iPURSE 2016

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https://ir.lib.pdn.ac.lk/handle/20.500.14444/40

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Burden of tobacco smoking and its awareness
(University of Peradeniya, 2016-11-05) Hewageegana, V.P.; Hemamala, K.S.V.L.; Herath, H.M.B.G.R.P.; Herath, H.M.S.S.K.; Herath, M.G.B.U.G.W.; Herath, R.H.S.M.; Herath, W.A.K.M.D.; Hettiarachchi, H.D.M.; Hewauluwatte, S.P.; Jayakody, J.A.A.C.; Jayalath, J.M.C.C.; Jayamaha, J.H.S.K.; Adikari, S.B.
Tobacco smoking is one of the leading causes of cardiovascular and respiratory diseases burdening the society. Smoking adversely affects individuals who smoke (first hand smoking), those who inhale smoke by being near smokers (second hand smoking) and those who are exposed to nicotine and other toxic residues left on indoor surfaces due to tobacco smoke (third hand smoking). The present study aims to describe the pattern of exposure of individuals to smoking, the socio- economic factors associated with smoking and the awareness on the health effects of being exposed to tobacco smoke in Gangawata Korale Medical Officer of Health (MOH) area in Sri Lanka. A cross sectional descriptive study was done with 648 randomly selected subjects using a self-administered questionnaire. Their awareness regarding the health effects of first hand, second hand and third hand smoking was assessed in three categories. Half or more correct answers in each category were considered as “Satisfactory Awareness” for that category. A separate section assessed smoking habits. The data was analysed using SPSS (Version 20). Of the sample, 48% were males. The ages ranged from 18 to 44 years (mean=30). Ninety (14%) of the sample were smokers and almost all (98.9%) of them were males. There was a significant correlation between the level of education and smoking, the better educated were more likely to be non-smokers (P< 0.001). The awareness on the health effects was found to be satisfactory in 499 (77%) regarding first hand smoking, 418 (64.5%) regarding second hand smoking and 305 (47.1%) regarding third hand smoking. There was a significant correlation between the level of education and the satisfactory awareness on the health effects of smoking (P=0.035). Public awareness campaigns mostly address first and second hand smoking. The novelty of the concept of third hand smoking is reflected in the limited awareness shown by the participants. Although the study population is aware about the health effects of first hand smoking and second hand smoking, the awareness regarding third hand smoking is lacking. Educated people tend to be non-smokers with better awareness about the effects of tobacco smoke on health. Interventions should target uneducated males. The issue of third hand smoking need to be highlighted in awareness programmes.
Comparison of oligoclonal band numbers of Western and Sri Lankan Multiple Sclerosis patients
(University of Peradeniya, Sri Lanka, 2016-11-05) Alahakoon, A.M.B.D.; Gamage, S.M.K.; Nanayakkara, T.D.; Adikari, S.B.; Wijeweera, I.; Dilhani, S.; Rajamanthree, P.S.; Sominanda, H.M.A.
Multiple Sclerosis (MS) is a highly heterogeneous disease in terms of clinical and paraclinical aspects, partly attributed to the possible differences in environmental and genetic aetiology. Oligoclonal bands (OCB) are an intrathecal IgG response which can be visualized by isoelectric focusing (IEF) and immunoblotting. OCB has been reported to be important in determining the immunopathology of MS and disease progression. The objective of this study is to compare the OCB numbers in Western and Sri Lankan MS patients. Serum and CSF electrophoresis was performed using the horizontal bed electrophoresis system in a pH gradient. The standard IEF protocol followed in Karolinska Hospital, Sweden was adapted to suit our laboratory conditions. OCB positivity or negativity band counts were independently observed and recorded by three trained investigators. Two or more OCBs present in CSF and absent in serum were considered as positive for MS. Statistical significance of the difference of the mean OCB counts was calculated by Unpaired t test using Graph pad prism 5 software. Statistical analysis confirmed that the mean values of average OCB counts in western positive controls were significantly higher than the Sri Lankan OCB positive MS patients (P < 0.05). Thus, a significant quantitative difference is observed in oligoclonal antibody response between prototypic MS in western and Sri Lankan MS patients. This may have an association to the differences in immunopathology and clinical subtypes of MS in different geographical regions. However, a larger sample is required to further confirm these observations.
Gender related differences of clinical, radiological features and oligoclonal band status among Sri Lankan Multiple Sclerosis patients
(University of Peradeniya, Sri Lanka, 2016-11-05) Herath, P.P.B.; Gamage, S.M.K.; Ekanayaka, E.M.K.G.H.B.K.; Rukmal, R.K.P.B.; Adikari, S.B.; Wijeweera, I.; Sominanda, H.M.A.
