1% while Sri Lanka reports 6.6%-11.2%. Compared to these figures, the rate of depression in the present sample is very high. This indicates that having a child with CAH may have a great psychological impact on the parents. Hence, it is imperative that Sri Lanka’s health system offer such parents psychotherapeutic services to manage their distress.

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Abstracts of Poster Presentations PP 125: Prevalence of depression among patients diagnosed with brain tumours SW Kotalawala, BJ Mendis, N Dolawaththa, KGCL Kapugama National Institute of Mental Health, Angoda Introduction: Prevalence of depression in the community is between 2 and 5 per cent. Depression rates are higher in patients with brain tumours. Sri Lankan data with regard to this are lacking. Aims: To determine the prevalence of depression among patients diagnosed with brain tumours admitted to neurosurgery units at National Hospital of Sri Lanka Methods: Descriptive cross sectional study. A sample of 50 inward patients with brain tumours at Neurosurgery units, National Hospital of Sri Lanka were interviewed using a self administered questionnaire to assess the presence and severity of depression (validated Sinhala version of Beck Depression Scale) which was followed by a clinical interview to confirm the results. Results: Twenty eight (56%) were males. Mean age was 45.7 years (Range 22-71). Most encountered tumour locations in the sample were frontal lobe (n=7, 14%), temporal lobe (n=6, 12%) and cerebropontine angle (n=6, 12%). Most common tumour types in the sample were meningiomas (n=15, 30%) and glioblastomas (n=6, 12%). 24% (n=12) of patients had mild depression; 18% (n=9) had moderate depression; 4% (n=2) had severe depression. 54% (n=27) of patients did not have depression. Conclusions: A significant proportion of patients with brain tumours had depression. Every patient diagnosed to have a brain tumour should undergo psychiatric evaluation in the course of their treatment and if they have symptoms of Depression should be treated vigorously. PP 126: A descriptive study on the use of rapid tranquilization at the psychiatric intensive care unit of the National Institute of Mental Health MMP Devadithya1, RMAVL Seneviratne1, J Mendis1, JKND Miththinda2 1National Institute of Mental Health, Angoda 2Colombo North Teaching Hospital, Ragama Introduction: Rapid tranquilization is the use of psychotropic medication to control acutely disturbed behaviour. The PICU functions as the unit in which psychiatric emergencies are managed on admission to NIMH. Aims: To estimate the percentage of total admissions that requires rapid tranquilisation on admission and to compare details by age, gender, route and by the number of tranquilizers. Methods: A descriptive cross sectional study involving all admissions (n=1143) to PICU was conducted from January to April 2011. Data gathered from OPD and PICU admission registers. Results: From total admissions 47% were admitted to PICU and of them 45% were chemically sedated. The male to female proportion among the sedated was 1.3: 1.The results revealed 22% to be less than thirty years, 66% were thirty to sixty years and 12% were over sixty years. There was no significant difference in sedation among the different age groups (p =0.220). IM route was preferred over oral route regardless of the age group (p = 0.000) and sex (p = 0.002).The majority (59%) got two IM drugs. Patients below 60 years received more than one drug while those over 60 years received one drug (p=0.04). Conclusions: There is a significant preference of IM route over oral in all age groups and in both sexes. The widespread usage of IM route for sedation indicates further investigation.

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Abstracts of Poster Presentations PP 127: Recurrent urinary tract infections in females â&#x20AC;&#x201C; a prospective analysis KCD Mettananda, A Ranaweera, DSG Mettananda Faculty of Medicine, University of Kelaniya Introduction: Urinary tract infection (UTI) is the commonest infection in women worldwide. Patients with co-morbidities or predisposing factors are at risk of developing recurrent UTI. They require hospitalisation, since causative organisms acquire resistance to first-line antibiotics and intravenous second-line antibiotics are indicated for complete eradication. Consequently, there is disturbance to lifestyle and loss of productivity for the patient. Aims: To describe clinical profile and risk factors of female patients with recurrent UTI. Methods: All females admitted to the University Medical Unit at Teaching Hospital, Ragama from April 2011- March 2012, with >2 UTI occurring within the previous 12-months, were recruited. Data was collected using an interviewer-administered questionnaire. Results: 22 patients [mean age 48.8 years (SDÂą16.8, range 14-73)] fulfilled inclusion criteria. 16 (73%) were post-menopausal.13(59%) had diabetes, with poor control in 12. Other risk factors were constipation (27%), cystocele (14%), urinary calculi (9%) and hydronephrosis (9%). Urine culture was performed before antibiotics in 17(77%). 88% pre-treatment cultures were positive. 11(50%) had pyelonephritis during the current admission. 85% of diabetics had positive cultures compared to non-diabetics (77%) (p=0.55). Escherichia coli was the commonest pathogen (in 67.5%). Pyelonephritis was commoner among diabetics (61%) than nondiabetics (33%) (p=0.193). Conclusions: Post-menopausal women with poorly controlled diabetes are likely to have pyelonephritis when they develop recurrent UTI. Better glycaemic control, avoiding constipation and early treatment of structural abnormalities will reduce recurrent UTI in the at-risk population. PP 128: Sexual dysfunction, practices and knowledge on reproductive health: does it differ between males and females of spinal cord injured patients S Samanmali, C Arambepola, I Sudasinghe Faculty of Medicine, University of Colombo Introduction: Spinal Cord injury (SCI) has a major impact on Reproductive Health (RH). Majority of people affected are in their reproductive age. Aims: To describe the knowledge and practices related to RH among adults with SCI Methods: A cross-sectional study was conducted among adults enlisted in the register of Ragama Rehabilitation hospital who had been rehabilitated and discharged since year 2000 following SCI. RH practices and knowledge based on a score were assessed using a self-administered questionnaire in local languages sent by post with a stamped return envelope. Results: Out of 65, 35 SCI patients (53.8%) with mean age of 35 years (SD=7.7) responded.25 (71.4%) were males; More than 25% were educated beyond school leaving age; 54.3% were currently married while some had divorced (5.7%) or separated (8.6%)following SCI. 29% had sensation in genital area. Following SCI, 60% have had sexual experience (23, 50% females; 23, 64% males), during which 33% experienced urinary leakage but none had bowel leakage. Among males, 96% had erectile and 64% had ejaculatory problems. Only 36% and 12% of males knew of alternative methods for such problems, respectively. Among females, 29% were practising contraception while one had undergone pregnancy. Following SCI, 54.3% sought RH information from peer groups (45.7%), rehabilitation centres (25.7%) and the internet (22.9%). RH knowledge was significantly higher among females who had experienced sex (p=0.04) but was not associated with education or marital status (p>0.05). Males did not demonstrate these relationships.

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Abstracts of Poster Presentations PP 129: Sri Lanka in global medical research: a scientific analysis of the Sri Lankan research output P Ranasinghe1, R Jayawardena2, P Katulanda3 1Department of Pharmacology, Faculty of Medicine, University of Colombo 2School of Human Movement Studies, Institute of Health and Biomedical Innovation, Queensland Universities, Australia 3Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo Introduction: Scientific research is essential for guiding improvements in healthcare systems. There are no studies examining the national medical research output at international level. Aims: To evaluate the Sri Lankan research output in medicine between years 2000–2009. Methods: Sri Lankan medical research publication data were retrieved from the SciVerse Scopus® database. Search criteria used were as follows; Affiliation: ‘Sri Lanka’/‘Ceylon’, Year: ‘01/01/200031/12/2009’ and Subject area: ‘Health’. Results: Sri Lanka’s cumulative medical publications output between years 2000–2009 was 1,740 articles published in 160 different journals. Average annual publication growth rate was 9.1%. Majority of the articles were published in ‘International’ (n=950, 54.6%) journals. Most articles were descriptive studies (n=611, 35.1%), letters (n=345, 19.8%) and case reports (n=311, 17.9%). The articles were authored by 148 different local authors from 146 different institutions. The three most prolific local institutions were Universities of Colombo (n=547), Kelaniya (n=246) and Peradeniya (n=222). UK was the largest collaborating partner (n=263, 15.1%), while 84 countries have published collaborative papers with Sri Lankan authors. Malaria (n=75), Diabetes (n=55), Dengue (n=53), Accidental injuries (n=42) and Filariasis (n=40) were the major diseases studied. The publications were cited 9,708 times but there were 597 publications without citations. The national contribution to global medical research output during the last decade was 0.086%. Conclusions: The Sri Lankan medical research output during the last decade is only a small fraction of the global research output. There is a necessity to setup an enabling environment for research and strengthen collaborations across the region to face common regional health challenges. PP 130: Medical student research in two Sri Lankan universities - where have all the research gone? KR Atukorala, KH Wickramasinghe, GM Rathnayake, GM Jayasena, PN Weerathunga, S Jayasinghe Department of Clinical Medicine, Faculty of Medicine, University of Colombo Introduction: Faculties of Medicine, University of Colombo(FMC) and University of Kelaniya(FMK), have undergraduate research(UGR) programmes that yield a wealth of research annually. It is a vital opportunity for students to go through the process of research. The profile or outcome of UGR in these faculties, were hitherto unknown. In western settings medical student research is a main contributor to the volume of research publications from each university. Aims: To find out the profile of research done by undergraduates of the FMC and FMK and to describe the outcome of such research with a view of providing data to develop the field of medical UGR. Methods: A descriptive cross sectional study was conducted at FMC and FMK involving 346 undergraduates who had completed their final examination in 2010. A self administered questionnaire was used. Results: The hospital setting was used by 48%(166/346). Clinical medicine topics were studied by 30.3%(105/346) and reproductive health by 25%(87/346). Patients were studied by 32.4%(112/346). Descriptive studies were done by 63.9%(221/346) and the rest did analytical studies. None conducted experimental or laboratory studies. Presentation of research in scientific for a was done by 57.6%(199/346). Only 1.73%(6/346) students had publications in indexed journals. A career in medical research was preferred by only 29.2%(101/346). Conclusions: Majority of UGR done were not published in indexed journals. Undergraduates should be encouraged to achieve indexed publications and also to do experimental and laboratory studies. More research needs to be conducted among other medical faculties to assess student research and publication profile.

