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THE SRI LANKA MEDICAL ASSOCIATION

133rd Anniversary International Virtual Medical Congress

“Professional Development for Quality Enhancement of Healthcare: Beyond the COVID-19 Pandemic”

24th – 26th July 2020

THE SRI LANKA MEDICAL ASSOCIATION

133rd Anniversary International Virtual Medical Congress

“Professional Development for Quality Enhancement of Healthcare: Beyond the COVID-19 Pandemic”

24th – 26th July 2020 No. 06, Wijerama Mawatha, Colombo 07

iii

CONTENTS

Message from the President 01

Message from the Honorary Secretary 02 Message from Hon. Minister of Health and 04 Indigenous Medical Services Message from the Secretary – Ministry of Health & Indigenous 05 Medical Services

Message from Director General of Health Services 06

Message from the Guest of Honour 07

The Sri Lanka Medical Association Council 2020 08

The Steering Committee 10

Programme at a Glance 12

Programme in Detail 15

Orations 38

Faculty 45

Summary of Presentations 52

List of Oral Presentations 69

List of Poster Presentations 75

Partners and Sponsors 04

iv 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

MESSAGE FROM THE PRESIDENT SRI LANKA MEDICAL ASSOCIATION

dented degree of uncertainty worldwide. Experts predict that life now would not be the same as in the pre-COVID era. Continuing Medical Education (CME) and Continuous Professional Development (CPD), are

not exceptions in this regard. The digital and technological transformation of CME and CPD is accelerated due to the challenges of adapting to the post-COVID New Normal.

The SLMA took a bold decision to go ahead with the congress considering our responsibility towards CPD and CME. This congress may be the only opportunity for medical professionals, allied health professionals

and students in Sri Lanka to present their research

findings at an international conference during 2020.

Pre-conference workshops, a Keynote Address, Sym- posia and Guest Lectures have been planned, consid- Professor Indika Karunathilake ering the need to adapt to the New Normal. In the process of developing policy and regulatory frame- works and public health interventions, the SLMA has In April 2005, SLMA NEWS, the Newsletter of the Sri utilized the expertise within itself, to bring together Lanka Medical Association carried the Editor’s note, multiple stakeholders on to a single platform. The “SLMA Sessions Totally Virtual - A Dream or Reality”. congress will give us an opportunity to listen to, en- That prediction I made 15 years ago, as the then Edi- gage with and learn from experts and practitioners tor of the SLMA, has now become a reality. Tthe on best practices adopted to mitigate these challeng- 133rd Anniversary International Medical Congress of es. the Sri Lanka Medical Association is being held as a virtual on-line conference from 24th to 26th July 2020, The challenges faced when organising this year’s con- and webcast worldwide from the historic Wijerama gress were immense, including the acquisition of House in Colombo. hardware, training human resources, availability of low cost/free software solutions. This was complicat- Established in 1887, the SLMA is the oldest profes- ed further by the current global and national financial sional medical association in Asia and Australasia. It crisis. My heartfelt gratitude goes to everyone who has contributed immensely towards the betterment contributed towards the success of the congress, in- of health of the nation over the years. During this cluding the Guests of Honour, the Resource Persons, global COVID-19 pandemic, the SLMA helped to con- Organizing Committee, SLMA staff, sponsors and very tain the spread of COVID-19 in Sri Lanka by creating specially, all the participants. awareness among the public and by playing a pivotal role in the formulation of interim guidelines for With over 400 registered participants, and the exper- screening and management of patients. It has taken tise provided by local and international resource per- a lead in advocacy initiatives of safety protocols and sons, this is going to be a landmark global event. continues to work closely with Sri Lankan authorities and international organisations to ensure the wellbe- Thank you. ing of Sri Lankan citizens.

Professor Indika Karunathilake COVID-19 has inflicted an unexpected and unprece- President – Sri Lanka Medical Association

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MESSAGE FROM THE HONORARY SECRETARY SRI LANKA MEDICAL ASSOCIATION

Dr. Sumithra Tissera

It is indeed a pleasure and a privilege to welcome you to the 133rd Anniversary International Medi- cal Congress of the Sri Lanka Medical Association (SLMA) in 2020 held from 24th to 26th July 2020 at the Dr. NDW Lionel Memorial Auditorium, Wijerama House, Colombo.

The ability of the SLMA to combine and connect medical officers of diverse grades and various specialties will be utilized to create a suitable platform where all can communicate and work towards a better post-COVID era.

In order to respect the current regulations especially social distancing and concepts of respiratory etiquette this years’ congress will be held as a virtual conference with very minimal physical participation. This will facilitate and ensure more participation in these difficult times. Thus the SLMA is one of the first of organizations in Sri Lanka to launch, not merely a lecture or seminar, but a com- plete congress on an online platform.

Though this much anticipated event will be curtailed due to the current circumstances, the spirit of the occasion and the exchange of knowledge and ideas will surely thrive in this new platform. This year, as in the preceding years, a fascinating and thought-provoking line up has been arranged by us. This year’s programme intends as always, to create a discourse and sharing of ideas from the different corners of the world.

The main academic programme is to be delivered through one Keynote Address, eight Main Sym- posia and six Guest Lectures. In addition, there will be three Orations and the much-acclaimed Doctors’ Concert

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The concert will ensure that the camaraderie and joy of this programme is maintained in spite of the restrictions. The SLMA Oration will be delivered at the Inauguration Ceremony and will be followed by the Professor N D W Lionel Memorial Oration and Dr. S C Paul Oration during the conference.

This year, in organizing this annual event, it is indeed evident that we at the SLMA have had to rise up in times of adversity and overcome many obstacles. As such, rising above these obstacles has been a collective effort under the able guidance and leadership of the President SLMA, Pro- fessor Indika Karunathilake, who has lead the team through the adversity of a pandemic and emerged by organizing one of the foremost web-based conferences in Sri Lanka. Under his advice and guidance, the objectives were met and decisions were made with ease, while at all times ensuring that team work played a pivotal role. His efforts were complemented by the Vice President of the SLMA Professor Manuj Weerasinghe, whose knowledge and untiring efforts added further colour to this congress. Co-editors of the Ceylon Medical Journal and the Editorial Board have to be commended for reviewing the many abstracts well within the deadline given by us.

I would also like to extend my appreciation to all the members of the Congress Organizing Com- mittee, the Editors of the Proceedings Book, Assistant Secretaries and members of the Council. This event would not have been possible without the support and efforts of them as well as the membership of the SLMA and the ever helpful supportive staff of the SLMA.

I would like to express our gratitude to all our sponsors including the UN agencies for ensuring that this event is a success.

Any event would not be a success without our participants who have submitted abstracts and have registered for the congress. We sincerely hope that all of you will gain knowledge on many health and non-health related topics during the two days of the conference.

As quoted by Kofi Annan, a former Secretary General of the United Nations, “Knowledge is pow- er. Information is liberating. Education is the premise of progress, in every society in every family.” As such, whilst wishing all delegates and participants a memorable conference I hope that all of you will all take this opportunity to gain more knowledge to step towards progress.

Dr. Sumithra Tissera Honorary Secretary - SLMA

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Message from Honourable Minister of Health and Indigenous Medical Services

Hon. Pavithra Wanniarachchi

The Sri Lanka Medical Association (SLMA), a professional and academic body dedicated to the medical profession, is one of the foremost organizations of this nature in Asia. With a membership span- ning most of the medical officers of all grades and specialties it covers the diversity of the medical profession.

The SLMA has played a role in the policy making and health planning of this nation since its inception. We are extremely thankful to the ever-continuous role played by the SLMA in the health sector of Sri Lanka.

During recent times with the COVID-19 pandemic playing a larger than life role in not just health but in all aspects of public life, the role played by SLMA is noteworthy. During this period of COIVD-19 the advice, guidance and information given by the SLMA has been continuous and essential.

The theme for this years’ congress “Professional Development for Quality Enhancement of Healthcare: Beyond the COVID-19 Pandemic” indicates the forethought that has gone into organizing this year’s event. It is indeed apt for the current scenario and truly in keeping with the times.

I would like to take this opportunity to wish the Sri Lanka Medical Association all success in the 133 rd Anniversary International Medical congress and hope they will continue to go from strength to strength during the coming years and continue the partnership and collaboration with the Ministry of Health.

Hon. Pavithra Wanniarachchi Honourable Minister of Health, Nutrition and Indigenous Medicine, Sri Lanka

4 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS Message from the Secretary - Ministry of Health & Indigenous Medical Services

Dr. S. H. Munasinghe It is with great pleasure that I write this message, as the Secretary to the Ministry of Health & Indige- nous Medical Services, for the 133th Anniversary International Medical Congress 2020 of the Sri Lanka Medical Association (SLMA).

The SLMA, as the premier academic body of the medical professionals of Sri Lanka, has played a pivotal role in the current context of the COVID–19 Pandemic. Therefore, whilst congratulating them on this occasion, I would also like to commend them on the theme of the congress to be held; “Professional Development for Quality Enhancement of Healthcare, beyond the COVID–19 Pandem- ic”.

Since its inception, the SLMA has played an important and necessary role in bringing together the Medical Community. Therefore, it comes as no surprise that, during the situation of uncertainty created by the COVID–19 Pandemic that the SLMA played an essential role in terms of medical education, enhancement and sharing of knowledge, advice and guidance given to the health sector in its’ management.

The continuous guidance given by the SLMA, not only during the pandemic, but also to the health sector during formulation of policies and guidelines, is much appreciated. Whilst extending my gratitude to the SLMA for playing such an essential role in the health sector of Sri Lanka I wish them success in all future endeavours. I hope that the SLMA will continue working in collaboration with the Ministry of Health and I would extend my fullest corporation to SLMA in such important activities to develop the Health Sector of Sri Lanka.

Congratulations and all success to the SLMA and its membership for the 133rd Anniversary Interna- tional Medical Congress.

Dr. S. H. Munasinghe Secretary, Ministry of Health and Indigenous Medical Services, Sri Lanka

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Message from Director General of Health Services

Dr. Anil Jasinghe

The Sri Lanka Medical Association is a pioneer organization in the Asian region dedicated to medical professionals. As such it is indeed a moment of pride and joy to submit this message in the event of the 133rd Anniversary International Medical Congress.

