JOURNAL OF THE CEYLON COLLEGE OF - ccp.lk

JOURNAL OF THE CEYLON COLLEGE OF

PHYSICIANSEstablished 1967

The Official Publication of the Ceylon College of Physicians

EditorsKamani Wanigasuriya

Namal Wijesinghe

Editorial BoardSarath Gamini De Silva

J IndrakumarPanduka Karunanayake

Dushyantha MadagedaraThilak WeeraratneNirmala WijekoonDinithi FernandoAchala Balasuriya

Priyamali JaysekeraMaduwanthi Hettiarachchi

Kishara GooneratneThushara Matthias

International AdvisorsCharles Warlow Edinburgh

David Warrell OxfordAndrew Dawson Australia

Georgi Abraham India

Published byThe Ceylon College of Physicians

341/1, Kotte Road, RajagiriyaSri Lanka

Telephone: +94 11 2888146Fax: +94 11 2888119E-mail: [email protected]

Printed byAnanda Press

277, Hokandara Road, ThalawathugodaSri Lanka

Telephone: +94 11 2774793E-mail: [email protected]

Journal available online at Sri Lanka Journals Online

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AIMS AND SCOPE

The Journal of the Ceylon College of Physicians (JCCP) is a forum for debate, education and

entertainment for health professionals interested in clinical medicine, and provides a source

for updating knowledge on medical developments and research worldwide. The Journal is

aimed at practicing physicians with commitments and interests in Sri Lanka and has relevance

to all those working in the health sector. The Journal’s prime responsibility is to the members

of the Ceylon College of Physicians (CCP) and its objective is to promote good clinical

practice and influence health policy planning in Sri Lanka and across the medical world

through peer reviewed original research and other forms of communications fostering

responsible and balanced debate on current issues that affect medicine and health care.

Contributions to the JCCP reflect its national and multidisciplinary readership and include

current thinking across a range of medical specialties. The Journal assists the College in its

continuing medical education programme.

While members of the CCP receive the JCCP as one of the benefits of membership, theJournal has full editorial independence.

ISSN 0379-802X

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CONTENTSOral Presentations 7

OP 1- Outcome of intravenous thrombolysis in patients with acute lacunarinfarctions 8

OP 2- Health system adjustments to provide friendly geriatric care services atthe out patient department (OPD) of University Hospital KDU (UHKDU) 9

OP 3- Cardiovascular autonomic neuropathy in diabetes; Data from malesexual dysfunction study, National Hospital of Sri Lanka 10

OP 4- Knowledge, attitudes and factors associated with knowledge andattitudes on down syndrome among students attending selected highereducational institutions in the Colombo district 11

OP 5- Opportunities for optimization of drug therapy and characterization ofdrug-related problems in CKD/ CKDU patients undergoing hemodialysisin Sri Lanka 12

OP 6- Changes in biochemical markers of outcomes in haemodialysis patientsfollowing a clinical pharmacy intervention 13

OP 7- Trends in venous lactate in the critical phase of dengue haemorrhagicfever and during fluid resuscitation 14

OP 8- Audit report on thyroid hormone requesting pattern in wards and clinicsof National Hospital Sri Lanka 15

OP 9- Reactogenicity following the first dose of ChAdOx1 nCOV-19 vaccineagainst SARS-COV-2: a multicenter observational study 16

OP 10- Undernutrition among elderly and effect of health education forundernourished 17

OP 11- Assessing the immunogenicity following the 1 st dose of Covishield(ChAdOx1 nCOV-19) vaccine, in a cohort of participants in Colombo 18

OP 12- Presence of long COVID syndrome and pulmonary functionabnormalities, at 3 months following recovery in a cohort of mildlysymptomatic and asymptomatic COVID-19 patients: a preliminaryanalysis 19

OP 13- Variables in the 4C mortality score in COVID-19 patients to predictin-hospital mortality and in-hospital deterioration: Sri Lankan experience 20

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Poster Presentations 21

PP 1- Predictors and patterns of polypharmacy in chronic diseases in amiddle-income country: a study on polypharmacy in both primary andtertiary care 22

PP 2- Sociodemographic characteristics of a cohort of female patients withacute coronary syndrome in Sri Lanka 23

PP 3- Emerging entomological evidence of cutaneous leishmaniasisendangerment in tomorrow’s Sri Lanka 24

PP 4- Audit on the adherence to ABCDEF bundle in intensive care units in atertiary care hospital of Sri Lanka 25

PP 5- Stress electrocardiography outcomes and associations in ischemic heartdisease patients in DGH Hambantota 26

PP 6- Post stroke depression – prevalence and associated factors in a tertiarycare center in Sri Lanka 27

PP 7- An audit on assessment, documentation, and implementation of painguidelines in district general hospital, Kalutara, Sri Lanka 28

PP 8- Treatment adherence behaviours and their determinants among patientsreceiving hemodialysis in Kurunegala Teaching Hospital, Sri Lanka 29

PP 9- Proportion and associated factors of insomnia during pregnancy 30

PP 10- Knowledge, attitudes, and practices regarding insect stings amongadvanced level students in Central province 31

PP 11- Knowledge, attitude, and practices on COVID-19 among the health careworkers at a tertiary care institute in Sri Lanka 32

PP 12- Management of patients with severe COVID pneumonia in highdependency units in a tertiary care hospital in Sri Lanka: a clinical audit 33

PP 13- Efficacy and safety of topical phenytoin ointment for venous leg ulcers:a randomized double-blind placebo controlled trial – interim analysis 34

PP 14- Prescription of statins in patients with type 2 diabetes mellitus: an auditat two tertiary care clinics 35

PP 15- Thrombolysis in acute ischemic stroke: a retrospective descriptive studyat teaching hospital, Peradeniya 36

PP 16- Clinical, immunological, and molecular assessment of SARS-COV-2 in amilitary group during the first wave of COVID-19 37

PP 17- A study on association of characteristics of chest pain and the diagnosisamong older adults presenting to Colombo South Teaching Hospital 38

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PP 18- Spontaneous intracerebral haemorrhages from a Sri Lankan tertiary carecentre: 5-year data 39

PP 19- Impact of COVID-19 on stroke admissions in a Sri Lankan tertiary carehospital: data from the Ragama stroke registry 40

PP 20- Trigger factors and associated factors of primary headache amongadvanced level students in the Western province 41

PP 21- Prevalence of Covishield COVID-19 vaccine (ChAdOx1 nCoV-19) adverseeffects among health care workers in Sri Lanka 42

PP 22- Do the health-related quality of life (HRQOL) parameters indicate thefactual health indices? A cross-sectional survey among apparentlyhealthy adults in Western province Sri Lanka 43

PP 23- Psychological distress and factors associated with psychologicaldistress among preventive health care workers involved in COVID-19prevention work in selected districts of Sri Lanka 44

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ORAL PRESENTATIONS

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Oral Presentation- 01

OUTCOME OF INTRAVENOUS THROMBOLYSIS IN PATIENTS WITH ACUTE LACUNARINFARCTIONS.

Senanayake HMS1, Rafzan H1, Risly NMM1, Lokunarangoda NC1, Weerawansa MRP1, PilapitiyaSD1, Sarathchandra C1, Siribaddana S1, Pushpakumara PHGJ2

1Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of SriLanka, 2Department of Family Medicine, Faculty of Medicine and Allied Sciences, RajarataUniversity of Sri Lanka

Introduction and Objectives

Lacunar infarcts (LACI) are small subcortical infarcts due to occlusion of deep penetratingbranches of large cerebral arteries. Intravenous thrombolysis (IVT) is the widely utilizedtreatment for acute ischemic stroke, nevertheless the outcome of IVT in LACI is debatedcompared to large artery infarcts (LAI). This study aims to explore the efficacy and safety ofIVT in acute LACI.

Method

Data were collected retrospectively from patients admitted with acute LACI and LAI,underwent IVT at the professorial Medical Unit, Teaching Hospital Anuradhapura, from March2016 to June 2021.

Results

A total of 158 patients received IVT, 60 (37.9%) had LACI and 98 (62.0%) had LAI. The meanNIHSS score on admission in LACI and LAI, were 7.4 (SD=3.3) and 12.6 (SD=5.9) and meanreduction of NIHSS score 24 hours after IVT were 3.6 (SD=3.2) and 3.8 (SD=5.3) respectively.The reduction of NIHSS scores between two groups were not significantly different (p=0.77,Independent Sample T-test). 28 (46.6%) of LACI and 42 (47.2%) of LAI had ≥4 reductions inNIHSS with IVT. Post thrombolysis mean Modified Barthel Index (PTMBI) of LACI was14.2(SD=6.0). It was 9.62 (SD=7.93) for LAI. 31(57.4%) of LACI and 28(33.9%) of LAI had PTMBIof ≥15. Having had a LACI carried a 2.6 times higher chance of having an independent PTMBIcompared to LAI (Odds ratio= 2.6, 95% CI=1.3-5.3), p=0.007 (Chi-Square Test). Hemorrhagictransformation was observed with 9 (15%) of LACI and 17(18.3%) of LAI and risk was notdifferent between the two groups (p=0.6, Chi-Square Test).

Conclusions

IVT is safe and associated with a greater chance of independence in acute LACI.

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HEALTH SYSTEM ADJUSTMENTS TO PROVIDE A FRIENDLY GERIATRIC CARE SERVICESAT THE OUT PATIENT DEPARTMENT (OPD) OF UNIVERSITY HOSPITAL KDU (UHKDU)

Jayasekera MMPT1, Hulugalle CDK2, Ramawickrama SM2, Merusinghe AP2, Marasinghe TD2,Edirisinghe EMDT2

1Department of Medicine, General sir John Kotelawala Defence University, 2University HospitalKotelawala Defence University

Introduction and objectives

Sri Lanka is one of the fastest-ageing countries in the world, with the proportion of thepopulation aged 60 years or older projected to increase from 12.5% currently to 16.7% in 2021.By 2041, one out of every four in Sri Lanka is expected to be an elderly person.We assessed the burden of geriatric presentation to OPD, existing geriatric care by OPDdoctors, paramedical staff, and patient’s satisfaction. Then assess the improvement of thesame after introducing special geriatric care counters in UHKDU.

Method

A clinical audit was conducted during March 2021 to June 2021.

Results

There were 406{mean age 72.25+5.63 years (58.4% female)} and 200 patients {mean age73.02+6.12years (51% female)} recorded in the first and second cycle of the audit respectively.Commonest diagnosis was musculoskeletal pain (109) followed by leg ulcers (89) in bothcycles. The mean consultation time was 55 (+42 SD) minutes and 30 +35SD) minutes in thefirst and second cycles respectively(p=0.000). Specimen collection time, time to receiveinvestigation results, and duration in pharmacy was <1 hour in 93.8% ,13.4% ,72.8% and100%,47.5%,93.1%in first and second cycles respectively. There was significant improvement inall three situations in the second cycle (p=0.035, p=0.000, p=0.000). Majority stated theoverall satisfaction as good {(first cycle (80.3%), second cycle (91%)} in both cycles while 5%and 1% were stated as poor in the first cycle and second cycle respectively.