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Abstracts of Poster Presentations PP 131: An innovative short course to facilitate a smooth transition from faculty-based learning to the clinical based learning environment RMGM Ratnayake, LP Ruwanpura, KR Atukorala, PN Weeratunga, GM Jayasena, S Jayasinghe Faculty of Medicine, University of Colombo Introduction: Students face several transitions during their academic career, of which transition to the hospital environment is stressful. Aims: To assess the student perception on the course. Methods: The batch of 200 was divided to 3 groups and each had the 5-day course consecutively to facilitate smooth transition. Course used three educational-models: Narrative-learning, Problem-Based Leaning and Self-directed learning and consisted of: Day-1: ward visits by student groups (7/group) to obtain the life story from patient (1.5-2hours); Day-2: present narratives, identify learning objectives and self-study (2hours); Day-3: presentations on self-study topics (1.5-2hours); Days-4 and 5: watch videos on history taking and physical examination produced by Faculty and distribute a workbook on Clinical Skills. Student perceptions were assessed using a questionnaire distributed at end. Results: Response rate was 195/200 (97.5%). The following numbers found the respective activities useful: (a) meeting patients: 192 (98.5%) as it helped to view patients in a more humane manner; (b) patient narratives as a method to identify learning objectives: 192 (98.5%); (c) basic sciences learnt in Faculty to explain pathophysiology : 189 (96.9%). (d) videos as a learning aid: 183 (93.8%); (e) workbook for future references: 124 (95.4%; n=120). Appreciable proportion 81 (38.5%) had not referred a text-book on clinical examination. Conclusions: Majority of students perceived the course as a useful learning activity. Narrative-based and Problem- based learning are useful methods in learning and can be further supplemented via workbooks, role-play and simulated patients. PP 132: A useful tool for a reflective approach in an undergraduate medical curriculum L Wanigabadu, V Jayasuriya, C Amarasinghe Department of Community medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura Introduction: Reflective capacity is essential for mdical professionals. It has been difficult to encourage its application in integrated curricula. The Community Medicine clerkship is based on experiential learning through field visits and a blog (web-log) was introduced to facilitate reflective practice. Aims: to describe the usefulness of a blog in developing reflective approach during a Community Medicine clerkship Methods: A blog (www.clerkship.blogspot.com) was created and 38 students wrote weekly posts based on their field visits. The text from 157 posts was extracted and content analysed. Feedback was sought by an online survey. Results: Blog content fitted into the 4 stages of experiential learning theory; experience (80% of the time), observation (62%), reflection (78%), abstract reconceptualization (68%), and experimentation (32%). Most posts were insightful and contemplative, for example at the school medical inspection ‘When we were leaving, children worshipped us, this was unbearable, we are still ‘students’… this reminds me we have responsibilities...ARE we responsible? ’Majority enjoyed posting (73%), and agreed that it was useful (93%) and wished to continue posting (70%) compared to a report. The only limitations were lack of internet access (29%) and lack of prior experience in blogging (29%). Conclusions: The high level of reflection and abstract reconceptualization indicates its usefulness among undergraduates (familiar with online networking platforms) creating a suitable method for demonstration of reflective practices. The usefulness of the blog could be maintained if limitations of internet access are removed.

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Abstracts of Poster Presentations PP 133: The master-apprenticeship model - medical undergraduates’ experiences in clinical learning settings in Western Province I Nazeer, V Jayasuriya Department of Community medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura Introduction: Clinical teaching is a complex learning situation influenced by the participants’ actions and interactions. Few studies have been conducted to explore how clinical supervision is carried out in such settings in Sri Lanka. Aims: to describe the Medical undergraduates’ experiences in clinical learning settings in Western province using qualitative methodology and pedagogical principles. Methods: In-depth interviews with 15 purposively sampled pre-intern medical undergraduates in Western Province was conducted by a peer in confidence. Respondents were asked to describe routine days at the ward during the final year. Names of persons and places were removed from the tape recordings and transcribed text before giving to the PI to assure confidentiality, impartiality and nonjudgment in analysis. The text was analyzed following an ethnographic approach to identify meaning patterns, similarities and differences in experience. Results :Pedagogical strategies applied were biased more towards transmission of knowledge (questions and answers 78/115 instances, lecturing 90/110), and less towards ‘organization of student activity’ piloting, prompting, supplementing (32/115), demonstrating (55/115) and intervening (45/115). The narratives demonstrate a high degree of separation between the teacher and the students, teacher imparting knowledge and students seeking refuge in a traditional structure with few interactions. These themes fit an outdated pedagogical formula the master-apprenticeship structure. Conclusions: Despite emerging evidence of limitations of the master-apprentice model, it is seen to be practiced in clinical settings. Greater knowledge of pedagogical strategies and student’s situational needs will be useful in our clinical learning settings. PP 134: Characteristics of health information-seeking behaviour of Suwasariya (Health Net) users GGAK Kulatunga1, GMK Perera2, RDF Kanthi2, S Amunugama3 1Post Graduate Institute of Medicine, University of Colombo 2Health Education Bureau, Colombo 3Ministry of Health, Colombo Introduction: Although an extensive amount of medical information and interactive services are available through the Internet, availability of web sites with Sri Lankan identity is Minimal. Addressing this deficiency “Health Net” {http//www.suwasariya.gov.lk } was launched in November 2011 by Health Education Bureau with aims of “serving Sri Lankans by Sri Lankans” to provide web based health information through web articles and resource call centre (Hot line 0710107 107). Increasing number of individuals are using the internet to meet their health information needs; however, little is known about the characteristics of online health information seekers. Aims: To determine the characteristics of Sri Lankan online health seekers and nature of the information sought and their behaviour. Methods: Characteristics of Sri Lankan health information seekers who accessed Suwasariya by SMS, email, Skype or Telephone calls were analysed. Results: Males seeks for health information more than females (71% vs 29%). Most of the health information seekers were from Colombo and Gampaha districts (34%). Most commonly sought information is the cause or description of disease (58%). And from those around 40% were on information on diseases of the kidneys genitourinary system and hormone and nutritional diseases. Conclusions: The Internet as an unlimited and uncontrollable source of information, can deliver preventative and clinical health information to Sri Lankans. But it is important to deliver correct information through a responsible source for the Sri Lankan information seeker. Health on the Internet also has the potential to challenge institutionalized and professional interests.

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Abstracts of Poster Presentations PP 135: Views of students on the use of computer aided pathology practical classes BAGG Mahendra, RMUS Rathnayake, J Hewaviisenthi Department of Pathology, Faculty of Medicine, University of Kelaniya Introduction: Conducting pathology practical classes in the traditional manner is becoming increasingly difficult. With rapidly advancing medical knowledge it is a challenge to impart a large amount of facts within a limited time. A programme of Computer Aided Pathology Practicals (CAPP) was introduced to overcome these challenges. Aims: To determine whether this programme was successful in the view of the students, what the short comings were, and how the system could be improved. Methods: A self administered questionnaire was used to assess the views of the students of Batch 20 of the Medical Faculty, Kelaniya. The pathology practicals for these students had been conducted using both the traditional and the CAPP systems. Results: 62.7 % students preferred the CAPP programme. The reasons offered for this preference included greater enhancement of knowledge of the course content (59.6% ), a greater area of knowledge covered within a single session (76.9%), ability to appreciate the architectural (73.4%) and cytological features ( 76.8%) of lesions better, being easier to operate (77%) and the saving of time ( 85.7%). However 67.9% of the students were of the opinion that the traditional pathology practicals were more realistic especially with regard to appreciating the macroscopic features, than the CAPP system. Conclusions: Overall the CAPP programme was well received by a majority of students. The lack of “hands on experience” is a problem encountered in all forms of virtual teaching. This could be improved by encouraging the students to use the pathology museum more frequently. PP 136: Awareness of clinical trial registration BCM Wimalachandra1, UK Ranawak2, KAG de Abrew1, CA Wanigatunga3, LC Rajapaksa1, C Goonaratna1 1Faculty of Medicine, University of Colombo 2Faculty of Medicine, University of Kelaniya 3Faculty of Medical Sciences, University of Sri Jayewardenepura Introduction: Prospective registration in a freely accessible public domain is mandatory for clinical trials. Little is known regarding awareness of clinical trial registration among the scientific community. Aims: To assess awareness of clinical trial registration among participants attending a scientific meeting in Sri Lanka. Methods: Knowledge of trial registration was assessed using a self-administered questionnaire. Results: Only 251 out of 714 participants (35.6%) returned completed valid questionnaires. Of them, 53.4% were males, 74.9% were below the age of 40 years, and 49% had less than 5 years of professional experience. Majority (56.6%) were currently involved in research. Registration was considered necessary for trial publication by 73.3%, for presentation of findings by 56.2%, and for ethics approval by 54.6%. Over 70% agreed that trials should be registered prospectively. Majority felt it was beneficial to have research findings freely accessible to other researchers (81.3%), clinicians (84.5%) and research participants (76.7%). Many agreed on the positive effects of trial registration - access to findings of all trials (61.4%), access to negative results (47.8%), preventing trial duplication (69.3%) and preventing multiple publications (70.1%). Increasing research workload (49.8%), additional restrictions on research (52.2%) and possibility of ‘intellectual theft’ (56.2%) were seen as potential negative effects. Awareness of access to registration mechanisms for trials conducted in Sri Lanka (49%), and a Sri Lankan trial registry (31.5%) was poor. Conclusions: Awareness of clinical trial registration was satisfactory in some aspects, but several areas need improvement.