This year it is of more importance, given the theme of the congress, “Professional Development for Quality Enhancement of Healthcare, beyond the COVID-19 Pandemic” which is in keeping with the present situation the world-over.

Given that the SLMA has worked closely with the Ministry of Health during this pandemic it is doubly a pleasure to be a part of the congress, which is in-essence a continuation of this good work.

I am pleased to note that the SLMA has continued through the years to work in collaboration with our ministry to identify issues and problems in the healthcare system and assist in developing practical solutions in terms of policies and guidelines and even in terms of implementation. We are grate- ful for this partnership with the Ministry of Health and hope that this will continue in the years to come.

Congratulations and felicitations to the President, Council, and the membership of the SLMA on the occasion of the 133rd Anniversary Celebrations.

I wish this event all success.

Dr. Anil Jasinghe Director General Health Services

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Message from the Guest of Honour

It is my pleasure and a great honour to send this message to the 133rd Anniversary Scientific Medical Congress of the Sri Lanka Medical Association (SLMA).

Established in 1887, SLMA is the oldest professional medical association in Asia and Australasia. It has contributed immensely to develop the quality and professionalism of medical practitioners. I am pleased to note that the SLMA has continued through the years to work in close collaboration with various stakeholders. This has led to developing and implementing practical solutions to healthcare issues. It has also taken a leading role in managing and mitigating health issues not only in Sri Lanka but also in the region, as we can currently witness from the COVID 19 experience.

The theme for the 133rd congress - Professional development for the Quality enhancement of Healthcare: Beyond the COVID-19 pandemic is very relevant and timely. The current COVID-19 crisis has created many challenges to the healthcare professionals battling the pandemic in the frontlines. The stresses of the possibility of getting infected or staying away from their families, providing opti- mal care to patients, and long working hours under trying conditions, can lead to burnout and pose challenges to one's professional practice. The congress will give us an opportunity to listen to, engage with and learn from the experts and practitioners on best practices adopted to mitigate these challenges. It is also interesting to note that for the first time in its history of SLMA, the 133rd Con- gress will be held on an entirely virtual on-line platform. I must congratulate the SLMA leadership and the Congress Organisers for taking this bold step in shaping the future of such medical congress- es.

Congratulations and felicitations to the President, Council, and membership of the SLMA on the occasion of the 133rd Anniversary Celebrations. I wish you all success and look forward to an interesting and engaging conference.

With my sincere and warmest regards

Dujeepa D. Samarasekera Director, Centre for Medical Education (CenMED), Yong Loo Lin School of Medicine, National University of Singapore, National University Health System Senior Consultant, Ministry of Health Singapore

7 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

SRI LANKA MEDICAL ASSOCIATION COUNCIL 2020

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

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9 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

STEERING COMMITTEE 2020

Seated Left to Right: Dr Sumitra Tissera, Dr Sarath Gamini de Silva, Dr BJC Perera, Prof Indika Karunathilake, Dr Padma Gunaratne, Prof MC Weerasinghe, Dr. Asela Olupeliyawa, Dr Kalyani Guruge

Standing Left to Right – 1st row: Dr Chiranthi K Liyanage, Dr Sajith Edirisinghe, Dr Sankha Randeniya, Dr Pamod Amarakoon, Dr Nimani de Lanerolle

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

PROGRAMME

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PROGRAMME AT A GLANCE

Virtual Pre-Congress Workshops

Workshop I 10th July 2020 12.00 noon – 02.00 pm Microplastics in Sri Lanka & Human Health

Deans’ Round Table “Future of Medical Edu- Workshop II 12th July 2020 12.00 noon – 02.00 pm cation”

Workshop 15th & 16th July Making an Effective Scientific Presentation 08.15 am – 11.15 am III 2020 (By invitation only)

Workshop 17th July 2020 12.00 noon – 02.00 pm Recognition of medical degrees beyond 2023 IV

Workshop V 18th July 2020 8.00 am – 1.00 pm Clinical Genomics for Medical Practitioners

Workshop 20th July 2020 10.00 am – 12.00 noon One Health Approach VI International Year of the Nurse & the Workshop 22nd July 2020 09.00 am - 11.00 am Midwife: Health Workforce Development VII beyond COVID-19 Pandemic

Workshop Practical infection Prevention and Control 23rd July 2020 02.00 pm - 03.30 pm VIII Considerations in the Fight against COVID-19

DAY 1 - Friday, 24th July 2020

INAUGURATION 6.00 pm onwards Wijerama House, No 06, Wijerama Mawatha, Colombo 07

The SLMA Oration 7.30 pm “Improving the care for children with thalas- seamia in Sri Lanka” Professor Sachith Mettananda

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

th Time Day 2 – Saturday, 25 July 2020

Keynote Address Challenges in Healthcare Delivery in the area of Professionalism in the 09.00 am – 09.30 am “New Normal” Dr. Thiru Thirukamoorthy Professor N D W Lionel Memorial Oration 09.30 am – 10.15 am The challenge of the early arrivals: Preterm births revisited Dr. Kapila Jayaratne

HALL A HALL B

Symposium 1 Symposium 2 Response to the COVID-19 Pandemic: Les- Are we forgetting the other Com- 10.30 am – 12.00 noon sons Learnt municable Diseases? Experiences from Sri Lanka, UK, USA & Leptospirosis, Influenza & TB Singapore

Guest Lecture 1 Guest Lecture 2 12.00 noon – 12.30 pm Supporting Primary Care during COVID-19 Environment and Communicable Dis- Pandemic eases

12.30 pm – 01.30 pm Lunch and Free Paper Session 1 Lunch and Free Paper Session 2

01.30 pm – 02.30 pm Lunch and Free Paper Session 3 Lunch and Free Paper Session 4

Guest Lecture 3 Guest Lecture 4 02.30 pm – 03.00 pm Looking Good in the “New World” COVID & Sexual Health

Symposium 4 Symposium 3 Emerging & Re-emerging Infections Challenges in the management of COVID- Global Scenario, are we prepared for 19 infection another pandemic? 03.00 pm – 04.30 pm Dilemmas in laboratory diagnosis, pre- Public Health Response to infection scribing as we go & prevention Challenges in treatment Preventing future pandemics: exploring a planetary health response

04.30 pm – 05.30 pm Health Innovation Awards

05.30 pm Tea & End of Day 2

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th Time Day 3 – Sunday, 26 July 2020

Plenary 1 Digital Delights and Spectacular Social Media in Continuing Professional 09.00 am – 09.30 am Development Dr. Lawrence Sherman Plenary 2 09.30 am – 10.15 am Promoting Ethics & Professionalism during COVID-19 pandemic Dr. Henrik Syse

10.15 – 10.30 am Tea

HALL A HALL B Symposium 5 (Panel discussion) Symposium 6 Right-based approach to delivering Impact of COVID-19: Policy Implica- 10.30 am – 12.00 noon comprehensive tions SRH Services for all in the New Nor- Primary Healthcare, NCD & Migration mal Guest Lecture 5 Guest Lecture 6 12.00 noon – 12.30 pm Gender Equity & Rights during Nutrition for Infants during emergen- emergencies cies

12.30 pm – 01.30 pm Lunch and Free Paper Session 5 Lunch and Free Paper Session 6

01.30 pm – 02.30 pm Lunch and Free Paper Session 7 Lunch and Free Paper Session 8

Symposium 7 Symposium 8 02.30 pm - 04.00 pm Fast Forward to the “Future” Psychosocial issues: During & After

Dr S C Paul Memorial Oration Child Mental Health: Literacy, Burden, Cultural Aspects and Developing Ser- 04.00 pm – 04.45 pm vices for Sri Lanka! Dr Miyuru Chandradasa

06.30 pm - 09.30 pm Doctors’ Concert

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

PROGRAMME IN DETAIL

Virtual Pre-congress Workshops

Pre-Congress Workshop 1 Microplastics in Sri Lanka & Human Health

10th July 2020, 12.00 noon to 2.00 pm CHAIRPERSON

Professor Indika Karunathilake & Dr Sajith Edirisinghe SPEAKERS Dr. H. M. P. Kithsiri Deputy Director General/ Research and Development, National Aquatic Resources Research & Development Agency

Mr. N. S. Gamage Director (Investigations), Central Environmental Authority,

Dr. M.F.M. Fairoz

Dean, Faculty of Fisheries of Ocean Science, Ocean University of Sri

Lanka, Crow Island, Mattakkuliya

Dr. Madura M. Wehella Additional Secretary, Planning & Performance Review, Ministry of Education

Professor Mahesh Jayaweera Department of Civil Engineering, University of Moratuwa

Mr. Ranil Vitharana Chief Innovation Officer at MAS Holdings

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Pre-Congress Workshop 2 Deans’ Round Table

“Future of Medical Education – Adapting to New Normal”

12th July 2020, 12.00 noon to 2.00 pm

CHAIRPERSON

Professor Indika Karunathilake & Dr Sajith Edirisinghe

SPEAKERS Professor Vasanthy Arasaratnam, Standing Committee on Medical and Dental Sciences

Professor Vidya Jyothi Vajira H.W. Dissanayake Dean, Faculty of Medicine, University of Colombo Professor Surangi Yasawardena Dean, Faculty of Medical Sciences, University of Sri Jayawardenepura

Professor Asiri Abegunawardena, Dean, Faculty of Medicine, University of Peradeniya, Peradeniya

Professor P. S. Wijesinghe Dean, Faculty of Medicine, University of Kelaniya Professor K. D. Pathirana, Professor in Medicine, Faculty of Medicine, University of Ruhuna

Dr. Angela Arulpragasam Anthony, Dean, Faculty of Health-care Sciences, Eastern University of Sri Lanka

Dr S. Raviraj Dean, Faculty of Medicine, University of Jaffna Dr Sanjeewa Bowatte Dean, Faculty of Medicine, Wayamba University of Sri Lanka Dr. Senaka Pilapitiya Dean, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka

Gp. Cpt. (Dr) R.A.N.K. Wijesinghe Dean, Faculty of Medicine, General Sir John Kotelawala Defence University

Professor Nirmali Wickramaratne Dean, Faculty of Medicine, Sabaragamuwa University of Sri Lanka