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system (CNS) more prevalent in young adults with a wide variety of geographic and ethnic distribution. Similar to other autoimmune diseases, this condition is more prevalent among females. Our objectives were to compare the basic demographic variations, variations in clinical manifestations and investigation findings between male and female MS patients in Sri Lanka. Thirty one (female/F-18, male/M-13) patients with definite MS diagnosed by revised McDonald criteria 2010 from tertiary care centers of Sri Lanka were selected. An interviewer based questionnaire was used to collect data regarding clinical and investigation findings. Visual Evoked Potentials (VEP) and MRI findings were traced and recorded. Oligoclonal bands (OCB) were tested by isoelectric focusing. Data were analyzed using SPSS, independent sample t test and Fisher’s exact test. The female to male ratio was 1.38:1. The mean ages of onset were F=31.94±3.02 and M=33.23± 3.159 years. The attack frequency per year was F=1.306±0.1573 and M=1.577±0.1776. Mean EDSS were F=3.08±0.158 and M= 3.15±0.468. 83.3% females and 53.8% males had insidious onset of disease. Regarding clinical features, optic neuritis (F-49%, M-77%), sensory manifestations (F-44.4%, M-61.5%), motor (F-61.1%,M-69.2%) , cerebellar manifestations (F-33.3%,M-46.2%), autonomic (F-11.1%,M-7.7%) were observed. VEP positivity was F-66.7% and M-84.6%. Occurrence of relapsing remitting, secondary and primary progressive MS and clinically isolated syndrome was not statistically significant between genders. There was no significant difference of occurrence of MRI lesions in MS typical areas of CNS. The OCB positivity was F-61.1% and M-46.2%; and the difference was not statistically significant between sexes. Multiple sclerosis is more prevalent among females in the population studied, although the sex ratio is lower than other western based studies. Males apparently have a higher tendency of having eye involvement suggested by both clinical features and VEP results and higher chance of having brainstem involvement suggested by clinical features. Both motor and sensory manifestations are slightly higher in males. Significant percentages from both sexes suffer from sexual dysfunctions. In conclusion, there are no significant differences in demographics, clinical, radiological and neurophysiological features between male and female MS patients in Sri Lanka.
Occurrence of Aquaporin 4 receptor antibodies in patients suggestive of Multiple Sclerosis
(University of Peradeniya, Sri Lanka, 2016-11-05) Gamage, S.M.K.; Alahakoon, A.M.B.D.; Dissanayake, D.R.K.C.; Adikari, S.B.; Wijeweera, I.; Sominanda, H.M.A.
Multiple Sclerosis (MS) and other related demyelinating diseases of the central nervous system are in a spectrum. The prognosis, course of the disease and the treatment of each entity are highly variable. Therefore, an early definitive diagnosis is critical. The presence of an objective biomarker: Aquaporin 4 receptor antibody (Anti-AQP4) in serum which is highly specific for Neuromyelitis Optica Spectrum Disorder (NMOSD) aids to exclude seropositive NMOSD from typical MS. The objective of this study is to determine the occurrence of Anti-AQP4 antibody in a sample of patients, who were tentatively diagnosed as MS. Eighty one tentatively diagnosed MS patients were included in the study during the period of 2012-2016. Their clinical and paraclinical data were collected and the Anti-AQP4 antibody was tested in the sera using a commercially available validated enzyme-linked immunosorbant assay (ELISA). Then the revised McDonald 2010 and Wingerchuk criteria were applied to categorize them into definite MS, possible MS and NMOSD. Thirty one patients were classified as definite MS and another thirty one as possible MS. Seven fulfilled the criteria for seropositive NMOSD. Although the clinical features of the remaining twelve patients were suggestive of NMOSD, none of them fulfilled the criteria for a definitive diagnosis. Out of the 31 definitive MS patients, 21 (67.7%), 03 (9.6%), 01 (3.2%) and 06 (19.3%) were classified as relapsing and remitting MS, secondary progressive MS, primary progressive MS and clinically isolated syndrome respectively. Interestingly, 1 out of 31 (3.2%) possible MS patients was positive for Anti-AQP4 antibody. This patient clinically had bilateral optic neuritis with paraclinical features suggestive of MS. The occurrence of Anti-AQP4 antibodies in Sri Lankan patients suggestive of MS is significantly low reflecting a better initial diagnostic accuracy by the clinicians. However, some NMOSD patients have still been misdiagnosed as MS. This drawback should have been overcome if Anti-AQP4 antibody was tested, especially in borderline MS patients. A significant proportion of Sri Lankan NMOSD patients are positive for Anti-AQP4 antibody which re-confirms its high specificity. Seropositive possible MS patients and the twelve seronegative patients suggestive of NMOSD may require further follow up and neuroimaging studies to arrive at a definitive diagnosis.