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Abstracts of Poster Presentations PP 137: Knowledge and practice of research among medical officers working in rural areas S Dolamulla, N Attanayake, PK Wickramasinghe, A Chandrasiri Regional Director of Health Services Office, Hambantota Introduction: Research experience is invaluable to the physician's evidence-based practice as it imparts skills such as literature search, collecting and analyzing data and critical appraisal of evidence Aims: The main objective of the study were to assess the existing level of knowledge and attitudes towards health research amongst medical professionals and to determine their research involvement and practices Methods: A cross sectional, survey was carried out in Southern province of Sri Lanka during February 2012. Pretested, anonymous and self-administered, questionnaire assessed basic demographic data, the willingness to engage in and practices related to research amongst medical officers [MO’s] and dental surgeons [DS’s]. Results: Response rate was 99%. (132/134). Only 22.7% of medical professionals had a good knowledge of HR while 55.4% and 45.5% of participants had a good attitude and practice towards HR. 88.1% believed MO’s and DS’s should perform HR and 85% were willing to conduct scientific research. 86.6 % had participated in HR, 59.1 % had written research proposals, 31.8% had produced scientific papers, 59.1 % had recently read a scientific journal, and 72.7 % had used research evidence in medical practice. Inadequate time, infrastructure and teaching considered as major constraints for HR. Conclusions: MO’s and DS’s demonstrated willingness to engage in research even thought their knowledge was poor. Establishment of training and research facilities at institutional level will encourage of HR among the MO’s working in rural areas. PP 138: The quality of controlled clinical trial reporting in five leading Sri Lankan medical journals TI Pathirana, C Abeysena Sri Jayewardenepura General Hospital Faculty of Medicine, University of Kelaniya Introduction: The Consolidated Standards of Reporting Trials (CONSORT) statement and the Transparent Reporting of Evaluations with Non-randomized Designs (TREND) checklist help improve the quality of reporting of trials. Report quality is often used as a surrogate measure of methodological quality. Aims: To assess the quality of reporting of clinical trials published in five leading Sri Lankan medical journals Methods: Five medical journals published between 1982 – 2011 were hand searched for randomized (RCT) and non randomized clinical trials(NRCT) conducted in humans. These were evaluated by two independent observers to assess them against a checklist developed based on CONSORT and TREND recommendations. Outcome measures were presence of checklist items in published reports. Results: Twenty two RCT and 16 parallel group NRCT from 160 journals were included. Out of them, Thirty six (94.7%) clearly described the objectives, 13 (34.2%) the periods of recruitment, 7(18.4%) sample size determination, 12(31.6%) the flow of participants through each stage,19 (50%) baseline demographic and clinical characteristics of each group. Twenty one (55.3%) used statistical methods to compare groups for primary outcome, 21(55.3%) effect size, 4 (10.5%) its precision. Twenty (52.6%) interpreted the results in the context of current evidence. Five (13.2%) described the generalizability of the findings. Of the 22 RCT, only one (4.5%) reported sequence generation, 3(13.6%) allocation concealment, 7(31.8%) blinding status of participants or investigators and 2(9.1%) intention to treat analysis. Conclusions: Reporting of several essential criteria of remain suboptimal. Awareness of the CONSORT and TREND statements may improve matters quality of reporting.

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Abstracts of Poster Presentations PP 139: Availability and distribution of infrastructure, and practice related to research in the health institutions in Hambantota district S Dolamulla1, N Attanayake2, K Wickramasingha1 1Regional Director of Health Services Office, Hambantota 2University of Colombo Introduction: Research work, skills and experience of the medical professionals [MP s] are encouraged by research friendly environment of the health institution [HI] and they may help influence career decisions of them. Aims: The main objective was to assess the availability and distribution of existing infrastructure and practice in HI to produce a plan for resource allocation to improve research practice. Methods: A cross sectional, check list based survey was carried out in Hambantota district of Sri Lanka during March 2012. A interviewer-administrated questionnaire and a check list were used to collect information on basic institution data, telecommunication facilities, availability of literature and practice related to health research in 20 hospitals, 14 dispensaries and 16 preventive institutions. Chi-square test was used and p<0.05 was taken as significant. Results: Valid response were received from 48 [96%] of 50 HIâ&#x20AC;&#x2122;s.Availability of resources and practice in HIs were not satisfactory. 90% of HIâ&#x20AC;&#x2122;s had telephone. Majority did not have fax [47%], computers [47%] and internet [33%]. Few had internet [47%], photocopy machine [29.1], digital camera [14.5%] .Very few had library collection 29%, international journals [10%] and institutional magazine [20%], research plan [6%], agenda [6%] and budget [8%]. collected research topics 16% while 35% of HIs involved with current research with 12.5% their own work. Majority of resources were available among preventive institutions and very few resources among the dispensaries. Conclusions: Inequity of facility distribution can be seen among the institutions as well as within the institution categories. It may adversely affect the research practice of MPs. PP 140: Does Sanders-Retzlaff-Kraff (SRK-2) formula suit a Sri Lankan population in phacoemulsification cataract surgery of medium axial length? MS Amaratunge1, J De Silva1, IM Wasthuhewaarachchi2, SH Uyangoda1, MAJI Mallawaarachchi1, R Premarathna3, AAN Nishad4 1Vijaya Kumaratunge Memorial Hospital, Seeduwa 2Teaching Hospital, Vavuniya 3Faculty of Medicine, University of Kelaniya 4Post Graduate Institute of Medicine, University of Colombo Introduction: After introduction of phacoemulsification with small incision techniques, intraocular lens (IOL) power calculation predictionhas become a crucial step for good refractive outcomes. SRK-2 formula is widely used for that purpose in many locations. Aims: To evaluate the predictive accuracy of post operative refraction using SRK-2 formula in phacoemulsification of eyes with 22-26mm axial length. Methods: Patients with senile cataracts undergoing phacoemulsification and IOL during 2011 in Gampaha district by a single surgeon were selected randomly. Single examiner measured simulated manual keratometry preoperatively, seven days postoperatively. Uncorrected visual acuity, slit lamp examination of anterior segment and best spectacle-corrected visual acuity (BSCVA) were measured. The implanted IOL power was used to calculate the predicted postoperative refractive error using time SRK-2 formula. Results: Of 274 patients (56% females, mean(SD) age 65.3(10) years), the right eye was operated in 142(51.8%). On postoperative seventh day, 79% had VA of 6/6 and 14% to 6/9, 4% to 6/12 to 6/36 in the operated eye. Mean(SD) of IOL power used 21.50 (1.90)D. The predicted refractive error with SRK-2 was -0.3(0.145)D and the achieved refractive error was -0.22(0.732)D. Difference between predicted and achieved refractive error presented a slight hyperopic shift {mean(SD) 0.054(0.397)D}. There was a negative Pearson correlation (-0.126) between the predicted refractive error and achieved refractive error (p=0.04). Predictive error was less than 0.5 in 80.2%, <0.75 in 88.6% and <1.0 in 96.7%. Conclusions: SRK-2 formula is a good option to predict the refractive error after cataract extraction by phacoemulsification in eyes with medium axial length.

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Abstracts of Poster Presentations PP 141: Gastric antral vascular ectasia - endoscopic patterns, aetiology and treatment options. ANR Fernandopulle, BS Sebastiampillai, AT Matthias NMM Navarathne National Hospital of Sri Lanka, Colombo Introduction: Gastric antral vascular ectasia (GAVE) can be associated with gastrointestinal blood loss in patients with and without cirrhosis. In previous reports approximately 30% of patients with GAVE had cirrhosis. GAVE has been associated with autoimmune diseases, hypothyroidism, bone marrow transplantation and chronic renal failure. Chawla et al distinguish three macroscopic patterns: watermelon stomach, honeycomb stomach and flat isolated lesions. Methods: 19 patients were diagnosed with GAVE. As in previous reports GAVE was diagnosed on endoscopic appearance and on histology when in doubt. All patients were investigated for the known associations if clinically indicated. Argon plasma coagulation (APC) was done for all patients, supplemented with tranexemic acid and followed up over a median of six month. Results: In our study the typical watermelon GAVE (Group A) was seen in 5 (26.3 %) patients, of which two had cirrhosis. A more diffuse (Honeycomb) type GAVE (Group B) was seen in 14 patients of which 13 (92.8%) were cirrhotic. Of the group A, one had hypothyroidism and one had a diagnosis of carcinoid syndrome. Patients in group A needed less number of APC sittings (1) compared to group B (2-3) Conclusions: Non-cirrhotic patients are more likely to have a classic â&#x20AC;&#x153;watermelonâ&#x20AC;? stomach with linear lesions within the antrum whereas in cirrhotics the disease is more often diffuse. Similar to previous studies in our study APC was a successful treatment option for the former but was less successful for the later. PP 142: Results of endoscopic management of bleeding gastric varices with cyanoacrolate glue in a cohort of Sri Lankan patients ANR Fernandopulle, BS Sebastiampillai, AT Matthias NMM Navarathne National Hospital of Sri Lanka, Colombo Aims: Open label non comparative study to evaluate the safety and efficacy of Cyanoacrolate glue injection for bleeding gastric varices. Methods: 112 patients with bleeding gastric varices were included. All were injected with Endocryl glue with a median volume of 3ml (range 2 -5). Oesophageal band ligation was performed for patients with concomitant esophageal varices. Rate of successful haemostasis, rebleeding rate and complications were analysed. Results: Of the patients 69 were male, 43 female while mean age was 53.8 years. 102 (91%) had cirrhosis while 10 (9%) had extrahepatic portal hypertension. 105 (93.7%) had gastroesophageal varices, six had isolated gastric varices(IGV)-1, while 1 had IGV -2. Immediate haemostasis was achieved in 110(98.2%) patients, Early (within 48h) re-bleeding occurred in 8 (7.2%), and bleeding after 48h to 6 weeks was seen in 12 (10.9%). Two patients who failed to achieve immediate haemostasis underwent emergency surgery. No deaths occurred within the first 48 hours after glue injection but 5 (4.5%) died during the 48h to 6 week period, two due to bleeding and rest due to complications of cirrhosis. Re-bleeders were treated with the same procedure. Ten patients (8.9%) developed ulcers at injection site while no other complications were seen. During the median follow up of 13.2 months (range 1 -44) complete eradication of gastric varices was observed in 38 (34.5%) patients. Conclusions: This study revealed that Endocryl injection is an effective treatment modality to achieve immediate haemostasis in patients with fundal varices. Although complications are very minimal, rebleeding can occur.

