Carukshi Arambepola

Quantification of Urbanization in Relation to Chronic Diseases in Developing Countries: A Systematic Review

During and beyond the twentieth century, urbanization has represented a major demographic shift particularly in the developed world. The rapid urbanization experienced in the developing world brings increased mortality from lifestyle diseases such as cancer and cardiovascular disease. We set out to understand how urbanization has been measured in studies which examined chronic disease as an outcome. Following a pilot search of PUBMED, a full search strategy was developed to identify papers reporting the effect of urbanization in relation to chronic disease in the developing world. Full searches were conducted in MEDLINE, EMBASE, CINAHL, and GLOBAL HEALTH. Of the 868 titles identified in the initial search, nine studies met the final inclusion criteria. Five of these studies used demographic measures (such as population density) at an area level to measure urbanization. Four studies used more complicated summary measures of individual and area level data (such as distance from a city, occupation, home and land ownership) to define urbanization. The papers reviewed were limited by using simple area level summary measures (e.g., urban rural dichotomy) or having to rely on preexisting data at the individual level. Further work is needed to develop a measure of urbanization that treats urbanization as a process and which is sensitive enough to track changes in “urbanicity” and subsequent emergence of chronic disease risk factors and mortality.

Syndromic approach to treatment of snake bite in Sri Lanka based on results of a prospective national hospital-based survey of patients envenomed by identified snakes.

Of 860 snakes brought to 10 hospitals in Sri Lanka with the patients they had bitten, 762 (89%) were venomous. Russells vipers (Daboia russelii) and hump-nosed pit vipers (Hypnale hypnale) were the most numerous and H. hypnale was the most widely distributed. Fifty-one (6%) were misidentified by hospital staff, causing inappropriate antivenom treatment of 13 patients. Distinctive clinical syndromes were identified to aid species diagnosis in most cases of snake bite in Sri Lanka where the biting species is unknown. Diagnostic sensitivities and specificities of these syndromes for envenoming were 78% and 96% by Naja naja, 66% and 100% by Bungarus caeruleus, 14% and 100% by Daboia russelii, and 10% and 97% by Hypnale hypnale, respectively. Although only polyspecific antivenoms are used in Sri Lanka, species diagnosis remains important to anticipate life-threatening complications such as local necrosis, hemorrhage and renal and respiratory failure and to identify likely victims of envenoming by H. hypnale who will not benefit from existing antivenoms. The technique of hospital-based collection, labeling and preservation of dead snakes brought by bitten patients is recommended for rapid assessment of a countrys medically-important herpetofauna.

Urban living and obesity: is it independent of its population and lifestyle characteristics?

Objectives  Living in an urban area influences obesity. However, little is known about whether this relationship is truly independent of, or merely mediated through, the demographic, socio‐economic and lifestyle characteristics of urban populations. We aimed to identify and quantify the magnitude of this relationship in a Sri Lankan population.

Measles outbreak in Sri Lanka, 1999-2000

A large measles outbreak occurred in Sri Lanka from October 1999 through June 2000 following a period of low incidence. During this period, >15,000 suspected cases were reported to the central Epidemiological Unit of the Department of Health Services. The outbreak was investigated through review of surveillance data for 1999-2000, which were compared with previous surveillance data. Among the clinically confirmed cases, the highest morbidity rate (114/100,000 population) was observed among children <9 months of age. Nearly 54% of the cases were among persons >/=15 years old, and this percentage had increased over the previous decade. Forty percent of cases had a history of measles vaccination. There were 5 deaths, giving a case-fatality rate of 0.1%. Action taken during the outbreak and plans for future outbreak prevention strategies were also evaluated.

The efficacy of moderate-to-high dose oral prednisolone versus low-to-moderate dose intramuscular corticotropin for improvement of hypsarrhythmia in West syndrome: a randomized, single-blind, parallel clinical trial.