Occurrence of optic neuritis and visual evoked potential characteristics in a group of Multiple Sclerosis patients in Sri Lanka
(University of Peradeniya, Sri Lanka, 2016-11-05) Herath, P.P.B.; Gamage, S.M.K.; Ranaweera, R.K.M.C.D.; Wijerathne, G.; Adikari, S.B.; Wijeweera, I.; Sominanda, H.M.A.
Optic neuritis (ON) is a common presentation in multiple sclerosis (MS). Visual evoked potential (VEP) is the main stay of the diagnosis of ON, of which P100 wave is used to measure the rate and amplitude of nerve conduction. Until now there were no studies conducted to determine the degree of P100 wave amplitude and latency and their relationship with occurrence of clinically apparent ON in MS patients in Sri Lanka. The objective of the study was to determine the occurrence of P100 latency delay in eyes with and without optic neuritis, of a group of MS patients. Study sample consisted of 46 eyes of 23 definite MS patients with VEP reports. Detailed history and a nervous system examination were performed. Patients with following features were categorized as having clinically apparent ON; abrupt deterioration of vision (distant or close) in one or both eyes and/or changes in colour vision with or without ocular or retro orbital pain associated with the visual symptoms and visual symptoms aggravated due to heat. Following examination findings were used to clinically diagnose ON; reduction of visual acuity, impaired colour vision, altitudinal field defects, central scotoma, papillitis and decreased pupillary light reaction. Details on amplitude and latency of P100 response of VEP reports were recorded in both eyes. P100 responses of all 46 eyes were analyzed with Fishers Exact. Cut off value for P100 wave latency was 103ms. There were 24 eyes with clinical ON and rest did not. Of the 24 eyes with clinical ON, 20 (83%) had P100 latency delay. Of the 22 eyes with no clinical features of ON, 20 (90%) had P100 latency delay. There were only 2 clinically normal eyes, without P100 latency delay. There was no significant difference of occurrence of P100 wave latency delay in eyes with clinical ON and eyes without clinically apparent ON. Mean P100 response latencies of right and left eyes were 111ms and 108ms respectively. In conclusion, majority of the eyes in this sample of MS patients show P100 latency delay. Interestingly, majority of clinically normal eyes had P100 latency delay indicating the presence of subclinical demyelination.
Oligoclonal band positive and negative multiple sclerosis: do they represent clinically distinct subgroups of multiple sclerosis?
(University of Peradeniya, 2016-11-05) Nasim, F.N.; Gamage, S.M.K.; Wickramarathna, A.A.D.; Wijenayake, W.M.W.C.; Wijeweera, I.; Adikari, S.B.; Sominanda, H.M.A.
The oligoclonal band test is an important investigation which aids diagnosis of Multiple Sclerosis (MS). Isoelectric Focusing (IEF) and immunoblotting is the gold standard method for OCB detection according to current consensus. In a typical western MS population, 95-98% of patients are positive for OCB, reflecting an intrathecal antibody response parallel to the central nervous system inflammatory pathology. A genetic basis for this discrepancy has been reported in a number of studies. OCB positive patients are associated with HLA-DRB1*15 and negative with HLA-DRB1*04, suggesting the possibility of immunogenetically different subgroups that may have a different disease course, and outcome status with varied drug response and possibly prognosis. Therefore, the relationship of OCB status has been studied in relation to clinical presentation and outcome in patients with MS, but still the relationship remains unclear. Thus, the objective of this study was to compare between OCB positive and negative MS populations in terms of clinical, demographic and investigation findings. Thirty one definite MS patients diagnosed using McDonalds criteria were included in the study. Clinical and MRI features were documented and analyzed to compare between OCB positive and negative groups. All were tested for OCB in both serum and CSF samples. Of the 31 MS patients, 14 (45.2%) were positive for OCB whereas 17 (54.8%) were negative. Comparison of demographic features (i.e. gender, nationality), clinical subtype frequency (i.e. relapsing- remitting, secondary progressive or primary progressive MS), disease course and disability (EDSS) revealed no significant difference between OCB positive and negative groups. Similarly, comparison of clinical features (i.e. cerebral sensory, cerebral motor, cerebellar, etc.) revealed no significant difference. However, on comparison of MRI features, the presence of cervical cord lesions were significantly higher among the OCB positive group (p<0.01). The rest of the imaging features were not different between groups. In conclusion, there are no major differences in presentation and clinical course of OCB positive and negative subgroups of MS. Yet, there are some differences seen in MRI findings reflecting an association between MS immunopathology and radiological manifestations of Sri Lankan MS. This might facilitate defining MS subtypes on OCB status with further studies on larger samples.

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