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

Pre-Congress Workshop 4 Recognition of Medical Qualifications Beyond - 2023

17th July 2020, 12.00 noon to 2.00 pm

CHAIRPERSON

Professor Indika Karunathilake, President Sri Lanka Medical Association Professor Nilanthi de Silva, Vice President, Sri Lanka Medical Council Professor Kosala Marambe, Department of Medical Education, Faculty of Medicine, University of Peradeniya

SPEAKERS Dr Thomas Zapata World Health Organization, South East Asia Regional Office

Dr Palitha Abekoon World Health Organization expert in Medical Education Dr Assanga Hapugoda Registrar, Sri Lanka Medical Council

Dr Dujeepa Samarasekara Executive Committee Member, World Federation for Medical Education

Pre-Congress Workshop 5 Clinical Genomics for Medical Practitioners

18th July 2020, 08.00 am to 1.00 pm

Conducted by the Human Genetics Society in Collaboration with the Human Genetics Unit, Faculty of Medicine, University of Colombo

TIME TOPIC

Introduction 08:00 - 08:10 am Dr Nirmala Sirisena, Senior Lecturer and Clinical Geneticist, Human Genetics Unit, Faculty of Medicine, Colombo Chromosomal Disorders & Cytogenetic Diagnostics 08:10 - 08:30 am Dr Sampath Paththinige, Senior Lecturer and Clinical Geneticist, Depart- ment of Anatomy, Rajarata University of Sri Lanka Basic Molecular Genetics & Genetic Diagnostics 08:30 - 08:50 am Dr Kalum Wetthasinghe, Senior Lecturer and Medical Geneticist, Human Genetics Unit, Faculty of Medicine, Colombo Patterns of Inheritance 08:50 - 09: 10 am Dr Lahiru Prabodha, Senior Lecturer and Clinical Geneticist, Dept. of Anato- my, University of Ruhuna, Karapitiya Alpha and Beta Thalassemias 09:10 - 09:30 am Dr Asantha Jayawardana, Senior Lecturer and Clinical Geneticist, Dept. of Anatomy, Rajarata University of Sri Lanka

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TIME TOPIC Hereditary Breast & Colorectal Cancers 09:30 - 09:50 am Dr Nirmala Sirisena, Senior Lecturer and Clinical Geneticist, Human Genetics Unit, Faculty of Medicine, Colomb Reproductive Genetics & Prenatal Diagnostics 9:50 - 10:10 am Dr Padmapani Padeniya, Senior Lecturer and Clinical Geneticist, Dept. of Anatomy, University of Kelaniya Clinical & Molecular Diagnostic Approach to the Dysmorphic Child 10:10 - 10:30 am Dr Dineshani Hettiarachchi, Lecturer, Human Genetics Unit, Faculty of Medi- cine, Colombo 10:30 - 10:40 am BREAK Neurogenetic Disorders & Dystrophinopathies 10:40 - 11:00 am Dr Dulika Sumathipala, Lecturer, Human Genetics Unit, Faculty of Medicine, Colombo Genetic Disorders of the Eye 11:00 - 11:20 am Dr Sajith Edirisinghe, Lecturer and Clinical Geneticist, Dept. of Anatomy, University of Sri Jayewardenepura Skeletal Dysplasias 11:20 - 11:40 am Dr Yasas Kolombage, Lecturer, Department of Anatomy, Faculty of Medicine, Sabaragamuwa University of Sri Lanka Inherited Cardiomyopathy and Arrhythmias 11:40 - 12:00 am Dr Thurayratnam Chenthuran, Senior Lecturer and Medical Geneticist, Dept. of Anatomy, University of Jaffna Basic Haemato-Oncogenetics 12:00 - 12:20 am Professor Hemali Goonasekera, Associate Professor and Consultant Haema- tologist, Human Genetics Unit, Faculty of Medicine, Colombo Pharmacogenomics 12:20 - 12:40 am Professor Vajira Dissanayake, Senior Professor and Medical Geneticist, Hu- man Genetics Unit, Faculty of Medicine, Colombo

Implementing Genomic Medicine in Clinical Practice - Case Based Discussions 12:40 - 01:00 am Professor Vajira Dissanayake, Senior Professor and Medical Geneticist, Human Genetics Unit, Faculty of Medicine, Colomb

Pre-Congress Workshop 6 Preventing the next pandemic: One Health approach

20th July 2020, 09.00 am to 11.00 am

MODERATORS

Professor Indika Karunathilake, President Sri Lanka Medical Association Dr. D.D.N. de Silva, President Sri Lanka Veterinary Association Professor Saroj Jayasinghe, Senior Professor and Chair of Medicine, Faculty of Medicine, University of Colombo Dr Tharanga Thoradeniya, Senior Lecturer, Faculty of Medicine, University of Co- lombo, Assistant Secretary, SLVA

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

SPEAKERS Professor Malik Peiris Chair Professor - Department of Microbiology, University of Hong Kong, Fac- ulty of Medicine, Hong Kong Honorary Consultant Microbiologist, Queen Mary Hospital and Scientific Di- rector, HKU-Pasteur Research Centre, Hong Kong

Dr B.M.A. Oswin Perera Visiting Professor, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya Director of the Sri Lanka Wildlife Health Centre

Professor N.P Sunil-Chandra Senior Professor & Chair of Medical Microbiology, University of Kalaniya

Dr Ravi Bandara Dissanayake Veterinary epidemiologist Food and Agriculture Organization of the United Nations, Rome

Dr Tikiri Priyantha Wijayathilaka AMR Technical Officer – World Organization for Animal Health, Sub-Regional Representation for South East Asia, Thailand

Dr. Dilan Amila Satharasinghe Senior Lecturer, Faculty of Veterinary Medicine and Animal Science, University of Peradeniya

Pre-Congress Workshop 7 International Year of the Nurse & the Midwife: Health Workforce Develop- ment beyond COVID-19 Pandemic

22nd July 2020, 09.00 am to 11.00 am MODERATORS

Dr. Sajith Edirisinghe

Time Title

Global & regional perspective of sustaining essential MCH services in the 9.00 am -9.20 am COVID-19 & Beyond Dr Anoma Jayathilaka, Medical Officer Maternal and Reproductive Health, WHO/SEARO

Improving quality of Midwifery services in RMNCAH care during COVID- 9.20 am -09.40 am 19 outbreak and beyond: Lessons learned and Key actions for Sri Lanka Dr Chitramalee de Silva, Director - Maternal and Child Health, Family Health Bureau, Ministry of Health

19 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

Addressing the need for capacity development among nurses in face of 9.40 am – 10.00 am the pandemic Mrs. Asoka Abeynayake, Director / Nursing, Ministry of Health

Tools and Technologies for Professional Development in “New normal” in the context of nursing and midwifery in Sri Lanka 10.10 am -10.20 am Dr Sudath Samaraweera, Deputy Director General/Education, Training and Research, Ministry of Health

New role of human resource in talent management of health workforce 10.20 am -10.40 am Ms. Chathuri Wimalanaga, Manager, Human Resources, Asiri Hospital Holdings PLC

10.40 am -11.00 am Discussion

Pre-Congress Workshop 8 Practical Infection Prevention and Control Considerations in the Fight against COVID-19

23rd July 2020, 02.00 pm to 03.30 pm

MODERATORS

Dr. Shirani Chandrasiri Professor Indika Karunathilake

Time Title

What we know about COVID-19 infection among health care workers 2.00 pm – 2.20 pm April Baller, WHO Health Emergencies, Geneva, Switzerland

Rational use of PPE and infection prevention and control of COVID-19: Min- 2.20 pm – 2.40 pm imum recommendations for Sri Lanka Dr Madhumanee Abeywardena, Consultant Microbiologist

Environmental surface disinfection during COVID-19 outbreak 2.40 pm – 3.00 pm Dr Vaithehi Rajeevan Francis Consultant Microbiologist

Introduction to the IPC training module for health care workers 3.00 pm – 3.10 pm Dr Sudath Dharmaratne, Director, Directorate of Healthcare Quality and Safety and WHO Country Office

3.10 pm – 3.30 pm Discussion

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

Virtual Medical Congress

th DAY 1 - Friday, 24 July 2020

INAUGURATION “Wijerama House”, No 06, Wijerama Mawatha, Colombo 07

5.30 pm - 6.00pm Guests take their seats

6.00 pm – 6.10 pm Arrival of the Guest of Honour

6.10 pm – 6.20 pm Ceremonial Procession

6.20 pm – 6.30 pm National Anthem

6.25 pm – 6.40 pm Lighting the Lamp of Learning

Welcome Address 6.40 pm – 6.50 pm Professor Indika Karunathilake

President, SLMA Address by the Guest of Honour 6.50 pm – 7.00 pm Major General Dr. Sanjeewa Munasinghe

Secretary, Ministy of Health, Sri Lanka Address by the Guest of Honour Dr. Dujeepa Samarasinghe 7.00 pm – 7.10 pm Chair, Faculty Teaching Excellence Committee, School of Medicine, National University of Singapore 7.10 pm – 7.20 pm Launch of the SLMA CPD portal and Health Educational Material

Vote of Thanks 07.30 pm – 07.40 pm Dr. Sumithra Tissera

Honorary Secretary, SLMA THE SLMA ORATION 2020

Professor Sachith Mettananda 07.40 pm – 08.25 pm MBBS, DCH, MD (Paed), Dphil(Oxon), FRCP (Edin) Professor and Head – Department of Paediatrics, Faculty of Medicine, University of Kelaniya Consultant Paediatrician, Colombo North Teaching Hospital, Ragama 08.25 pm – 08.55 pm Musical Interlude

08.55 pm The procession leaves the hall

09.00 pm Refreshments

21 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS Day 2 – Saturday, 25th July 2020

09.00 am – 09.30 am KEYNOTE ADDRESS Chair: Professor Indika Karunathilake

CHALLENGES IN HEALTHCARE DELIVERY IN THE AREA OF PROFESSIONALISM IN THE “NEW NORMAL”

Professor Thiru Thirukamoorthy Adj. Professor, Duke-NUS Medical School, Singapore

09.30 am – 10.15 am PROFESSOR N D W LIONEL MEMORIAL ORATION

THE CHALLENGE OF THE EARLY ARRIVALS: PRETERM BIRTHS REVISITED

Dr. Kapila Jayaratne Consultant Community Physician, National Program Manager – Maternal & Child Morbidity & Mortality Surveillance, Family Health Bureau – Ministry of Health

10.30 am – 12.00 noon SYMPOSIUM 1 HALL A Chair: Professor Indika Karunathilake & Dr Olivia Corazon Nieveras

RESPONSE TO THE COVID-19 PANDEMIC: LESSONS LEARNT Experiences from Sri Lanka, UK, USA & Singapore

Sri Lanka - Dr Nihal Abeysinghe

UK- Professor Zafar Iqbal

USA - Dr. Navid Pour-Ghasemi

Singapore - Professor TEO Yik Ying SYMPOSIUM 2 HALL B Chair: Dr. Sarath Gamini de Silva

ARE WE FORGETTING THE OTHER COMMUNICABLE DISEASES?