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Abstracts of Poster Presentations PP 143: Age specific cut-off levels of serum prostate specific antigen (PSA) for symptomatic Sri Lankan men, aged 50 years and above NP Panapitiya1, U Samarasinghe2, LDJU Senarath3, MVC De Silva1, MDS Lokuhetty1 1Departments of Pathology Faculty of Medicine, University of Colombo 2Department of Radiology, Nawaloka Hospital, Colombo 3Department of Community Medicine, Faculty of Medicine, University of Colombo Introduction: Carcinoma Prostate (CaP) is amongst the ten leading cancers in Sri Lankan men, aged 50 years and above. PSA values help to identify symptomatic men having a higher probability of CaP. They would benefit from trans rectal ultra sound guided biopsy(TRUSB), a specific diagnostic tool for CaP. Age specific reference values for serum PSA are however unavailable in the local setting. Aims: To develop age specific cut-off values for serum PSA in symptomatic Sri Lankan men, aged 50 years and above. Methods: This descriptive cross sectional study evaluated the PSA values and the TRUSB findings of 966 Sri Lankan men presenting with lower urinary tract symptoms, aged 50 years and above. Information was retrieved from case records retrospectively. Sensitivity and specificity were calculated using SPSS. Receiver Operating Characteristic curves were produced for PSA values for 3 different age categories. (50-59, 60-69 and ?70 years) Results: The age specific cut-off values obtained for Serum PSA level at a sensitivity level of >96% include: 1) 50-59years – 4.6ng/ml(specificity – 7.4%), 2) 60-69years – 5.6ng/ml (specificity – 5%), 3) ?70years –6.6ng/ml (specificity – 9.4%). Conclusions: The suggested age specific cut-off values for PSA developed for symptomatic Sri Lankan men aged 50 years and above are highly sensitive(>96%) in detecting CaP, however with low specificity(<10%). These suggested PSA cut-off values will be useful when evaluating symptomatic Sri Lankan males for CaP in the given age categories. PP 144: Pathological significance of epidermal growth factor receptor, vascular endothelial growth factor, chemokine receptor4 and vimentin expression by colon carcinoma cells MIM De Zoysa1, DN Samarasekera1, LDJU Senarath1, CA Samarasekera2, CB Reid3, MDS Lokuhetty1 1University of Colombo 2National Hospital of Sri Lanka, Colombo 3Charles Drew Medical University, Los Angeles, USA Introduction: Colon carcinoma has a worldwide incidence of over one million with a 5 year survival rate of <20% for metastatic disease. Identification of metastasis related biomarkers will enable risk evaluation of metastasis in colon carcinoma. Aims: To correlate the expression of EGFR, VEGF, CXCR4 and Vimentin with the pathological tumour and nodal stage(pTN) of colonic carcinoma. Methods: Ninety one consecutive patients who underwent resection for colon carcinoma are included. Information on(pTN) staging was obtained from the histopathology records. Four biomarkers were evaluated on paraffinized tumour tissue using immunohistochemistry methodology. Biomarker expression was assessed by two reviewers blinded to(pTN) staging. Positive staining was evaluated as high and low expression in VEGF, CXCR4 and Vimentin. EGFR was evaluated as positive/negative. Crosstabulations were generated between T&N stages and biomarker expression levels. The Chi Square test was used to indicate statistical significance of the association. Results: T2, T3 and T4 tumours accounted for 21(23)%, 60(66%), 10(11%) and N0, N1 and N2 tumours accounted for 54(61%), 23(26%) and 12(13%) respectively. T4 tumours were associated with positive expression of EGFR(X2=7.1,p=0.008) and VEGF(X2=3.9,p=0.048) compared with T2+T3 tumours. T3+T4 tumours showed reduced expression of Vimentin(X2=4.41,p=0.036) compared to T2 tumours. N2 status was associated with positive EGFR expression(X2=3.905,p=0.048) compared with N0+N1. Conclusions: EGFR expression was associated with advanced tumour and nodal stage. High VEGF and reduced Vimentin expression were also associated with advanced tumour stage. Advanced nodal stage was only associated with high EGFR expression. CXCR4 was not associated with pTN stage.

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Abstracts of Poster Presentations PP 145: Liver resection and arrest of bleeding from liver trauma - a novel technique developed in a war setting K Somaratne1,T Seneviratne2 1Army Base Hospital, Palaly 2Teaching Hospital, Karapitiya Introduction: During the humanitarian operations of Sri Lanka Armed forces against the terrorists of the LTTE, penetrating missile injuries of the liver were not uncommon among the military casualties. Arrest of bleeding from liver in such injuries is a daunting task; furthermore liver resection in a trauma setting is difficult and challenging. We intend to present a novel and a fast technique designed to address this issue, hitherto not-described in literature. Methods: Two special suture lines are placed across the liver (using a thick absorbable material) separating the damaged and non damaged parts of the liver. A purpose designed needle called the Sinhale needle is used to place this particular suture. This effectively cuts off the blood supply to the damaged parts. Resection of the liver is carried out as an emergency or delayed (in 48 hrs) procedure depending on the stability of the patient. Results: 13 such liver trauma patients were managed from January to May 2009 (08 at right lobe and 05 at left lobe). 04 of them had liver resections done at the acute setting (03 at left lobe and 01 at right lobe) and 06 in48 to 72 hrs. One patient succumbed to his injuries. Conclusions: Military liver injuries are extremely difficult to manage. This new approach reduced mortality and morbidity. We believe that this new technique (Rajasinhe technique) can be applied for elective liver resections as well. PP 146: The use of degloved skin as meshed skin graft to cover the original defect in a geriatric patient K Sun1, K Rajapakse2, S J Chong2 1Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, Australia 2Royal Adelaide Hospital, Australia Introduction: The harvesting of skin graft from avulsed tissues has been reported previously while Khoo [1] has recently reported on the successful use of degloved palmar skin to resurface the hand. Case report: A 92 year old with known history of aplastic anaemia requiring regular transfusion with thin friable skin, presented within an hour after suffering a rapidly expanding hematoma of her right calf after minor trauma. She was operated within 2 hours and the degloved skin was debrided and reapplied as a meshed skin graft. The skin graft took well and she was discharged l on the seventh post-operative day. She was able to walk without assistance. Conclusions: Surgical management of similar wounds will becommon due to increase of aging population. Keys to successful return to pre-injury states are early coverage and rehabilitation. Geriatric patients have decreased wound healing and decreased dermal thickness this increases the difficulty of obtaining skin grafts and managing donor site wound healing. Our patient presented early after relatively minor trauma and the relatively undamaged skin allowed â&#x20AC;&#x153;like for likeâ&#x20AC;? replacement coverage. The meshing was necessary as the degloved skin insufficient to cover the wound. This management avoided donor site issue which would have handicapped her for 3 months . The case highlight the possible utilization of degloved skin for coverage particularly in elderly patients with donor site considerations.

