I am greatly privileged to be elected as the 47th

president of the Kandy Society of Medicine (KSM)

for the year 2016 /17. . I pledge that I carry out my

duties as the new President to the best of my ability for

progress of the society.

The Kandy Society of Medicine was formally

established as a society in 1963in the central hill capital.

It had taken a major role in enhancing knowledge skills

and attitudes of the Medical profession. The KSM had

reached out to the society in uplifting the same in all

strata of healthcare workers as well as the public.

We shall be continuing the routine academic

programmes, such as the very popular Wednesday CME

program. Along with the council I hope to promote

multidisciplinary approach in healthcare through the

CME program. In this respect, it would make an arena

for all grades of medical officers as speakers to share

their experiences and disseminating their knowledge. A

series of Specialty Updates to cover all branches of

medicine also will be carried out.

Our academic programme will target all grades of

doctors, and postgraduate students, and we would

encourage doctors taking up postgraduate studies. I

thank the previous councils for arranging the live

webcast of the CME programme in Kandy to

Peradeniya and Kegalle and I am happy to announce

that Nawalapitiya joined us this February.

The Message from the President

Having listened to two excellent orations during the annual

academic sessions 2016 the council wishes to carry out the

messages delivered by the orators. In this regard I’m happy

to announce the first regional clinical meeting arranged at

Anuradhapura along with the “World Kidney Day”

programmes in the management of chronic kidney disease

of unknown origin.

The Sri Lanka Journal of Medicine, the official publication

of the KSM, belongs to you all and I greatly appreciate your

contributions to the journal to make it a both nationally and

internationally popular indexed journal during the past year.

I greatly appreciate the very hard work of Prof Sudheera

Kalupahana and DrHeshan Jayaweera towards the journal.

I wish to thank Dr. Shenal Thalgahagoda and Dr. Pathum

Dissanayake who readily agreed to compile a regular

newsletter and Dr. W Somasiri for his valuable advice.

Finally I take this opportunity to thank the immediate Past

President Prof. Rathnathunga, her council and all the past

Presidents and their councils of the Kandy Society of

Medicine for their invaluable contribution, which has made

the KSM what it is today.

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The KSM oration

Professor Neelakanthi Ratnatunga The

President 2015/2016 Presenting the

Medal to Dr Rajewva Dasanayake

(Consultant Nephrologist) who delivered

the KSM oration at the annual academic

sessions of the KSM February 2016.

Dr R M Mudiyanse (Consultant Paediatrician)

delivered the Bibile memorial oration at the

annual academic sessions of the KSM -

February 2016

The 38th Annual Academic Sessions February 2016

The 38th

Annual Academic Sessions of the Kandy Society of

Medicine were held from the 11th

to the 13th

of February 2016 at

the Plant Genetic Resources Centre at Gannoruwa. The theme for

this year was ‘Medicine without boundaries’, aiming at reaching

out to all.

The inauguration ceremony was held on the 11th

of February.

Prof. Sudarshan Seneviratne, former High Commissioner for Sri

Lanka to India and former Professor of Archeology at the

University of Peradeniya was the chief guest while Dr. Ruvan

Ekanayaka, Senior Consultant Cardiologist was the guest of

honour.

Prof. Seneviratne gave an interesting account of the

refurbishment process of Galle fort in his address titled ‘Heritage

beyond borders: Revitalisation of the Galle fort world heritage

site’. Dr. Ekanayaka spoke about medicine in ancient Sri Lanka in

his address which captivated the audience.

The inauguration ceremony culminated with the Kandy Society of

Medicine oration which was delivered by Dr Rajeeva Dasanayake,

Consultant Nephrologist. The oration titled ‘Kidney disease in the

North Central Province of Sri Lanka: Beyond the aetilogy’ gave

new insight into the current problem in the NCP. It was indeed

thought provoking and projected new avenues that need to be

looked into.

The Bibile memorial oration was delivered this year by Dr R M

Mudiyanse, Consultant Paediatrician and Senior Lecturer in

Paediatrics at the Faculty of Medicine, Peradeniya. Dr

Mudiyanse’s oration titled ‘Teaching beyond knowledge and skills

for the needs of society’ was well received by the gathering.

The academic programme composed of many interesting guest

lectures and symposia covering a wide range of topics. Free

paper sessions comprised 72 oral presentations and 53 poster

presentations.

The annual sessions were a great success and best wishes go out

to the President Prof NeelakanthiRatnatunge and her council for

a job very well done.

Update on Interstitial Pneumonia Dr D L B Dassanayake, Consultant Respiratory Physician,

G H Ampara

Interstitial lung diseases are a heterogeneous group of disorders which involves lung parenchyma. They are classified into three main groups in the latest international classification given below. Revised American Thoracic Society/ European Respiratory Society Classification of idiopathic Interstitial Pneumonias 2013 Major idiopathic interstitial pneumonias

Idiopathic pulmonary fibrosis (IPF/UIP)

Idiopathic nonspecific interstitial pneumonia (NSIP)

Respiratory bronchiolitis–interstitial lung disease (RBILD)

Desquamative interstitial pneumonia (DIP)

Cryptogenic organizing pneumonia (COP)

Acute interstitial pneumonia (AIP) Rare idiopathic interstitial pneumonias

Idiopathic lymphoid interstitial pneumonia (LIP)