Conclusion

There has been a significant improvement of geriatric care in the outpatient department afterintroducing special geriatric counters in UHKDU.

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CARDIOVASCULAR AUTONOMIC NEUROPATHY IN DIABETES; DATA FROM MALESEXUAL DYSFUNCTION STUDY, NATIONAL HOSPITAL OF SRI LANKA

De Silva AMNL1,2, Athukorala TG2, Liyana Gamage JK3, Katulanda G4, Sumanatilleke M2,Somasundaram NP2

1Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala DefenceUniversity, 2Diabetes and Endocrine Unit, National Hospital of Sri Lanka, 3Department ofRadiology, National Hospital of Sri Lanka, 4Department of Chemical Pathology, NationalHospital of Sri Lanka


Cardiovascular autonomic neuropathy (CAN) in diabetes is associated with increasedmorbidity and mortality. The objective was to assess the prevalence of CAN, its associationsand performance of cardiovascular autonomic reflex testing (CART) in clinical practice.

Methods

A cross-sectional study was conducted at the diabetes clinic, National Hospital of Sri Lanka.Men aged 18 to 70 years were recruited consecutively. Basic socio-demographic data andclinical information were collected using an interviewer-administered data proforma. Inaddition to the assessment of sexual function, an electrocardiograph recorded during deepbreathing, standing from supine and Valsalva manoeuvre was interpreted using standardizedcriteria. Significance was tested using the chi-square test and t-test.

Results

Hundred and thirty-seven participants underwent CART. Deep breathing, standing andValsalva manoeuvre were abnormal in 59 (43.1%), 58 (42.3%) and 70 (51.1%), borderline in 19(13.9%), 3 (2.2%) and 30 (21.9%) participants, respectively. Out of the 56, whose postural bloodpressure was tested, four had postural hypotension. Electrocardiographic evidence of CANwas present in 90 (70.3%), (early: 29, definite: 61). Patients with CAN were older than theothers (Mean age: 56.1±8.7 Vs. 50.95±9.7 years, p=0.004). The mean score in the prematureejaculation diagnostic tool was higher among those with CAN (12.77±7.3 Vs. 9.89±6.3,p=0.027). Ankle-brachial pressure index >1.4 is associated with CAN (p=0.033). Deepbreathing as a single test had 92% specificity and 79% sensitivity in diagnosing CAN.

Conclusions

Cardiovascular autonomic neuropathy is common among men with diabetes. Simplediagnostic tools can be used in clinical practice to enable early diagnosis and interventions.

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KNOWLEDGE, ATTITUDES AND FACTORS ASSOCIATED WITH KNOWLEDGE ANDATTITUDES ON DOWN SYNDROME AMONG STUDENTS ATTENDING SELECTED HIGHEREDUCATIONAL INSTITUTIONS IN THE COLOMBO DISTRICT

Kottahachchi AS1, Suriyaarachchi PI1, Rangana RLP1, Kithma BKMV1, Karikalan RA1,Alagiyawanna AMADK2, Nazeer F.I.2, Wijesekara DS3

1Faculty of Medical Sciences, University of Sri Jayewardenepura, 2Department of CommunityMedicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, 3Department ofPaediatrics, Faculty of Medical Sciences, University of Sri Jayewardenepura


Down syndrome (DS) is the commonest chromosomal abnormality worldwide. Studentsattending higher education institutions will be key stakeholders of society. This studydescribes the knowledge, attitudes, and factors associated with knowledge and attitudes onDS among these students.

Methods

A descriptive cross-sectional study was conducted, and data was collected using aself-administered web-based questionnaire from 330 subjects.

Results

Majority (53.9%) demonstrated good knowledge, and 50% showed positive attitudes. Themajority knew that DS is a genetic disorder and the features of identification. Knowledge onmaternal age as a risk factor, antenatal screening tests, and complications of DS was low.Most preferred providing education and occupations to individuals with DS and believed theyshould live with family (81.2%). However, 44.3% believed integrating them may createproblems. Most (55.7%) decided to allow pregnancy with DS babies themselves and look afterthem. Attitudes regarding their sociability were positive. Gender, faculty/department, stream ofA/L, and having a previous encounter with persons with DS showed statistically significantassociations with knowledge (p<0.05). Only the stream of A/L showed a statistically significantassociation with attitudes. A significant correlation was observed between knowledge andattitudes.

Conclusions

Overall knowledge towards DS among the participants was good, and 50% showed positiveattitudes. Knowledge was inadequate on the association of advanced maternal age with DS.Further, those who followed the A/L biology stream (educational level) had better knowledge.As there is a positive correlation between knowledge and attitudes, increasing awareness inthe community may be of value.

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OPPORTUNITIES FOR OPTIMIZATION OF DRUG THERAPY AND CHARACTERIZATION OFDRUG-RELATED PROBLEMS IN CKD/CKDU PATIENTS UNDERGOING HEMODIALYSIS INSRI LANKA

Kalpani AGS1,2, Mohamed F2,3, Hough JE2,3, De Silva DNN1, Jayamanne SF1,2

1Department of Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka, 2Collaborationof Australian and Sri Lankans for Pharmacy Practice Education and Research (CASSPER),Brisbane, Australia, 3Department of Pharmacy, Faculty of Allied Health Sciences, University ofPeradeniya, Sri Lanka

Introduction and objectives

Drug-related problems (DRPs) in ESRD patients undergoing haemodialysis have not beeninvestigated in Sri Lanka. The present study was conducted to identify and characterize thepotential drug-related problems and identify opportunities to optimize drug therapy in ESRDpatients undergoing haemodialysis.

Method

As part of RCT at ambulatory hemodialysis (HD) units of Teaching Hospital Anuradhapura(THA) and District General Hospital (DGH) Polonnaruwa, randomly selected ESRD patientsundergoing hemodialysis were recruited for the study. DRPs were identified by reviewing theclinic drug charts, patient clinic records and structured interviews with patients or caregiversto identify the patients’ actual drug-taking behaviour. Identified DRPs were categorized usinga PCNE classification system V.08.

Results

A total of 1350 drug related problems were identified in 283 ambulatory HD patients duringthe study period. Patients were taking an average of 10.64 drugs and had 4.77 DRPs.Unnecessary drug treatment (30.3%), effect of the drug treatment not optimal (29.9%) followedby untreated symptom or indication (24.5%) were the most prevalent DRP categoriesaccording to the PCNE classification system. The major cause for the identified DRPs was aprescriber related (50.22%) followed by patient related (30.0%) and dispensing related (16.9%)causes in ESRD patients undergoing HD.

Conclusions

ESRD patients undergoing HD had a large number of medications which increases the risk ofpotential DRPs. Significant opportunities exist for pharmacists' input to improve the quality useof medicines by identifying and resolving the DRPs in ESRD patients undergoinghaemodialysis in the current Sri Lankan government hospital setting as part ofmultidisciplinary team

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CHANGES IN BIOCHEMICAL MARKERS OF OUTCOMES IN HAEMODIALYSIS PATIENTSFOLLOWING A CLINICAL PHARMACY INTERVENTION

Kalpani AGS1,2, Mohamed F2,3, Hough JE2,3, De Silva DNN1, Chandrasena WMHNM1, JayamanneSF1,2

1Department of Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka, 2Collaborationof Australian and Sri Lankans for Pharmacy Practice Education and Research (CASSPER),Brisbane, Australia, 3Department of Pharmacy, Faculty of Allied Health Sciences, University ofPeradeniya, Sri Lanka


Common complications of End-Stage Renal Disease (ESRD) include cardiovascular disease,diabetes, anaemia and mineral and bone disease. Achieving an optimum level of biochemicalmarkers of outcomes is crucial in managing ESRD. This study was conducted to assess thechanges in selected biochemical parameters following a clinical pharmacy intervention (CPI)in this population.

Method

A randomized controlled trial was conducted at outpatient haemodialysis units in NorthCentral Province, Sri Lanka. Serum phosphate, serum calcium, haemoglobin, lipid profile,eGFR and ‘adequacy of dialysis’ (AoD) (determined by urea reduction ratio (URR); calculatedbased on pre-post blood urea nitrogen measurements and Kt/V measurements) weremeasured in patients at baseline (BL) and after one year (PI). The Intervention Group (IG),n=143 patients received comprehensive pharmaceutical care by the clinical pharmacist onfour consecutive occasions at recruitment, and 2, 6 and 10 months after recruitment. While theControl Group (CG), n=140, received standard care.

Results

At the baseline, there was no significant difference in the biochemical markers of outcomesbetween the two groups and AoD was within the acceptable range. However, there was asignificant improvement in the mean serum phosphate levels (IG 4.04±1.19 vs CG 5.00±1.67,p<0.0001), mean serum calcium levels (IG 8.90±1.35 vs CG 7.11±2.07, p<0.0001), and meanhaemoglobin levels (IG 10.5±1.25 vs CG 9.4±1.87, p<0.0001) in the IG compared to the CG atthe end of one year. However, eGFR, lipid profiles did not change significantly (p>0.05). AoDwas within the acceptable range in both groups at baseline and post intervention and did notchange significantly (p>0.05)

Conclusions

Improvement in the selected biochemical markers of outcomes resulting from CPI suggestsbetter patient management outcomes in the ESRD population.

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TRENDS IN VENOUS LACTATE IN THE CRITICAL PHASE OF DENGUE HAEMORRHAGICFEVER AND DURING FLUID RESUSCITATION

Priyankara WDD1, Samarutilake DGN1, Wijewickrama A2, Manoj EM1, Wanigasuriya K1

1National Hospital of Sri Lanka, 2National Institute of Infectious Diseases, Sri Lanka, 3Faculty ofMedical Sciences, University of Sri Jayewardenepura, Sri Lanka


Management of dengue haemorrhagic fever (DHF) is mainly guided by clinical parametersand haematocrit (HCT) values. Serum lactate is a useful indicator of effective tissue perfusion.We aimed to find out the trend in venous lactate levels during the critical phase and duringfluid resuscitation of DHF.

Methods

Study was carried out at the Colombo South Teaching Hospital and the National Institute ofInfectious Diseases, Sri Lanka. Consecutive patients with DHF/DSS were enrolled. Venouslactate levels were measured using a pre-validated lactate analyser at each time ofperforming HCT.