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Abstracts of Poster Presentations PP 147: Longterm outcome of cardiac rehabilitation programme of National Hospital of Sri Lanka S Mendis1, Z Jamaldeen1, S Athukorala1, RBD Ranasinghe1, R Premaratne2 1Inistitute of Cardiology, National Hospital of Sri Lanka, Colombo 2Epidemiology Unit, Ministiry of Health, Colombo Introduction: Long term follow up study of CABG Surgery at Institute of Cardiology, National Hospital of Sri Lanka. Aims: To assess outcome of CABG at NHSL at 5 years or more in post-CABG rehabilitation Program. Methods: We analysed the 5 years or more outcome of 100 consecutive patients out of 199 in our institution (mean age at surgery 55.37 years, 91% male) who underwent CABG between 2002 and 2004. During 8 years follow up, data was obtained by reviewing hospital records and prospective evaluation done by patient interviews and investigations. Mean follow up period was 68 months. Results: There were 40% diabetic, 59% hypertensive, 77% dyslipidaemic patients and 51% were exclusive male smokers. Pre-CABG mean FBS and LDL were 153 and 132 whereas that in post-CABG was 123 and 104mg/dl. Ninety-eight quit smoking. The mean BMI was 23.6 kg. 56% patients had triple vessel diseas ; 94% had LIMA grafts and 93% had venous grafts. There was no significant improvement of left ventricular ejection fraction. Exercise ECG became positive in 36% patients and positive at stage 1 in 3 patients, who underwent coronary angiogram, showed 100% patent LIMA and 100% blocked venous grafts. There was 98.5% survival rate and only 3 deaths at 8 years of follow up. Conclusions: Study showed there was significant improvement in coronary risk factors in patients who has undergone CABG and post-CABG rehabilitation program and a 98.5% survival rate. However, 36% patients had exercise induced ischaemia. PP 148: Covered stenting for coarctation of aorta - an initial experience S Mendis, G Galappatty, D Dharmawardena, D Seneviratne, C De Silva Institute of Cardiology, National Hospital of Sri Lanka, Colombo Introduction: Coarctation of aorta is a congenital heart disease which causes significant morbidity and mortality. Its incidence is around 5 in 10000 live births. Treatment of this condition has evolved over time and the latest method available is stenting the coarctation with covered stent provided the anatomy is suitable. This was not yet available in Sri Lanka and the main advantage is less major complications such as aneurysm formation, rupture and dissection. Careful patient selection is needed for this procedure to be successful and minimize complications. Aims: To improve coarctation management and to analyze our procedural success rate with other methods of treatment for coarctation. Methods: Patients who were having coarctation of aorta with >20 mmHg pressure gradient and weighing >30kg were selected and subjected to aortogram. Patients having minimum of 10mm distance between the left subclavian orifice and the origin of the coarctation were selected to undergo stenting with Advantaâ&#x201E;˘ V12 Covered Stent provided the maximum length of the coarctation was <45mm. Results: A total number of six patients were selected for the aortogram and four patients selected according to set criteria for stenting and successfully underwent the procedure. The average preprocedure pressure gradient was 74.25 mmHg and post-stent pressure gradient was 6.75 mmHg. The average percentage gradient reduction was 90%. No major complications such as aneurysm formation, dissection or rupture were noted. Conclusions: Coarctation of aorta can be successfully treated with stenting with PTFE covered stents if the patients are properly selected. It is a safer procedure when compared to balloon dilatation, bare metal stenting and surgical correction.

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Abstracts of Poster Presentations PP 149: True digital artery aneurysm â&#x20AC;&#x201C;a case report D Beneragama1, T Beneragama2 1Department of Pathology, Faculty of Medical Sciences, University of Sri Jayewardenepura 2Plastic and Reconstructive Surgery Unit, National Hospital of Sri Lanka, Colombo Introduction: True aneurysms of digital arteries are extremely rare with only a few reported cases in the literature. The majority of reported cases were caused by trauma or overuse. We present a rare case of digital artery aneurysm caused by atherosclerosis. Method: A 38 year old female presented with a progressively enlarging, tender mass on the palmar surface of the ring finger for one year. On examination, the mass was subcutaneous, firm, ovoid, nonpulsatile and measured 1.5 x 2cm. An ultrasound examination of the right ring finger showed a dilatation of the proper digital artery. The mass was excised completely and the distal and proximal ends of the arteries were ligated preserving nerves. Microscopic features were compatible with a true digital artery aneurysm caused by atherosclerosis. Conclusions: True aneurysms occur due to weakening of the arterial wall caused by repeated trauma in occupational and sports- related injuries. Occurrence of true aneurysms in superficial parts of the digits supports this concept. The usual presenting feature in a digital artery aneurysm is a tender lump in the digits of the hand which progressively increases in size. Other presentations include loss of sensation and arterial insufficiency. Treatment modalaties of digital artery aneurysm include complete excision of the dilated segment and ligature of distal and proximal ends. Arterial reconstruction with reverse vein grafts can be performed for aneurysms of the common digital artery to restore blood flow to the distal parts of the digits. PP 150: Soft tissue reconstruction of war injuries to the hand and upper limb TS Beneragama, M K P Karunadasa, G Ekanayake Plastic and Reconstructive Surgical Unit National Hospital of Sri Lanka, Colombo Introduction: Soft tissue coverage to hand and upper limb wounds has been a challenging problem in war casualties as they are frequently complicated by associated fractures, vascular and nerve injuries. The main goal of limb reconstruction is restoration of function. Methods: Records of 187 patients treated with upper extremity wounds at the plastic surgery unit of the National Hospital of Sri Lanka and Military Hospital, Colombo between August 2006and July 2009 were analyzed retrospectively. Criteria for analysis included mechanism of injury, associated injuries, types of reconstruction, post-operative complications, wound infection rates and outcome measures. The outcome of surgical procedures was assessed by flap survival, infection rates and the completeness of coverage of the injured area. Results: In 121/187 (64.7%) patients, reconstruction was done with fascio-cutaneous flaps and in the remaining cases reconstruction procedures included composite tissue reconstruction 35/187(18.7%), skin grafts 20/187(10.7%) and free tissue transfer 11/187 (5.9%). Pedicle flap survival rate was114/121 (94.2%) and free flap survival rate was 10/11 (91%). Overall infection rate was 15/187(8%). Complete coverage was achieved in all upper extremity wounds and early occupational therapy resulted in improved return to function. Conclusions: Despite massive bone and soft tissue defects, high preoperative wound colonization, and delays in definitive reconstruction, devastating war wounds can be successfully reconstructed in the subacute period with low incidence of flap failure, infection, and amputation rates. This will help the injured to return to normal or near normal life and hand function early.

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Abstracts of Poster Presentations PP 151: Outcome of surgically managed vascular anomalies of the upper extremity TS Beneragama1, TH Beneragama2 1Plastic and Reconstructive Surgical Unit, National Hospital of Sri Lanka, Colombo 2Department of Pathology, Faculty of Medical Sciences, University of Sri Jayewardenepura Introduction: Surgical excision of vascular anomalies of the hand, forearm and arm remains a challenge to the surgeon due to the complexity of the condition. The aim of this study was to assess the outcome following surgical excision. Methods: A retrospective study was performed to assess the surgical outcome of vascular anomalies of upper extremity. Fifteen patients were included in this study from May 2006 to April 2010. Arteriography was performed only in selected patients. The clinical and radiological data, procedural results and follow up data were reviewed. Results: Ten females (67%) with a median age of 17 years (3-52) and a median follow up of 22 months (2-38) had symptomatic vascular lesions in the upper extremity. Two patients had partial skin necrosis following surgery and were managed conservatively. All patients remained free of symptoms and recurrences during follow up. Conclusions: Vascular anomalies of the upper extremity are uncommon and demand correct approach for optimal diagnosis and management. Surgical treatment in selected patients has offered a high success rate with minimal morbidity. These patients require long term follow-up to assess the outcome and recurrence of lesions. PP 152: Efficacy and safety of ‘true’ cinnamon (Cinnamomum zeylanicum) as a pharmaceutical agent in diabetes P Ranasinghe1, R Jayawardena2, P Galappaththy1, GR Constantine3, P Katulanda3 1Department of Pharmacology, Faculty of Medicine, University of Colombo 2School of Human Movement Studies, Institute of Health and Biomedical Innovation, Queensland Universities, Australia 3Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University of Colombo Introduction: Diabetes is a leading cause of morbidity and mortality worldwide. Studies have frequently looked at dietary components beneficial in its treatment and prevention. Aims: To systematically evaluate the literature on the safety and efficacy of Cinnamomum zeylanicum (CZ) on diabetes. Methods: A comprehensive search of the literature was conducted in the following databases; PubMed®, Web of Science®, Biological Abstracts®, SciVerse Scopus®, SciVerse ScienceDierect®, CINAHL® and The Cochrane Library®. A meta-analysis of studies examining the effect of CZ extracts on clinical and biochemical parameters was conducted. Data were analysed using RevMan v5.1.2. Results: The literature search identified 16 studies on CZ (in-vitro=5, in-vivo=6 and in-vivo/in-vitro=5). However there were no human studies. In-vitro CZ demonstrated a potential for reducing post-prandial intestinal glucose absorption by inhibiting pancreatic amylase and glucosidase, stimulating cellular glucose uptake by membrane translocation of GLUT-4, stimulating glucose metabolism and glycogen synthesis, inhibiting gluconeogenesis and stimulating insulin release and potentiating insulin receptor activity. The beneficial effects of CZ in animals include attenuation of diabetes associated weight loss, reduction of FBG, LDL and HbA1c, increasing HDL cholesterol and increasing circulating insulin levels. CZ also significantly improved metabolic derangements associated with insulin resistance. CZ also showed beneficial effects against diabetic neuropathy and nephropathy, with no significant toxic effects on liver and kidney and a significantly high therapeutic window. Conclusions: Cinnamomum zeylanicum demonstrates numerous beneficial effects in animal studies, both in-vitro and in-vivo, as a potential therapeutic agent for diabetes. However, further randomized clinical trials are required to establish therapeutic safety and efficacy.