Leptospirosis Dr. Panduka Karunanayake

Influenza in the setting of COVID-19 Dr Chandimani Undugodage

A battle of old and new; Repercussions of COVID 19 on Tuberculosis Dr Neranjan Dissanayake

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

12.00 noon – 12.30 pm GUEST LECTURE 1 HALL A Chair : Dr Sankha Randenikumara

SUPPORTING PRIMARY CARE DURING COVID-19 PANDEMIC

Professor Michael Kidd

GUEST LECTURE 2 HALL B Chair : Dr. Sajith Edirisinghe

ENVIRONMENT AND COMMUNICABLE DISEASES

Professor Bruce Maycock

12.30 pm – 01.30 pm LUNCH AND FREE PAPER SESSIONS

Free Paper Sessions 1 HALL A

OP: 15 Viability of the Amniotic Membrane in Several Solutions Suraji LHH, Adhikarie AAAP, Wijeyaratne SM, De Silva MVC, Ranaweera GG

OP: 16 Surgery for Insulinomas – a Single Unit Experience Jayasinghe R, Subasinghe D, Sivaganesh S

OP: 17 Upper Limb Vascular Injuries, a Unique Problem. A Single Unit Experience in a Tertiary Care Centre Kapilan G, Arudchelvam J

OP: 18 A Seasonal Killer; Variability of the Incidence of Necrotizing Fasciitis with the Weather Pattern De Silva GPUP, Bandara HMC, Rathnayake RMSSB, Karunadasa MSE

OP: 19 Outcome of Open Live Donor Nephrectomies in 258 Cases Laksiri HPW, Arudchelvam J

OP: 20 Endoscopic Ultrasound-Guided Transmural Drainage of Pancreatic Fluid Collec- tions. A Study to Analyze its Efficacy and Complications Fernandopulle N

OP: 21 Anatomical Variations of the Renal Vasculature and its Association with the Outcome of Live Donor Nephrectomies Laksiri W, Arudchelvam J

Free Paper Session 2 HALL B OP: 01 Practice and Socio-Demographic Determinants of Diabetes Self-Care among Patients with Type 2 Diabetes Mellitus Fernando SSW, Danansuriya MN

OP: 02 A Retrospective Comparative Study on the Outcomes of a Low Dose and High Dose Cyclophosphamide Regimen in the Management of Class III and IV Lupus Nephri- tis in Sri Lanka Wijayaratne DR, Atukorala I, Gunawardena NS, Wijesundara DA, Gunarathna K, Lan- erolle RD

OP: 03 Clinico-Epidemiology of Hypnale zara (Hump-Nosed Viper) Envenoming in Sri Lanka Rathnayaka RMMKN, Ranathunga PEAN, Kularatne SAM

23 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

12.30 pm – 01.30 pm Free Paper Session 2 HALL B

OP: 04 Use of Antibiotics among Office Workers in a Private Company Saneeja MAF, Sampath RW, Sampath PKI, Alagiyawanna D

OP: 06 Efficacy and Safety of Oral Hydroxyurea in Patients with Transfusion Depend- ent β Thalassaemia: a Randomized Double-Blind Placebo-Controlled Clinical Trial Yasara N, Wickramarathne N, Silva I, Hameed N, Attanayaka AMKR, Jayasinghe VL, Wick- ramasinghe N, Rodrigo R, Perera L, Mettananda KCD, Manamperi A, Premawardhena A, Mettananda S

OP: 07 Duration before Hospitalization, Hospital Stay and the Clinical Course of COVID- 19 Patients in Sri Lanka: Evidence from First 100 Patients Following Discharge or Death Wickramasinghe ND, Jayakody S, Hewage SA, Wijewickrama A, Gunewardena NS, Idam- pitiya D, Palihawadana P, Jasinghe A, Prathapan S, Arambepola C

OP: 50 Caregiver Burden in Relation to Child's Disability among Primary Caregivers of Children with Cerebral Palsy attending a Sri Lankan Tertiary Care Facility Hewawitharana BDR, De Silva MHA, Wickramarachchi WAPS, Wijesinghe CJ

01.30 pm – 02.30 pm Free Paper Sessions 3 HALL A

OP: 28 Balance, Hand Grip Strength and Risk of Falling in Children with Visual Impair- ment Ruwanmali PAS, Dissanayake WDN

OP: 29 Childhood Asthma and its Association with Selected Obstetric and Neonatal Factors among Children Aged 3 -10 Years in Tertiary Care Hospitals in Colombo District Deen FAH, Kottahachchi KC, Perera SS, Dissanayake DMOC, Jayakaduwa JS, Undugodage C, Jayakody S

OP: 30 In-Utero Exposure to Tsunami and Conflict and Adolescent Health in Sri Lanka Devakumar D, Sathiyadas MG, Jayawardana P, Arulpragasam A, Busert L, Osmond C, Fall CHD, Wells JCK, Wickramasinghe PV

OP: 31 Gender Difference in Accuracy Error in Bioelectrical Impedance Analysis Com- pared to Dual Energy X-Ray Absorptiometry in the Measurement of Body Composition Indices in Obese Children de Silva MHAD, Hewawasam RP, Lekamwasam S

OP: 32 Differences in Serum Markers of Oxidative Stress in Well Controlled and Poorly Controlled Asthmatic Children in Sri Lanka Fernando YN, Wickramasinghe VP, Anuradha KWDA, De Silva U, Alahakoon M, Handun- netti S

OP: 33 Association of Severe Asthma with Allergic Rhinoconjunctivitis and Eczema in a Cohort of Preschool Children of Anuradhapura District, Sri Lanka Rajapakse RMSI, Amarasiri WADL, Yasaratne BMGD, Warnasekara YPJN, Agampodi SB

Free Paper Session 4 HALL B OP: 22 Screening for Future Metabolic and Cardiovascular Risks: a Missed Opportunity During Pregnancy Jayasinghe HMIU, Hettiarachchi DAU, Koralegedara KIS, Amarasinghe GS, Warnasekara YPJN, Wickramasinghe ND, Kumara DMA, Agampodi TC, Agampodi SB

OP: 23 Awareness and its Associates of Occupational Hazards and Safety Practices Among Medical Laboratory Technologists Working in Government Tertiary Care Health Institutions in Colombo District Karunarathna BJ, Weerasinghe MC

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

01.30 pm – 02.30 pm Free Paper Session 4 HALL B

OP: 24 Assessment of Direct Out of Pocket Expenditure of Tuberculosis Treatment in Intensive Phase in Kalutara District Ranawaka N, Nandasena YLS

OP: 25 Prevalence and Correlates of Smoking, Alcohol Consumption and Illicit Sub- stance Abuse in School Adolescents in Sri Lanka Kumbukage MP, Senanayake SJ, Gunawardena SRHP, Wickramasinghe SC, Loku- balasooriya A, Gunawardena NS, Pieris R, Wickramasinghe SA, Maddumahewa CV

OP: 26 Prevalence of Cardiovascular Conditions among First Trimester Pregnant Fe- males in Anuradhapura District Hettiarachchi DAU, Lokunarangoda NC, Agampodi TC, Jayasinghe HMIU, Koralegedara KIS, Warnasekara YPJN, Madhushika MMH, Agampodi SB

OP: 27 Quality of Life in Elderly in Rural Sri Lanka: a Large Community-Based Cross- Sectional Study Wickramasinghe ND, Perera RA, Agampodi SB

OP: 11 Graduate Perceptions on Teaching of Clinical Relevance in Different Compo- nents of the Colombo MBBS Curriculum

02.30 pm – 03.00 pm GUEST LECTURE 3 HALL A Chair: Dr. Indika Kahawita

Looking Good in the “New World” Dr. Nayani Madarasinghe

GUEST LECTURE 4 HALL B Chair: Dr. Chitran Hathurusinghe

COVID & Sexual Health Dr. Lilani Rajapakshe

03.00 pm – 04.30 pm SYMPOSIUM 3 HALL A Chair: Professor Gita Fernando & Dr. Preethi Wijegunawardene

CHALLENGES IN THE MANAGEMENT OF COVID-19 INFECTION

Dilemmas in laboratory diagnosis Dr. Jude Jayamaha

Prescribing as we go Professor Chandanie Wanigatunge

Challenges in treatment Dr. Ananda Wijewickrama

25 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

SYMPOSIUM 4 HALL B Chair: Dr. Asela Olupeliyawa

EMERGING & RE-EMERGING INFECTIONS

Global Scenario Professor Malik Peiris

Public Health Response to infection prevention Professor Manuj C Weerasinghe

Preventing future pandemics: exploring a planetary health response Professor Saroj Jayasinghe

04.30 pm – 05.30 pm HEALTH INNOVATION AWARDS

05.30 pm TEA & END OF DAY 2

Day 3 – Sunday, 26th July 2020

09.00 am – 09.30 am PLENARY 1 Chair: Professor Indika Karunathilake

DIGITAL DELIGHTS AND SPECTACULAR SOCIAL MEDIA IN CONTINUING PROFES- SIONAL DEVELOPMENT

Dr. Lawrence Sherman

09.30 am – 10.15 am PLENARY 2 Chair: Dr. Malik Fernando

PROMOTING ETHICS & PROFESSIONALISM DURING COVID-19 PANDEMIC

Dr. Henrik Syse

10.15 am – 10.30 am Tea break 10.30 am – 12.00 noon SYMPOSIUM 5 HALL A Moderator: Mr. Sriyal Nilanka