Results

Total number of 162 patients was analyzed. Mean age was 32 years (±11.87) and 92 (56.8%)were men. Mean day of onset of critical phase was 4 (±1). Majority of the leakers 124 (76.5%)had free fluid in the abdomen, whereas 24 (14.8%) had HCT rise above 20%. Majority (95.5%)had their lactate values ranging between 0-2 mmol/l (95.5%) and median HCT ranging from36- 45 (69.7%). There was no significant difference in mean lactate value after a fluid bolus.There was a correlation of mean HCT difference with dextran, crystalloid + dextran bolusesand blood transfusions. Crystalloid boluses did not show a significant correlation with HCT.The hospital stay was longer when the lactate level was high.

Conclusions

The degree of lactate difference behaved within a narrow range and majority of the patientshad their venous lactate between 0-2 mmol/L. There was no significant difference observedin lactate values with fluid resuscitation.

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AUDIT REPORT ON THYROID HORMONE REQUESTING PATTERN IN WARDS ANDCLINICS OF NATIONAL HOSPITAL SRI LANKA

Sujeeva N1, Balasooriya BMCM1, Samarakoon SMPP1, Gunawardena SA1, Katulanda GW1

1Department of Chemical Pathology, National Hospital of Sri Lanka

Introduction

RIA laboratory of the National Hospital of Sri Lanka (NHSL) gets requests for thyroid hormonesfrom NHSL and a few peripheral hospitals. This audit was carried out to identify therequesting pattern against standards instructed by the laboratory.

Objectives

We aimed to assess the requesting pattern, indications, provision of clinical history andadherence to guidelines given by the laboratory for requests filling.

Methodology

We retrospectively reviewed thyroid requests received at the laboratory in January 2021,entered and analysed data in Excel.

Results

A total of 751 requests were studied out of which 66.44% were from inward patients. Theproportion of TSH only, TSH with free T4 (fT4), TSH with fT4 and T3, fT4 only were 6.52%,84.28%, 8.26% and 0.93% respectively. Out of all 20.50% and 79.50% requests had one nameand two names respectively. Standards were met in a majority (92%) with regard to age,gender and BHT number. Clinical information was not given in 49.4%. Among the requestswith diagnosis, drug history was mentioned in 38.57%; previous results were not mentionedin >95%. Standards for information on the requesting personnel (name, signature and stamp)were fulfilled in 92.54% of inward patients, while only 64.29% fulfilled in outpatients. Date andtime of sample collection were absent in > 99%.

Conclusion

Absence of clinical history, drug history and previous results in majority of requests preventschemical pathologist giving appropriate interpretative comments. Absence of date and time ofsample collection, collectors name and signature in majority indicates lack of concern ofward/clinic staff for the quality of results. Inadequate information on requesting personnelwhich was mostly seen for outpatients indicates unauthorised requesting. Proper filling of therequest form is important to validate results clinically, improve quality, reduce cost of repeattesting and prevent unauthorised requests.

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REACTOGENICITY FOLLOWING THE FIRST DOSE OF CHADOX1 NCOV-19 VACCINEAGAINST SARS-COV-2: A MULTICENTER OBSERVATIONAL STUDY

Undugodage CM1, Dissanayake U2, Hemantha Kumara PG3, Samarasekera B4, Yapa L5,Dissanayake O1, Domingoarachchi D5, Priyankara D2, Seneviratne K5, Ganegama R5,Wickramasinghe WK2, Samarakoon S2, Wijesinghe KDP6, Wijemanne WMUS6, SandaruwanUHC6, Neranjan R6, Illeperuma PDK4, Thenuwara HM6, Amashakya GA1, Dasanayake HD1,Jayasooriya DASC7, Kalubandara BS7, Madurawala MDDNC1, Prasath T6, Perera N1

1Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka, 2National HospitalSri Lanka, Sri Lanka, 3Base Hospital Panadura, Sri Lanka, 4District General Hospital Gampaha,Sri Lanka, 5Teaching Hospital Anuradhapura, Sri Lanka, 6Colombo South Teaching Hospital, SriLanka, 7Faculty of Medicine, University of Ruhuna, Sri Lanka


Acceptability of a vaccine is largely dependent on the reactogenicity and therefore is animportant factor during mass vaccination programs. The objective was to identify thesystemic and local reactions to ChAdOx1 nCoV-19 vaccine in health care workers (HCW).

Methods

A multicenter observational study was performed to identify the reactogenicity to ChAdOx1nCoV-19 vaccine. HCWs of five selected hospitals who received the first dose of the vaccinewere included. Symptoms of reactogenicity occurring within eight days of vaccination wererecorded.

Results

There were 4478 participants with a median age of 42 years (IQR 34-51) and 2863(63.9%) were females. At least one symptom of local or systemic reactogenicity was reportedby 4151 (92.7%). Local reactions were reported by 2612 (58.3%) with two receiving antibiotics.Anaphylaxis was noted in one vaccine recipient and 2 (0.04%) reported urticaria.Commonest systemic reactions were bodyache (3244,72.4%), fatigue (2379, 53.1%),headache (2277, 50.8%), fever (2290, 51.1%), feverishness (1912, 42.7%) and chills (2295,51.3%). Lower age (p<0.0001) and female gender (p 0.002) were associated with ahigher frequency of developing systemic reactions. Hospital admissions were reported by24 (0.5%) vaccine recipients for severe systemic symptoms. There were 342 (7.6%)reports of palpitations and one hospital admission due to ventricular bigeminy. One HCWwas hospitalized for possible aseptic meningitis.

Conclusions

This study demonstrates that early systemic and local reactions are common. Most symptomswere self-limiting. Systemic reactions were more frequent in females and in the youngerpopulation. ChAdOx1 nCoV-19 vaccine appears safe in the studied population.

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UNDERNUTRITION AMONG ELDERLY AND EFFECT OF HEALTH EDUCATION FORUNDERNOURISHED

Somaratna RMJC1 , Samaranayake TSP2

1Registrar in Family Medicine, Postgraduate Institute of Medicine, University of Colombo,2Department of Family Medicine, Faculty of Medical Sciences, University of SriJayewardenepura

Introduction and Objective

Undernutrition is a well-known cause of physical and psychosocial retardation in elderly,which makes them dependent and a burden to society.Objective of this study was to evaluate the nutritional status of elderly and the effectivenessof health education programmes among undernourished elders.

Methods

Cross sectional descriptive study was conducted on elderly attending Primary care settings inColombo district. Demographic, medical, social, and dietary (24 hour recall) data andnutritional status [BMI, calf circumference (CC), mid upper arm circumference (MUAC) and Hblevels] were assessed. Undernourished elderly were divided into 2 groups and advice ondietary modifications were given to one group. Dietary modification guides were prepared inconsultation with a nutritionist. Reinforcements given over the phone monthly andreassessment of nutritional status and dietary habits were done after 6months.

Results

404 elders (>60 years) were recruited. Prevalence of undernutrition was 24% and prevalenceof anaemia was 58%. Post interventional significant improvement in CC(p=0.02) andHb(p=0.004) seen in the intervention group. Adherence to dietary guidance was poor (35%).Therefore, sub analysis was done between the adherence and non-adherence groups.Improvement in BMI(p=0.02) and CC(p=0.04) were significant in the adherence groups. Hblevels improved in both groups with a more profound increase in the adherence group(p=0.004). Hb reports were provided to patients and anaemics needing further treatment,informed to caring physicians.

Conclusions

Adherence to nutritional education improved the nutritional status significantly. It isrecommended to assess nutritional status in elderly during routine consultations at primarycare settings and to provide individualized dietary plans to improve nutritional status.

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ASSESSING THE IMMUNOGENICITY FOLLOWING THE 1ST DOSE OF COVISHIELD(CHADOX1 NCOV-19) VACCINE, IN A COHORT OF PARTICIPANTS IN COLOMBO

Gunawardane SA1, Jinasena TMRR2, Hewa SP2, Agampodi SB3, Dissanayake DJGGN1,Jayasinghe IN2, Inthujah T1, Samarakoon SMPP1, Balasooriya BMCM1, Sujeeva N1, ThowfeekZTM1, Prashanthan S1, Wijesuriya WAM1, Thushyanthi P2, Athapaththu AMTU2, SamarasingheM2, Ediriweera TW1, Katulanda GW1

1Department of Chemical Pathology, National Hospital of Sri Lanka, 2Department of ChemicalPathology, Colombo South Teaching Hospital, 3Department of Community Medicine, Faculty ofMedicine and Allied Sciences, Rajarata University of Sri Lanka


As a part of the global effort to combat SARS Cov-2 infection the vaccination program usingCovishield vaccine, one of the firstly introduced, was launched in early 2021 in Sri Lanka. Forthe decision making on the vaccination programme in the future, it is essential to assess thesuccess of the initiative and analysis of the immune response among recipients appears as aconvenient short-term method for such evaluation. The study aimed to assess the antibodyresponse to S antigen of the virus to 1st dose of Covishield vaccination prospectively in acohort of recipients and to correlate the response to age, gender, BMI, and comorbidities.

Methods

This is the first part of an ongoing study. Participants were randomly selected receivers whoconsented for the study at vaccination centers which were set up at two major hospitals of SriLanka, National Hospital of Sri Lanka (NHSL) and Colombo South Teaching Hospital (CSTH).The study was carried out from 28.01.2021 to 14.05.2021. Blood samples were collected onday 0, 14, 21, 45 and 90 days after the first dose of vaccine. Interviewer administeredquestionnaire was used to collect relevant data. Total antibody levels to receptor bindingdomain (IgM and IgG) were measured using Advia XP quantitative chemiluminescence assay.

Results

Serum antibody level more than 1.0 index was considered as the cut-off for seroconversionand out of 190 recruited participants (45.45% male, 54.55% female) seroconversion wasobserved in 87.5% on day 14, 95.0% on day21 and 100% on day45 following a single dose ofthe vaccine irrespective of the age, gender, BMI and comorbidities. Immune response wassimilar across almost all age groups with a maximum response on day 45 (median 14.43 Index,IQR-5.5-34.3) following the 1st dose with an exception in participants of >80 years (day21,median-0.19 Index, IQR-0.1-0.29, p<0.001). Participants with <18.5kg/m² BMI showed lowantibody levels (day 45, median-3.53 Index, IQR-2.39-4.64, p<0.001). Healthy category hadhigher antibody levels at day45 (median 20.46 Index, IQR-5.88-34.69, p 0.09) than theparticipants with chronic diseases.

Conclusions

A single dose of the vaccine was shown to be highly immunogenic irrespective of the age,gender, BMI and comorbidities. However, no immune response is seen in participants >80Yrs.For an assessment on the overall effectiveness of the vaccine long term studies are needed.

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PRESENCE OF LONG COVID SYNDROME AND PULMONARY FUNCTIONABNORMALITIES, AT 3 MONTHS FOLLOWING RECOVERY IN A COHORT OF MILDLYSYMPTOMATIC AND ASYMPTOMATIC COVID-19 PATIENTS: A PRELIMINARY ANALYSIS

Undugodage C1, Deen FAH1, De Silva HDK1, Indrakantha RAD2, Ranatunga RAYV2,Weveldeniya WTP2, Wicramasinghe WADE2, Samarasekera GBL2

1Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka, 2District GeneralHospital, Gampaha.