BACKGROUND The role of therapy on improvement of hypsarrhythmia has not been systematically assessed. This study was performed to assess the efficacy of oral prednisolone and intramuscular adrenocorticotrophin hormone in improving hypsarrhythmia in West syndrome. METHOD Children (2 months-2 years), with previously untreated West syndrome, were randomized to receive 40-60 IU every other day of intramuscular adrenocorticotrophin hormone or 40-60 mg/day of oral prednisolone for 14 days. Children with tuberous sclerosis were excluded. Improvement of hypsarrhythmia was assessed blindly using a hypsarrhythmia severity scale before and after completion of therapy. Adverse effects were assessed on day 14 using symptom diary. (Clinical trial registry identifier: SLCTR/2010/010.) RESULTS From 92 newly diagnosed West syndrome infants, 48 were randomized to receive prednisolone and 44 to receive adrenocorticotrophin hormone. Eighty infants completed the posttreatment evaluation according to specifications. The hypsarrhythmia severity score, significantly improved with hormonal therapy for 2 weeks (10.45 ± 2.65 vs 3.45 ± 2.67); P < 0.01. When individual treatment arms were compared using mean differences in the improvement of scores, improvement in prednisolone arm (7.95 ± 2.76) was significantly greater than that in the adrenocorticotrophin hormone arm (6.00 ± 2.61); P < 0.01. Both forms of therapy were tolerated well. Frequent crying, irritability, weight gain, increased appetite, and abdominal distension were more common (but not statistically significant) with prednisolone. CONCLUSIONS Hypsarrhythmia severity score improved significantly with both hormonal therapies, but this improvement was significantly better with oral prednisolone than intramuscular adrenocorticotrophin hormone. This is the first ever documentation of a superior therapeutic role of oral steroids in West syndrome.

Randomized, Single-Blind, Parallel Clinical Trial on Efficacy of Oral Prednisolone Versus Intramuscular Corticotropin on Immediate and Continued Spasm Control in West Syndrome

OBJECTIVE A single-center, single-blind, parallel-group, randomized clinical trial was performed to test the null hypothesis that adrenocorticotropic hormone is not superior to high-dose prednisolone for treatment of newly diagnosed West syndrome. METHODS Newly diagnosed infants with West syndrome were randomized to receive 14 days of oral prednisolone (40-60 mg/day) or a synthetically prepared intramuscular long-acting adrenocorticotropic hormone (40-60 IU/every other day [0.5-0.75 mg]) according to the United Kingdom Infantile Spasm Study protocol. They were blindly evaluated for infantile spasm remission by day 14, electroclinical remission (spasm cessation + resolution of hypsarrhythmia on a 30-minute electroencephalograph) by day 14 and continued spasm freedom for 28 days. RESULTS Ninety-seven patients were enrolled in the study, with 48 of them receiving prednisolone and 49 receiving ACTH. There was no significant difference in the baseline characteristics or risk factors for the two treatment groups. By day 14, cessation of infantile spasms occurred in 28/48 (58.3%) infants on prednisolone compared with only 18/49 (36.7%) infants given adrenocorticotropic hormone (P = 0.03) and electroclinical remission in 21 on prednisolone compared with nine on adrenocorticotropic hormone (P = 0.007). Sustained spasm control for 28 consecutive days following electroclinical remission occurred in 15 children on prednisolone compared with six on adrenocorticotropic hormone (P = 0.008). The total number of days required for spasm cessation was significantly less in those treated with prednisolone (3.85 days ± 2.4) compared with adrenocorticotropic hormone (8.65 days ± 3.7) (P = 0.001). Among patients who did not achieve remission, there was a non-significant trend toward greater quantitative reduction of spasms with prednisolone than with adrenocorticotropic hormone (P = 0.079). CONCLUSION Synthetic adrenocorticotropic hormone of 40-60 IU/every other day did not yield superior rates of electroencephalographic or clinical remission when compared with prednisolone of 40-60 mg/day. Significantly, more patients achieved electroclinical remission when treated with prednisolone than with adrenocorticotropic hormone.

Prevalence of Stroke and Its Risk Factors in Urban Sri Lanka: Population-Based Study.