RIGHT-BASED APPROACH TO DELIVERING COMPREHENSIVE SRH SERVICES FOR ALL IN THE NEW NORMAL

Panellists Professor Susan Sawyer, Dr. Suchitra Dalvie, Professor Hemantha Senanayake, Ms. Tanzila Khan

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

10.30 am – 12.00 noon SYMPOSIUM 6 HALL B Chair: Dr. Jayasundara Bandara & Professor Indika Karunathilake

IMPACT OF COVID-19: POLICY IMPLICATIONS

Five shifts required by health systems Dr Mickey Chopra

Non-communicable diseases Dr Vindya Kumarappeli

Migration Dr Razia Pendse

12.00 noon – 12.30 pm GUEST LECTURE 5 HALL A Chair : Ms. Madusha Dissanayake

GENDER EQUITY & RIGHTS DURING EMERGENCIES

Professor Liesl A Nydegger

12.00 noon – 12.30 pm GUEST LECTURE 6 HALL B Chair : Dr. BJC Perera

Nutrition for Infants during emergencies

Professor Colin Binns

12.30 pm – 01.30 pm LUNCH AND FREE PAPER SESSIONS

Free Paper Sessions 5 HALL A OP: 08 Impact of COVID-19 on Postgraduate Surgical Training - a Global Perspective Wijerathne HGPK

OP: 09 Training of Medical Officers in Peripheral Medical Clinics to Screen for Diabetic Retinopathy using Direct Ophthalmoscopy Wewalwala WHD, Fonseka HCN, Aryasinghe JAD, Amarasinghe BA, Piyasena MMPN

OP: 10 Online Clinical Cased Based Discussions as a Novel Education Tool Jayarathne YGSW, Pilapitiya SD, Lokunarangoda NC, Sarathchandra RDNC, Chandrakuma- ra WAJC, Amarakoon GGGT, Srishankar S, Wickramasinghe BAM, Kumara DMA

OP: 12 Reconstruction of Metabolic Pathways for the Setaria digitata Whole Genome Rashanthy N, Kothalawala MSA, Mugunamalwaththa TS, Darshika WAS, Lakmali GLY, Kasun de Zoysa, Chandrasekharan NV, Gunawardene YINS, Prashanth Suravajhala, Dassa- nayake RS

OP: 13 Are They Ready to Handle Anaphylaxis?: a Study among Pre-Intern Medical Graduates of Three Universities in Sri Lanka Wijekoon CN, Fernando ADA, Dissanayake AS, Wettasinghe ,I Gunawardana M, Minu- wanpitiya G, Jayawardane P, Thenuwara PM

27 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

12.30 pm – 01.30 pm Free Paper Sessions 5 HALL A OP: 14 Assessment of Plate Waste in Base Hospital, Warakapola Mallawarachchi SMNSM, Mallawarachchi CH, Dalpatadu KCS

Free Paper Session 6 HALL B

OP: 41 Comparative Effect of Crude Extracts of Two Sri Lankan Medicinal Plants (Epaltes divaricata and Vetiveria zizanioides) against Methicillin-Resistant Staphylococcus Aureus Rathnayake H, De Zoyza MHN, Hewawasam RP, Wijayaratne WMDGB

OP: 42 Clinicopathological Profile of Cutaneous Leishmaniasis in Army Personnel in the Kilinochchi and Mulllativu Districts of Sri Lanka Wijesinghe HD, Gunathilaka N, Semege S, Pathirana KPN, Manamperi N, de Silva MVC, Fernando SD

OP: 43 Endoscopic Ultrasound Guided Fine Needle Aspiration in Patients with Pancre- atic Masses: a Study to Assess its Efficacy and Complications Fernandopulle N, Matthias T

OP: 44 The Incidence and Patterns of Lung Cancers in Sri Lanka from 2001-2010: Analysis of National Cancer Registry Data Jayarajah U, Arulprashanth A, Fernando A, Ilangamge S, Seneviratne SA

OP: 45 Burkholderia pseudomallei Peri-Prosthetic Infection following Medial Malleolar Internal Fixation: a Case Report Koculen V, Jayarajah U, Arulprashanth A, Palkumbura C, Faleel A, Sooriyarachchi R

OP: 46 Unintentional Injuries Among In-School Adolescents in Sri Lanka Gallage AOP, Wickramasinghe SA, Senanayake SJ, Kumbukage MP, Gunawardena SRHP, Wickramasinghe SC, Lokubalasooriya A, Gunawardena NS, Peries R, Maddumahewa CV

OP: 47 Epidemiological and Clinical Characteristics of Covid-19 Patients: the Initial Expe- rience of Sri Lanka Hewage SA, Wickramasinghe ND, Jayakody S, Arambepola CA, Gunewardena NS, Wijew-

01.30 pm – 02.30 pm Free Paper Sessions 7 HALL A OP: 34 Early Pregnancy Mental Health Reflecting Health System Deficits and the Need for Psychosocial Support in Anuradhapura, Sri Lanka Amarasinghe GS, Senanayeka TD, Wijesinghe ADN, Sundharum R, Herath KM, Malasekera C, Wickramasinghe A, Agampodi TC

OP: 35 Translation and Validation of Abnormal Involuntary Movement Scale (AIMS) into Sinhala Baminiwatte A, Bandara T, Liyanage H, Perera M, Kuruppuarachchi KALA, Hapangama A

OP: 36 Association between Toxoplasmosis and Schizophrenia - Preliminary Findings of a Case Control Study Dayabandara LRM, Galhenage J, Perera I, Gange Y, Dayananda S, Gunatillake H, Gun- awardena S

OP: 37 Randomized Controlled Trial Investigating the Effectiveness of Cognitive Behav- iour Group Therapy Compared to a Waitlist Control in the Treatment of University Stu- dents with Social Phobia Hapangama A, de Silva BGR, de Zoysa PT, Kuruppuarachchi KALA, Ravindran A, Wick- remasinghe AR, Williams SS

OP: 38 Prevalence and Correlates of Interpersonal Violence Among In-School Adoles- cents in Sri Lanka Wickramasinghe SA, Kumbukage MP, Senanayake SJ, Gunawardena SRHP, Wick- ramasinghe SC, Lokubalasooriya A, Gunawardena NS, Peries R, Maddumahewa CV 28

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

01.30 pm – 02.30 pm Free Paper Sessions 7 HALL A

OP: 39 The Health Effects of the Combined Use of Protein, Multivitamins and Electrolyte Dietary Supplements on Sri Lankan Athletes: a Pilot Study Fernando PNJ, Pigera S, Rashani SAN, Niriella MA, Jayawickreme S, de Silva AP

OP: 40 Prevalence of Geriatric Depression and Associated Factors in Institutionalized Elders: a Descriptive Study in Galle District

Free Paper Session 8 HALL B OP: 48 Economic Burden of Out-Of-Pocket Expenditure During Early Pregnancy: Evidence from a Pregnancy Cohort in the Anuradhapura District Gunarathne SP, Wickramasinghe ND, Agampodi TC, Prasanna RPIR, Agampodi SB

OP: 49 Knowledge, Attitudes and Practices Regarding Dengue Fever among Mothers of Paediatric Dengue Victims at Colombo South Teaching Hospital, Sri Lanka Sainiranjan B, Sainiranjan P, Pirabakar M, Ariyadasa T, Razeen FZ

OP: 51 Evaluation of the Effectiveness of Counselling for the Correct Inhaler Techniques among Asthmatic Patients Madushika KBP, Pathiraja VM, Jayasinghe C, Dhanarisi HKJ, Mohamed F

OP: 52 A Sustainable Program for the Innovations to Combat COVID-19 Pandemic in Sri Lanka Padeniya A, Colombage P, Samarasinghe H, Silva TEUND, Aluthge H, Fernando S, Soysa ND, Ananda S, Lanerolle ND, Navodanie MRUN

OP: 53 Echocardiographic Evaluation of Anthracycline-Induced Cardiotoxicity in Breast Cancer Patients from Southern Sri Lanka Sandamali JAN, Hewawasam RP, Fernando MACSS, Jayatilaka KAPW, Madurawe RD, Sadanandan PP, Ekanayaka U, Horadugoda J

OP: 54 Meteorological Associations of Leptospirosis in Different Climate Zones of Sri Lanka; a Time Series Analysis Warnasekara YPJN, Agampodi SB, Ranawaka HCJ, Dembatapitiya DRWNK, Wijesinghe PATAB, Dewapriya IKS, Koralegedara KIS, Abeynayake R

OP: 05 EEG Patterns during Mindfulness Meditation Marasinghe MGCP, Tennakoon V, Mahawithanage STC 02.30 pm - 04.00 pm SYMPOSIUM 7 HALL A Chair: Dr Pandula Siribaddana

FAST FORWARD TO THE “FUTURE”

Go back to Human Mode from Auto Mode Professor Rangika Halwathura

Advances in delivery of Education Dr Dujeepa D. Samarasekera

New frontiers in Health Communication Dr. Dinil Abeygunawardena

29 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

02.30 pm - 04.00 pm SYMPOSIUM 8 HALL B Chair: Dr. Padma Gunaratne

PSYCHOSOCIAL ISSUES: DURING & AFTER

Livelihoods and mental health D. Vajira Dharmawardene

Burnout among healthcare workers during the covid-19 pandemic Professor Wah-Yun LOW

The nature of, and coping with, family conflict during a lockdown Professor Piyanjali de Zoysa 04.00 pm – 04.45 pm DR S C PAUL MEMORIAL ORATION

Child Mental Health: Literacy, Burden, Cultural Aspects and Developing Ser- vices for Sri Lanka!

Dr Miyuru Chandradasa MBBS (Colombo) MD (Colombo) MRCPsych (UK) Consultant Child and Adolescent Psychiatrist, Colombo North Teaching Hospital in Ragama Senior Lecturer, Department of Psychiatry, Faculty of Medicine, the University of Kelaniya Senior Lecturer (Honorary), Faculty of Medicine Nursing and Health Sciences of the Monash University, Australia.