Long COVID syndrome (LCS) is a recognized sequelae of SARS-CoV-2 infection. The aim wasto identify symptoms of LCS and pulmonary function abnormalities following recovery fromSARS-CoV-2 infection.

Methods

An observational study was conducted at 3-months following recovery on patients who hadmildly symptomatic or asymptomatic COVID-19 infection. Symptoms were assessed by aninterviewer-administered questionnaire and lung function by spirometry.

Results

There were sixty patients with mean age of 40.73 years (SD=14.3) and female preponderance(56,93.3%). During the period of infection, 16(26.7%) had asymptomatic disease and 44(73.3%)had symptoms. Seventeen (28.3%) had at least one respiratory symptom. Twenty (33.3%) hadmild pneumonia. At 3 months, 45(75%) had at least one symptom. Commonest was shortnessof breath (SOB) (41, 68.3%). SOB was new in onset in 34(82.9%) and persistent in 7(17.1%). Eight(50%) with asymptomatic disease and 33(75%) with mild disease had SOB. Their mMRC wasgrade 1(28,68.3%), grade 2(12,29.3%) and grade 3(1, 2.4%). Abnormal spirometry was noted in46(76.7%), and among 11(68.8%) who had asymptomatic disease, and 14(73.7%) who hadpneumonia. Majority had restrictive spirometry (35,58.3%). Evidence of airway obstruction wasseen in 11(18.3%), out of them 9 (81.8%) did not have previous asthma. In addition, other longCOVID symptoms such as headache (n=7), rhinitis (n=1), cough (n=1), myalgia (n=2), andpalpitations (n=1) were present.

Conclusion

Presence of LCS is common following SARS-CoV-2 infection. SOB is the commonestsymptom, with the majority having new onset SOB. Abnormal spirometry was seen in asignificant proportion at 3 months.

19


VARIABLES IN THE 4C MORTALITY SCORE IN COVID-19 PATIENTS TO PREDICTIN-HOSPITAL MORTALITY AND IN-HOSPITAL DETERIORATION: SRI LANKAN EXPERIENCE

de Silva A1, Indrakumar J1, Perera N1

1Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura


Severity prediction scores are useful to identify patients at risk of a worse outcome. Weassessed variables used in the 4C mortality score in predicting in-hospital mortality(IHMort)and in-hospital deterioration(IHDet) among a cohort of Sri Lankan COVID-19 patients.

Methods

A retrospective observational study was conducted at Colombo South Teaching Hospital byextracting data from the bed-head tickets of COVID-19 patients admitted from05.05.21-04.07.2021. Demographic data and parameters on-admission were extracted. IHDet(need for respiratory support and/or escalation to ICU/HDU) and IHMort were assessed.

Results

Data from 225 confirmed COVID-19 patients, with a median age of 56years (IQR 41-67) and104 (46.2%) males were included. Increased age, low SpO2 on admission, presence of 2 ormore co-morbidities and CRP used in 4C score conferred higher risk of IHDet and IHMort. DM,HT and male gender were not associated with a worse outcome. Age≥40years (4.7% vs95.3%, p 0.001), SpO2 <96 (9.3% vs 90.7%, p <0.001) resulted in IHDet. A statistically significantincrease in mortality was seen with age≥40years (0% vs 100%, p <0.0001) and SpO2<96(5.4% vs 94.6%, p <0.0001). CRP >10mg/dL (p <0.001), ≥2 comorbidities (p <0.05) andcreatinine >100µmol/L (p <0.05) resulted in higher IHDet and IHMort. Presence ofneutrophil:lymphocyte ratio ≥2.5 and HR ≥90 on admission had a worse outcome. SpO2 <96than SpO2<92 was better at predicting IHMort( AUC 0.9 vs 0.78) and IHDet (AUC 0.9 vs 0.75).

Conclusions

Variables of 4C score and the cut-off values should be validated to suit the Sri Lankanpopulation. We recommend adding tachycardia and neutrophil/lymphocyte ratio in riskprediction scores.

20

POSTER PRESENTATIONS

21

Poster Presentation- 01

PREDICTORS AND PATTERNS OF POLYPHARMACY IN CHRONIC DISEASES IN AMIDDLE-INCOME COUNTRY: A STUDY ON POLYPHARMACY IN BOTH PRIMARY ANDTERTIARY CARE

Matthias AT1, Fernando GVMC2,3, Somathilake BGGK3, Prathapan S4

1Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, SriLanka, 2National Centre for Primary Care and Allergy Research, University of SriJayewardenepura, Sri Lanka, 3Department of Family Medicine, Faculty of Medical Sciences,University of Sri Jayewardenepura, Sri Lanka, 4Department of Community Medicine, Faculty ofMedical Sciences, University of Sri Jayewardenepura, Sri Lanka


Low and middle-income countries (LMIC) are increasingly affected by non-communicablediseases (NCD), which overburden the health system. With the rising prevalence ofmultimorbidity, polypharmacy is inevitable. Sri Lanka too faces the burden of polypharmacyand multimorbidity, and it is a strain on the economy as Sri Lankan health care isfree-of-charge to all citizens. Therefore, steps to reduce inappropriate polypharmacy are anecessity.

Methods

A descriptive cross-sectional study was carried out in medical clinics of a tertiary care hospitaland a university primary care department. Data were extracted from the clinical records ofpatients over the age of 20 years with a minimum of one NCD diagnosed by either aconsultant physician or a consultant family physician. The sample size was 1600.

Results

Multimorbidity was present among 63.5% of patients. Polypharmacy (five or more than fivedrugs) was seen in 36.8% of the patients. Diabetes, hypertension, and coronary heart diseasewere the commonest of all diseases. Those on more than 11 drugs were found to havediabetes mellitus, hypertension, coronary heart disease, chronic kidney disease and cardiacfailure. 15% of the patients in the primary care setting and 59% of the patients in tertiary careexperienced polypharmacy. Multiple regression analysis confirmed that polypharmacyincreased with male gender, advancing age and the degree of multimorbidity.

Conclusion

Polypharmacy is common in patients with multimorbidity. Integration of multidisciplinary teamsmight be helpful in medication management of patients with NCD in order to optimize themanagement and reduce polypharmacy.

22


SOCIODEMOGRAPHIC CHARACTERISTICS OF A COHORT OF FEMALE PATIENTS WITHACUTE CORONARY SYNDROME IN SRI LANKA

Ralapanawa U1, Karunathilake EMPW1, Premarathna ABNN2, Shahmy MAA2, Poornima PKS2,Palihana PRA2, Deegala HMTD1

1Department of Medicine, Faculty of Medicine, University of Peradeniya, 2Teaching Hospital,Peradeniya


Acute Coronary Syndrome (ACS) is the leading cause of death and disability worldwide.Epidemiological studies on females with ACS are limited in Sri Lanka.

Methods

This cross-sectional descriptive study was conducted at the Teaching Hospital Peradeniya, SriLanka, among females with ACS. An interviewer-administered structured questionnaire wasused to collect data, and the sociodemographic factors were analyzed.

Results

A total of 316 female patients with a mean age of 62.2±11.1 years were included in the study,where unstable angina, NSTEMI and STEMI were present in 162(51.3%), 97(30.7%) and57(18.0%), respectively. The mean age of onset was higher in NSTEMI, 63.7±12.7 (p=0.037) andSTEMI, 64.1±9.3 (p=0.027) than unstable angina, 60.6±10.5. The majority (84.4%) weremenopausal, and the mean duration from menopause to the age onset of ACS was 16.4±10.1years. 56.8% had studied up to less than O/L, and 25.7% had done O/L, showing a statisticallysignificant difference (p<0.001). 71.8% were housewives, and only 4.3% were professionals.There was no association between the education level (p = 0.906) or the occupation (p =0.104) with the spectrum of ACS. None of the individuals were smokers, and only oneindividual had taken alcohol.

Conclusion

Most females had unstable angina, and its age of onset was lower than NSTEMI or STEMI, andmost of them were menopausal. The majority were less educated females and unemployed,and the prevalence of smoking or alcohol was extremely low.

23


EMERGING ENTOMOLOGICAL EVIDENCE OF CUTANEOUS LEISHMANIASISENDANGERMENT IN TOMORROW’S SRI LANKA

Kumarasiri RWCK1, Senanayaka SASC2, Shantha DS2 , De Silva BGDNK3, Karunaweera ND2

1Postgraduate Institute of Medicine, University of Colombo, Sri Lanka, 2Department ofParasitology, Faculty of Medicine, University of Colombo, Sri Lanka, 3Department of Zoology,Faculty of Applied Sciences, University of Sri Jayawardanapura, Sri Lanka

Introduction

Cutaneous leishmaniasis (CL) has transmitted to all 25 districts in Sri Lanka without specificcontrol or prevention. This is the first island-wide molecular-based evaluation ofentomological factors contributing to the escalating burden of CL in Sri Lanka.

Methodology

DNA was extracted from 1520, island-wide collected, morphologically identified, femalePhlebotomus argentipes glaucus (Ph.glaucus). Identification was molecularly confirmed withCOI and Cyt b markers. The presence of Leishmania parasite in sandflies was tested using aconventional PCR and confirmed using donovani specific nested PCR. Blood-meal analysiswas done using light-trap collected 270 blood-engorged female sandflies targetingvertebrate Cytochrome b gene. Positive amplicons of all PCR experiments were sequencedand analyzed.

Results

Thirteen blood-fed and 2 non-fed sandflies were infected with L.donovani indicating aninfection rate of 1% (15/1520). Eleven infected sandflies (73%) were engorged with humanblood implicating humans as a possible parasitic reservoir. The presence of infectednon-engorged sandflies reconfirmed Ph.glaucus as L.donovani vector in Sri Lanka. Out of 216positive PCR amplicons of blood-meal analysis, 153 (70%) were Ph.glaucus and 63 (30%) wereSergentomyia species. The presence of human blood in 133 (87%) out of 153 vertebrateblood-engorged Ph.glaucus, favouring the probable anthropophilic nature of Ph.glaucus.

Conclusion

The majority (70%) being Ph.glaucus, rising infection rate (previous rate of 0.3% in 2008),anthropophilic nature of Ph.glaucus with humans as a possible parasitic reservoir, may partlyexplain the future health danger of CL. The evidence uncovered will aid future planning andimplementation of vector control strategies, to contain the rapid spread of leishmaniasis in SriLanka.