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Abstracts of Poster Presentations PP 153: Medicinal drug use in elderly CA Wanigatunge, DS Dissanayake, UN Hewahetawatta University of Sri Jayewardenepura Introduction: Age is a fundamental cause of disease and elderly are a special population with regards to drug use. Aims: To determine the diseases prevalent and drug categories prescribed in elderly where long term treatment is needed and to determine whether prescribing of the most widely prescribed drugs in selected medical clinics is appeopriate. Methods: Prescriptions and clinic records of elderly patients (> 60 years) attending medical and diabetic clinics at three hospitals were collected over a period of one month. Results: 1114 patient records were analysed. Majority of the elderly patients were females (n=634, 56.9%). Most of the patients were from the 60-64 age group (n=353, 31.7%) while the very old (> 80 years) accounted for only 6.4% (n=71). The most prevalent diseases were hypertension, ischaemic heart disease (IHD), diabetes mellitus and chronic respiratory disorders. Majority of the patients had 2 or more diseases. 66% (n=735) did not have their renal function assessed within the last year. 51.44% (n=573) had 6 or more drugs prescribed daily. Antiplatelets (n=665, 60.6%), statins (57.4%) and diuretics(51.4% ) were the most commonly used drug groups. There were differences in the use of drugs between the three institutions. In those with IHD, 12.7% (n=43) were not prescribed any antiplatelet agent. Conclusions: Non communicable diseases are the most prevalent disease categories in the elderly. Prescribing needs to be improved in keeping with accepted guidelines and doses to ensure the desired benefits and minimize harm in this vulnerable population. PP 154: Evaluation of anti-carcinogenic potential of Flueggea leucopyrus (Wild) in human hepatoma (HepG2 cells) SR Samarakoon, I Thabrew, PB Galhena, KH Tennekoon Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo Introduction: A decoction of Flueggea leucopyrus (Willd) aerial parts has recently become popular among Sri Lankan traditional medical practitioners for cancer treatment despite lack of scientific evidence to validate the claimed anti-carcinogenic properties. Aims: To determine whether a decoction of F. leucopyrus (Willd) can mediate cytotoxic and apoptosis modulating effects in human hepatoma (HepG2) cells. Methods: Cytotoxicity to HepG2 cells was evaluated by the 3-(4,5-Dimethylthiazol-2-yl)-2,5diphenyltetrazolium bromide (MTT) and sulphorhodamine B (SRB) assays. Effects on regulation of apoptosis were evaluated by (a) fluorescence and light microscopic observations of cell morphology, (b) DNA fragmentation analysis, (c) activities of caspase 3 and 9 proteins. Results: Decoction exerted a significant time and dose dependent cytotoxicity to HepG2 cells evident from (a) MTT assay (IC 50: 154.8 μg/ml at 24 h, 101.4 μg/ml at 48 h and 48.58 μg/ml at 72 h post incubation) and (b) SRB assay (IC 50; 164.1 μg/ml at 24 h, 100.05 μg/ml at 48 h and 48.98 μg/ml at 72 h post incubation). The ability of the decoction to induce apoptosis was evident from results of (a) DNA fragmentation analysis, (b) microscopic observation of characteristic morphological changes associated with apoptosis (nuclear condensation, nuclear fragmentation and apoptotic bodies) and (c) enhancement of caspase-3 and caspase-9 activities. Conclusions: Cytotoxicity and induction of apoptosis exerted by F. leucopyrus (Willd) decoction in HepG2 cells support the ethno pharmacological use of this plant for cancer therapy.

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Abstracts of Poster Presentations PP 155: An effort to understand microbiological properties of Sri Lankan bee honey JMRWW Wadanamby, TSKRD Caldera, TLI Lankika Base Hospital, Angoda Introduction: Bee honey is used for management of wounds in developed countries. Its use can benefit us in terms of reducing cost in wound care. Aims: To study microbiological properties of Sri Lankan (SL) bee honey. Methods: Eighteen samples of bee honey were cultured in blood agar media to confirm sterility. Blotting paper discs (diameter;8mm) impregnated with 50μl and 100 μl of bee honey was used in sensitivity testing for MRSA, MSSA and Pseudomonas. After 24 hours incubation the organism free diameter was checked. Results: Nine out of 18 samples were sterile. Following growths were observed in other samples; spore bearers only(7), spore bearers and Candida(1) spore bearers and gram positive cocci(1). Growth of MSSA up to the disc(resistance) was observed in 12 samples(67%) when 50μl of bee honey was used and in 2 samples(11%) when 100μl was used. When 100μl was used the organism free diameter ranged from 10mm to 18mm (mean=13.3mm) in 15 samples. Resistance of MRSA to 50 μl and 100 μl of bee honey was observed in 7(39%) and 1(5%) sample respectively. The organism free diameter ranged from 10 to 18 (mean=13.1mm) in 17 samples when 100μl was used. Resistance of Pseudomonas to the above volumes was 15(83%) and 5(28%) respectively. The organism free diameter when 100 μl was used ranged from 10mm to 12mm(mean=11) in 13 samples. Conclusions: Testing for sterility of bee honey before medical use is important as some were not sterile. Antibacterial properties were observed against MSSA, MRSA and Pseudomonas related to the volume used. PP 156: Early bedside removal versus delayed cystoscopic removal of ureteric stents following renal transplantation N Gunawansa, M Wijerathne, R Cassim, R Dissanayake, J Arudchelvam National Hospital of Sri Lanka, Colombo Introduction: Major urological complications (MUC) such as ureteric leak and stenosis are the 'Achilles heel' of renal transplantation. Routine stenting of the allograft ureter has been shown to significantly reduce MUC. However, stenting also increases the incidence of post-transplant urinary tract infections (UTI). Furthermore, they require invasive cystoscopic removal. We studied early bedside removal of the ureteric stent attached to the urinary catheter as an alternative to the standard technique. Methods: Consecutive consenting transplants were randomized to delayed (day 21-28) cystoscopic stent removal (group-1) and early (day 7) bedside removal (group-2). In group-2 the ureteric stent was tied to the tip of the urinary catheter intra-operatively and was removed along with the urinary catheter at the bedside. Both groups were prospectively followed up for MUC and UTI. Results: One hundred and seventeen (Group-1, 54; Group-2, 63) transplants between January 2010 and September 2011 were followed up for a mean 10 (range 4-24) months. No MUC were encountered during this period. There were 22/117(19%) culture proven UTIs during the period of follow up, 9/54 (17%) in Group-1 and 13/63 (20%) in Group-2, p=0.5. Conclusions: Tying the ureteric stent to the urinary catheter intra-operatively and early bed-side removal is a safe alternative to the conventional technique. Its greater convenience to the patient and cost-effectiveness to the institution are added advantages. We recommend this as the standard method for stenting the allograft ureter.

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Abstracts of Poster Presentations PP 157: Early post-transplant urinary tract infections: impact on graft and patient survival N Gunawansa, M Wijerathne, R Cassim, R Dissanayake, J Arudchelvam National Hospital of Sri Lanka, Colombo Introduction: Sepsis is a major cause of morbidity and mortality following transplantation. Urinary tract infection (UTI) is the commonest infection encountered following kidney transplantation. We studied the incidence of early (post-operative day 0-30) post-transplant UTI to identify potential risk factors and outcomes. Methods: A prospective analysis of 396 consecutive kidney transplants performed by the Colombo University Transplant Unit between January 2007 and December 2011 were studied. The mean follow up was 22 (range 2-60) months. Results: A total of 66 (17%) early UTI were encountered in this cohort which included 15 (5%) cases of graft pyelonephritis. In a multi-variate analysis, diabetes mellitus in the recipient (p=0.9), female gender (p=0.7), acute rejection requiring added immunosuppression (p=0.3) and pre-operative pyuria (p=0.6) were not significantly associated with early UTI. However, time on dialysis prior to transplantation of >1 year was found to be an independent risk factor (p<0.001). 53/66 (80%) of the UTIs were successfully treated while 7 (10%) were associated with primary graft failure (PGF) and 6 (10%) with sepsis related deaths. One with PGF also died during follow up while 1 was re-transplanted after complete resolution of the UTI and 4 remain on haemodialysis. Conclusions: The incidence of post-transplant UTI is high in our experience. Transplants performed in a limited resource public sector health care set-up may have been a significant risk factor. A better balance between aggressive treatment of UTIs and post-transplant immunosuppressant needs to be achieved to minimize UTI related graft loss and death. PP 158: Diagnosis and treatment of malaria by private practitioners - findings from a post conflict district in Sri Lanka SD Fernando1, R Abeyasinghe2, J Lima3 1Department of Parasitology, Faculty of Medicine, University of Colombo 2Anti Malaria Campaign, Ministry of Health, Colombo 3Department of Public Health and Primary Care, University of Oxford, UK Introduction: Enhanced disease surveillance is a key strategy of the malaria elimination programme with emphasis being made on the need for health care providers (HCPs) to refer any patient presenting with fever for confirmation of malaria by microscopy/rapid diagnostic test. Methods: A cross sectional study was carried out in the Batticaloa district of Sri Lanka. Seventy two HCPs who see patients privately were interviewed. Results: Of the 72 HCPs interviewed, 94% indicated they will refer a patient with suspected malaria for confirmation of diagnosis by laboratory testing. Only 51% of them were familiar with the National Guidelines for the Treatment of Malaria. During the period January 2009 to June 2010, 18 HCPs (25%) reported having clinically suspected malaria in patients presenting with fever. All were referred for laboratory confirmation. Excluding two HCPs who were working full time in the private sector, the rest were government doctors doing private practice on a part time basis. Fourteen HCPs (full time government practitioners) indicated that they had treated 25 patients with Plasmodium vivax malaria after confirmation by microscopy. The treatment prescribed in 22/25 patients claimed to have been positive for vivax malaria was not in accordance with the guidelines due to use of incorrect doses of antimalarials for inappropriate durations. Conclusions: Initiatives to train both the public and private sector HCPs to enhance their knowledge regarding malaria surveillance, reporting of malaria positive cases and accurate management, need to be strengthened.