06.30 pm –09.00 pm DOCTORS’ CONCERT

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

EDUCATIONAL PROGRAMME FOR THE GENERAL PUBLIC

th Day 1 - Saturday 25 July 2020 SESSION 1 09.30 am – 11.00 am Let’s know about • Dr Yasas Abeywickrama – Consultant Plastic & Re- injuries constructive Surgeon • Dr Ayeshmantha Peiris – Consultant Ophthalmolo- gist • Dr Lalith Ekanayake – Surgeon Rear Admiral Consult- ant Physician, Consultant in Diving & Hyperbaric Medicine SESSION 2 11.30 am – 01.00 pm Kids & Adolescents: • Dr BJC Perera - Consultant Paediatrician What are your • Dr Sajeewana Amarasinghe - Consultant Psychiatrist concerns • Professor Shaman Rajindrajith - Consultant Paedia- (Sinhala Medium) trician

SESSION 3 01.30 pm – 03.00 pm Kids & Adolescents: • Dr R Ajanthan - Consultant Paedeatrician What are your • Dr Shanthini Ganeshan - Consultant Paedeatrician concerns • D. Mahesan Ganeshan - Consultant Psychiatrist (Tamil Medium)

SESSION 4 03.30 pm – 05.00 pm Sex & You • Dr Chiran Hathurusinghe – Consultant Venereologist • Dr Prageeth Suranga - Consultant Venereologist

th Day 2 – Sunday, 26 July 2020 SESSION 5 09.30 am – 11.00 am Caring for the Elders • Dr Padma Gunaratne - Consultant Neurologist • Dr Udayangani Ramadasa - Consultant Physician • Dr Dilhara Samaraweera - Consultant Physician SESSION 6 12.00 noon – 01.30 pm Tips to lead a healthy • Dr Kayathri Periyasamy - Consultant Physician life style • Dr Noel Somasundaram – Consultant Endocrinologist (Tamil Medium) • Dr MK Ragunathan - Consultant Physician

SESSION 7 02.00 pm – 03.30 pm Tips to lead a healthy • Dr Priyankara Jayawardena - Consultant Physician life style • Dr Upul Dissanayake - Consultant Physician (Sinhala Medium) • Dr Navoda Attapattu– Consultant Paediatric Endocri- nologist

31 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

DOCTORS’ CONCERT

6.30 pm to 9.00 pm Sunday, 26th July 2020 New Auditorium, PGIM Academic Centre, Colombo 8

1. Shantha Me Re Yame - Dr BJC Perera A capella - Students from Colombo Medical Faculty 2. (Thirasara, Tharushi, Mihidinee, Uththara, Keshini, Maheshi, Danushi) Santana Medley – Dr Christo Fernando, Ray Gomes, Upali Fernando & Manoj Rama- 3. nayake 4. Lo Ada Ninde – Professors Jennifer & Joe Perera 5. Soothe - Dil & Desh Dissanayake 6. Mini Mini Poda Wesse – Dr Kushlani Jayatilleke 7. “The Magical 80s” - Dr Yamuna Rajapakse and kids A flute solo - Professor Shaman Rajindrajith featuring Dr Kolitha Lelwala (keyboard) & Dr 8. Sisira Dissanayake (tabla) 9. Nil Ahas Thale – Dr Anula Wijesundere with grandchildren 10. One Call Away – Nishalee Weeraratne 11. Laaba Sonduriyak – Dr Sanjeewani Rupasinghe Nim Him Sewwa – Drs Nirodha Jayawickrema and Sankha Randenikumara featuring In- 12 deewara Muthuarachchi (violin) Senaka Batagoda Medley – Students from Kelaniya Medical Faculty 13. (Uvindu, Keshan, Vishan, Rumeshika, Savindi, Rameesha, Jishal, Evin, Sithiji, Solamon, Janidu) 14. Shallow – Dr Nilanka Munasinghe

“Corona Vaada Baila” - Students from Sri Jayewardenepura Medical Faculty 15. (Sathira, Akalanka, Anjana, Dasan, Gayan, Ishan, Iwoshini, Sandani, Senara, Sho-

16. Indunil Gangulel - Song by the SLMA Council

17. Clarence Medley & Nonstop - Dr Christo Fernando, Ray Gomes, Upali Fernando & Manoj Band Ray Gomes (Bass Guitar) Upali Fernando (Rhythm Guitar) Manoj Ramanayake (Keyboard) Dr Mathisha de Silva (Drums) Dr Christo Fernando (Drums)

Compere Dr Nimani De Lanerolle

32 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

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ORATIONS

42 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

THE SLMA ORATION 2020

2016 in Medical Research and a Commonwealth Scholarship award in 2012. He has also received several awards during the Academic Sessions held by the Sri Lanka Medical Association and the Annual Con- gress of the Sri Lanka College of Paediatricians.

His research publications are many in number. He has a H-index of 12 with over 60 publications in peer re- viewed journals. Furthermore, he has authored 4 book chapters.

In addition to his numerous academic accomplish- ments, he also serves in both the National Thalassae- mia Council of Sri Lanka and the National Health Re- search Council of Sri Lanka He is a member of the Editorial Board of the Ceylon Medical Journal and the Sri Lanka Journal of Child Health. Professor Sachith Mettananda MBBS, DCH, MD (Paed), Dphil(Oxon), FRCP (Edin) Improving the care for children with Professor and Head – Department of Paediatrics, thalassaemia in Sri Lanka Faculty of Medicine, University of Kelaniya Thalassaemia is one of the most common genetic Professor Sachith Mettananda is at present the disorders in the world. It is particularly common in Professor in Paediatrics and Head of the Depart- the south and south east Asia including Sri Lanka. ment of Paediatrics, Faculty of Medicine, Univer- Due to limitations and non-availability of curative sity of Kelaniya. He is attached as a Consultant therapies, most patients with severe b-thalassaemia Paediatrician to the Colombo North Teaching in Sri Lanka are managed medically with blood trans- Hospital, Ragama. fusions and iron chelation for life. Although, the medical management has improved considerably during the past decade, many patients in Sri Lanka do not Having obtained his MBBS degree from the Uni- survive beyond the fourth decade. This is in contrast versity of Colombo with many accolades, he went to higher life expectancies, usually up to the sixth on to do his postgraduate studies; firstly, the Di- decade, among patients in the developed world. In ploma in Child Health in 2007 at which he ob- this oration I aim to explore the reasons for this dis- tained the prestigious SLCP Gold Medal and fol- parity and to provide solutions to some of the out- lowing this, the MD in Paediatrics from the Uni- standing clinical and research questions in relation to versity of Colombo. the medical management of b-thalassaemia in Sri

Lanka. He then obtained a DPhil from the University of

Oxford in 2015 and FRCP from Edinburgh in 2020. We performed a multi-centred, cross-sectional study Professor Mettananda is an accomplished re- in the three largest thalassaemia centres situated in searcher who has received numerous awards in- Kurunegala, Anuradhapura and Ragama teaching hos- cluding the President’s Award for Scientific Publi- pitals that care for over two-thirds of patients with cations in 2011, 2015 and 2016, the Ten Out- thalassaemia in Sri Lanka. All regularly transfused standing Young Persons (TOYP) in Sri Lanka Award patients with b-thalassaemia who were aged be-

43 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

A total of 328 patients were recruited; 83% had b- bly high serum ferritin levels. Trends revealed rapid thalassaemia major whereas 16% had haemoglobin rise in serum ferritin during the first 5 years of life E b-thalassaemia. Over 60% of patients with transfu- before reaching a plateau emphasising the need for sion dependent b-thalassaemia were inadequately intensive iron chelation during first few years of life. transfused. Specifically, the patients with haemoglo- Finally it was revealed that despite having improved bin E b-thalassaemia were having suboptimal pre- management, patients with b-thalassaemia still ex- transfusion haemoglobin levels and higher preva- perience a poor quality of life and have abnormal lence of hepatosplenomegaly, despite receiving psychological symptom scores. This is more pro- large transfusion volumes. We also found that over nounced in the subset of patients with haemoglobin one fifth of children with b-thalassaemia were in- E b-thalassaemia. Based on these results we make fected with hepatitis C. This raises huge concerns on several recommendations to improve the care for the safety of blood products used in the manage- patients with transfusion dependent b-thalassaemia ment of b-thalassaemia in Sri Lanka. We next report in Sri Lanka to enable them to live a near normal life that approximately 70% of regularly transfused pa- until a permanent cure is available. tients with b-thalassaemia were having unaccepta-

PROFESSOR N D W LIONEL MEMORIAL ORATION

Dr. Kapila Jayaratne is a Consultant Community Physi- cian currently working as the National Programme Manager for Maternal & Child Morbidity & Mortality Surveillance at the Family Health Bureau - Ministry of Health, Sri Lanka.

Dr. Jayaratne graduated from Faculty of Medicine, University of Colombo and obtained masters and doc- torate in Community Medicine from the Postgraduate Institute of Medicine of the University of Colombo. He had his post-doctoral training at the University of Melbourne, Australia.

He is the national focal point for surveillance of maternal deaths, maternal suicides, maternal near- misses, infant deaths, birth defects and injury-related child deaths. Dr. Jayaratne has carried out numerous studies in maternal and child health. He claims for an H index of 12, thirty PubMed indexed publications and more than 850 citations. He delivered the prestigious SLMA Oration in the year 2010 and Sir Nicho- las Attygalle Memorial Oration in 2017.

Dr. Jayaratne has contributed to reshaping maternal Dr. Kapila Jayaratne and child health service delivery by translating lessons learnt out of maternal and feto-infant deaths Consultant Community Physician, National Pro- gram Manager – Maternal & Child Morbidity & into practice in the country. He was a Past President of the Perinatal Society of Sri Lanka and served as the Mortality Surveillance, Family Health Bureau – Honorary Secretary of the Sri Lanka Medical Associa- Ministry of Health tion 2019.

