Jaffna Medical AssociationAnnual Scientific Sessions 2012

29th of November - 2nd of December 2012

Programme & Abstract Book

President Dr. N. Jeyakumaran

President Elect Dr. P. Lakshman

Immediate Past President Dr. S. Raviraj

Senior Vice President Dr. T. PeranantharajahJunior Vice President Dr. A. Keshavaraj

Secretary Dr. V. Sutharshan

Treasurer Dr. S. Sivapathamoorthy

Editor Dr. R. Surenthirakumaran

Librarian Dr. S. K. Arulmoli

Assistant Librarian Dr. R. Rahulan

Council Members Dr. M. Guruparan Dr. K. Mukunthan Dr. S. Premakrishna Dr. S. Sathiyareka Dr. S. Sivayokan

Council of the Jaffna Medical Association 2012

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Welcome to the JMA’s Annual Scientific Sessions 2012 ! This year’s theme, “From Sick Care to Health Care” focuses on the prevention of common diseases in Sri Lanka. This year we have extended the programme to four days with the involvement of sixty speakers incorporating many specialties. The sessions commenced with three parallel Pre congress workshops on 29th of November and 30th of November 2012.

During the plenary sessions on the 1st and 2nd of December 2012, we have five symposia, five guest lectures and two free paper sessions. With a view to improve the quality of research, this year we have introduced the best paper and best poster awards for the free papers. In addition to it on the evening of the first day we will have Prof C. Sivagnanasundram Memorial Oration on a topic related to the theme:

“Health Transition: Emerging Issues in Sri Lanka”

This year we are introducing healthy foods during the tea time of the sessions so that you can experience the taste of it.

Many people contributed to the success of our sessions. In particular, the Council of JMA, the abstract reviewers and judges for free papers & oration deserve my special thanks for their excellent work on these endeavours amidst their busy schedules.

We are also very grateful to the generous financial support from our sponsors and exhibitors of their products to have this session a successful one.

We hope that you have a rewarding and enjoyable learning experience during the JMA’s Annual Scientific Sessions2012 with the opportunities for furthering your professional career and to meet many eminent people.

I look forward to meeting with you and hearing your views and ideas.

Yours Sincerely,Dr.Nadarajah Jeyakumaran,

The President JMA.Jaffna Medical Association.

MESSAGE FROM THE PRESIDENT

One more fruitful year has come in the long history of JMA. I hope this year journal contains many useful articles and papers which will definitely enlighten all the JMA members.

I strongly believe that, JMA events this year have become successful with the invaluable support you all have rendered.

I am indebted to you all, members and non members of JMA who have extended their support generously.

Thank you very much and kind regards.

Dr.V.Sutharshan,The Secretary,

Jaffna medical association.

MESSAGE FROM THE SECRETARY

JMA which started about 70 years ago has become a powerful academic body over the years and the highlight of its activity is the academic session.

Academic sessions were held even during war period and identify local problems and provide appropriate solutions. It also helps the junior Doctors and medical students to present papers and get involved in furthering medical education in Jaffna.

It helps the average doctor to update his knowledge and adopt recent developments in his or her practice which would help the community. We also learn various recent developments in the world in medical practice. This helps us to refer our patients to the appropriate centre anywhere in the world.

I wish the academic sessions a great success and also wish the JMA a bright future

Dr.M.GanesaratnamSenior Consultant Surgeon .

Past President, Sri Lanka College of Surgeons.Past President , Jaffna Medical Association.

MESSAGE FROM THE CHIEF GUEST

I am greatly privileged to be invited as your Guest of honour on the occasion of the Jaffna Medical Association annual scientific Sessions 2012. I accept this singular honour with all humility and sincerely thank for this kind invitation.

The Jaffna Medical Association with long and noble history has rendered valuable service to the people of this country for several decades. The continuous academic activities conducted by your Association in the sphere of training medical personnel to uplift the health services of Sri Lanka is also greatly appreciated.

Whilst congratulating your Association for the great services rendered over the years, I sincerely wish that you will grow from strength to strength in all your future endeavours.

I take this opportunity to wish your Annual Scientific Sessions 2012 all success.

Dr.Jayantha Balawardane,Senior Consultant Clinical Oncologist.

President, Sri Lanka college of Oncologist.Chairperson, Board of Study in Clinical Oncology

MESSAGE FROM THE GUEST OF HONOUR

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8.00am - 8.30am Registration

8.30am - 9.00am Introductory Remarks By Chairperson Dr.S.Jeyaratnam

Consultant Surgeon, TH Jaffna

9.00am - 9.30am Laparoscopic Instruments and Ergonomics Dr.B.Aathavan Consultant Surgeon, GH Vavuniya

9.30am -10.15am Access- open and closed techniques Dr.S.Rajendra Consultant Surgeon, TH Jaffna

10.15am -10.30am Tea

10.30am -11.00am Anaesthesia for Laparoscopic Surgery and Complications of Pneumoperitoneum Dr.J.Arulmoli

Consultant Anaesthetist, TH Jaffna

11.00am -11.30am Port closure Dr.V.Sutharshan Consultant Surgeon, TH Jaffna

11.30am -12.30pm Hands on training in Endo trainer

12.30pm -1.00pm Discussion and closing remarks

1.00pm - 2.00pm Lunch

1. Basic Skill Development in Laparoscopic SurgeryVenue: Cancer Education Unit, Ward 26, TH Jaffna

Jaffna Medical Association Annual Scientific Sessions 2012 Pre Congress Workshop - I ( 29th of November 2012 )

Venue: Faculty of Medicine, University of Jaffna

8.00am - 8.15am Registration 8.15am - 9.15am Dizziness and vertigo - Skype lecture Dr Chandra Jayasuriya - Consultant ENT Surgeon Dr. MTD Lakshan - Consultant ENT Surgeon Dr. Mohamed Milhan - Consultant ENT Surgeon

9.15am - 10.15am Basic history taking and examination in a dizzy patient Dr. S.Mathanakumara Consultant ENT Surgeon, BH Mannar Dr.A.Kesavaraj Consultant Neurologist, TH Jaffna

10.15am - 10.30am Tea10.30am-12 Noon Neuro otological examination in a dizzy patient Groups I-IV Dr.B.Thirumaran Consultant ENT Surgeon, TH Jaffna

2. How to Manage a Dizzy Patient

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8.00am - 8.15am Registration8.15am - 8.30am Welcome Address & Opening Remarks Dr.S. Uthayakumar Consultant Physician, TH Jaffna.8.30am - 8.50am Medicine Dr.S.Sivansuthan. Consultant Physician, TH Jaffna.8.50am - 9.10am Surgery Dr.V.Sutharshan. Consultant Surgeon, TH Jaffna.9.10am -9.30am Paediatrics Dr.G.Sathiyadas Consultant and Senior Lecturer, Dept. of Paediatrics. Faculty of Medicine, University of Jaffna9.30am -9.50am Obstetrics and Gynaecology Dr.G.Bavani Consultant and Senior Lecturer, Dept. of Obstetrics and Gynaecology, Faculty of Medicine, University of Jaffna.

Venue: Medical Students’ Hostel Auditorium

Dr S Mathanakumara Consultant ENT Surgeon, BH Mannar Dr.A.Kesavaraj Consultant Neurologist, TH Jaffna Dr. D. A. D. G. Daminda Consultant ENT Surgeon, GH Vavuniya

12 Noon - 1.00pm Lunch

1.00pm- 3.00pm Neuro otological investigations in a dizzy patient Dr.A.Kesavaraj Consultant Neurologist, TH Jaffna Dr.B.Thirumaran Consultant ENT Surgeon, TH Jaffna Dr S Mathanakumara Consultant ENT Surgeon, BH Mannar Dr. D. A. D. G. Daminda Consultant ENT Surgeon, GH Vavuniya

3.00pm-4.30pm Evidence based Management of dizzy patients Dr. D. A. D. G. Daminda Consultant ENT Surgeon, GH Vavuniya Dr.A.Kesavaraj Consultant Neurologist, TH Jaffna

4.30pm-5.00pm Evaluation of workshop by MCQs

3. Career Guidance for Junior Doctors

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9.50am - 10.05am Otolaryngology Dr.B.Thirumaran Consultant Otolaryngologist, TH Jaffna.10.05am - 10.20am Community Medicine Dr.V.Murali Consultant Community Physician Management, Development and Planning Unit10.20am -10.40am Tea

10.40am - 10.55am Anaesthesiology Dr.S.Premakrishna Consultant Anaesthesiologist, TH Jaffna.10.55am -11.10am Pathology Dr.Jayanthi Dissanayakae Consultant Pathologist, BH Avissawella11.10am - 11.25am Radiology Dr.S.Nimalan Consultant Radiologist, TH Jaffna

11.25am - 11.40am Clinical Oncology Dr.N.Jeyakumaran Consultant Clinical Oncologist, TH Jaffna

11.40am -11.55am Dermatology Dr.S.Sivaprakasam Consultant Dermatologist, TH Jaffna.

11.55am - 12.10pm Psychiatry Dr.S.Sivayokan Consultant Psychiatrist, TH Jaffna.