24


AUDIT ON THE ADHERENCE TO ABCDEF BUNDLE IN INTENSIVE CARE UNITS IN ATERTIARY CARE HOSPITAL OF SRI LANKA

Kalhari ST1, Priyankara WDD2

1Critical Care, University Hospital KDU, Werahera, Sri Lanka, 2Critical Care, National HospitalSri Lanka, Colombo, Sri Lanka


The ABCDEF bundle (Assessment, prevention and management of pain, Both spontaneousawakening trial (SAT) and spontaneous breathing trials (SBT), Choice of sedation, Deliriumscreening, prevention and management, Early mobilization, Family engagement) isrecommended to practice in intensive care units by the Society of Critical Care Medicine.

Methods

This was carried out in 6 ICUs of a tertiary care centre among patients who stayed more than24 hours to assess the compliance. Individual components-A, B, C, D, E, and F were assessedusing validated pain scale, SBT, sedation score, delirium scale and relevant questionsrespectively.

Results

Out of 76 patients the compliance to the ABCDEF bundle in ventilated patients was 6.3% andADEF bundle in non-ventilated patients was 32%. Pain was assessed only in 20 (27.7%). Forty-two (89.3%) patients were screened for the eligibility for SAT and 31 (65.9%) received SAT.Thirty-nine (82.9%) were screened for the eligibility for a SBT and only 4(14.6%) received SBT.Only 9(19.14%) were assessed for the depth of the sedation and 4(5.5%) were assessed fordelirium. Forty- nine(66.6%) were screened for early active mobilization, and only 11(15.2%)were mobilized out of bed. In 39(40.4%) patients’ families were engaged in the discussionswithin 72 hours. High vasopressor and oxygen requirement was the most frequent cause toprevent the SAT and SBT. Most common contraindication for early mobilization was deepsedation or low GCS.

Conclusion

The overall compliance to the ABCDEF bundle was poor. Education of the ICU staff, setting upprotocols and re-auditing is recommended.

25


STRESS ELECTROCARDIOGRAPHY OUTCOMES AND ASSOCIATIONS IN ISCHEMICHEART DISEASE PATIENTS IN DGH HAMBANTOTA

Sandeepani YD1, Kumbukage PSP1, Mihirani MHL1, Amarasekera SC1, Hewarathna UI1

1Cardiology unit, DGH Hambantota

Background

Ischemic Heart Disease (IHD) is the leading cause for indoor morbidity and mortality in SriLanka and in the world. Stress electrocardiogram can be used as a less resource intensive,noninvasive, cost-effective tool for evaluation and risk stratification of IHD.

Objective

To analyze the stress electrocardiography (ETT) outcomes and associated factors among theIHD patients in DGH Hambantota.

Method

A Retrospective observational study was conducted. All patients who underwent ETT fromMay 2019 to 2021 April at DGH Hambantota were enrolled. Patients’ demographiccharacteristics, IHD history and ETT outcomes were evaluated.

Results

Among 1235 patients, the majority were females (54.6%). Age ranged from 18 to 76 (mean53.1±10.3) years. Majority of patients’ indication for ETT was stable angina (53.6%) followed byunstable angina (23.7%), STEMI (12.1%) and NSTEMI (10.5%). Mean exercise time was 9.3±2.6minutes and the majority (56%) completed all four stages of ETT. Out of all, 32% had positiveresults. Most were positive in stage 2 (31.6%) while the least in stage 1 (18%).Interestingly, thehighest ETT positivity was among NSTEMI patients (52.3%) followed by STEMI patients (40.7%)while least was among stable angina patients (22.4%). Positive test result was significantlyassociated (chi-squared) with male sex (P<0.001), age above 60 years (P=0.009), history oftroponin positive ACS (P<0.001) and impaired ejection fraction (p<0.001).

Conclusion

NSTEMI patients had higher ETT positivity than STEMI patients. Male sex, age above 60years, history of troponin positive ACS and impaired ejection fraction were strong predictorsof positive stress electrocardiography.

26


POST STROKE DEPRESSION – PREVALENCE AND ASSOCIATED FACTORS IN A TERTIARYCARE CENTER IN SRI LANKA

Thambirajah N1, Senanayake S2, Gooneratne IK2,3,4, Suraweera C2,5, Ranasinghe LI6,Kumbukage MP6

1Postgraduate Institute of Medicine, Colombo, 2National Hospital, Sri Lanka, 3District GeneralHospital, Hambantota, 4Department of Clinical Medicine and Mental Health, Faculty ofMedicine, University of Moratuwa, 5Department of Psychiatry, Faculty of Medicine, Universityof Colombo, 6Ministry of Health, Sri Lanka


Prevalence of stroke in urban Sri Lanka is estimated at 10.4 per 1000 and is expected to rise.Post-stroke depression (PSD) is an independent predictor of poor long-term outcome. It leadsto suboptimal rehabilitation, decreased quality of life and increased mortality and isunder-recognized. Main objectives of this survey were: to estimate prevalence of depressionin stroke, to assess factors associated with PSD.

Methods

A descriptive cross-sectional study was conducted at Neurology and Medical wards, NationalHospital of Sri Lanka. Non-probability, consecutive sampling was used to collect data frompatients with ischaemic stroke admitted from January 2019 to January 2020. Patients withsignificant pre-existing depression, cognitive impairment and language deficits wereexcluded. A structured, pre-tested interviewer-administered questionnaire was used to assessprevalence and associated factors of PSD. Beck’s Depression Inventory (BDI) wasadministered three months following the stroke to screen for depression.

Results

Eighty-one stroke patients were screened. Mean age was 66.6 years (± SD 12.5). Male:female ratio was 1.2:1. Depression at three months of follow-up was observed in 35.8% (95%CI-25.4%-47.2%) of participants. Following bivariate analysis, large vessel stroke (p<0.001),cortical stroke (p<0.001), frontal lobe lesions (P<0.001), history of past stroke (P=0.014) andsexual dysfunction (P=0.026) were associated with increased risk of PSD.

Conclusion

PSD occurs in 1/3 of strokes, keeping with international data. Most studies focus on data in theacute phase, whereas we have screened for depression at three months post-stroke.Identifying risk factors for post-stroke depression is important to mitigate poor outcomes.

27


AN AUDIT ON ASSESSMENT, DOCUMENTATION AND IMPLEMENTATION OF PAINGUIDELINE IN DISTRICT GENERAL HOSPITAL, KALUTARA, SRI LANKA

Amaratunga H1, Samarajiwa G1, Kaviratne PDS1

1District General Hospital, Kalutara

Introduction

Accident and emergency (A&E) departments carry out immense responsibility in treating illand injured patients in Sri Lanka. Early recognition and alleviation of pain are paramount inthese patients. Failure to assess, document, implement pain guidelines leads to poor painmanagement and dissatisfaction.

Objective

Aimed to describe the severity of pain, adherence to Royal College of Emergency Medicine(RCEM) pain guideline, and satisfaction regarding pain management among patients admittedto A&E at district General Hospital (DGH) Kalutara.

Method

An observational cross-sectional study with convenience sampling and bed head ticketreview among A&E patients for 1 week period.

Results

52 patients were recruited. Mean age was 48.8 years (SD ±14.5). Majority were males (69.2%)and presented with chest pain (38.5%). 27(51.9%) and 24 (46.1%) reported having moderateand severe pain, respectively. 42(80.7%) reported reduction in pain while 10(19.2%) reportedstatic pain on discharge from A&E. 20(83%) with severe pain were treated with IV opioids, but11(40.7%) patients with moderate pain were not prescribed any analgesic. A&E staff respondedto pain in 35(67.3%). Among this group, only 11(21.2%) patients were attended within 20minutes of arrival. In the majority (90.4%) pain was not reassessed. None of the patients wereassessed by a pain scale. Majority of the patients’ (90.4%) pain was not documented in theBHT. 22 (42.3%) patients were satisfied regarding the quality of pain relief and 30(57.7%) wereunsatisfied.

Conclusion

Pain management was not practiced according to guidelines, and the majority wereunsatisfied regarding pain management. There is an urgent need to implement painmanagement guidelines in A&E in Sri Lanka.

28


TREATMENT ADHERENCE BEHAVIORS AND THEIR DETERMINANTS AMONG PATIENTSRECEIVING HAEMODIALYSIS IN KURUNEGALA TEACHING HOSPITAL, SRI LANKA.

Lasanthika TLC1, Wanigasuriya JKP2, Hettiaratchi UPK3, Amarasekara AATD1, GoonewardenaCSE4

1Department of Nursing and Midwifery, Faculty of Allied Health Sciences, University of SriJayewardenepura, Sri Lanka, 2Center for Kidney Research, Faculty of Medical Sciences,University of Sri Jayewardenepura, Sri Lanka, 3Department of Biochemistry, Faculty of MedicalSciences, University of Sri Jayewardenepura, Sri Lanka, 4Department of Community Medicine,Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka


Adherence to haemodialysis attendance, medications, diet and fluid restrictions are the pillarsof successful haemodialysis treatment. Non-adherence remains a major obstacle in deliveringeffective treatment. The aim of this study was to assess selected treatment adherencebehaviors and their determinants among patients receiving haemodialysis.

Method

This was a descriptive cross-sectional study involving a convenience sample of 150 patientsundergoing haemodialysis at Teaching Hospital, Kurunegala. Validated End Stage RenalDisease- Adherence Questionnaire was used to obtain self-reported adherence tohaemodialysis therapy. Data analysis was performed using IBM SPSS version 25.0 software.Ethical approval was obtained from the relevant authorities.

Results

Majority of participants were males (72.7%). Mean age was 54.08±10.78 years. Self reportedadherence to haemodialysis attendance, medications, diet and fluid restrictions were 96.0%,96.7%, 71.3% and 32.7% respectively. Perceived adherence to prescribed medications (98.0%)was higher compared to diet (92.0%), haemodialysis attendance (94.0%) and fluid restrictions(92.0%). Overall, 81 (54.0%) patients had good adherence while 134 (89.3%) patients had goodperception towards the adherence to haemodialysis therapy. There was significant correlationbetween overall adherence and overall perception score (p<0.05). Patients who wereemployed, having good income and able to afford monthly expenditure for treatments hadsignificantly good adherence while forgetfulness was associated with a significantly low levelof adherence (p<0.05). Good adherence to fluid restrictions was significantly associated withadequate communication (r=0.241; p=0.003 <0.01) and offering clarifications (r=0.190; p=0.02<0.05) by health care professionals. Good adherence to diet was significantly associated withthe advice offered by a medical professional (r=0.188; p=0.021 < 0.05).

Conclusions

Periodic counselling by health care professionals improves the adherence among patientsreceiving haemodialysis and measures should be implemented to overcome financialconstraints and forgetfulness to follow treatments.

29


PROPORTION AND ASSOCIATED FACTORS OF INSOMNIA DURING PREGNANCY

Kumarasinghe KWKN1, Karunasekara NPTS1, Jayawickrama UCV1, Jayashani GS1, JayathilakaLGRLK1, Senaratna BCV2, 3

1Faculty of Medical Sciences, University of Sri Jayewardenepura, 2Non-CommunicableDiseases Research Centre, University of Sri Jayewardenepura, 3Department of CommunityMedicine, Faculty of Medical Sciences, University of Sri Jayewardenepura.