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

THE CHALLENGE OF THE EARLY ARRIVALS: PRETERM BIRTHS REVISITED

Babies born before the term have a good chance of We did a secondary analysis of data with the follow- survival in modern health facility contexts. The “early ing objectives; to understand the risk factors and arrival before the expected date of delivery”, pre- outcomes of spontaneous and provider-initiated preterm birth, is a baby born before completing 37 term birth, to estimate the risk factors for SGA in- weeks or 259 days of gestation. Preterm birth rates fants in preterm and term delivery, and SGA’s associ- vary from 5% to 18% world-wide with low income ation with adverse perinatal outcomes and to de- countries accounting for approximately 90% of the scribe Severe Maternal Outcomes (SMO) and Pre- preterm births. The survival of preterm babies is also term Births dependent on the income status of the countries. More than 90% of babies, born less than 28 weeks of Out of the total of 318,534 deliveries, we restricted gestation in low-income countries, die within the our analysis to different number of deliveries based first few days of life while only 10% of similar babies on the criteria of analysis. To determine the effect of die in high-income countries. maternal complications on spontaneous and provider-initiated preterm delivery, we constructed multi- Appropriate birth weight for gestational age is a ma- level multinomial multivariate logistic regression jor determinant of survival and the future health of a models comparing different delivery outcomes. preterm baby. Almost 3 million infants (2%) are born preterm and small for gestational age. Preterm birth The proportion of preterm birth among 299878 sin- is caused by more than one mechanism of disease or gleton deliveries was 6.7%. This proportion was not aetiology. The most common direct cause of preterm higher in lower HDI countries, and varied largely delivery is maternal complications. An in-depth un- from 1–10% by country. In Sri Lanka, the study in- derstanding of risk factors can be utilized to reduce cluded 1215 (6.9%) (out of 17512 eligible deliveries) preterm births by avoiding the possible preventable preterm deliveries. Provider-initiated preterm births factors, especially in high-risk pregnancies before increased as HDI increased, with the percentage be- they occur. ing 20% in low HDI countries, and 40% in high HDI countries. The provider-initiated delivery rate in Sri In order to achieve the sustainable development Lanka was the fourth highest (44%) with Brazil lead- goals (SDGs), The World Health Organization (WHO) ing (59%). Identified risk factors for preterm delivery has identified preterm births as one of the major were; teenage (<20) and advanced maternal age bottlenecks and a challenge which needs timely and (>35); unmarried civil status; lower education; severe effective interventions. It has been postulated that anaemia, systemic bacterial infection, malaria and/or more than 75% of these deaths could be prevented dengue, hypertensive disorders (chronic hyperten- with currently available cost-effective interventions. sion, pre-eclampsia or eclampsia) and other mater- As such, focusing on the preterm births is a necessity nal conditions. Risks of stillbirth and early neonatal not only to reduce neonatal or infant deaths, but death were both lower in spontaneous preterm de- also to prevent acute and chronic complications. liveries compared to provider-initiated deliveries. Perinatal mortality within both spontaneous preterm delivery and provider-initiated preterm delivery de- The WHO Multi-country survey on Maternal and creased as the HDI increased. Newborn Health (WHO-MCS) was conducted as a cross-sectional study in 29 countries including Sri Lanka. A stratified, multistage cluster sampling strat- We constructed multilevel logistic regression models egy was used. Health facilities with at least 1000 de- with random effects for facilities and countries to liveries per year were eligible for the study. We re- estimate the risk factors for SGA infants using coun- cruited all women who were admitted for delivery try-specific birth weight reference standards in pre- irrespective of gestational age. Individual data were term and term delivery. We compared the risks and extracted from the medical records of mother and adverse perinatal outcomes with appropriate for the newborn. In Sri Lanka, we selected health facili- gestational age (AGA) infants categorized by preterm ties (n=14) in the Western, Southern and Eastern and term delivery. provinces.

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Out of a total of 295,829 singleton infants delivered, epidemiological study to determine the risk factors, the overall prevalence of SGA was highest in Cambo- immediate triggering factors, critical neonatal out- dia (18.8%), Nepal (17.9%), the Occupied Palestinian come predictors of preterm births and to assess the Territory (16.1%), and Japan (16.0%), while the low- coverage of essential interventions for preterm ba- est was observed in Afghanistan (4.8%), Uganda bies in the government hospitals of Colombo District. (6.6%) and Thailand (9.7%). For Sri Lanka, the study We used unmatched case-control stud and case- included 17530 eligible deliveries and identified a crossover study to identify risk factors & triggering total of 2249 (12.8%) SGA babies. Further categoriza- factors of preterm births. tion based on GA are; < 32 weeks: (26.8%), 33 – 36 weeks: (17.8%) and 37 – 41 weeks: (12.4%). The Key risk factors of preterm birth in the multivariate rates of both preterm and term SGA deliveries were analysis included; multiple pregnancy, bleeding/ consistently high across HDI groups. The risk of pre- spotting during pregnancy, past preterm birth, re- term SGA infants was significantly higher among nul- cent stressful life event, higher gravidity, Pregnancy liparous mothers and mothers with chronic hyper- induced hypertension. No recent sexual intercourse tension and preeclampsia/eclampsia (aOR: 2.89; 95% was a protective factor. The immediate triggering CI: 2.55–3.28) compared with AGA infants. The risk factors for preterm labour were disturbed sleep and of perinatal mortality was significantly higher in pre- travelling by three-wheeler. The risk factors for criti- term SGA deliveries in low to high HDI countries. cal neonatal outcome included; first minute abnormal APGAR, birth weight <2000g, bleeding/spotting We defined women with SMO as having had a ma- during pregnancy, stressful life event during preg- ternal death or maternal near miss up to 7 days after nancy, PPROM, frequent sexual intercourse, multiple giving birth or having an abortion, irrespective of previous abortions and husband consuming alcohol. gestational age or delivery status. Out of 314 623, a Protective factors were; pre-delivery magnesium sul- total of 23 015 (7·3%) women had potentially life- fate and treated poor oral hygiene. threatening disorders and 3024 (1·0%) developed an SMO (2538 maternal near miss and 486 maternal The strategic plan, Every Newborn: An Action Plan to deaths). Rates of preterm birth and admission to ne- End Preventable Deaths (ENAP) aim to catalyze glob- onatal intensive care units, were 4 -5 times higher in al action to eliminate wide disparities in the risk of women with SMOs (p<0·0001). The perinatal mortali- death and to end preventable newborn mortality ty ratio in women with SMOs was nearly 15 times and stillbirths within a generation. The essence of higher than it was for women without SMOs. the evidence generated through this oration would lead to innovation and advances in care and research Considering the country demand for quality data on in Sri Lanka to avoid, manage and limit disabilities of preterm births in Sri Lanka, we conducted a major preterm births and those approaches could be trans- lated into policies, programs and practice.

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DR S C PAUL MEMORIAL ORATION

He is attached to the Department of Psychiatry, Fac- ulty of Medicine, University of Kelaniya as a Senior Lecturer. Further, he works as a Senior Lecturer of the Faculty of Medicine Nursing and Health Sciences of the Monash University in Australia in an honorary position. He is the first Board-Certified Child Psychia- trist of the University of Kelaniya and only such specialist for the District of Gampaha.

Miyuru Chandradasa obtained his primary education from St Bernadette’s School in Polgahawela and entered Royal College Colombo through the grade five scholarship examination. As a student at Royal Col- lege, Dr Chandradasa won the Dr F. E. Weerasooriya and Peter de Abrew gold medals and the Best Stu- dent Award by the Group of 45. He excelled in Hock- ey and Boxing at school.

He was placed at the all-island 4th place at the Ad- vanced Level Examination and entered the Faculty of Medicine of the University of Colombo. He graduated with the Dr Alaric Jayasinghe Gold Medal for the best student in Clinical Paediatrics and several distinc- Dr Miyuru Chandradasa tions. As a postgraduate trainee he won the Bobby Somasundaram Gold Medal for excellence at MD part MBBS (Colombo) MD (Colombo) MRCPsych 1, the Andrew Sims Gold Medal for excellence at MD (UK) part 2 and Peter & Mable Cooray Gold Medal for best Consultant Child and Adolescent Psychiatrist, research in psychiatry. Colombo North Teaching Hospital in Ragama Senior Lecturer, Department of Psychiatry, Miyuru Chandradasa has obtained MD Psychiatry Faculty of Medicine, the University of from the University of Colombo, MRCPsych from the Kelaniya Royal College of Psychiatrists in the United Kingdom and advanced child psychotherapy training of two years duration from the University of Melbourne. As a researcher, he has won several Senate and Vice- Chancellor awards for his research related to child mental health in Sri Lanka. Miyuru is interested in researching the adolescent character and personality development and at present, he is reading for a PhD Dr Miyuru Chandradasa MBBS (Colombo) MD in that domain. (Colombo) MRCPsych (UK) is a Consultant Child and Adolescent Psychiatrist at the Colombo North Teach- ing Hospital in Ragama, Sri Lanka. He is a medical spe- Miyuru Chandradasa is married to Dr Layani Rathna- cialist in behavioural, emotional and learning issues yake, a Consultant Adult Psychiatrist and they have a of children, adolescents and youth. son and a daughter.

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CHILD MENTAL HEALTH: LITERACY, BURDEN, CULTURAL ASPECTS AND DEVELOPING SERVICES FOR SRI LANKA!