12.10pm - 12.25pm Ophthalmology Dr.P.Sriharanathan Consultant Ophthalmologist, TH Kandy

12.25pm - 12.40pm University Dr. S.Thiahini Senior Lecturer & Head Dept. of Pharmacology Faculty of Medicine, University of Jaffna

12.40pm - 12.55pm Forensic Medicine Dr.U.Mayoorathan Senior Registrar, TH Anuradapura2.55pm - 1.10pm Medical Administration Dr.T.Sathiyamoorthy Medical Superintendent, GH Vavuniya.1.10pm - 1.30pm Family Medicine Dr.S.Kumaran Lecturer, Dept. of Community & Family Medicine Faculty of Medicine, University of Jaffna1.30pm. Lunch

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8.00am - 8.30am Registration 8.30am - 9.00am Introductory Remarks By Chairperson Dr.N.Sivarajah WHO Consultant, Jaffna9.00am - 9.30am Evidence Based Medicine What does it mean? Dr.Palitha Abeykoon Former Director, WHO, South East Asia WHO Consultant, Chairman Health Management 9.30am -10.15am Evaluating Evidence in Medical Research Dr.V.Murali Consultant Community Physician Management, Development and Planning Unit10.15am -10.30am Tea10.30am -11.00am Evidence Based Psychiatry Dr.Shavindra Dias Senior Lecturer, Department of Psychiatry Faculty of Medicine, University of Peradeniya11.00am -12 Noon Systematic Review and Cochrane Library Dr.R.Surendrakumar Head, Department of Community & Family Medicine Faculty of Medicine, University of Jaffna12 Noon -12.30pm Role of CME and CPD in Practicing Evidence Based Medicine Dr. Indika Karunatilake Senior Lecturer, Department of Medical Education Faculty of Medicine, University of Colombo.12.30pm - 1.00pm Discussion and Concluding Remarks1.00pm - 2.00pm Lunch

1. Evidence Based Medicine Venue: Medical Students’ Hostel Auditorium

Jaffna Medical Association Annual Scientific Sessions 2012 Pre Congress Workshop - II ( 30th of November 2012 )

8.00am - 8.30am Registration8.30am - 9.30am Welcome Address & Opening Remarks Dr.S.R.Jude Provincial Director of Health services, Northern Province

2. Screening and Treatment of Cervical Cancer Venue: RDHS Auditorium

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9.30am -10.30am Objectives of the workshop and Current Trends in Cervical Cancer Screening in low resource setup Dr.K.Muhunthan Consultant and Senior Lecturer in Obstetrics and Gynaecology Faculty of Medicine, University of Jaffna

10.30am -11.00am Tea

11.00am - 12 Noon Treatment of cervical pre cancer and cancer Gynecologists’ perspective Dr.A.Sritharan Consultant Obstetrician and Gynecologist Teaching Hospital, Jaffna

12. Noon -12.30pm Treatment of cervical cancer Oncologist’s perspective Dr.C.Rajasooriyar Consultant Clinical Oncologist Teaching Hospital, Jaffna

12.30pm-1.00pm Discussion and Concluding Remarks

1.00pm - 2.00pm Lunch

3. Palliative Care from Day 1 Venue: Auditorium, Nurses Training School, TH Jaffna

8.00am - 8.30am Registration8.30am - 8.50am Welcome Address & Opening Remarks Dr.N.Jeyakumaran Consultant Clinical Oncologist, TH Jaffna8.50am - 9.10am Breaking Bad News & Communication Skills Dr.T.Gadambanathan Consultant Psychiatrist, TH Batticaloa9.10am -9.30am “Freedom from Pain.” A Documentary Pain & Policy Studies Group - University of Wisconsin-Madison, USA9.30am -9.50am Management of Pain Dr.N.Sooriyakumar Consultant Anasthesiologist, TH Jaffna9.50am -10.20am Tea10.20am -10.40am Experience at Cancer Unit Dr.N.Yoganathan Consultant Clinical Oncologist, TH Karapitiya

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Venue: Public Library Auditorium, Jaffna

Jaffna Medical Association Annual Scientific Sessions 2012Day 1 (1st of December 2012)

10.40am - 11.00am Surgical Options in Palliative Care Dr.Rasitha Manathunga Consultant Onco Surgeon, NCI, Maharagama11.00am -11.20am Management of Anxiety and Depression Dr.T.Gadambanathan Consultant Psychiatrist, TH Batticaloa11.20am - 11.40am Setting up a Pain Clinic in Peripheral Hospital Dr.J.Arulmoli Consultant Anasthesiologist, TH Jaffna11.40am -12 Noon “Home based Palliative Care” - The initial experience Dr. SidathGananathaWijesekera Member, Cancer Care Association12 Noon - 12.20pm Nurses role in Palliative Care Mr.S.Jeyakumar Nursing Tutor, NTS, Jaffna12.20pm - 1.00pm A Talk on “Survivorship and Palliative Care” Prof. James F Cleary Associate Professor of Medicine & Palliative Care Physician Palliative Care and Supportive Oncology Working Group University of Wisconsin, Madison, USA1.00pm - 1.30pm Discussion and Concluding Remarks 1.30pm - 2.30pm Lunch

8.00am - 8.30am RegistrationSession 18.30am - 9.00am Guest Lecture – 1 - Chairperson - Dr.S.Raviraj “Update on Surgical Management of Breast Cancer” Dr.M.Ganesharatnam Senior Consultant Surgeon

9.00am - 10.30am Symposium 1 – Oncology Chairpersons - Dr.K.Muhunthan & Dr.K.Sivaraman “Prevention of Common Cancers in Sri Lanka”9.00am - 9.15am 1. Burden of Cancers in Northern Province Dr.N.Jeyakumaran Consultant Clinical Oncologist Teaching Hospital, Jaffna9.15am - 9.40am 2. Prevention of Common Cancers among Females Dr.Jayantha Balawadna Senior Consultant Clinical Oncologist National Cancer Institute of Sri Lanka, Maharagama

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9.40am - 10.00am 3. Role of Dental Surgeons in Oral Cancer Prevention Dr.Suresh Shanmuganathan Consultant Oral & Maxillofacial Surgeon District General Hospital, Kalutara10.00am - 10.15am 4. Tobacco Control in Sri Lanka Dr. Samadhi Rajapaksa - Founder Cancer Care Association10.15am - 10.30am Discussion10.30am - 11.00am Tea & Viewing Posters11.00am - 12.30pm Free Papers -Chairpersons - Prof.K.Sivapalan & Dr.T.Kumanan12.30pm - 1.00pm Guest Lecture – 2 Chairperson - Dr.S.Uthayakumar “Update on Management of Diabetes Mellitus” Dr.Noel Somasundram Consultant Endocrinologist National Hospital of Sri Lanka1.00pm - 2.00pm Lunch & Viewing PostersSession 22.00pm - 3.15pm Symposium 2 – Medicine Chairpersons - Dr.T.Peranantharajah & Dr.R.Arudchelvam “NCD Beyond Malignancies”2.00pm - 2.20pm 1.Prevention of Chronic Kidney Disease Dr.Mathu Selvarajah Consultant Nephrologist Teaching Hospital Kurunegala2.20pm - 2.40pm 2. Prevention of Obesity Dr.V.Murali - Consultant Community Physician Management, Development and Planning Unit2.40pm - 3.00pm 3. Primary and Secondary Prevention of Stroke Dr.A.Keshavaraj Consultant Neurologist Teaching Hospital, Jaffna3.00pm - 3.20pm 4. Diabetic Retinopathy Everybody’s Business Dr.M.Malaravan Consultant Ophthalmologist General Hospital, Vavuniya3.20pm - 3.30pm Discussion3.30pm - 3.45pm Tea & Viewing Posters3.45pm - 4.30pm Symposium 3 - Paediatrics “Nutrition” Chairpersons - Dr.G.Sathiyadas & Dr.A.Ketheeswaran3.45pm - 4.05pm 1. NICU graduate what to expect Dr Angela Arulpragasam Consultant Paediatrician Teaching Hospital, Batticaloa.4.05pm - 4.25pm 2. Dietary modification in a child with special needs Dr Niruba Umashangar Paediatrician and Lecturer, Department of Paediatrics. Faculty of Medicine, University of Jaffna.4.25pm - 4.45pm 3. Ensuring Nutritional Status of Children Challenges and Way Forward - An Experience from Batticaloa Dr Chithra Gadambanathan Consultant Paediatrician Teaching Hospital, Batticaloa4.45pm - 5.00pm Discussion

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Venue: Public Library Auditorium, Jaffna

Jaffna Medical Association Annual Scientific Sessions 2012Day 2 (2nd of December 2012)

Session 1

8.00am - 9.30am Free Papers Chairpersons - Dr.S.Balakumar & Dr.S.Sivaganesh

9.30am - 10.00am Guest Lecture -3 - Chairperson - Dr.M.Guruparan “A Decade of Transradial Coronary Intervention” from Colombo to Jaffna Dr.S.Mithrakumar Consultant Cardiologist10.00am - 10.30am Guest Lecture - 4 - Chairperson - Dr.K.Umapathy “Update on Management of Rheumatoid Arthritis” Dr.Lalith Wijeratne Consultant Rheumatologist National Hospital of Sri Lanka

10.30am - 11.00am Tea & Viewing Posters

11.00am - 12 Noon Symposium 4 - Rheumatology Chairperson - Dr.K.Sivakumar & Dr.T.Srikaran “Rheumatology in Other Specialties”

11.00am - 11.20am 1. Ophthalmological Manifestations Dr.M.Malaravan Consultant Ophthalmologist General Hospital, Vavuniya

11.20am - 11.40am 2.Haematological Manifestations Dr.T.Sooriyakumar Consultant Haematologist Teaching Hospital, Jaffna

11.40am - 12 Noon Discussion

12 Noon - 12.15pm “Awarding Prizes to Free Papers”

12.15pm - 12.45pm Guest Lecture - 5 - Chairperson - Dr.S.Nimalan “Clinical Application of PET-CT” Dr.Manoj Gupta Head, Department of Nuclear Medicine and PET CT ASIRI Surgical Hospital PLC

12.45pm - 2.00pm Symposium 5 - Surgery Chairpersons - Dr.T. Ambalavanar & Dr.R. Gnanasekaram “Managing Road Traffic Accidents (RTA)”

12.45pm - 1.00pm 1. Radiologist’s Role in Managing RTA Dr. Nalini Rajendra Consultant Radiologist Teaching Hospital, Jaffna

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1.00pm - 1.15pm 2. Anaesthetist’s Role in Managing RTA Dr.V.Devanesan Consultant Anaesthesiologist Teaching Hospital, Jaffna

1.15pm - 1.30pm 3. Surgeon’s Role in Managing RTA Dr.S.Raviraj Consultant and Senior Lecturer in Surgery Faculty of Medicine, University of Jaffna

1.30pm - 1.45pm 4. JMO’s Role in Managing RTA Dr.S.Mayoorathan Senior Registrar Teaching Hospital, Anuradapura

1.45pm - 2.00pm Discussions

2.00pm Lunch End of Scientific Sessions

Venue: Kailasapathy Auditorium, University of Jaffna

Jaffna Medical Association Annual Scientific Sessions 2012Inauguration 30th of November 2012

Programme5.00pm Arrival of Guests5.30pm Arrival of Guest of Honour & Chief Guest5.40pm Ceremonial Procession5.50pm Lighting of Lamp of Learning5.55pm National Anthem6.00pm JMA Anthem6.05pm Presidential Address Dr.N.Jeyakumaran President, JMA6.20pm Address by the Guest of Honour “Recent Advances in Radiotherapy” Sri Lanka Shihamani Dr.Jayantha Balawadna Senior Consultant Clinical Oncologist6.40pm Address by Chief Guest Dr.M.Ganesharatnam Senior Consultant Surgeon7.10pm Vote of Thanks Dr.V.Sutharshan Secretary, JMA7.15pm Cultural Performance7.45pm Procession leaves the hall8.00pm Refreshments

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Venue: Tilko City Hotel, Jaffna