Insomnia in pregnancy is associated with adverse health outcomes but its prevalence in SriLankan pregnant women is unknown. We aimed to determine this and its associated factorsduring pregnancy.

Methods

A descriptive cross-sectional study was conducted using an online, self-administeredquestionnaire in Sinhala and English languages, distributed among pregnancy groups onFacebook such as 'Pregnant Mothers’ and 'Pregnancy Support Sri Lanka’. Insomnia wasassessed using Insomnia Severity Index (ISI). Some factors associated with insomnia weredetermined using questions adapted from Penn State Worry questionnaire, Stanford SleepQuestionnaire and Pittsburgh Sleep Quality Index. Statistical significance of the associationbetween insomnia and some selected factors were checked using a chi-squared test.Results

Among 404 respondents, 8.3%, 46.2% and 45.5% had insomnia in the first, second and thirdtrimesters, respectively. The overall proportion of insomnia was 32.7%, while severe,moderate and subthreshold insomnia were 0.5%, 9.1% and 37.4%, respectively. Insomnia wasassociated with age>30 years (p=0.017), obesity at booking visit (p=0.019), gestationaltrimester (p=0.002), low habitual sleep efficiency (p=0.001), irregular sleep routine (p=0.001),back pain (p=0.048), nocturnal dyspnoea (p=0.002), gastritis (p=0.007), GORD symptoms(p=0.001), higher level of worry (p=0.001), foetal-related nocturnal awakenings (p=0.001) andCOVID-19 related limitations (p=0.039). None of the women used natural remedies forinsomnia but 31.8% practiced listening to classical music, 63.6% religious activities and 14.4%meditation to relieve it.

Conclusion

Insomnia during pregnancy was high and associated with several comorbidities. Furtherresearch is needed to assess benefits of routine screening for insomnia during pregnancy.

30


KNOWLEDGE, ATTITUDES AND PRACTICES REGARDING INSECT STINGS AMONGADVANCED LEVEL STUDENTS IN CENTRAL PROVINCE

Lambhotharan Y1, Kariyawasam NK1, Premathilake WNK1, Warnakulasuriya NS1, WeerakkodiSP1, Malavige GN2, Alagiyawanna D3

1Medical undergraduate, Faculty of Medical Sciences, University of Sri Jayewardenepura,2Professor in Immunology and Molecular Medicine, Faculty of Medical Sciences, University ofSri Jayewardenepura, 3Lecturer, Department of Community Medicine, Faculty of MedicalSciences, University of Sri Jayewardenepura


Insect sting injuries range from localized swelling to anaphylaxis. Proper identification of theseinsects can prevent unnecessary encounters with them and proper practices when stung canmake the difference between life or death. Insect sting is commonly encountered in theCentral Province of Sri Lanka. A/L students represent a high-risk group and are feasible tostudy. Therefore, this study was aimed to assess knowledge, attitude and practices regardinginsect sting among Advanced Level students in Central province, which would help inidentifying areas that need interventions.

Methods

A descriptive cross sectional study was performed by surveying the population using a textualand picture based online self-administered questionnaire. As random sampling was notfeasible with the pandemic situation, a snowball sampling method was used. Data analysiswas conducted using IBM SPSS STATISTICS 26 software.

Results

A total of 288 participants completed the questionnaire. The mean knowledge score was19.95 out of 32 and 56.6% had good knowledge. The mean attitude score was 4.92 out of 8and 56.9% had a good attitude. The mean practices score was 8.45 out of 14 and 49.7% hadgood practices. Technology, physical science and biological science streams were associatedwith good knowledge. Sinhalese, Sri Lankan Tamils and Muslim ethnicities were associatedwith positive attitudes. Significant associations were found between A/L subject stream andknowledge (p = 0.024), and ethnicity and attitude (p = 0.049).

Conclusions

Although a majority of the participants had good knowledge they lacked awareness in areassuch as identification of insects and insect sting prevention methods. Moreover, a majority ofthe participants had poor practices. Thus, interventions to improve the knowledge andpractices would be recommended.

31


KNOWLEDGE, ATTITUDE AND PRACTICES ON COVID-19 AMONG THE HEALTH CAREWORKERS AT A TERTIARY CARE INSTITUTE IN SRI LANKA

Manilgama SR1, Jayasinghe IK1, Hettiarachchi NM2, Nandasena S3, Rathnayake RMSK1, HanifaMHMH1, Dasanayake DMDMB1, Abeywickrama U4

1National Hospital Kandy, 2Teaching Hospital Peradeniya, 3Office of Regional Director ofHealth Services, Kalutara, 4Faculty of Medicine, University of Kelaniya

Introduction

The healthcare workers (HCWs) play a major role in the struggle against COVID-19 pandemic.They were not used to managing a pandemic of this proportion in the recent past. A soundknowledge (K), good attitudes (A) and practices (P) on preventive measures are needed tosuccessfully combat COVID-19 pandemic.

Objectives

A cross sectional study was conducted to assess the KAP on COVID-19 among HCWs in theNational Hospital Kandy.

Methods

A questionnaire with four components (i.e., sociodemographic data, knowledge, attitudes andpractices) related to COVID-19 was administered among HCWs. The number of HCWsrecruited represented the proportion of their categories. Scores of KAP were categorized tomedian-or-above (“better”) and less-than-median.

Results

Among the participants (n=382) HCWs 264(70%) were females and 199(52.1%) were more than40 years old. The majority (80.4%) had education up to advanced level or higher. The studypopulation consisted of nursing officers(33.5%), doctors(13.9%), health care assistants(27.7%).HCWs having education higher than A/L had “better” knowledge (80.7%,P< 0.001) and “better”practices (76.4%,P=0.001) than A/L or less. Doctors, nurses and other categories showed“better” knowledge in 91.8%, 84.3% and 38.8%; “better” attitudes in 67.3%, 55.4% and 53.1%; “better” practices in 89.8%, 74.4% and 59.9%; respectively. More than 15 years of workexperience showed “Better” knowledge(73.1%) attitude(66.2%) and practices(77.2%). Higherthe work experience better the knowledge and practices.KAP was not significant in relation toage of HCWs or work setting.

Conclusion

Significant differences in knowledge and practices were observed in relation to HCWscategory, years of work experience and education level.

32


MANAGEMENT OF PATIENTS WITH SEVERE COVID PNEUMONIA IN HIGH DEPENDENCYUNITS IN A TERTIARY CARE HOSPITAL IN SRI LANKA: A CLINICAL AUDIT

Vidanapathirana MN1, Minuvanpitiya GN1, Karunaratne DR1, Angammana HMCU1, DissanayakeU1

1National Hospital of Sri Lanka


The covid-19 pandemic surged in Sri Lanka from April 2021 with rising case numbers andmortality rates. The objective of this study was to assess the management of severe covidpneumonia in high dependency units (HDU) in a tertiary care centre in comparison with thelocally published guidelines.

Methods

Patients with severe covid pneumonia admitted to covid-HDUs of National Hospital of SriLanka since their inception in May 2021 were included in the study (n=60). Data on admissioncriteria warranting HDU care (vital parameters, saturation and findings on arterial blood gasand imaging), use of antibiotics and dosing of steroids and anticoagulants were extractedthrough patient records and compared with the local guideline.

Results

The mean age of patients requiring HDU care was 56.8 years (M-70%). Admission criteria forHDU care were documented in 81.7% (n=49) of case records. Antibiotics were started on 91.6%(n=55) of patients on admission and of these, antibiotic escalation ensued in 15% (n=9). Allpatients received the recommended dose of steroids, with 73.3% (n=44) later receiving higherthan recommended doses and 26.6% (n=16) receiving steroid pulses. Prophylactic dose ofanticoagulation was prescribed to all patients without contraindications. Of these, 41.6%(n=25) received anticoagulants above the prophylactic dose, without radiological evidence ofthrombosis. Clinical justification for non-conformation with guidelines was documented in allinstances.

Conclusion

Deviation from local guidelines was seen with regard to the use of antibiotics and dosing ofanticoagulants and steroids, with satisfactory documentation of clinical reasoning.

33


EFFICACY AND SAFETY OF TOPICAL PHENYTOIN OINTMENT FOR VENOUS LEGULCERS: A RANDOMIZED DOUBLE BLIND PLACEBO CONTROLLED TRIAL – INTERIMANALYSIS

Rameshkumar T1, Abhayaratne SA1, Kumaradasa PP1, Gunawardane DGMM1, Cassim R2,Mudalinayaka K1, Pathirana W1, Wijeyaratne SM2, Galappatthy P1

1Department of Pharmacology, Faculty of Medicine, University of Colombo, 2Department ofSurgery, Faculty of Medicine, University of Colombo


Compression therapy and leg elevation is the standard treatment for venous ulcers. Thisstudy assessed the efficacy and safety of topical phenytoin sodium ointment 10% w/w onhealing of venous ulcers.

Methods

A randomized double-blind placebo controlled parallel group trial was carried out at theUniversity vascular surgical clinic of National Hospital of Sri Lanka from 2016 to 2019. Topicalphenytoin ointment or placebo ointment was applied to venous ulcers weekly withcompression therapy for 12 weeks. Serial photographs were taken to assess wound healing(primary outcome) and wound surface area and analysed using ImageJ software. Pain scoreswere assessed using a 10-point visual analogue scale. Interim analysis was performed.

Results

Out of 87 patients who completed the trial, 61(70%) were males, mean age 59.4±12.3 years,and 43 were in phenytoin group. Mean ulcer duration was 50.6±144.9 weeks, mean ulcer sizewas 9.4±8.6 cm2 and 19(22%) had type 2 diabetes. Baseline characteristics were equallydistributed. Patients who had ulcers healed by 12 weeks in phenytoin and placebo groupsrespectively were 21(49%) and 15(34%), p=0.16 Secondary outcomes of mean percentagechange in wound surface area at 4, 8 and 12 weeks (-35% vs -23%, -52% vs -24%, -54% vs-34% respectively with phenytoin and placebo) and pain scores and adverse events were notsignificantly different.

Conclusions

Use of topical phenytoin on venous ulcers showed a tendency to heal with reduction of ulcersize but results were not statistically significant. Completion of trial with increased sample sizeis needed.

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PRESCRIPTION OF STATINS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: AN AUDITAT TWO TERTIARY CARE CLINICS

Matthias AT1, Kaushalya PDJ1, Somathilake G 2, Garusinghe C3

1Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura,2University of Sri Jayewardenepura, 3Colombo South Teaching Hospital, Sri Lanka.