Background and Purpose— Stroke is a leading cause of disability and death worldwide. In the absence of published population-based prevalence data, we investigated the prevalence and risk factors of stroke in a population of varying urbanization in Sri Lanka. Methods— A population-based, cross-sectional study was conducted among 2313 adults aged ≥18 years residing in Colombo, selected using a multistage, probability proportionate-to-size, cluster sampling technique. Data were collected using an interviewer-administered questionnaire. Ever diagnosis of stroke was confirmed by medical doctors based on World Health Organization criteria and corroborated by documental evidence. Results— Of the total population (52.4% women; mean age, 44.2 years; SD, 16.6), the prevalence of stroke was 10.4 per 1000 (95% confidence interval, 6.3–14.5) with a 2:1 male:female ratio. Beyond the age of 65 years, the prevalence was higher by 6-fold among men and by 2-fold among women. Ninety two percent had developed hemiparesis, 58.3% had dysphasia, and 16.7% had loss of balance. Hypertension was the commonest risk factor (62.5%) followed by smoking (45.8%), excess alcohol (41.7%), diabetes mellitus (33.3%), and transient ischemic attack (29.2%); 79.2%, predominantly men, had ≥2 risk factors. A percentage of 58.3 had brain computed tomographic scans, of whom 85.7% had ischemic strokes. A percentage of 64.3 had to change or give up working because of stroke-related disability. Conclusions— Age-adjusted stroke prevalence in urban Sri Lanka lies between high-income and low-/middle-income countries. The prevalence of stroke and its risk factors were higher among men.

History, pelvic examination findings and mobility of ovaries as a sonographic marker to detect pelvic adhesions with fixed ovaries

To compare the performance of history and examination findings combined with transvaginal ultrasound (TVS) ‘soft marker’ evaluation of ovarian mobility for the prediction of fixed ovaries secondary to endometriosis at laparoscopy.

Portion size estimation aids for Asian foods.

BACKGROUND Portion size estimation is fundamental to the accuracy of dietary recall, as well as interventions in obesity. Data on portion size estimation aids (PSEA) for Asian foods are limited. PSEA for Asian foods were developed and their accuracy and precision were tested for inclusion in a food atlas. METHODS Sixteen food items were selected to represent all food groups. Small and life size photographs were developed, and line diagrams were drawn. These, together with household utensils, were tested among a random sample of 80 schoolchildren (aged 10-16 years). A total of 3180 estimations were made: 876 for small photographs (n = 11 foods), 558 for life size photographs (n = 7 foods), 1271 for line diagrams (n = 16 foods) and 475 for household utensils (n = 6 foods). RESULTS Line diagrams had a high percentage (63.9%) of correct estimations and a low percentage of over estimations (18.0%) and under estimations (18.1%), whereas household utensils performed poorly with 0.6% correct estimations. Greater accuracy and precision were obtained for amorphous foods with small photographs and for non-amorphous foods with line diagrams. The combination of small photographs (for vegetables) and line diagrams (for other foods) achieved a high correlation (r = 0.959, P ≤ 0.001), percentage correct estimations (68.3%) and low under estimations (19.9%) and over estimations (11.8%). Food texture, but not age or sex, was associated with correct estimations in all of the PSEA, except household utensils. CONCLUSIONS Accuracy and precision of a combination PSEA is convincing, enabling inclusion into an Asian food atlas for dietary assessment and intervention.

Distribution of obesity-related metabolic markers among 5-15 year old children from an urban area of Sri Lanka.

Background: Obesity-associated metabolic consequences are commonly seen among young South Asians. Objective: To assess the nutritional status, prevalence of metabolic derangements and to identify the validity of different obesity diagnostic criteria in the detection of metabolic derangements among 5–15 year old school children in the Colombo district of Sri Lanka. Materials and procedures: After a 12-hour overnight fast, blood was drawn for glucose, lipid profile and alanine amino transferase (ALT) enzyme. Oral glucose tolerance test (OGTT) was done with blood taken for random blood sugar 2 hours after glucose load. Height, weight, waist circumference (WC) and blood pressure were measured. Results: Nine hundred and twenty children were studied (boys, n = 547). Thirty-two (3.5%) were obese according to IOTF classification. Five (0.5%) and 57 (6.2%) children had systolic and diastolic hypertension. Twelve (1.3%) and three (0.3%) had impaired fasting glucose and 2-hour OGTT, respectively. One hundred and thirty-nine (15.1%) had hypercholesterolemia and 36 (3.9%) hypertriglyceridaemia. Two hundred and fifteen (23.3%) had low HDL. Fifteen (1.6%) had metabolic syndrome according to IDF definition. Two hundred and eighty-three (30.7%) had one metabolic derangement; 95 (10.3%) had two metabolic derangements; and 16 (1.7%) had three or more metabolic derangements. Sri Lankan BMI and WC obesity cut-offs had a higher sensitivity in detecting metabolic abnormalities than international cut-offs. Conclusion: Metabolic derangements are prevalent in children who were detected to be non-obese by anthropometric measures, and clinicians should actively look and correct them. New research is needed to study the long-term effects on health.