Jaffna Medical Association Annual Scientific Sessions 2012 Prof.C.Sivagnanasundram Oration 1st of December 2012

Programme

6.30pm Arrival of Guests

6.40pm Ceremonial Procession

6.50pm Lighting of Lamp of Learning

7.00pm Introduction of Orator Dr.N.Jeyakumaran President, JMA

7.10pm Prof.C.Sivagnanasundram Oration “Health Transition: Emerging Issues in Sri Lanka” By: Dr. Murali Vallipuranathan MBBS (Jaffna), PGD (Population Studies) MSc (Community Medicine), MD (Community Medicine) PhD Research Scholar King’s College, London. Consultant Community Physician Management, Development and Planning Unit Ministry of Health

8.10pm Vote of Thanks Dr.V.Sutharshan Secretary, JMA

8.20pm Procession leaves the hall

8.30pm Dinner

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Dr.B.AathavanConsultant SurgeonGenaral Hospital, Vavuniya

Dr.A.KesavarajConsultant NeurologistTeaching Hospital, Jaffna

Dr Angela ArulpragasamConsultant Paediatrician

Dr.G.BavaniConsultant and Senior Lecturer,Dept. of Obstetrics and Gynaecology,Faculty of Medicine, University of Jaffna

JMA Annual Scientific Sessions 2012Resource Persons

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Dr Chandra JayasuriyaConsultant ENT SurgeonNational Hospital of Sri Lanka

Dr Chithra GadambanathanConsultant PaediatricianTeaching Hospital, Batticaloa

Dr.C.RajasooriyarConsultant Clinical OncologistTeaching Hospital, Jaffna

Dr. D. A. D. G. DamindaConsultant ENT SurgeonGenaral Hospital, Vavuniya

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Dr.T.GadambanathanConsultant PsychiatristTeaching Hospital, Batticaloa

Dr.M.GanesharatnamConsultant Surgeon

Dr.G.SathiyadasConsultant and Senior Lecturer, Dept. of Paediatrics.Faculty of Medicine, University of Jaffna

Dr. Indika KarunatilakeSenior Lecturer, Department of Medical EducationFaculty of Medicine, University of Colombo

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Prof. James F ClearyAssociate Professor of Medicine & Palliative Care PhysicianPalliative Care and Supportive Oncology Working GroupUniversity of Wisconsin, Madison

Dr.J.ArulmoliConsultant Anaesthetist Teaching Hospital, Jaffna

Dr.Jayantha BalawadnaConsultant Clinical OncologistNational Cancer Institute of Sri Lanka

Dr.Jayanthi DissanayakaeConsultant PathologistBase Hospital, Avissawella

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Mr.S.JeyakumarNursing TutorNurses' Training School, Jaffna

Dr.N.JeyakumaranConsultant Clinical OncologistTeaching Hospital, Jaffna

Dr.S.R.JudeNorthern Provincial Director of Health

Dr.S.KumaranLecturer, Dept. of Community & Family MedicineFaculty of Medicine, University of Jaffna

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Dr. MTD LakshanConsultant ENT Surgeon, Genaral Hospital, Hambatota

Dr.Lalith WijeratneConsultant RheumatologistNational Hospital of Sri Lanka

Dr.M.MalaravanConsultant OphthalmologistGeneral Hospital, Vavuniya

Dr.Manoj GuptaHead, Department of Nuclear Medicine and PET CTASIRI Surgical Hospital PLC

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Dr. S.MathanakumaraConsultant ENT SurgeonBase Hospital, Mannar

Dr.Mathu SelvarajahConsultant NephrologistTeaching Hospital Kurunegala

Dr.U.MayoorathanSenior RegistrarTeaching Hospital, Anuradapura

Dr.S.MithrakumarConsultant Cardiologist

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Dr. Mohamed MilhanSenior Registrar, ENTTeaching Hospital, Ragama

Dr.K.MuhunthanConsultant and Senior Lecturer Dept. of Obstetrics and GynaecologyFaculty of Medicine, University of Jaffna

Dr.V.MuraliConsultant Community PhysicianManagement, Development and Planning UnitMinistry of Health

Dr. Nalini RajendraConsultant RadiologistTeaching Hospital, Jaffna

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Dr.S.NimalanConsultant Radiologist Teaching Hospital, Jaffna

Dr Niruba UmashangarPaediatrician and Lecturer, Department of Paediatrics.Faculty of Medicine, University of Jaffna

Dr.Noel SomasundramConsultant EndocrinologistNational Hospital of Sri Lanka

Dr.Palitha AbeykoonFormer Director, WHO, South East AsiaWHO Consultant, Chairman Health Management

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Dr.S.PremakrishnaConsultant AnaesthesiologistTeaching Hospital, Jaffna

Dr.S.RajendraConsultant Surgeon & Senior Lecturer, Dept.of Surgery, Faculty of Medicine, University of Jaffna

Dr.Rasitha ManathungaConsultant Onco SurgeonNational Cancer Institute, Maharagama.

Dr.S.RavirajConsultant Surgeon & Senior Lecturer, Head, Dept.of Surgery, Faculty of Medicine, University of Jaffna

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Dr.Samadhi RajapakshaFounder, Cancer Care Association

Dr.T.SathiyamoorthyMedical SuperintendentGenaral Hospital, Vavuniya

Dr.S.SivaprakasamConsultant DermatologistTeaching Hospital, Jaffna

Dr.Shavindra DiasSenior Lecturer, Department of PsychiatryFaculty of Medicine, University of Peradeniya

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Dr. SidathGananathaWijesekeraMember, Cancer Care Association

Dr.S.UthayakumarConsultant Physician Teaching Hospital, Jaffna

Dr.S.SivansuthanConsultant PhysicianTeaching Hospital, Jaffna

Dr.N.SivarajahWHO ConsultantJaffna

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Dr.S.SivayokanConsultant PsychiatristTeaching Hospital, Jaffna

Dr.N.SooriyakumarConsultant AnasthesiologistTeaching Hospital, Jaffna

Dr.P.SriharanathanConsultant OphthalmologistTeaching Hospital, Kandy

Dr.A.SritharanConsultant Obstretrician and Gynaecologist Teaching Hospital, Jaffna

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Dr.R.SurenthirakumaranConsultant Community PhysicianHead, Department of Community & Family MedicineFaculty of Medicine, University of Jaffna

Dr.Suresh ShanmuganathanConsultant Oral & Maxillofacial SurgeonDistrict General Hospital, Kalutara

Dr.V.SutharshanConsultant SurgeonTeaching Hospital, Jaffna

Dr.T.SooriyakumarConsultant HaematologistTeaching Hospital, Jaffna

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Dr. S.ThiahiniSenior Lecturer Head Dept. of PharmacologyFaculty of Medicine, University of Jaffna

Dr.B.ThirumaranConsultant ENT SurgeonTeaching Hospital, Jaffna

Dr.V.DevanesanConsultant AnaesthesiologistTeaching Hospital, Jaffna

Dr.N.YoganathanConsultant Clinical Oncologist, Teaching Hospital, Karapitiya

Dr.S.JeyaratnamConsultant Surgeon, Teaching Hospital, Jaffna

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Abstract Book

Oral Presentations Lists Abstracts Poster Presentations Lists Abstracts Jaffna Medical Association Annual Scientific Sessions 2012

29th November to 2nd December, 2012 Jaffna Public Library Auditorium Jaffna

List of Oral PresentationsFree Paper Symposium 1: Date: 1st December 2012 11.00 am to 12.30 pmVenue: Public Library Auditorium, Jaffna

OP 1: A pilot study of Cohort Event Monitoring in detecting adverse events following immunisation associated with Measles-Mumps-Rubella and lives attenuated Japanese Encephalitis (JE) vaccineK Sanchayan1, R Fernandopulle2, A Amerasinghe3, T S Navaratinaraja1, S Sri Ranganathan21 Department of Pharmacology, Faculty of Medicine, University of Jaffna.2 Department of Pharmacology, Faculty of Medicine, University of Colombo.3 Epidemiology Unit, Ministry of Health

OP2: Prevalence and socio-demographic factors of malnutrition among children aged 1 to 5 years in Jaffna districtK Kandeepan 1, R Surenthirakumaran 2, S Balakumar 1, V Arasaratnam11Department of Biochemistry, Faculty of Medicine, University of Jaffna 2Department of Community Medicine and Family Health, Faculty of Medicine, University of Jaffna

OP 3: Descriptive study of the post graduate education plan of intern medical graduates and eliciting determining factors S R DiasDepartment of Psychiatry, Faculty of Medicine, University of Peradeniya

OP 4: An analysis admissions and outcome of burn injuries: tertiary care hospital Batticaloa S Pirasath, V Jasotharan , P Jeepara Teaching Hospital Batticaloa, Sri LankaOP 5: Impact of obesity on glucose and lipid profile among adults in Jaffna District A Sivarathy, S Balakumar, V ArasaratnamDepartment of Biochemistry, Faculty of Medicine, University of Jaffna

OP 6: Study on demography and behavioural patterns of patients of patients staying overnight for the following day clinic in the Teaching Hospital SR Dias1, C Dalugama2, R Higgoda2, T Amaratunga11Depatment of Psychiatry, Faculty of Medicine, University of Peradeniya2 Faculty of Medicine, University of Peradeniya

Established-Jaffna Medical Association Annual Scientific Sessions 2012

The Jaffna Medical Journal

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OP 7: Enteric fever: Epidemiology and Surveillance in JaffnaS SivaganeshRegional Director of Health Services Jaffna

OP 8: A Study of paediatric patients with accidental ingestion of kerosene oil, admitted to the General Hospital Vavuniya M R G JANSZGeneral Hospital Vavuniya Sri Lanka

Free Paper Symposium 2:

Date: 2nd December 2012 8.00 am to 9.30 amVenue: Public Library Auditorium, Jaffna

OP 9: The status of Infant immunization, its documentation and the knowledge of mothers on immunization in the resettled population in the Killinochchi district.P Ananthan1, PR Wijesinghe21Post Graduate Institute of Medicine, University of Colombo, Sri Lanka2 Epidemiolgy unit, Ministry of health, Sri Lanka

OP 10: Effect of a herbal formulation on the incidence and severity of 15 upper respiratory symptoms in healthy volunteers: A randomized open – label controlled trial.M. R Sooriyarachchi1, C Goonaratna21Department of Statistics, University of Colombo 2 Registrar, Ceylon Medical College Council

OP 11: Yellow Oleander poisoning: An analysis of cardiac toxicity, treatment and outcome in a tertiary care hospital Batticaloa. K Arulnithy, P Ahila, Anula, L Dushaiyanthy, S Pirasath, N Sathiyashakaran, N Surendrakumar Teaching Hospital, Batticaloa, Sri Lanka

OP 12: Jaffna in the era of Laparoscopic Cholecystectomy: Three year experience in a single surgical unit S Rajendra, M A Anomilan, K M Niroshinee, Department of Surgery, Faculty of Medicine, University of Jaffna.