Patients with type two diabetes mellitus have high morbidity and mortality due tocardiovascular disease(CVD). The ACC/AHA 2019 guideline recommends all patients withtype 2 diabetes between 40-75 years to be prescribed at least a moderate intensity statin. Weaimed to audit the prescription of statins among type 2 diabetes patients (T2DM).

Method

A cross sectional prospective study was conducted from February- April 2021 among patientswith Type 2 Diabetes Mellitus between 40-75 years attending the University Medical Clinicand Endocrine Clinic at Colombo South Teaching Hospital, Sri Lanka. All patients attendingthe clinic during the three months were recruited.

Results

471 patients were enrolled with a mean age of 59.05(±9.139) years. The mean diabetesduration was 10.97(±9.57) years. 441(93.6%) patients were on statin and 30(6.4%) patientswere not on statin therapy. The patients who were not on statins were not prescribed. Out of163(34.61%) patients who required high intensity statin, only 3(1.73%) were on high intensitystatin. Rest was on moderate (152, 93.25%), low (4, 2.45%) intensity and 4(2.45%) were not onstatins. All patients (60,12.74%) with prior history of atherosclerotic cardiovascular disease(ASCVD) were on statin. However, the ASCVD risk didn’t have a statistically significantrelationship with statin prescription. (p= 0.119). Among patients with a history of ASCVD andhigh-risk category (155, 32.91%), only 17(10.97%) have achieved optimal LDL therapeutictargets (55 mg/dL).

Conclusions

Prescription of statins among patients with T2DM is satisfactory and in keeping withguidelines. The majority of ASCVD patients are on suboptimal doses of statin and haven’tachieved therapeutic LDL-C targets. Prescribers need to ascertain that the lipid targets areachieved in high-risk patients.

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THROMBOLYSIS IN ACUTE ISCHEMIC STROKE: A RETROSPECTIVE DESCRIPTIVE STUDYAT TEACHING HOSPITAL, PERADENIYA

Pathirage LPMMK1, Kularathne SAM1, Dissanayake DMMH2, Balasooriya BMDS1

1Department of Medicine, Faculty of Medicine, University of Peradeniya, 2Department ofPhysiotherapy, Faculty of Allied Health Science, University of Peradeniya


Intravenous thrombolysis with recombinant tissue plasminogen activator improves functionaloutcome in ischemic stroke patients. This study analyzes the effectiveness and importance ofthrombolysis in acute ischemic stroke patients.

Methods

This study was carried out at professorial medical wards Teaching hospital Peradeniya. Datawas extracted from ‘Peradeniya Stroke Registry’ from 1st of January 2017 to 30th of September2020 and analyzed using SPSS 20 statistical software.

Results

Out of 619 ischemic stroke patients, 77 (34 males and 43 females) patients who presentedwithin 4.5 hours since onset were treated with thrombolysis and among them 75 weredischarged and two deaths were reported. Barthel Index Score and National Institutes ofHealth Stroke Scale were used to measure the outcome of the patient. The mean differenceof pre- and post- measures of BIS and NIHSS in thrombolytic patients were 32.8 (SD 25.2) and4.4 (SD 7.5) and in non-thrombolytic patients were 14.9 (SD 28.6) and 1.3 (SD 5.7) respectively.There was a statistically significant difference in pre- and post- measures in both thrombolyticand non-thrombolytic groups (CI, 95%, p<0.05). The outcome in BIS and NIHSS werecomparatively higher in the thrombolytic group which was by 2.2 and 3.3 foldscorrespondingly. Highest BIS and NIHSS mean differences were recorded where thethrombolysis was given between 3.3 hours to 4.3 hours from the onset.

Conclusion

Thrombolysis is a high impact treatment method for acute ischemic stroke, and it is highlyrecommended to increase its practice in Sri Lankan hospital setup for significant functionaloutcomes.

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CLINICAL, IMMUNOLOGICAL AND MOLECULAR ASSESSMENT OF SARS-COV-2 IN AMILITARY GROUP DURING THE FIRST WAVE OF COVID-19

Govindapala DS1, Nakkawita WMID2, Jayasinghearachchi HS3, Premaratne PH2, GoonasekaraCL2, Jayasinghe J4, Karunaratne M5, Kawyangana DGP2, Chathuranga KWT3, Kulasekara US3,De Silva AD2,3

1Department of Clinical Sciences, Faculty of Medicine, General Sir John Kotelawala DefenceUniversity, 2Department of Para-Clinical Sciences, Faculty of Medicine, General Sir JohnKotelawala Defence University, 3Biomedical Laboratory 2, Faculty of Medicine, General SirJohn Kotelawala Defence University, 4Colombo East Base Hospital, Mullariyawa, 5NationalInstitute of Infectious Diseases, Angoda


The dynamic profile of viral shedding and antibody responses among COVID-19 patients is yetto be fully understood. This study aims to describe clinical characteristics, dynamics of viralshedding and antibody responses in a military group during the first wave of COVID-19.

Methods

The first 26 from a cluster of 936 SARS-CoV-2 positive Navy personnel were enrolled.Sequential nasopharyngeal swabs and blood samples were collected at various time pointsup to nine months. A commercial ELISA kit (Dia Pro, Italy) was used to detect SARS-CoV-2specific antibodies. SARS-CoV-2 RNA samples from 10 participants were subjected to nextgeneration sequencing using the Ion-Torrent platform and genome analysis was performedusing the Phylogenetic assignment of named global outbreak lineages (PANGOLIN).

Results

The median age was 31.5 years (range 23-44 years). Seven (26.92%) were symptomatic at thetime of diagnosis, two (7.69%) had symptoms prior and 12(46.15%) became symptomatic afterthe diagnosis. Five remained asymptomatic. Fever was the commonest (59.69%) symptom.Serological transformation observed in 8(30.7%), 16(61.53%) and 21(80.76%) participants by day7, 14 and 21 respectively. The peak positivity rate of IgM (n=14,53.84%) was one week earlierthan that of IgG. The positive rates of IgG increased with the disease course, peaked in thethird week (n=21,80.76%) and were detectable up to 9 months. Five participants had noantibody response. Majority of antibody positive participants had fever and high viral loads. Byday 21, all were negative for SARS-CoV-2 RNA. Genome sequencing revealed strainsbelonged to B.1.3 and B.1 lineages.

Conclusions

Potent and persistent antibody response was observed in pre-symptomatic patients with highviral loads.

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A STUDY ON ASSOCIATION OF CHARACTERISTICS OF CHEST PAIN AND THEDIAGNOSIS AMONG OLDER ADULTS PRESENTING TO COLOMBO SOUTH TEACHINGHOSPITAL

Silva FHDS1, Misthaq ARM2, Indrakumar J1

1Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura,2Colombo South Teaching Hospital


Chest pain as a symptom has varied characteristics leading to varied differential diagnosis. Itcan be primarily categorised as typical, atypical and non-cardiac in nature. Acute coronarysyndrome (ACS) is one of the medical emergencies which require careful assessment ofsymptomatology along with investigations. Atypical presentations of ACS are also observed.This study aims to determine the characteristics of chest pain with regards to the significanceof the symptomatology.

Method

A cross sectional descriptive study was conducted at the University Medical Unit of ColomboSouth Teaching Hospital from the 1st January to 30th May 2021. All consenting patientspresenting with acute chest pain, above 60 years of age were recruited. Data was collectedwith a validated interviewer administered questionnaire in all three languages.

Results

One hundred eleven participants were recruited in the study with ages ranging 60 - 92 years(56.8% males). Thirty one patients (27.9%) had typical chest pain while 47 (42.3%) and 33(29.7%) had atypical and non-cardiac type pain. There was no significant association betweenpatients’ age and type of chest pain (p=0.385) and the patients’ age and diagnosis of chestpain (p=0.120). However there was a significant association between the type of chest painand diagnosis (p<0.05). These were observed between ACS and gastro-oesophageal refluxdisease (GORD), ACS and musculoskeletal pain (MSKP), angina and GORD, and panic attacksand MSKP.

Conclusion

This study affirms careful evaluation of symptomatology as clinical reasoning is important todiagnose and differentiate between life threatening conditions such as ACS.

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SPONTANEOUS INTRACEREBRAL HAEMORRHAGES FROM A SRI LANKAN TERTIARYCARE CENTRE: 5-YEAR DATA

Dep WDC1, Deelaka AGS1, Somaratne KGSK2, Meegahapola H2, Premadasa HMSD2,Kurukulasuriya SAF1, Mettananda KCD1, Ranawaka UK1

1Faculty of Medicine, University of Kelaniya, 2Colombo North Teaching Hospital, Ragama


Epidemiological data on spontaneous intracerebral haemorrhage (sICH) is limited from SouthAsia. We sought to describe epidemiology of sICH in a Sri Lankan cohort.

Methods

We studied all patients with stroke admitted to the Stroke Unit, Colombo North TeachingHospital over five years. Data from sICH patients regarding treatment seeking delays, clinicalcharacteristics, risk factors, stroke severity and functional outcome were compared withischaemic stroke (IS) patients.

Results

984 patients (mean age 58.7 years; 62.1% males) were studied: sICH 15.0% (147 patients), IS85.0%. sICH patients: mean age 58.0 years; 67.3% males. sICH patients presented to hospitalearlier (<3h sICH 70.6%, IS 37.2%, p<0.001) and had more severe strokes (NIHSS>15) (sICH21.3%, IS 12.2%; p<0.001). Hypertension was commoner in sICH group (sICH 72.6%, IS 63.5%;p=0.034), whereas diabetes (sICH 39.0%, IS 51.6%; p=0.005) and smoking (sICH 16.6%, IS25.5%; p=0.021) were less common. Altered consciousness (sICH 30.3%, IS 18.3%; p=0.001),dysphagia (sICH 55.9%, IS 34.4%; p<0.001), bladder involvement (sICH 56.6%, IS 28.7%;p<0.001), and seizures (sICH 4.1%, IS 1.5%; p=0.029) were commoner among sICH patients.sICH patients had more severe disability on discharge (Barthel index 0-60: sICH 71.1%, IS45.2%; p<0.001; modified Rankin scale (mRS) 3-6: sICH 76.7%, IS 52.1%; p<0.001). sICH location(lobar vs. deep) and presence of intraventricular haemorrhage was not associated with strokeseverity. Lobar ICHs had more severe disability on discharge (Barthel index <60: p=0.037;mRS≥3: p=0.020).

On logistic regression, sICH was independently associated with early presentation to hospital(OR 1.79; p=0.039), and severe disability on discharge (Barthel index <60: OR 2.42, p=0.028;mRS≥3: OR 2.70, p=0.012).

Conclusions

sICH patients sought medical attention early and had different clinical profiles, more severestrokes and more severe disabilities.