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Abstracts of Poster Presentations PP 159: Prevalence of toxoplasmosis in immunocompromised cancer patients attending a tertiary care hospital NSAR Cooray1, N Karunaweera2, N Samaranayake2 1Institute of Oral Health, Maharagama 2Faculty of Medicine, University of Colombo Introduction: Toxoplasmosis is caused by the intracellular parasite Toxoplasma gondii. Acute toxoplasmosis in an otherwise healthy person is often asymptomatic. However, in immunocompromised hosts toxoplasmosis can be life threatening. The reported seroprevalences of toxoplasmosis in Sri Lanka are mostly based on studies conducted on pregnant mothers. Aims: To assess the prevalence of toxoplasmosis among immunocompromised cancer patients Methods: 108 patients attending the Out Patientsâ&#x20AC;&#x2122; Department of National Cancer Institute were recruited following informed written consent. All had a confirmed diagnosis of malignancy and had undergone at least one dose of radiotherapy or chemotherapy. Five milliliters of venous blood was collected from each patient. PCR was performed to detect a 193bp non variable region of B1 gene of T. gondii. Direct Agglutination Test was performed to detect anti toxoplasma IgG antibodies. Results: The ages of the patients ranged from 19 to 83 years. The overall prevalence of toxoplasmosis was 11.1%. T. gondii DNA was detected in two patients. Ten were positive for anti toxoplasma IgG antibodies. The highest titre was 1/400. None of those positive by PCR showed seropositivity. Those patients positive by PCR had received both chemotherapy and radiotherapy. Testing positive for toxoplasmosis was not associated with any of the treatment methods. Conclusions: This study confirms the presence of undetected toxoplasmosis in immunocompromised patients. A larger study based on a more representative patient population would verify the true magnitude of this infection. Regular screening by PCR would help in early detection of infection in those with impaired immunity. PP 160: Antimicrobial susceptibility and empirical prescribing practices in treating urinary tract infections CN Wijekoon1, KMMP Dassanayake2, A Pathmeswaran2 1Faculty of Medicine, University of Kelaniya 2Colombo North Teaching Hospital, Ragama Introduction: Empiric antimicrobials are recommended for urinary tract infection (UTI). Knowledge of local antimicrobial susceptibility is essential for prudent empiric therapy. Aims: To describe antimicrobial susceptibility patterns and empirical prescribing practices in adult inward patients with UTI. Methods: Data for this descriptive study was collected prospectively from consecutive adult patients with positive urine culture admitted to Colombo North Teaching Hospital. Sensitivity testing was done using Joan Stokes method. Results: Among 745 patients, 441 (59.2%) were females. Mean (SD) age of the study population was 48.2 (19) years. Coliforms were the commonest (85.6%) isolates followed by Streptococcus spp., Candida spp., Staphylococcus spp., and Pseudomonas spp.. Susceptibility of bacteria to antimicrobials was as follows; nitrofurantoin- 76.8%, gentamicin- 62.7%, cefuroxime- 46.3%, co-trimoxazole- 44.1%, norfloxacin43.6%, cefalexin- 37.6%, ciprofloxacin- 37.3%, co-amoxiclav- 20.7%, ampicillin- 17.6%. 381(51.1%) received empirical antimicrobial therapy. 75 received more than one antimicrobial. Ciprofloxacin was the most frequently prescribed empirical antimicrobial (208/381; 54.6%). Nitrofurantoin was prescribed in only 9.2%. Concordance between the empirical antimicrobial prescribed and the sensitivity of the isolated organism was seen only in 25.7%. In 29.6%, urinary isolate was resistant to the empirical antimicrobial and in 44.7% the prescribed empirical antimicrobial was not included in sensitivity testing. Conclusions: Susceptibility was low (<50%) to the first line antimicrobials other than nitrofurantoin and gentamicin. Ciprofloxacin was the most frequently prescribed empiric therapy even though susceptibility to it was low. Despite high susceptibility nitrofurantoin was underutilized. There was obvious discrepancy between empirical prescribing practices and susceptibility pattern of isolates.

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Abstracts of Poster Presentations PP 161: Laboratory based diagnosis of intestinal parasitic infections among food handlers in kitchen-canteen complexes of University of Sri Jayewardenepura KASC Jayawardena1, HMR Rathnayaka1, DMDEA Gunawardane2, MVF Jayasuriya3, LDGG De Silva2, PHKIS Ranasinghe2 1Department of Medical Laboratory Sciences, Faculty of Medical Sciences, University of Sri Jayewardenepura 2Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura 3Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura Introduction: Food handlers are considered a major source of infection in intestinal parasitic infections and University canteens are at risk of such infections in Sri Lanka. Aims: To assess the proportion of intestinal parasitic infections among food handlers and their adherence to safe food handling guidelines at University of Sri Jayewardenepura. Methods: A descriptive cross-sectional study was conducted among 56 food handlers from 12 kitchencanteen complexes. Adherence to World Health Organization’s (WHO) “Five keys to safer food” guidelines was assessed using an interviewer-administered questionnaire and by observations made by the researchers. Stool samples collected from each worker was examined by saline mount, formal-ether concentration technique and modified Ziehl-Neelsen stain for presence of parasites. Results: Thirteen percent of food handlers harbored intestinal parasites in their stool samples including Entamoeba coli (7.14%), Giardia lamblia (1.79%), Blastocystis hominis (1.79%) and Entamoeba hartmanni (1.79%). According to ‘Five keys to safer food’ guidelines 11 out of 12 canteens left food at room temperature for >2 hours of cooking, 6/12 kitchen-canteen complexes do not protect food items from insects and pests. Seven percent of food handlers did notwash hands with soap after usage of the toilet and all kitchens defrosted meat items at room temperature. Conclusions: Faeco-orally transmitted parasitic infections were prevalent among 13% of the food handlers with inadequate adherence to “Five keys to safer food” making them a ready source of infection to others. PP 162: A pilot study on comparison of rapid immunodiagnostics for confirmation of leptospirosis EJ Eugene1, SA Wickramasinghe1, TL Kalugalage1, C Rodrigo2, H Wickremesinghe3, N Dikmadugoda3, P Somaratne4, HJ de Silva5, S Rajapakse6, SM Handunnetti1 1Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo 2Department of Clinical Medicine, Faculty of Medicine, University of Colombo 3Base Hospital, Homagama 4Department of Microbiology, Medical Research Institute, Colombo 5Department of Medicine, Faculty of Medicine, University of Kelaniya 6Department of Clinical Medicine, Faculty of Medicine, University of Colombo Introduction: In Sri Lanka, leptospirosis is mostly diagnosed on clinical grounds. Serological confirmation is not obtainable during the acute stage of the illness. There is a need for rapid immunodiagnostics for confirmation of leptospirosis. Two immunodiagnostic assays, ie: enzyme linked immnnosorbent assay (ELISA) and immunochromatographic technique Leptocheck-WB test (LCT) are used to detect leptospira specific IgM antibodies which are prevalent in early stages of acute infections. Aims: To compare the efficacy of these two rapid immunodiagnostic assays with the microscopic agglutination assay (MAT) to determine their applicability. Methods: A set of sera (n=83) collected in 2010 for which MAT titres were available was used to perform IgM ELISA and LCT. Results: Positivity for LCT and IgM ELISA were 55.4% and 48.2% respectively, and both assays detected acute infection by day 3 of the illness. MAT> 400 was used as the reference standard. For LCT, the overall sensitivity, specificity, accuracy, PPV and NPV (86.5%, 75.0%, 79.6%, 69.6% and 89.4% respectively) were higher compared to the respective values for IgM ELISA (50.0%, 62.3%, 57.1%, 50.0%, 62.3%). The highest of these values were observed during the first week for LCT and during the second week for IgM ELISA. The highest agreement was observed between LCT and MAT>400 (p=0.568) and there was a good agreement between LCT and IgM ELISA (p=0.520). Conclusions: The high sensitivity and specificity, ease of use, and non-requirement of specialized skills and equipment makes LCT a good choice for screening, while IgM ELISA is an appropriate test for confirming acute leptopsirosis.

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Abstracts of Poster Presentations PP 163: Clostridium difficile infection in inflammatory bowel disease patients in Sri Lanka PR Waraketiya, AP De Silva, NT Wijesinghe, PR Waraketiya, HS Wijewantha, LG Chandrasena, A Pathmeswaran, HJ De Silva Faculty of Medicine, University of Kelaniya Introduction: Over the last decade an increase in Clostridium difficile associated diarrhoea (CDAD) has been observed among Caucasians (1%). The frequency of CDAD is very high in Caucasian IBD patients; 8.7% in one study of IBD patients in remission. This has led to guidelines recommending routine screening for CDAD in IBD. Clinical impressions are that CDAD is rare among Sri Lankans. Aims: This study was conducted to determine the frequency of CDAD in a cohort of Sri Lankan IBD patients and healthy controls. Methods: Cases (n=154) were histologically confirmed IBD patients, in clinical remission. The controls (n=100) were non-IBD patients who presented to medical clinics without diarrhoea and with no exposure to antibiotics for up to 8 weeks prior to recruitment. Immunoassays for Clostridium difficile toxins A and B were performed on stool samples obtained from both groups. Results: The frequency of CDAD was 0.7% (n=1) and 0% (n=0) in IBD patients and controls respectively. Conclusions: Compared to Caucasians, CDAD was very rare in this cohort of Sri Lankans, including those with IBD. Routine screening for CDAD does not seem necessary in our setting. PP 164: Imported malaria â&#x20AC;&#x201C; is it a threat to the elimination of malaria from Sri Lanka? GNL Galappaththy1, D Fernando2, R Abeyasinghe3 1Anti Malaria Campaign, Ministry of Health, Colombo 2Department of Parasitology, Faculty of Medicine, University of Colombo 3World Health Organisation, Sri Lanka Introduction: Malaria infections acquired abroad due to international travel and local employment of labourers from malaria endemic countries poses a formidable threat to the resurgence of the disease in Sri Lanka. The epidemiological characteristics of imported malaria between 2008-2011 and the potential impact of these cases towards a possible resurgence of the disease in the country is discussed. Methods: Country where the infection originated, species of Plasmodium, district where the case was reported, number of days between disembarkation and diagnosis, treatment strategies/ response and percentage of patients followed up have been analysed. Results: Over the four-year period 152 imported malaria cases were reported. The proportion of imported malaria recorded has increased annually with the decline in indigenous cases. Majority of infections (64%) have been due to Plasmodium vivax and have been acquired in India. Approximately 50% of the cases were diagnosed in theWestern Province. The average duration to diagnose malaria following arrival in Sri Lanka was 3.6 days. Patients were managed according to the National guidelines and 82% of the patients were followed up for 28 days to ensure parasite clearance. Conclusions: Reintroduction of malaria to the country from imported cases is a threat to the National Malaria Elimination Programme. Early diagnosis, correct treatment and follow up of cases can prevent possible re-emergence. A high level of sustained commitment is required to carry out malaria surveillance amongst travelers to prevent reintroduction of malaria.