OP 13: Perforated carcinoma of the caecum presenting as psoas abscess- an unusual presentation K Saseekaran, P Pragatheeswaran, P Jayasekara National Cancer Institute of Sri Lanka, Maharagama

OP 14: Study of fecal contamination in ice creams sold in MOH areas of Jaffna & Nallur Y Abhiramie1, R Shampika, 1 N Sivarajah3, K Murugananthan31 Faculty of Medicine, University of Jaffna2 WHO, Jaffna , Sri Lanka 3Department of Pathology, Faculty of Medicine, University of Jaffna

OP 15: Study on women with colles fracture – a single unit experienceK Saseekaran, NWBKH de Silva, MKC Mendis, PDGMC de AlmeidaColombo South Teaching Hospital, Kalubowila

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List of Poster Presentations

PP 1: Lung functions among Traffic and Non-traffic police officers in Colombo DivisionL K Hirimuthugoda1, SPK Wathudura1, H Edirimanna2, HPMadarasingha3 WLS Mahapitiya31Base hospital, Elpitiya2 Provincial Director of Health Services- Southern province3 Teaching Hospital , Kegalle

PP 2: The role of perceived self efficacy in dengue vector control activities among residents of Kundasale Medical Officers of Health areaRDL RangamaTeaching Hospital, Kandy

PP 3: Audit of workload and resources of a newly established endoscopy unit in a District General Hospital K Saseekaran, RMASN Ranathunga, RD YapaSurgical Unit, District General Hospital, Gampaha

PP 4: Hypercholesterolaemia in patients with symptomatic gallstonesP.PragatheswaranColombo South Teaching HospitalPP 5: Patients attitude towards participation of medical students their management in Gynaecology and Obstetrics wards in a Teaching hospital S Arthihai, Y Manjuvarne, R Rathigashini, N Vaany, W Kumudu, MVF Jayasuriya, RC Fernandopulle Faculty of Medical Sciences University of Sri Jayewardenepura

PP 6: Retrospective descriptive study on cerebera manghas poisoning in eastern province of Sri Lanka: an analysis of admissions and outcome in a tertiary care hospital, BatticaloaS Pirasath1, T Sundaresan2, G Ariaranee21Teaching Hospital Batticaloa2 Faculty of Medical Sciences, Eastern University3Faculty of Medicine, University of Colombo

PP 7: Serial serum C - reactive protein levels in the diagnosis of neonatal sepsis – A prospective studyNI Gamaathige, M Weerasekare Sri Jayewardenepura Hospital, Nugegoda

PP 8: Suicidal poisoning in batticaloa district: an analysis of admissions and outcome: professorial unit, teaching hospital.S Pirasath Selladurai1, V Jasotharany2, T Sundaresan1 1Teaching Hospital, Batticaloa, Sri Lanka2Faculty of Medical Sciences, Eastern University Sri Lanka

PP 9: Study on mobile phone usage and its impact on the psychological conditions of University students of University of Jaffna V Koculen1, S Sasikanth1, N Sivarajah2, S.Sivayokan3

1Faculty of Medicine, University of Jaffna2Consultant, WHO, Jaffna 3Teaching Hospital Jaffna

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OP 1: A pilot study of Cohort Event Monitoring in detecting adverse events following immunisation associated with Measles-Mumps-Rubella and lives attenuated Japanese Encephalitis (JE) vaccineK Sanchayan1, R Fernandopulle2, A Amerasinghe3, T S Navaratinaraja1, S Sri Ranganathan2

1 Department of Pharmacology, Faculty of Medicine, University of Jaffna.2 Department of Pharmacology, Faculty of Medicine, University of Colombo.3 Epidemiology Unit, Ministry of Health

Introduction: Recent changes in the Expanded Programme of Immunisation such as administering Measles Mumps Rubella vaccine (MMR) at 1 year and advancing the live attenuated Japanese Encephalitis (JE) vaccine to 9 months call for suitable post marketing pharmacovigilant techniques to assess their safety as pre-marketing clinical trials are poor predictors of safety. Adverse events following immunisations (AEFI) are the key safety concerns with any vaccines, and they become more important when the vaccines are given during infancy.

Objectives: The Objective of this pilot study was to determine the suitability of the Cohort Event Monitoring, (CEM) an active prospective pharmacovigilant technique in detecting AEFI occurring with MMR and JE vaccine in Jaffna District.

Methods: Over a period of 3 months in mid 2012, participants were recruited into the cohort after obtaining informed consent at the time of MMR/ JE immunisation from Jaffna and Nallur MOH area clinics. Each participant was followed up for 45 days either by home visits or through telephone interviews on day 1,3,14 and 45. Pre-tested questionnaires were used in obtaining the required data and standard pharmacovigilant tools were used in analysis.

Results: Of the 55 (MMR: 19, JE; 36) participants recruited, 52 (93%) were followed up until 45 days: 26 AEFI in 15 (79%) infants and 74 AEFI in 24 (67%) infants were detected, respectively, following MMR and JE vaccines. Except 2 infants who were hospitalized for AEFI following JE vaccine, the remainder were non serious AEFI such as fever, irritability and injection site pain. Logistics and data collection instruments were appropriate for the purpose and cooperation of mothers and support of clinic staff was encouraging.

Conclusion: To conclude, CEM is found to be suitable to administer in Jaffna District to detect AEFI following MMR and JE vaccines. Large cohort is required to detect rare serious AEFI following these vaccines

OP2: Prevalence and socio-demographic factors of malnutrition among children aged 1 to 5 years in Jaffna districtK Kandeepan 1, R Surenthirakumaran 2, S Balakumar 1, V Arasaratnam1

1Department of Biochemistry, Faculty of Medicine, University of Jaffna 2Department of Community Medicine and Family Health, Faculty of Medicine, University of Jaffna

Introduction: Malnutrition continues to be a significant contributing factor to infant and child mortality and public health problem throughout the country.

Objectives: To determine the prevalence of malnutrition among children aged 1 to 5 years in terms of wasting, underweight, stunting and overweight and to investigate some socio-demographic risk factors associated with malnutrition in Jaffna district.

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Methods: Multistage cluster sampling was used and a total of 846 children were recruited in this study. Anthropometric measurements such as height, weight, Head Circumference (HC) and Mid Upper Arm Circumference (MUAC) were used to compute age and sex specific Z scores for malnutrition based on World Health Organization (WHO) standards. Information regarding Socio-demographic factors such as age, gender, sector and details on household members were collected by using interviewer administrated questionnaires. Data were analyzed with SPSS version 16.0. The association between malnutrition and socio-demographic factors were tested using the Pearson’s Chi-squared test.

Results: Among 846 children, 414 (48.9%) were males and the mean age were 34.73 months [95 % CI (33.84, 35.62)]. The overall prevalence of wasting, underweight, stunting and overweight was 21.6, 33.1, 26.4 and 3.4 % respectively. Among the children, 8.6% had less HC-for-age, and 11.5% had less MUAC-for-age. Trend of underweight and stunting were significantly increased while overweight was decreased with age [Chi-squared for trend was applied (p<0.01)]. Mean value of the Z scores for Weight-for-height, Weight-for-age and Height-for-age were significantly higher in males than in females (p<0.05). Of this study population, 75.8% (n=641) were from rural area and had wasting (OR=2.157, p=0.001), underweight (OR=2.014, p=0.001 and stunting (OR=1.471, p=0.04) than urban children. Prevalence of overweight [5.9% (n=12)] was significantly higher in urban children than in rural children [2.3% (n=15)] (p= 0.013). Under nutrition was significantly high in children from nuclear families (59.1% (n=500) than those from extended families. Prevalence of under nutrition was significantly increased with the number of children in a household.

Conclusion: In the studied population, malnutrition was persistent and is a serious public health problem. The risk factors identified in this study confirmed the influence of socio-demographic factors on the nutritional status of children in Jaffna district.

OP 3: Descriptive study of the post graduate education plan of intern medical graduates and eliciting determining factors S R DiasDepartment of Psychiatry, Faculty of Medicine, University of Peradeniya

Introduction: Among the postgraduate medical students, many of them do start planning their higher studies by the time they commence internship. Many decide their intern appointment depending on their Post graduate plan.

Objective: To describe the postgraduate study profile and factors influencing the decision of medical graduates at the commencement of their internship.

Method: Medical graduates who commence their internship in years 2001, 2003 and 2006. Each batch of graduates had intern doctors numbering approximately 1000 of which 25-30% were sampled, with equal representation of members across the each merit list. On the day of internship appointments were delivered, trained research assistant, solicited consent to participate in the study, and from them gave oral consent were interviewed. Data were collected using a pre-tested, self reporting questionnaire.

Results: Median age of a Sri Lankan intern is 28 years, of them 40% married. More than 50% claimed to have decided the field of study. Disciplines such as Medicine and Surgery are in high frequency and preferred as first option. Disciplines such as Forensic Medicine, Psychiatry, Microbiology and Anaesthesiology were selected by default and low in rank of preference. The main reason for selection of a discipline is interest in the subject and increased patient contact. There is a significant correlation between the time

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of exposure to a field during the undergraduate studies and the probability of selecting that subject as a specialty. Cardre vacancies or Possibility of working at a tertiary center was not considered. They were unhappy about their awareness about postgraduate studies, during their undergraduate days. 60% of the graduates did not mind serving rural areas.

Op 4: An analysis of admissions and outcome of burn injuries: tertiary care hospital, BatticaloaS Pirasath, V Jasotharan , P Jeepara Teaching Hospital Batticaloa, Sri Lanka

Introduction: A high number of accidental and self-burning injuries are noted in Batticaloa.

Objectives: To describe the epidemiology, types, treatment and outcome of patients with burn injuries admitted to surgical units, Teaching hospital, Batticaloa.

Methods: Data was collected by interviewer administered questionnaires from all patients admitted with burn injuries to surgical units during the period of 1st August 2011 to 31st March 2012. Data were analyzed using the SPSS analytical package.