Idiopathic pleuroparenchymal fibroelastosis

Unclassifiable idiopathic interstitial pneumonias Out of these Non Specific Interstitial Pneumonias (NSIP) are an interesting group due to its good prognosis. NSIP accounts for 14%-36% of cases of idiopathic interstitial pneumonias. Etiology Most are NSIP cases are idiopathic. It is the commonest manifestation of collagen vascular diseases in lung and may proceed the diagnosis by months. In polymyosistis , mixed connective tissue disease and ,systemic sclerosis – NSIP pattern is common but in rheumatoid arthritis ,SLE and Sjogrens syndrome other patterns are common however NSIP pattern is also described. Drugs such as flecainide, amiodarone, methotrexate, nitrofurantoin, statins, and chlorambucil can cause NSIP. Hypersensitivity pneumonitis, diffuse alveolar damage and HIV are other causes of NSIP. Therefore its challenging for the clinician to exclude these secondary causes before diagnosing idiopathic NSIP. Most will present with exertional shortness of breath.Some may have the clinical features of the underlying systemic disease. There are two distinct pathological types whose prognosis also differ significantly. 1. Cellular NSIP: Uniform alveolar septal infiltrate of mononuclear cells 2 .Fibrotic NSIP: uniform collagen accumulation in alveolar septa, peribronchiolar interstitium, interlobular septa or visceral pleura HRCT scan of chest which is a key tool in investigation of patients with interstitial lung diseases will show ground glass opacities predominantly. Septal thickening and honey combing are less common features. Accuracy of HRCT for the discrimination between NSIP and UIP is 66% Treatment Secondary NSIP is managed by treating the underlying disease and removing the offending drug. There isn’t much data on specific treatment options. For idiopathic NSIP steroid is the main stay. Duration of treatment is usually one year. If relapses occur, second line agents (azathioprine, cyclophosphamide and cyclosporine) needs to be given. Lung transplant is an option for patients with severe disabling lung disease. Prognosis of NSIP is much better than in IPF and relapse is

uncommon.

UPDATE IN RESPIRATORY MEDICINE UPDATE IN INTERSTITIAL LUNG DISEASE 17/02/2016 Dr. Dinesh Dassanayaka Consultant Respiratory Physician - GH – Ampara CASE BASED DISCUSSION Dr. Punyajeewa Athukorala Senior Registrar in Respiratory Medicine - TH Kandy Dr. Buddika Gurunayaka Senior Registrar in Radiology - TH Kandy

PLATELET RICH PLASMA (PRP) FOR HAIR LOSS AND FACIAL REJUVENATION

24/02/2016 Dr Sanjeewani Fonseka (MBBS, MD, FAM) Consultant Dermatologist Lecturer Department of Pharmacology Faculty of Medicine University of Peradeniya

CME Lectures - February 2016 3

Platelet rich plasma in dermatology

Dr Sanjeewani Fonseka Platelet rich plasma (PRP) is high concentration of autologous platelets suspended in a small amount of plasma after centrifugation. It is high in various growth factors such as platelet-derived growth factor (PDGF), transforming growth factor (TGF), vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF) etc. Once injected to dermis these growth factors increase the proliferation of dermal fibroblasts, collagen and blood vessels. Because of that PRP is used in various dermatological conditions and among those are androgenetic alopecia, skin rejuvenation, acne scars, wound healing, striae and lichen sclerosus. Preparation of PRP should be done in a proper way for it to be effective and there are different methods of preparing it. There is no single protocol for the procedure and the level of evidence from the available published data is low for its long term efficacy and safety. However PRP seems to be a promising therapeutic modality to treat various types of dermatological conditions and its use in other branches of medicine is also expanding.

Upcoming events

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It is with great pleasure that we undertook the task of compiling a regular E- newsletter as a new addition to the services provided by the Kandy society of Medicine to its' members. The need of a new media to communicate with the KSM members was highlighted by Dr Anoma Siribaddena and as a result, the KSM E-newsletter emerged. We hope to compile a newsletter every month highlighting the events carried out by the KSM membership during that month as well as keep you in touch with upcoming events. We warmly welcome any comments or suggestions which would aid us in making our newsletter a success.

Dr Pathum Dissanayake Dr Shenal Thalgahagoda Consultant Paediatrician Consultant Paediatric Teaching Hospital, Peradeniya Nephrologist Teaching Hospital, Peradeniya

Message from the editors

World TB Day program

AN UPDATE IN TUBERCULOSIS

Microbiology and Diagnosis of Tuberculosis Dr. Dammika Vidanagama Consultant Microbiologist

National Program for TB control

Pathophysiology and Management

Dr. Neranjan Dissanayaka Consultant Respiratory Physician

GH Nuwaraeliya

Prevention of Tuberculosis

Dr. (mrs) Anoma Siribaddana Consultant Respiratory Physician

TH Kandy

On 23rd

Wednesday March 2016 At PMCK Auditorium

02/03/2016 SEPSIS- UPDATE Dr. S. Kiriwattuduwa Consultant Anesthetist Dr. Tharaka Wijerathne Senior Registrar in Anesthesia Dr. Nawam Kumarasinghe Senior Registrar in Surgery Dr. Wasana Kudagammana Senior Registrar in Microbiology

09/03/2016 Osteoporosis : Diagnosis and Management Prof. Sunil Wimalawansa Professor of Medicine and Endocrinology 16/03/2016 Nuclear Medicine Imaging for better patient care Dr. J M C Udugama Specialist in Nuclear Medicine