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Abstracts of Poster Presentations PP 165: Association of clinical and biochemical parameters of leptospirosis with leptospira specific IgM and IgG antibodies MLG Piyatissa1, G Premawansa1, SU Thrikawala2 1Colombo North Teaching Hospital, Ragama 2Department of Zoology, Faculty of Science, University of Colombo Patients clinically suspected of leptospirosis, from Teaching Hospital, Ragama and Base Hospital, Gampaha were tested for Leptospira specific IgM and IgG antibodies by ELISA and the clinical and biochemical parameters of patients were compared in the antibody positive and negative patients. Out of 74 patients, 47% were positive for IgM and 39% for IgG. Myalgia was significantly present among both IgM and IgGpositive patients (P<0.05) compared to that of negatives. Presence of fever, conjunctival suffusion, chest pain, muscle tenderness and oliguria or anuria were significantly higher (P<0.05) in IgM positive patients while the presence of chest pain, muscle tenderness, icterus and oliguria or anuria were significantly higher (P<0.05) in IgG positive patients when compared to respective negatives. Blood urea levels were significantly higher (P<0.05) in IgM positive patients compared to that of negative patients. In the set of antibody positive patients, presence of fever, chills, muscle tenderness and icterus declined while nausea increased with increasing IgM levels. Presence of vomiting and muscle tenderness tended to decrease while fever and icterus increased with increasing IgG levels. Thrombocytopenia, elevated levels of WBC, total bilirubin, direct bilirubin, serum creatinine and blood urea were observed both in IgM and IgG antibody positive patients. IgM and IgG responses appeared within 0-10 days, after the onset of symptoms and persisted up to 6 months. 40% (n=20) of non-infected individuals from risk groups were positive for IgG suggesting the presence of sub-clinical infections. These findings warrant further investigations on leptospirosis disease status and human antibody responses. PP 166: Clostridium difficile infection in stools among patients presenting with exacerbations of inflammation ANR Fernandopulle, BS Sebastiampillai, AT Matthias, NMM Navarathne National Hospital of Sri Lanka, Colombo Introduction: Global studies report that 5%â&#x20AC;&#x201C;19% of patients with relapsing inflammatory bowel diseases (IBD) are positive for Clostridium difficile. Data from Sri Lanka is lacking. This study investigated patients with exacerbations of IBD for Clostridium difficile infection. Methods: All IBD patients admitted with exacerbations from August 2011 to March 2012 were included. Diagnosis was based on the ELISA test to detect clostridium difficile toxin A, done on a single sample of stools within 24 hours of admission. Results: 21 patients; 20 with ulcerative colitis (UC) and one with Crohns disease were included. All presented with moderate to severe exacerbation on stool frequency. Four (19%) tested positive for Clostridium difficile of which one was female. The mean age was 26.25 and 45.2 years in the positives and negative group respectively. Of the positive patients two were previously on aminosalicylates and two were treatment naive. None gave a history of antibiotic or PPI use or hospital admission within 3months. The WBC, ESR or stools full report were unable to predict the presence of clostridium difficile infection. Neither endoscopy nor histology was suggestive of clostridium difficile infection in any of the positive patients. Conclusions: This study shows a high prevalence of clostridium difficile infection among patients presenting with exacerbations of IBD which is in keeping with other studies reported. As suggested by previous authors the risk factors associated with development of clostridium difficile infections in IBD seems different to the general population.

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Abstracts of Poster Presentations PP 167: Factors associated with antimicrobial susceptibility in urinary tract infections CN Wijekoon1, KMMP Dassanayake2, A Pathmeswaran1 1Faculty of Medicine, University of Kelaniya 2Colombo North Teaching Hospital, Ragama Introduction: Empiric therapy is recommended for urinary tract infection (UTI). It is important to identify factors that could indicate the antimicrobial susceptibility. Aims: To describe factors associated with antimicrobial susceptibility of uropathogens in adult in-ward patients with UTI Methods: Data for this descriptive study was collected prospectively from consecutive adult patients with positive urine culture admitted to Colombo North Teaching Hospital. Patient interviews and hospital records were used for data collection. Sensitivity testing was done using Joan Stokes method. Results: Among 745 patients, 441(59.2%) were females. Mean age was 48.2 years (SD19). 172(23.1%) were >65years. Hospital-acquired infection, abnormal urinary tract, recurrent UTI and diabetes was seen in 132(17.7%), 199(26.7%), 77(10.3%), 182(24.4%) respectively. Coliforms were the commonest uropathogens (85.6%). The resistance rates of coliforms to nitrofurantoin, norfloxacin, nalidixic acid, ciprofloxacin and cefuroxime in patients >65years of age were higher as compared to those aged <65years (p<0.05). The resistance rates to the first line antibiotics, ciprofloxacin and cefuroxime were higher among males (p<0.01). Resistance rates to nitrofurantoin, gentamicin, norfloxacin, ciprofloxacin and cefuroxime were significantly higher (p <0.005) in presence of abnormal urinary tract. There was a significant difference (p<0.05) in resistance rates to nitrofurantoin, gentamicin, ciprofloxacin, amikacin and netilmicin in hospital-acquired infection. Higher resistance to norfloxacin and ciprofloxacin was observed with diabetes (p<0.05) and recurrent UTI (p<0.05) Conclusions: Variables like age, gender, origin of infection, nature of the urinary tract and co-morbidities are useful indicators of antimicrobial susceptibility in adult in-ward patients with UTI. PP 168: Trends in antimicrobial resistance in urinary tract infections at De Soysa Hospital for Women MHWMN Wijayapala1,WDMG Amarasinghe1, BMR Fernandopulle2, P Chandrasiri3 1De Soysa Hospital for Women, Colombo 2Department of Pharmacology, Faculty of Medicine, Colombo 3National Hospital of Sri Lanka, Colombo Introduction: Acquired or emerging bacterial resistance to one or several antimicrobial drugs (AMD) is a global problem and monitoring of antimicrobial susceptibility is important. Aims: To identify the organisms cultured in urine culture reports in year 2009 and 2010 at De Soysa Hospital for Women, Colombo (DMH). and to describe the trend in resistance patterns of the cultured organisms over time. Methods: Descriptive study conducted at DMH, Colombo using Urine culture reports throughout the year 2009 and 2010 Results: There were 352 (15.2%) and 374(19.4%) culture positive urine samples at DMH in 2009 and 2010 respectively. Coliforms were the commonest organism isolated, which accounted for 48% in 2009 and 58.8% in 2010. Staphylococcus species were the second commonest. (14.2% in 2009 and 20% in 2010). Coliforms showed the highest resistance to aminopenicillins increasing from 76.5% to 85% over time. Ciprofloxacin and cephelexin also demonstrated an increasing trend of resistance from 23% to 28% and 30% to 38% respectively. In contrast nalidixic acid (from 70% to 46%) and co-trimoxazole(from 57% to 48%) showed a downward trend of resistance to Coliforms over two years. Coliforms were most sensitive to gentamicin but showed rising resistance from 6% to 16%. Resistance to norfloxacin remained unchanged (33%). Methicillin resistance to Staphylococcus aureus showed a downward trend from 31% to 24.2% over time. Conclusions: Our findings demonstrate a significant increase of resistance to various groups of antibiotics. A national monitoring programme is urgently needed.

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Abstracts of Poster Presentations PP 169: Snakebites in children- a five year retrospective review of victims admitted to two hospitals in Sri Lanka YC Jayasinghe, A Kasturiratne, SASG Samaraweera, HJ de Silva Faculty of Medicine, University of Kelaniya Introduction: Snakebite in children causes great parental concern and medical unease. Aims: To determine characteristics of paediatric snakebite in two hospitals, in the wet zone (Colombo North Teaching Hospital (CNTH) and dry zone (Base Hospital Polonnaruwaâ&#x20AC;&#x201C;BHP). Methods: A retrospective study collected data on snakebite by reviewing records of children admitted to CNTH and BHP from January 2007 to December 2011. Results: There were 188 snakebite victims (CNTH 71, BHP 117).Similarities in the two cohorts were (CNTH and BHP â&#x20AC;&#x201C;M:F=35:36and 64:53; mean age 6 years (SD3) and 7 years (SD3); definite bites 30(53.6%) and 39(37.5%); circumstantial evidence in 57(80.3%) and 84(71.8%);time of bite: between 48pm 42.6% and 47.2%. Majority of confirmed bites were HNV (60%) in CNTH and Kraits (30.8%) in BHP. Differences in the cohorts were :place of bite: in and around the home, median time from bite to hospital, administration of first aid, antivenom use, intensive care, median (range) duration of hospitalization and deaths (CNTH vs BHP): 37(56.9%) and 29(27.6%),35 vs 102.5 minutes, 21.4% vs 1%, 5.6% vs 17.1%, 1.4% vs 5.1%, 1 (1-7) days vs 2 (1-13), 0 vs 3.4% (Krait bites). Conclusions: Snakebites occur in ambulatory children, diagnosed mainly on circumstantial evidence and occur in and around homes irrespective of geographic location. Clinical features and outcome depend on offending species and availability of resources.

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