Results: Thirty nine of 63 victims were females. 67% of the victims were under the age of 40.73% were married. The incidence was common in rural areas (62%) than urban areas. The majority of them were Tamils (81%) but Muslims (14%) and Sinhalese (5%) were also represented. Accidental burn injuries (56%) were common than suicidal injuries (41%).Homicidal burn injuries (3%) were also reported. Traditional lamps (Nos-18) and kerosene oil cookers (Nos-9) were the main causes for accidental burn injuries. Psychological problems (6%), Alcoholism (16%) and epilepsy (3%) were risk factors for accidental burn injuries. Marital problems (Nos-14, 54%) and courtship failure (Nos-6, 23%) were mainly contributed to suicidal burn injuries. Deep burns (73%) were common than superficial burns. Almost all the patients needed strong analgesics and needed cover of prophylactic antibiotics. Skin graft (40%) was also significant mainstay of treatment. Wound infections ( 82%) were the commonest encountered problem among them.

10 (15%) died. Mortality was higher (Nos-7, 11%) for accidental burns during 2nd week of hospital stay due to infections. Marital problems and courtship failure were significantly associated with the suicidal burn injuries (P<0.05).

Conclusion: Accidental burn injuries were common than suicidal injuries. Traditional lamps and kerosene oil cookers were the main causes for accidental injuries. Marital problems and courtship failure were significantly contributed to suicidal burn injuries The Fire was a very significant causative factor method of accidental and suicidal burn injuries in Batticaloa.

Op 5: Impact of obesity on glucose and lipid profile among adults in Jaffna DistrictA Sivarathy, S Balakumar, V ArasaratnamDepartment of Biochemistry, Faculty of Medicine, University of Jaffna

Introduction: Obesity is rapidly becoming one of the most important medical and public health problems. Obesity increases the risk of developing cardiovascular diseases and diabetes.

Objectives: Aims of this study were to describe correlation between Body Mass Index (BMI) with fasting plasma glucose (FPG) and lipid profile and to describe correlation between waist circumferences (WC), hip circumferences (HC), and waist hip circumferences (WHR) with FPG and lipid profile among adults in Jaffna District.

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Methods: This was a community based cross sectional descriptive study among adults (above 18 years) in Jaffna District. Body weight, height, WC, and HC were taken in standardized methods. FPG, High Density Lipoprotein (HDL), Triglycerides (TG) and total cholesterol were analyzed by the enzymatic colorimetric assay (Hitachi 704 Clinical chemistry analyzer/Roche diagnostics). Ethical clearance was obtained from the Ethical Review Committee, Faculty of Medicine, University of Jaffna. Written consent was obtained from each participant.

The TG, HDL cholesterol levels and FPG levels were considered abnormal based on International diabetic federation definition and underweight, overweight and obesity were classified based on WHO classification for Asians (2006).

Results: Five hundred and eleven adults were selected for this study. Forty four percentages (224) of the samples were males. Hundred and twenty four subjects (24%) were overweight and among them 59% (73) were females. Twenty eight subjects (5.5%) were obese and among them 64% (18) were females. With the increase in BMI, the subjects had the risk of developing impaired fasting glucose (R2= 0.930) and DM (R2=0.998). There was positive linear relationship between BMI and raised TG level (R2=0.804).Overall, there were correlation between WC, HC, WHR with FPG in both males and females (P < 0.05). Age had correlation with TG (P=0.008) and LDL (P< 0.001) while BMI had correlation with TC (P< 0.001). Among the underweight subjects, the BMI had correlation with TG in males (P=0.037) while WHR had correlation with LDL (P=0.038) of males and with FPG of females (P< 0.001). Among the normal subjects, FPG had correlation with age (P=0.002) and WC (P=0.022) of males whereas TG had correlation with BMI (P=0.001) and FPG (P=0.001) of females. Among the overweight subjects, FPG had correlation with WC of males (P=0.035) and WHR of females (P=0.014). TG had correlated with WC (P=0.018) and WHR (P=0.013) of overweight males while with the FPG (P=0.012) of overweight females. Among the obese females BMI had correlation with FPG (P=0.016), and WHR had correlation with TG (P=0.02).

Conclusion: Subjects with increased BMI had the risk of developing IFG and DM. A positive linear relationship between BMI and raised TG level was obtained while age had correlation with TG and LDL.

Op 6: Study on demograghy and behavioral patterns of patients staying overnight for the following day clinic in the Teaching Hospital KandySR Dias1, C Dalugama2, R Higgoda2, T Amaratunga1

1Depatment of Psychiatry, Faculty of Medicine, University of Peradeniya2 Faculty of Medicine, University of Peradeniya

Introduction: Many patients seek medical treatment from clinics in the Teaching Hospital, Kandy as out patients. The number of patients attending the clinics greatly outweighs the services that can be provided by the clinics

Objective: The general objective of the research was to conduct a study on demography, behavioral patterns, concerns and complaints of these patients.

Methodology: Ethical clearance was obtained from the Teaching Hospital, Kandy. Descriptive cross sectional methodology was used in the study. Patients who were staying in the hospital premises in the night for the following day clinic were sampled. Each patient was subjected to an interviewer administered questionnaire

Results: In the study population 68% were females. The mean age of population was 47.6 years. Vast

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majority of the clinic attendees were farmers, labourers and housewives. Mean distance to the Kandy Teaching Hospital was 60km. Average family income per month of the attendee was Rs.8000/=. Average cost for a single clinic visit was Rs. 740/=. Only 42% get some place in the rest room to sleep and none of them get toilet facilities. Twenty three percent commented that they were aware of attendees being subjected to theft and 12% were aware of sexual encounters among clinic attendees. Mean duration of the clinic consultation was 7.8 minutes per patient compared to average time of 18 hours spent per clinic visit. 41% of the patients were not fully satisfied with the care received from the minor staff and nursing staff and 32%, the service provided by the doctors.

Conclusion: In conclusion vast majority of the index population were from the lower socio-economic class and the expenditure for each clinic visit was very high when compared to their income. They received very low facilities during the night stay. Health care providers should address this matter with regard to these issues and reassure better service to the patients.

OP 7: Enteric fever: Epidemiology and Surveillance in JaffnaS SivaganeshRegional Directorate of Health Services Jaffna

Introduction: Food and waterborne diseases are very common in Jaffna. According to the Epidemiology Unit, Sri Lanka, in 2011, out of 6788 reported dysentery cases 451 were from Jaffna (6.6%) and out of 1683 reported enteric fever cases 382 were from Jaffna (22.7%). In Jaffna, among 1678 reported cases of common notifiable diseases 925 were (55.1%) food and waterborne (dysentery, enteric fever and food poisoning) diseases (Epidemiology unit, 2012). A better surveillance system is vital for prevention and control of the diseases.

Objectives: Objectives of this study are to describe the epidemiology of enteric fever in Jaffna and to evaluate the surveillance activities of the disease in Jaffna.

Methods: This was a cross sectional descriptive study used all 304 field Investigation Reports (H 411) of enteric fever investigated and kept at all 11 MOH offices in 2011. All 304 H411 were brought to RDHS office on 06.02.2012. All 11 SPHII were briefed about the purpose of the study and a data extraction form was given to each SPHI. Principal investigator guided them in person with the help of a pre-prepared guide. SPHID facilitated the whole session. Informations from the H411 were taken in to the data extraction form by the respective SPHI of the MOH area. Data was analyzed with SPSS.

Results: Majorities (51.3%) of the patients were between 20-60 years of age and females (55%) while 10.5% were below 5 years. Most patients (34%) were students. Most (21%) cases were reported in Point pedro MOH area and least (3%) from Kayts MOH area. Most (34%) cases were reported in 4th quarter of the year. 1st contact institutions were mainly THJ (51%) and BHP (21%). But 53% of notifications were from THJ and 25% from BHP.

According to H411 recording around 86% presented with fever and 2% had no fever, 35% had headache, 21% had nausea and or vomiting, 21% had abdominal pain, 11% had constipation and or diarrhoea, 2% had tender abdomen, 1% had liver and or spleen enlargement, 12% had other clinical features and 7% had other morbidities

Around 72% had water sealed toilets, 62% had protected or semi protected wells, 59% drank un-boiled water, 22% had the source in living environment and 9% in working environment.

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Around 42% were confirmed by SAT, 20% clinically and or SAT and only 1% through blood culture. Only 13% had 1 or more follow up visits by PHI.

Conclusion: In the variables with low percentages, recordings were not done. This is a known limitation of usage of secondary data. Enteric fever was endemic in all MOH areas and surveillance was fairly good. If immediate supervising officers take more care about record keeping better information could be obtained for preventive activities.

Op 8: A study of paediatric patients with accidental ingestion of kerosene oil, admitted to the General Hospital Vavuniya M R G JANSZGeneral Hospital Vavuniya Sri Lanka

Introduction: Accidental ingestion of kerosene oil in children is a common problem in Sri Lanka and other developing countries

Objectives: To gauge the magnitude of this problem at General Hospital Vavuniya (GHV), to determine the common complications, to assess its management at GHV and to identify factors contributing to its occurrence with a view towards implementing preventive measures to reduce its incidence in the Vavuniya district.

Methods: A 2 year retrospective descriptive study of patients admitted to the paediatric ward at GHV during the period of October 1st 2009 to September 31st 2011. A questionnaire cum data sheet was formulated to extract information from the case notes.

Results: 77 patients were admitted to the paediatric ward with kerosene oil ingestion during the period of study. It accounted for 0.8% of total admissions. The male to female ratio of patients was 1.75:1. Children between 1 and 3 years of age accounted for 73% of the admissions. The average admission rate was 3 patients a month which peaked at a rate of 9 patients per month in August and September 2011.This was attributed to kerosene being colourless during these two months leading to children mistaking it for water. The commonest symptom encountered was cough (85% of patients), followed by vomiting (66%). The commonest complication was pneumonitis. The main risk factor identified in accidental ingestion overall was the improper storage of kerosene oil. Chest x-rays were not routinely done but only ordered when there were persistent symptoms.

Conclusion: Kerosene oil ingestion is a significant problem at GHV. The main complication seen was pneumonitis. Colourless kerosene was associated with an increase in the number of admissions during two months of the study. Chest x –rays were not necessary for routine management of patients. Parents need to be made more aware of safe storage of kerosene, as well as the need to avoid forced emesis.

OP 9: The status of Infant immunization, its documentation and the knowledge of mothers on immunization in the resettled population in the Killinochchi district.P Ananthan1, PR Wijesinghe2

1Post Graduate Institute of Medicine, University of Colombo, Sri Lanka2 Epidemiolgy unit, Ministry of health, Sri Lanka

Introduction: Immunization forms the cornerstone of prevention of childhood illnesses; the immunization status of children affected by war is unknown. A Cross sectional descriptive study was done on a sample

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of 300 children aged 12-23 months and their mothers in the resettled population in Kilinochchi district from July to November 2010.