39


IMPACT OF COVID-19 ON STROKE ADMISSIONS IN A SRI LANKAN TERTIARY CAREHOSPITAL: DATA FROM THE RAGAMA STROKE REGISTRY

Deelaka AGS1, Dep WDC1, Nanayakkara YP2, Chandrasiri HMJ2, Mettananda KCD1,Pathmeswaran A1, Ranawaka UK1,2

1Faculty of Medicine, University of Kelaniya, 2Colombo North Teaching Hospital, Ragama


The coronavirus disease 2019 (COVID-19) pandemic has had a tremendous impact on strokecare globally. We investigated the impact of the pandemic on stroke admissions in a SriLankan tertiary care hospital.

Methods

We studied the number of admissions to the Stroke Unit and the University Medical Unit,Colombo North Teaching Hospital (CNTH) over four years, and delays in seeking medical careof patients admitted to the Stroke Unit. We compared data during a calendar year of COVIDpandemic (01.04.2020 – 31.03.2021) with the preceding 3 pre-COVID years (01.04.2017 –31.03.2020). Data regarding COVID year was compared with pre-COVID years usingindependent-samples t-test and nonparametric test.

Results

Mean number of stroke admissions per month during the pandemic was significantly lowercompared to that of pre-COVID years: Stroke Unit (monthly mean admissions, COVID year vspre-COVID years; 11 ± 3.5 vs 20 ± 3.1; p<0.01); University Medical Unit (12 ± .2 vs 18 ± 3.4;p<0.01). The lowest number of admissions was reported during the period with the highestCOVID caseload in Sri Lanka. However, there was no significant difference in the mediandelays to seeking medical care between the COVID pandemic and pre-COVID years: delay tofirst medical contact: 2.0 h vs 2.4 h, p=0.208; first hospital admission: 3.0 h vs 3.0 h; p=0.993,admission to CNTH: 3.4 h vs 5.0 h; p=0.174.

Conclusions

Stroke admissions were significantly lower during the COVID pandemic, but there was nodifference in the delays in seeking medical care during the same period.

40


TRIGGER FACTORS AND ASSOCIATED FACTORS OF PRIMARY HEADACHE AMONGADVANCED LEVEL STUDENTS IN THE WESTERN PROVINCE

Doluweera DT1, Nanthakumar B1, Adhikari S1, Vinoja O1, Weerasinghe D1, Adikaram S1,Jayakody S1

1Faculty of Medical Sciences, University of Sri Jayewardenepura


Primary headaches are one of the most common neurological disorders worldwide. However,numerous variations in the presentation, trigger factors, and therefore management exist indifferent geographical regions and demographics. This study aimed to determine theproportion of primary headache, its trigger factors, and associated factors among AdvancedLevel (A/L) students in the Western Province, Sri Lanka.

Methods

A descriptive cross-sectional study including 441 students from the Western Provincefollowing the local Advanced Level curriculum were selected using non-probabilityconvenient sampling. A pretested self-administered questionnaire was administered viaonline platforms. Chi-square tests, Fisher’s exact tests and independent t-tests were used,taking a p-value of <0.05 to be significant.

Results

The proportion of primary headaches among the A/L students was 75.9%. Most of theparticipants were females (66.4%), and the mean age of the sample was 19 years (SD= 0.87;range= 16-23 years). Primary headaches were mostly triggered by stress (57.1%), prolongedscreen time (52%), lack of sleep (46.8%) and studying (46%). The female gender (p=0.011) andthe bioscience stream (p=0.032) had a significant association with primary headaches.Conversely, the BMI, financial status and the number of attempts had no association (p>0.05).

Conclusions

A high proportion of A/L students in the Western Province are suffering from primaryheadaches. Female students and those pursuing the biology stream were affected more.Stress, prolonged screen time, lack of sleep and studying were the most common triggers.

41


PREVALENCE OF COVISHIELD COVID-19 VACCINE (CHADOX1 NCOV-19) ADVERSEEFFECTS AMONG HEALTH CARE WORKERS IN SRI LANKA

Manilgama SR1, Hettiarachchi NM2, Jayasinghe IK3, De Silva S4, Jayalath T5, Wanigaratne T6,Bandusiri RP7, Suganthan N8, Sudarshan P9, Pathirage M5, Rajaratnam N10, Senaratne G11,Rajapaksha V3, Wickramasinghe A1, Kulaweera MTD12

1Colombo North Teaching Hospital, Ragama, 2Teaching Hospital Peradeniya, 3NationalHospital Kandy, 4Faculty of Medicine, University of Kelaniya, 5Faculty of Medicine, University ofPeradeniya, 6District General Hospital, Matale, 7Teaching Hospital Ratnapura, 8Faculty ofMedicine, University of Jaffna, 9District General Hospital, Polonnaruwa, 10Teaching HospitalJaffna, 11Teaching Hospital Karapitiya, 12High School Advanced Mathematics, Gampaha

Introduction

A Community vaccination programme is the best approach to combat COVID-19 pandemic.The priority was given to the health care workers (HCWs) with the introduction of Covishieldvaccine to Sri Lanka. An independent post-vaccine surveillance is important to identifyadverse effects(A/E) in the population.

Objectives & Methodology

A multicentred cross-sectional survey was conducted in four provinces to estimate theprevalence of A/E after covishield vaccination among HCWs after the first dose. Aself-administered questionnaire was used to gather demographic data and A/E.

Results

Of 4834 participants, 72.4% were females. The median age was 42.23(SD±9.64) years. 87.4%of persons had at least one A/E and 53.1% had local A/E. Body aches (68.2%), headaches(63.8%), fever (58%), chills (51.4%), fatigue (41.2%) and arthralgia (38.1%) were the mostreported systemic A/E. Their duration was mainly 24 hours. Pain and redness at the site werethe most commonly reported local A/E. Mean duration of onset of fever and pain at the sitewas 9.76 and 4.47 hours respectively. Most of the systemic and local A/E were significantlyhigher among the ≤42-year-old group and females. 61 had reactions within the first 20minutes. 4 developed anaphylaxis, 31 had urticaria. 15.4% had at least one comorbidity. 1.3%had a history of drug or food allergies, they didn’t show significant relation to currentvaccine-induced allergies or anaphylaxis. 69.2% attended the routine work despite havingminor A/E. 7 were hospitalised and treated.

Conclusion

Though more than 60% reported minor A/E, there were only a few serious A/E. Overall, thefirst dose of the Covishield vaccine was well-tolerated by HCWs.

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DO THE HEALTH-RELATED QUALITY OF LIFE (HRQOL) PARAMETERS INDICATE THEFACTUAL HEALTH INDICES? A CROSS-SECTIONAL SURVEY AMONG APPARENTLYHEALTHY ADULTS IN WESTERN PROVINCE SRI LANKA

Kaushalya CMAU1, Munasinghe TD1, Fernando DR2, Gunaratne PS2, Chandrasiri KSS2,Wijewickrama E2, Wickramsinghe P3, Katulanda P2

1Diabetes Research Unit, Department of Clinical Medicine, Faculty of Medicine, University ofColombo, 2Department of Clinical Medicine, Faculty of Medicine, University of Colombo,3Department of Paediatrics, Faculty of Medicine, University of Colombo


Absence of disease may give a higher perception of being well. We aimed to evaluate theeffect of common indices of non-communicable diseases (NCDs) with HRQOL.

Methodology

Preliminary data from Sri Lanka Non-Communicable Diseases Survey (SLNCDS) in WesternProvince were used for this study. The participants not reporting NCDs (n=639) were included.Three parameters of HRQOL were assessed using the RAND-36 questionnaire: general health(GH), physical functioning (PF) and role limitations due to physical health (RL). Mean scores ofthese three parameters of HRQOL were compared between normal and abnormal groups ofhealth indices (blood pressure, waist circumference (WC), lipids, body mass index, HbA1C,estimated glomerular filtration rate (eGFR), urine albumin to creatinine ratio (UACR)). Aseparate analysis compared the means of health indices between high and low categories ofHRQOL parameters. Statistical analyses were performed using t-Test.

Results

Statistically significant differences of GH were detected between normal and abnormalgroups of WC (65.38 vs 61.42, p=0.006) and eGFR (64.05 vs 60.78, p=0.033) respectively.Physical functioning was significantly different between normal and abnormal groups of eGFR(90.17 vs 86.14, p=0.022). No significant differences were observed between other healthindices and HRQOL. In the alternative analysis, HbA1C (5.59 vs 5.79, p=0.018), high densitylipoprotein (HDL) (48.57 vs 51.33, p=0.025) and eGFR (108.16 vs 97.46, p<0.001) revealeddifferences between high and low (across median) levels of PF and UACR (9.34 vs 16.88,p=0.004) in RL.

Conclusion

Significant differences in GH and PF parameters were seen between normal and abnormalgroups of WC and eGFR.

43


PSYCHOLOGICAL DISTRESS AND FACTORS ASSOCIATED WITH PSYCHOLOGICALDISTRESS AMONG PREVENTIVE HEALTH CARE WORKERS INVOLVED IN COVID-19PREVENTION WORK IN SELECTED DISTRICTS OF SRI LANKA.

Dissanayake DMSY1, Rathnayaka RMSM1, Perera KR1, Gamage DHP1, Fernando WARS1, NazeerI1, Palihawadana V1

1Faculty of Medical Sciences, University of Sri Jayewardenepura


The COVID-19 pandemic has gravely affected the mental health of preventive healthcareworkers (HCW) in Sri Lanka. The study aimed to describe psychological distress, itsassociated factors and coping mechanisms among preventive HCW involved in COVID-19prevention in Sri Lanka.

Methods

A descriptive cross-sectional study was conducted among 158 preventive HCW [MedicalOfficers of Health (MOH), Assistant MOH, Public Health Inspector (PHI) and Supervising PHI] atMOH offices in Colombo, Gampaha, Kalutara, Matara and Badulla districts from November2020 to March 2021. Data collection utilized convenience sampling. Psychological distresslevel was determined by Kessler’s Psychological Distress Scale 10.

Results

Among the respondents 57.6% were psychologically distressed. The significant associationswere, age above 40 years (p=0.019), having pregnant women at home (p=0.032), workexperience less than 15 years (p = 0.007), unavailability of sufficient PPE (p=0.024), stressfulwork environment (p=0.013), dissatisfaction on control and prevention strategies (p = 0.029).Distress between PHIs (Mean= 22.0) and Medical Officers (Mean= 21.2) was not significant(t=0.580, p=0.563). The commonest coping mechanism of distress was maintaining a positiveattitude (77.7%). Negative coping mechanisms included resorting to alcohol (8.2%), smoking(5.1%) and drugs (0.6%).

Conclusions

Over half of the participants were psychologically distressed. Participant’s age, presence ofchildren and pregnant women at home, work experience, unavailability of sufficient PPE,dissatisfaction on current prevention and control strategies and stress at workstation werereported to have a significant association with psychological stress. Commonest positivecoping strategy of stress was maintaining a positive attitude towards the pandemic.

44

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