Objectives: To assess infant immunization coverage, age appropriateness of immunization, availability and, quality of documentation pertaining to immunization and mothers’ knowledge on immunization.

Methods: A sample of 300 was selected by two stage cluster sampling. A check list and an interviewer administered questionnaire were used to collect data.

Results: Immunization coverage for infant vaccines in the national schedule was high with the exception of measles (91.7 %.). Study revealed that 91% of infants were fully immunized.

Despite a high coverage, age appropriateness of all infant vaccinations was low except for BCG (94%). Only a small proportion had been vaccinated earlier than the recommended day (0.6%-3%). A preceding delay was significantly associated with a subsequent delay in vaccination.

The completeness of data in the immunization card was high for vaccination dates and batch numbers (> 88%).But it was around 50% for AEFI data.

Knowledge of mothers was assessed on vaccine preventable communicable diseases, vaccination, AEFI, and Vaccination schedule. Having fully immunized children (P=0.02), more than 2 children

Conclusion: The study recommended the need for actively identifying partially immunized children and organizing catch-up immunization. in-service training programmes are suggested for health staff to update their knowledge on delayed preceding vaccinations, avoiding invalid vaccinations and ensuring completeness and legibility of immunization records. Public education programmes are also recommended to educate the resettling population on the need for immunization, their age appropriateness, AEFI and subsequent vaccination following AEFI.

OP 10: Effect of a herbal formulation on the incidence and severity of 15 upper respiratory symptoms in healthy volunteers: A randomized open – label controlled trial.M. R Sooriyarachchi1, C Goonaratna21Department of Statistics, University of Colombo 2 Registrar, Ceylon Medical College Council

Introduction: Many traditional preparations with varying combinations of plant products have been used for over 1500 years to treat the upper respiratory symptoms of colds and catarrh. Link Samahan is a formulation containing the extract of 14 such medicinal plants. Marketing and anecdotal evidence strongly suggested that this formulation may not only relieve upper respiratory symptoms, but also may reduce their incidence and severity.

Objectives: To determine whether taking one sachet of Link Samahan daily reduces the incidence and severity of 15 upper respiratory symptoms of colds and catarrh.

Methods: 985 healthy volunteers from MAS Linea Aqua, a garment factory, took daily for 84 consecutive days, either one sachet of Link Samahan in warm water (test group, n=465, mean age 29.5 ±7.7 years) or plain tea (control group , n=491, mean age 29.7±7.9), and recorded the incidence of 15 respiratory symptoms in a purpose – designed form. The 15 symptoms were from the Wisconsin Upper Respiratory Symptom Survey, which have been validated for reliability, responsiveness, convergence with other measures and importance to patients. Volunteers were randomly allocated to the two groups. The study was approved

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by the Ethical Review Committee of the Sri Lanka Medical Association and registered with the Sri Lanka Clinical Trials Registry.

Results: At the end of 84 days, when compared to the control group, the average incidence of symptoms in the Link Samahan group showed a highly significant reduction at pificant at psymptoms, and pd p5 for 4 symptoms, but only marginal for the balance 2.

Severity of symptoms was reduced at p h not significant at the 5 % level.

Conclusion: Our results indicate that Link Samahan taken as one sachet daily significantly reduces average incidence, incidence over time and severity of 15 upper respiratory symptoms in healthy adults

OP 11: Yellow Oleander poisoning: An analysis of cardiac toxicity, treatment and outcome in a tertiary care hospital Batticaloa. K Arulnithy, P Ahila, Anula, L Dushaiyanthy, S Pirasath, N Sathiyashakaran, N Surendrakumar Teaching Hospital, Batticaloa, Sri Lanka

Introduction:Objectives: To determine the clinical manifestations, cardiac arrhythmias, electrolytes abnormalities and outcome of management using currently available treatment in the Poisoning Unit, Tertiary Care Hospital from 1st January to 31st December 2011.

Methods: 65 patients [Mean age : 23(±0.43)yrs], (Male: Female=27:38) with yellow oleander poisoning (YOP) admitted to Poisoning Unit, Tertiary Care Hospital in Eastern Sri Lanka from January to December 2011 were involved. 12-lead standard electrocardiography (INNOMED Medical ECG machine) and 2-lead ECG monitoring were taken during the standard work up of each patient in this unit. Blood samples were collected during the standard work up of each patient.

Differences between the two groups (patients with significant arrhythmia vs. patients with insignificant arrhythmia) were analyzed with pair-wise comparisons. Baseline results are presented as counts and percentages and as mean ± SD for continuous variables. A P value < 0.05 was considered significant.

Results: Most patients were symptomatic who presented with classical symptoms of vomiting, abdominal pain and diarrhea. Cardiac dysrhythmias such as bradycardia or an irregular pulse were the most common findings on examination. Most symptomatic patients had conduction defects affecting the sinus node, the atrioventricular (AV) node, or both. Patients showing cardiac arrhythmias that required transfer for specialised management had significantly higher serum potassium concentrations. Almost all patients were treated with multiple activated charcoal even for late presentation. Patients with brad arrhythmias were treated with intravenous boluses of atropine and intravenous infusions of isoprenaline. Temporary cardiac pacing was done for those not responding to drug therapy. There were two deaths (3.07%), both had third-degree heart block. They died even through definitive treatment could be instituted. Of the remaining 63 patients, 54 (83.1%) patients required treatment, and 29 were treated with only atropine and/or isoprenaline while one required cardiac pacing in addition. 12 (18.4%) patients had arrhythmias that were considered life threatening (second-degree heart block type II, third-degree heart block and nodal bradycardia). They had good recovery even though they had developed cardiac toxicity. Multiple activated charcoals alone were safe and adequate in most cases. Treatment with atropine and isoprenaline was safe and adequate in significant cases.

Features of severe toxicity such as persistent vomiting, severe abdominal pain, neurological signs and persistent hyperkalemia has significantly associated with high risk of mortality and morbidity (P<0.05).

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The risk of cardiac toxicity did not significantly associate with number of seeds (P>0.05). Multiple activated charcoals alone were safe and adequate in most cases but it has not been proven.

Conclusion:YOP are common among young females. The cardiac toxicity develops within 24hrs of ingestion of YO seeds. The risk of toxicity has negative correlation with number of seeds. Most patients have nonspecific symptoms. AV conduction defects are common. Multiple activated charcoals alone were safe and adequate in most cases even in late presentation. Treatment with atropine and isoprenaline was safe and adequate in significant cases. Patients presenting with features of severe toxicity such as persistent vomiting, severe abdominal pain, neurological signs and persistent hyperkalemia has a risk of mortality

OP 12: Jaffna in the era of Laparoscopic Cholecystectomy: Three year experience in a single surgical unit S Rajendra, M A Anomilan, K M Niroshinee, Department of Surgery, Faculty of Medicine, University of Jaffna.

Introduction: Laparoscopic cholecystectomy is the gold standard of treatment for gallstone disease. Laparoscopic cholecystectomy is being performed in increasing numbers in Jaffna in the last few years.

Objective: To assess the clinical outcome of Laparoscopic Cholecystectomy in patients treated in the professorial surgical unit during the period of 2009 January to 2012 October.

Methods: From January 2009 to October 2012, the bed head tickets of 120 cases of laparoscopic cholecystectomy were retrospectively analyzed.

Results: A total of 120 patients who underwent cholecystectomy were included in this study. Out of 120 patients, 63 (52.5%) were females and 57 (47.5%) were males. The age ranged from 13 to 84 years, median age being 52.00 years.

Total cases of Laparoscopic cholecystectomy were 104 (86.5%). Among them 98 (81.5%) had laparoscopic cholecystectomy alone and 6 (5%) had other surgical interventions along with laparoscopic cholecystectomy.

Laparoscopic cholecystectomy was converted to open surgery in 16 patients (13.3%). Among them 14 (11.7%) had laparoscopic cholecystectomy alone and 2 (1.6%) had other surgical interventions along with cholecystectomy.

Complications during surgery were cystic duct injury 0.8% (1), GB perforation and bile leak 1.7% (2), visceral injuries 1.7% (2), and stone spillage 0.8% (1)

Median post operative hospital stay was 1.5 days.

Post operative complications were bile leak in 3 (2.5%), post operative bleeding in 1(0.8%), retained stone in 1(0.8%) and port site infection in 4 (3.3%).

Mortality as a complication in patients underwent laparoscopic Cholecystectomy was nil.

Conclusion: The parameters which concerned with laparoscopic Cholecystectomy in the above study were compared with international standards and there were no significant variations noted.

Op 13: Perforated carcinoma of the caecum presenting as psoas abscess- an unusual presentationK Saseekaran, P Pragatheeswaran, P Jayasekara National Cancer Institute of Sri Lanka, Maharagama

Introduction: Right-sided colorectal cancers usually present with mass in right iliac fossa, iron-deficiency anaemia, weight loss, intestinal obstruction and appendicitis in caecal lesions. About one-third of colorectal

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cancer presents as an emergency with obstruction or perforation. But there are unusual modes of presentation as well. Rare presentations of cancers are difficult situations to the surgeon as well as to the patient.

Objectives: To report an unusual presentation of the carcinoma of caecum

Results: A previously well 62 year old woman presented with a discharging sinus in the upper part of the anterior aspect of the right thigh of one week duration. An ultra sound scan identified a psoas mass on right side which is infiltrating the ascending colon. Colonoscopic biopsy confirmed a caecal adeno carcinoma.

She underwent exploratory laparotomy and revealed a tumour arising from caecum. Tumour had perforated posteriorly and eroded into the posterior abdominal wall. Perforation and tumour necrosis had caused passage of bowel contents and pus; tracking anterior to the psoas muscle and pointing out side on the upper part of the anterior aspect of the right thigh. Right hemicolectomy was performed and debridement of posterior abdominal wall and excision of fistula tract was done.

Psoas abscess as a mode of presentation is unusual and has an insidious characteristic. Even in those cases with contamination from the gastrointestinal tract, the course appears relatively benign. Retroperitoneal abscess rarely results from perforation of the colon as most perforations occur into the peritoneal cavity. Those that perforate into the retroperitoneum rarely result in formation of a psoas abscess.

Conclusion: Carcinoma of the caecum can unusually present as right psoas abscess.

OP 14: Study of fecal contamination in ice creams sold in moh areas of Jaffna & NallurY Abhiramie1, R Shampika, 1 N Sivarajah3, K Murugananthan31 Faculty of Medicine, University of Jaffna2 WHO, Jaffna , Sri Lanka 3Department of Pathology, Faculty of Medicine, University of Jaffna

Introduction: Ice cream is a popular food consumed by all most all the people. Depending on production methods, storage facilities and safety handling, ice cream is more prone to get contaminated. Ice cream can be microbiologically analyzed by using the methods that are applicable to drinking water.

Objectives: This study aimed to determine and assess the level of the fecal contamination in ice cream vendors sold in MOH areas of Jaffna and Nallur and to compare the association of contamination related to place of production, site of production, method of storage in selling points, type of storage device and type of selling point.

Methods: This was a laboratory based experimental study of faecal contamination in Ice-creams. Fifty four samples were collected from selling points in MOH areas of Nallur and Jaffna and analyzed for Total Bacterial count (TBC), Probable Coliform count and Escherichia Coli count by using the method used for identification of faecal contamination in water.

Results: TBC showed a range from 7.5 x 103 to 3.758 x106 cfu/g, with the mean of 5.18 x 104 cfu/g and median of 3.64 x 104 cfu/g. 22.2% of all samples exceeded the Sri Lankan Standards for ice creams (5.0 x 104 cfu/g). Coliform count was between 0 to 32 in the unit of Most Probable Number per gram (MPN/g), with the mean of 2.8 MPN/g and median of 1.2 MPN/g. All the samples conformed to Sri Lankan Standards (100 MPN/g). Majority 29 (53.7%) of samples showed contamination for E.coli, thus exceeded the limits of Sri Lankan Standards (0 cfu/g). Among the factors studied for association for contamination, place of production (Jaffna), Method of Storage (Bulk and popsicles) and Type of storage (Deep Freezer) were significant at p value 0.05 level.

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Conclusion: This study reveals the status of contamination with E.coli in ice creams. This possible contamination may be a possible route to transmit the enteric pathogens to the community.Hence, public health authorities have to pay more attention in the food safety methods.

OP 15: Study on women with colles fracture- a single unit experienceK Saseekaran, NWBKH de Silva, MKC Mendis, PDGMC de Almeida Colombo South Teaching Hospital, Kalubowila

Introduction: Colles’ fracture is the commonest fracture seen in post menopausal women who fall on outstretched hand. Osteoporosis is an associated factor and early menopause increases the early occurrence of osteoporosis associated fractures. Association between side of fracture and hand dominance is important because the disability is more when dominant side is fractured.

Objectives: To check the association between early menopause and presenting age. To check the association between the side of fracture and hand dominance.

Methods: A descriptive study of women admitted with Colles fracture to the accident service of Colombo south teaching hospital, Kalubowila from 1st of July 2011 to 31st of October 2011 was carried out. Age, age at menopause, side of fracture and hand dominance were analyzed.

Results: Fifty nine women with a median age of 62 years (range 31-85 years) were studied. Twenty eight (47%) women had reached menopause under the age of 45 years. Early menopause was not significantly associated with age at presentation with Colles fracture (menopause<45 group - mean age= 63.6 years: SE= 3.522 versus menopause>45 group- mean age= 61.06 years: SE= 1.625; t= 0.679, P= 0.491). Fifty three were right handed (90%). Majority of fracture observed on the left side (63%; n= 37). Among the patients with left sided fracture 33 were right handed (62% of right dominants) and 4 were left handed (67% of left dominants). Hand dominance and side of the fracture were not significantly associated (χ2=1.264, P= 0.531).

Conclusion: There is no significant association between early menopause and age at presentation in this study group. Colles fracture was commonly observed on the left side with no relation to hand dominance.

List of Poster Presentations

PP 1: Lung functions among Traffic and Non-traffic police officers in Colombo DivisionL K Hirimuthugoda1, SPK Wathudura1, H Edirimanna2, HPMadarasingha3 WLS Mahapitiya3

1Base hospital, Elpitiya2 Provincial Director of Health Services- Southern province3 Teaching Hospital , Kegalle

Introduction: Police officers spend much of their working hours on the roads exposing themselves to polluted air and thus at a higher risk of developing impairment in respiratory functions. Among them, traffic police officers are the people who work in heavy traffic roads in the capital city Colombo during most of their hours.

Objective: The aim of this study was to compare lung function among traffic & non traffic police officers

Methods: Lung function of 100 Traffic police officers and 100 Non traffic police officers randomly selected from the Colombo division was assessed. Self administered questionnaire was used to gather socio-economic data and respiratory symptoms and anthropometric parameters were measured. Respiratory functions were measured using the mini-spirometer.

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Results: The traffic police officers (100, males) and non traffic police officers (100,males) were comparable in age and body mass index to non traffic police officers. Traffic police officers had a significantly reduced FEF 75%value(mean+/-SD,6.04+/-2.83versus6.23+/-2.43,p=0.041),FEV1(p=0.008),FVC(p=0.001),FEV1/FVC ratio,PEFR(p=0.001). There was no significant difference between two groups in other lung function parameters [FEF25%(p=0.13),FEF50%(p=0.37),MMEF(p=0.38)].There was also a significant difference in the prevalence of eczema (p=0.022)and allergic rhinitis (p=0.009) among the two groups with higher prevalence among traffic police officers.

Conclusion: The findings suggest that there is an association in lung function deterioration in traffic police officers when compared to non traffic police officers possibly due to their more exposure to polluted air and prevalence of eczema and allergic rhinitis were also high among traffic police officers

PP 2: The role of perceived self efficacy in dengue vector control activities among residents of Kundasale Medical Officer of Health areaRDL RangamaTeaching Hospital, Kandy

Introduction: Dengue is a fatal vector borne, viral infection endemic in Sri Lanka. Aedes aegypti and Aedes albopictus are common vectors in Sri Lanka. Public perceive changing their behaviour to control dengue vector breeding sites is a challenge. Bandura proposed that Perceived Self Efficacy (PSE) is an internal determinant and predictor of the human behaviour in response to challenges in life events.

Objectives: To determine the role of PSE in dengue vector breeding site control activities among residents in Kundsale MOH area.

To describe the association between Perceived self efficacy and sociodemographic characteristics, knowledge and level of positive influence on breeding site control.

Methodology: A descriptive cross sectional study. A sample of 600 residents was selected from households in Kundasale MOH area by method of cluster sampling of population proportionate to size. A questionnaire with Perceived Self-Efficacy Scale and a check list of potential dengue breeding sites in the household was completed by the respondent with the assistance of the interviewer

Results: A statistically significant negative correlation appeared between the PSE scores and container index at house hold level (r= -0.176). Container Index (CI) was 3.6%, House Index (HI) was 22.5% and Breteau Index (BI) was 39.3%.Median score of PSE was 64.%. PSE significantly associated with HI (P

Conclusion: The perceived self efficacy is possibly an important determinant of dengue vector breeding site control.

PP 3: Audit of workload and resources of a newly established endoscopy unit in a District General Hospital K Saseekaran, RMASN Ranathunga, RD YapaSurgical Unit, District General Hospital, Gampaha

Introduction: Gastrointestinal endoscopies are usually performed in dedicated endoscopy day units with adequate equipments and specially trained staff. An audit of such facility is vital for resource allocation, improving existing services and development of new services.

Objectives: To see the work load and to assess the adequacy of resources of newly opened endoscopy unit at the District General Hospital, Gampaha.

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Methods: All procedures in the endoscopy unit, District general hospital, Gampaha from the day of opening on 1st April 2012 to 30th September 2012 were prospectively documented. Man power, operating hours and facilities available to perform the procedures were analyzed. A comparison was made with the report of a working party of the British society of gastroenterology endoscopy committee published in 2001 regarding the provision of endoscopy related services in district general hospitals in UK.

Results: Total number of endoscopies performed was 503(weekly average 20). Procedures were Oesophagogastroduodenoscopy 228(45%), Flexible sigmoidoscopy 208(41%) and Colonoscopy 67(14%). All endoscopies were performed by 2 General surgeons, 1 ENT surgeon, 1 Physician and 2 surgical registrars. There were only 2 specially trained nurses undertaking administrative and clinical work. No minor employee was separately allocated to the unit. Unit functions 40 hours a week. One Oesophagogastroduodenoscope, 1 flexible sigmoidoscope and 1 colonoscope are only available to perform all procedures. The area available for all procedures is a 144 square feet room.

Conclusion: Resources to run the newly established endoscopy unit in District general hospital, Gampaha are inadequate; particularly in terms of supporting staff, equipments and space. But the unit is functioning adequately with limited resources. This should be taken into account when allocating resources and setting up a new endoscopy unit.

PP 4: Hypercholesterolaemia in patients with symptomatic gallstonesP.PragatheswaranColombo South Teaching Hospital

Introduction: Gallstone disease is common in Sri lanka. Although there are anecdotal reports of the high incidence of hypercholesterolaemia among patients with symptomatic gallstones, little published data are available on this subject. Cholesterol is exclusively excreted in bile and it is also known that cholesterol is a constituent of gallstones. It seems logical to assume that patients with hypercholesterolaemia may therefore, form gallstones more frequently, than those with normal serum cholesterol, and this would be reflected as a higher incidence of hypercholesterolaemia among patients with symptomatic gallstones.

Objectives: To determine the incidence of hypercholesterolaemia in patients with symptomatic gallstones

Methods: A descriptive observational study was done to see the preoperative serum cholesterol level of patients admitted to a single surgical unit.

Results: There were 33(100%) patients with a mean age of 48.75 years. 6(18.18%) patients were known to have hyperlipidaemia and 12(36.36%) patients were newly found to have high serum cholesterol levels. 5(15.15%) of them were less than 40 years old. The lowest recorded cholesterol level was 118mg/dl.

Conclusion: More than 50% of patients with symptomatic gallstones have higher than reference range serum cholesterol levels in Sri lanka. Serum cholesterol estimation in patients with symptomatic gallstones helps to find new cases of hypercholesterolaemia. Maximum level of serum cholesterol associated with no risk of gallstone formation is less than 118.2mg/dl in this study. However, large scale study with ultrasound examination of asymptomatic patients and biochemical analysis of retrieved gallstones is likely to throw more light upon this subject.

PP 5: Patients attitude towards participation of medical students their management in Gynaecology and Obstetrics wards in a Teaching hospital

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S Arthihai, Y Manjuvarne, R Rathigashini, N Vaany, W Kumudu, MVF Jayasuriya, RC Fernandopulle Faculty of Medical Sciences University of Sri Jayewardenepura

Introduction: A vital component of medical undergraduate education is learning through interaction and direct contact with patients and a patient’s willingness to involve students in his or her care is important..

Objectives: To describe patients’ attitude towards undergraduate medical students taking gynaecological and obstetric history and performing examination and clinical procedure

To describe the association of factors with the attitudes of the patients towards medical students’ participation in patients’ management at gynaecological and obstetrics wards in CSTH

Methods: A descriptive cross sectional study involving 384 patients in three obstetrics and gynaecology wards of Colombo South Teaching Hospital. Self administered questionnaire was administered in the mother language of patients.

Results: Almost all patients (99.2%) believed that proper training of medical students is important and most of them (88.2%) feel that both parties benefit equally by the presence of medical student in their management. However, 15% of them felt their privacy was affected by the presence of medical students, 6.5% that felt students did not obtain consent and 13.4% of the time an explanation was not given prior to examination . Although 97% of male students had a female chaperon during examination, where it’s expected to be100%. There is an overall preference for female students over male students in this setting and younger patients and the primipara were more likely to be sensitive to the students’ gender.

Conclusion: Majority of patients in this study had more positive attitude towards medical students and felt comfortable in interactions with them. However it is necessary to insist that basic ethical standards of a doctor patient relationship are maintained by all medical students in interactions with patients.

PP 6: Retrospective descriptive study on cerebera manghas poisoning in eastern province of Sri Lanka: an analysis of admissions and outcome in a tertiary care hospital, BatticaloaS Pirasath1, T Sundaresan2, G Ariaranee2

1Teaching Hospital Batticaloa2 Faculty of Medical Sciences, Eastern University3Faculty of Medicine, University of Colombo

Introduction: Self-poisoning with plant seeds or fruits is a common method of self-harm in South Asia. While most deaths follow ingestion of Thevetia peruviana (yellow oleander) seeds, other plants are locally common. We noted cases of self-poisoning with Cerbera manghas (CM) (sea mango, pink eyed cerbera, odollam tree) fruits in Eastern Province.

Objectives: We carried out a retrospective study to determine the clinico - epidemiology, treatment and outcome of patients with Cerebera Manghas (CM) self poisoning in Batticaloa Teaching Hospital.

Methods: We reviewed the Bed Head Tickets of all patients and collected data on all cases with CM self poisoning admitted to Batticaloa Teaching Hospital, during the period of 1st January 2011 to 31st May 2012 by using predesigned questionnaires, retrospectively.

Results: There were 24 patients [Mean age: 20(±0.43) yrs], (Male: Female=16:8) with CM self poisoning. Sixteen (67%) of them were unmarried. The majority of patients were Tamils (20, 83%), but Muslims (4, 18%) were also involved. Thirteen (54%) of them had ingested half a seed. Most of the patients were

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symptomatic with classical symptoms of vomiting (24, 100%), dizziness (12, 50%) and abdominal pain (10, 42%). Cardiac dysrhythmias such as bradycardia or an irregular pulse were the most common findings on examination. ECG findings showed 10 Heart block (5, 21%), 20 heart block(Type I:II)( 3,13%: 4,17%),Complete heart block(5,21%) and sinus bradycardia (4,17%). A normal ECG was found only in 3 (13%) patients. Four (17%) of them had significantly higher serum potassium concentrations (6.0-6.9mmol/ L). Three patients had life threatening hyperkalemia (>7.0mmol/ L). Eighteen (75%) of them had cardiac arrhythmia that required transfer to the Poisoning Unit for specialized management.

Almost all patients were treated with multiple activated charcoals. Patients with bradyarrhythmias were treated with intravenous boluses of atropine and intravenous infusions of isoprenaline. Temporary cardiac pacing was inserted in three (13%) of them who had not responded to drug therapy. There were four deaths (17%), who had third-degree heart block and life threatening hyperkalemia. They died before even definitive treatment could be instituted. Others had good recovery even though they had developed cardiac toxicity.

Conclusion: Cerbera manghas (CM) self poisoning was common among young unmarried males in Batticaloa district of the Eastern Province. The risk of toxicity seems to have a negative correlation with number of seeds. Most patients had nonspecific symptoms. AV conduction defects are common. Multiple activated charcoals alone were safe and adequate in most cases. Patients presenting with features of severe toxicity has a greater risk of mortality.

PP 7: Serial serum C - reactive protein levels in the diagnosis of neonatal sepsis – A prospective studyNI Gamaathige, M Weerasekare Sri Jayewardenepura Hospital, Nugegoda

Introduction: Neonatal sepsis is a significant cause of neonatal morbidity and mortality and its diagnosis is one of the major challenges in neonatal medicine. Early detection and treatment however, will help in improving the outcome. C-reactive protein (CRP), an acute phase protein, has been evaluated in the diagnosis of neonatal sepsis

Objectives: To assess the correlation between serial C-reactive protein (CRP) levels and clinical sepsis in neonates

Methods: Neonates with suspected sepsis were recruited for the study. Serum CRP levels were obtained on three occasions that is at 0 hours (before starting antibiotics), 12-24 hours after the first sample and 24 hours after the second sample. Neonates were categorized as proven sepsis, probable sepsis and no sepsis without considering the CRP level. Sensitivity, specificity, positive predictive value(PPV) and negative predictive value(NPV) were calculated for first, second, highest of the second and third and all three CRP levels. Proven or probable sepsis was strongly correlated with elevated CRP levels (>6mg/dl) in all testing strategies.

Results: Sepsis was suspected in 65 neonates. There were five episodes of proven sepsis, 27 of probable sepsis, and 33 of no sepsis. For the proven or probable sepsis, the sensitivity was only 45.2% for the CRP#1 and 68.4% for the CRP#2. However, it rose to 90.6% when all three CRP levels were combined together. The specificity was highest (97.1%) for the CRP#1 and there was no significant difference for other testing strategies. PPV ranged between 81.2% to 93.3% for either proven or probable sepsis. NPV, however were highest (90.9%) for both groups of CRP #*3 and CRP #2 and #3 when compare to CRP#1 alone (66%).

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Conclusion: Serial CRP levels are more reliable in evaluating neonatal sepsis when compared to a single CRP level.

PP 8: Suicidal poisoning in batticaloa district: an analysis of admissions and outcome: professorial unit, teaching hospital.S Pirasath Selladurai1, V Jasotharany2, T Sundaresan1 1Teaching Hospital, Batticaloa, Sri Lanka2Faculty of Medical Sciences, Eastern University Sri Lanka

Introduction: A high number of accidental and self-burning injuries are noted in Batticaloa.

Objectives: To determine the epidemiology, methods, treatment and outcome of patients with suicidal poisoning admitted to single medical unit, Teaching Hospital, Batticaloa.

Methods: Data was collected by interviewer administered questionnaires from all patients with suicidal poisoning admitted to single medical unit during the period of 1st December 2011 to 31st May 2012. Data were analyzed using the SPSS analytical package.

Results: Seventy two out of 120 victims were females and 61.6% were in the 20-29 years age range. 78 victims were unmarried. The majority were Tamils (Nos-105), but Muslims (Nos-15) were also involved. The suicidal ideas are common among Hindus (76.6%) when compared to Christian and Muslim population. Most had courtship failure (Nos-45, 37.5%) for their suicidal attempts. Marital (17.5%) , social (10%), economical (20%) and family problems (8.33%) were also contributed for the suicidal attempts. Young girls (Nos-12) had previous attempted suicidal poisoning to threaten their partners. The strong family history of poisoning (Nos-32, 26.6%) influenced the people to select poisoning as the suicidal method. The Yellow oleander (50%), Cerberus Magus (3.3%), Organophosphate (30%), Kerosene oil poisoning (6.7%) and drug overdose (10%) were the common encountered poisoning. The gastric decontamination (76%) was the principal stay of treatment in most cases. Four victims ended up in death. Courtship failure Economical and marital problems were significantly associated with suicidal poisoning (P<0.05). The strong familial history and previous attempts of poisoning were significantly associated with suicidal poisoning (P<0.05).

Conclusion: Poisoning was common among young unmarried females who attempted suicide. The Oleander poisoning was a method of poisoning in Batticaloa. The courtship failure and marital problems were the main contributing factors. The previous and familial suicidal poisoning attempts led the victims to select poisoning as suicidal method.

PP 9: Study on mobile phone usage and its impact on the psychological conditions of University students of University of Jaffna V Koculen1, S Sasikanth1, N Sivarajah2, S.Sivayokan3

1Faculty of Medicine, University of Jaffna2Consultant, WHO, Jaffna 3Teaching Hospital Jaffna

Introduction: Mobile phones have merged into the day to day life events as comforting and communicating tools, preferentially by the digital friendly young population. Despite the beneficial aspects, negative impacts on the general health of mobile users have been constantly debated.

Objectives: The prime objective is to analyze the Impact of Mobile Phone Usage on the Psychological conditions of students of University of Jaffna.

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Methods: A total of 278 second year students were randomly selected from 15 streams of study using a population proportionate sampling technique. Self administered questionnaire was used, which comprised of tools such as Rosenberg self esteem scale, Athens Insomnia Scale and a modified Mobile addiction test respectively for analyzing the psychological indices of self esteem, insomnia and mobile addiction.

Results: 50.4% had mobile addiction, which was significantly associated with male sex, high levels of mobile usage per day, faculty of study and late night mobile induced sleep disturbance. 81.6% of the respondents had low self esteem which also had significant relationship with the sex of the participant and the faculty of study. 77.1% were insomniacs according to Athens Insomnia score, which also had significant associations with sex of the participant, late night Mobile Phone usage, District of university entrance and the Faculty of study. Sex related problems were significantly related to the tendency of developing new relationship and responding to anonymous contacts over mobile phone.

Conclusion: The study reveals a significant risk posed by mobile use in the psychological outcomes of its users. It deems worthy for the parents, teachers, mental health professionals and the students to pay more attention to the problematic mobile phone use.

01. Mega Pharma Pvt Ltd

02. Roche Pharmaceuticals

03. Sun Pharma Pvt Ltd

04. Ceymed Hospital Services Pvt Ltd

05. Kiss International Pvt Ltd

06. Pharma Associates Pvt Ltd

07. Hemas Pharmaceuticals Pvt Ltd

08. Cic Holdings Plc

09. Harcourts Pvt Ltd

SponsorsThe Jaffna Medical Association acknowledges the following

sponsorships with gratitude

10. J.l. Morison Son & Jones (Cey) Plc

11. A. Baur & Co. (Pvt) Ltd

12. Glaxo Smithkline Pharmaceuticals

13. Abc Pharma Services

14. Sanofi Pvt Ltd

15. Servier Pharmaceuticals Pvt Ltd

16. Usv Pharmaceuticals Pvt Ltd

17. Swiss Biogenics Limited

18. Ranbaxy