For decades mental health services in Sri Lanka were ity and peer relationship symptoms were higher in mostly hospital-based and barely adequate to man- children with transfusion-dependent β-thalassaemia age the major adult psychiatric disorders. With the compared to others. gradually rising number of psychiatrists in the country establishment of subspecialties has become a After identifying neurodevelopmental disorders reality. However, with the limited number of experts, effective treatment need to be offered. Due to the the child mental health services face an enormous limited number of child psychiatrists in the service, challenge in developing relevant services for Sri psychotherapeutic interventions are not available in Lanka. all settings and psychopharmacological management may take precedence. In a 12-month follow-up study Child mental health literacy is important for early conducted among children with tic disorders, we detection and referral of psychological issues and found that almost 80% with persistent motor tic dis- developmental delays for early interventions, that order respond to low-dose risperidone with manage- would improve the long-term functionality of the able adverse effects. individual. In a study conducted among 523 preschool teachers and parents in an urban region of Sri The cultural background and social learning need to Lanka, knowledge on identifying and seeking appro- be considered when diagnosing and treating child- priate professional help for child mental health hood mental health disorders. The need for compre- presentations was assessed using common psycho- hensive sexuality education is not widely recognised logical and physical case vignettes. We found that in the society and child sexual abuse is under- knowledge was significantly low for mental health reported. We have reported attention deficit hyper- vignettes compared to physical ones and early edu- activity presenting as sexual offending and high- cators did not demonstrate better capabilities com- functioning autism presenting as zoophilia. Further, pared to parents. children with autism may present with unique cultural phenomena such as stories of reincarnation. Neurodevelopmental disorders such as autism have lifelong economic and social impacts to the individu- The future child and adolescent mental health ser- al, family and the wider community. Added to this vices need pragmatic multi-disciplinary and multi- burden is the medical comorbidities. In a study con- sectoral collaborations. Human resource and infra- ducted at a tertiary care children’s hospital, we structure limitations could be overcome by innova- found that the prevalence of febrile seizures, epilep- tive methods such as telepsychiatry and mental sy, bronchial asthma, atopic dermatitis and recurrent health promotion through social media networks. gastrointestinal symptoms were higher in the autism Rather than copying a Western model, finding a Sri group compared to the typically developing control Lankan recipe for our child mental health services is group. In addition, psychological morbidity is signifi- of utmost importance. cantly seen in chronic physical disorders and we found that abnormal emotional, conduct, hyperactiv-

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

FACULTY

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LOCAL FACULTY

Dr. Ananda Wijewickrama Professor Chandanie Wanigatunge Consultant Physician, National Institute Specialist in Internal Medicine of Infectious Diseases Chair Professor of Pharmacology, Faculty of Medical President - Ceylon College of Physicians Sciences, University of Sri Jayewardenepura

Dr Chandimani Undugodage Dr. Dinil Abeygunawardena Lecturer, Department of Physiology, of Medical Educator/Researcher in Visual Communication & Sciences, University of Sri Jayawardenapura Colour Management Consultant Respiratory Physician, Colombo South Founder / Managing Director Teaching Hospital Institute of Multimedia Education

Professor Hemantha Senanayake Dr. Jude Jayamaha Professor Emeritus, Department of Obstetrics & Lead and Consultant Virologist, National Influenza Gynaecology, Faculty of Medicine, University of Centre, Department of Virology, Medical Research Colombo Institute President - Sri Lanka Endometriosis Association 50

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

Dr. Lilani Rajapakshe Professor Manuj C Weerasinghe Consultant Venereologist Professor in Community Medicine Deputy Director, National STD/AIDS Control Faculty of Medicine, University of Colombo Programme, Sri Lanka

Dr. Nayani Madarasinghe Dr Neranjan Dissanayake Consultant Dermatologist at National Institute for Consultant Pulmonologist, Teaching Hospital & Infectious diseases, Colombo District Chest Clinic, Rathnapura

Dr. Nihal Abeysinghe Dr. Panduka Karunanayake Consultant Epidemiologist Consultant Physician Deputy Director, Institute of Research and Develop- Senior Lecturer in Clinical Medicine, Department of ment for Health & Social Care Clinical Medicine, Faculty of Medicine, University of Colombo

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Professor Piyanjali de Zoysa Professor Rangika Halwathura Professor in Clinical Psychology, Commissioner - Sri Lanka Inventors Commission Department of Psychological Medicine, Faculty of Professor, Department of Civil Engineering, Medicine, University of Colombo Faculty of Engineering, University of Moratuwa

Professor Saroj Jayasinghe Dr. Vajira Dharmawardene Chair Professor of Medicine Consultant Psychiatrist, Teaching Hospital Ratnapura, Former Head, Department of Medical Humanities Managing Editor, Journal of Ruhunu Clinical Society University of Colombo. Hon. Consultant Physician National Hospital of Sri Lanka

Dr. Vindya Kumarappeli Consultant Community Physician Director Non-Communicable Diseases (NCD) and the Director Policy Analysis and Development, Ministry of Health, Sri Lanka

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

FOREIGN FACULTY

Professor Bruce Maycock Professor Collin Binns Secretary General John Curtin Distinguished Professor of Public Health Asia-Pacific Academic Consortium of Public Health Editor in Chief, Asia Pacific Journal of Public Health Honorary Professor, College of Medicine & School of Public Health, Curtin University Health, University of Exeter Perth, Western Australia

Dr Dujeepa D Samarasekera Dr Henrik Syse Director, Centre for Medical Education, Research Professor, Peace Research Institute Oslo Yong Loo Lin School of Medicine, (PRIO), Professor of Peace and Conflict Studies at National University of Singapore Björknes University College, Oslo, Norway Senior Consultant, Ministry of Health Singapore

Dr Lawrence Sherman Professor Liesl A Nydegger President, Meducate Global, LLC Assistant Professor, Health Behaviour and Health Edu- International Development, Association for Medi- cation, Department of Kinesiology & Health Education, cal Education in Europe (AMEE) University of Texas at Austin

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Professor Malik Peiris Dr. Navid Pour-Ghasemi Professor and Chair in Virology, School of Public Assistant Clinical Professor of Medical Education, Health, University of Hong Kong Keck School of Medicine, USA

Professor Michael Kidd Dr. Mickey Chopra Principal Medical Advisor and Deputy Chief Medical Global Lead, Health System Development, Officer, Department of Health, Australia World Bank Professor of Primary Care Reform, Australian National University, Canberra

Dr. Razia Pendse Dr. Suchitra Dalvie World Health Organisation Representative, Sri Lanka Coordinator Asia Safe Abortion Partnership Member of Royal College of Obstetrics and Gynaecology, UK

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

Professor Susan Sawyer Ms. Tanzila Khan President, International Association for Adolescent Founder-Girlythings Health, Lancet commissioner Women Deliver young leader- Disability rights activist Geoff and Helen Handbury Chair of Adolescent Health - Department of Paediatrics, The University of Mel- bourne - Director, Centre for Adolescent Health - Royal Children’s Hospital

Professor TEO Yik Ying Dr Thiru Thirukamoorthy Dean, Saw Swee Hock School of Public Health, Adj. Professor at Duke NUS Medical School, Singapore National University of Singapore, Singapore Director, Professionalism Development Program, Office of Academic & Clinical Development Academic Director, Singapore Medical Association, Centre for Medical Ethics and Professionalism.

Professor Zafar Iqbal Professor Wah-Yun LOW Visiting Professor Staffordshire University Professor of Psychology, Faculty of Medicine, Associate Medical Director Public Health MPFT University of Malaya, Kuala Lumpur, Malaysia. Associate Medical Director Public Health, Deputy Executive Director (Research & Internationali- Keele University, UK zation), Asia-Europe Institute, University of Malaya

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

SUMMARY OF PRESENTATIONS

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

DAY TWO 25th July 2020

Keynote Address

CHALLENGES IN HEALTHCARE PROFESSIONALISM viz-a-viz -in Healthcare delivery in the New normal Dr T Thirumoorthy

In this short presentation, I would like to share some thoughts on the challenges and possible solutions to developing professionalism in healthcare.

The first challenge in Healthcare professionalism is the lack of a universally accepted definition. I would like to offer this as a working definition “ Healthcare Professionalism is a multi-dimensional concept encompassing a set of duties, competencies, behaviours, values (principles), virtues (professional conduct), outcomes (performance) and relationships that aims to achieve the Goals of Medicine, and promote Trust & Confidence in the healthcare system.

The second challenge is to determine when does one become or qualifies to be a Healthcare Professional (HCP). For the individual, healthcare professionalism is a 30 to 40-year transformative journey from novice to mastery. Similarly, it may take a decade for a healthcare institution to develop and embed a culture of professionalism.

The third challenge in Healthcare professionalism is to be clear to whom this concept of professionalism ap- plies, traditional beliefs ignorantly attribute it to the individual only. In today’s healthcare enterprise, professionalism to work must be owned by the healthcare systems, organisation or institutions, departments, teams in addition to the individual.

The eternal challenge to professionalism lies in the value system of societies and humans. The challenge is for the professionals committed to altruistic healing and science, is to find a proper balance from the commercial- isation of healthcare and politicisation of healthcare.

In conclusion I would like to offer the deliberate development of leadership modules in healthcare education as a long-term endeavour to enhance and rejuvenate healthcare professionalism in the “New Normal”.

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Symposium 1 - Response to the COVID-19 Pandemic: Lessons Learnt

UK RESPONSE TO THE COVID-19 PANDEMIC: LESSONS LEARNT Professor Zafar Iqbal

This has been the most serious Public Health Crisis since the Spanish Flu Pandemic. What has been the UK experience? This talk will cover a range of critical questions:

What has been the UK policy response? The Government has introduced an array of public health, heath service, social and economic policy measures. Have these policy measures been effective? The answer to this question depends on how success is defined. What has happened to the COVID 19 epidemic curve and mortality rates? How dos the UK compare with the international experience?

Initially PCR testing was introduced and now antibody tests have been added. Why has the policy of test and trace been introduced?

To prepare for the worst case pandemic scenario additional hospital beds and intensive care capacity was created. How has the health service coped with the pandemic? What has the been the impact on hospitals and community services.

What has been the social and economic impact of the pandemic and the policy measures to deal with it? There are many different opinions on how the UK has coped with the pandemic. I will provide my personal perspective on the lessons learnt.

SINGAPORE Professor TEO Yik Ying

Singapore was one of the first few countries in the world to experience the COVID-19 outbreak, with its first case seen in mid-January. From the beginning, the government recognised this was an outbreak that will have tremendous impact on lives and livelihoods, and thus initiated a whole-of-government response which included government agencies overseeing trade, labour, education and the environment, as well as the health sector. Singapore’s response to the COVID-19 outbreak can be characterised in three principles:

Aggressive case finding, comprehensive contact tracing, and rapid isolation and quarantine;

(2) Relying on science, evidence and empathy to shape rapidly evolving national responses;

(3) Clear and trusted communication strategies informing individuals and communities on the current outbreak situation, national regulations, and what individuals can do to protect themselves and their house- holds from being infected.

These three principles have helped Singapore contain the first wave that was introduced in mid-January by travelers from China, and are still guiding the country in handling the second wave introduced in mid-March by returning Singaporeans and which has affected the densely-population migrant worker community residing in dormitories. To break the transmission of SARS-CoV-2 in the community, Singapore implemented a “circuit breaker” from 7 April until 1 June, which was effectively a partial lockdown with schools and- non essential workplaces closed thereby successfully reducing the effective reproduction number to less than1.

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Symposium 2 - Are we forgetting the other Communicable Diseases?

LEPTOSPIROSIS Dr Panduka Karunanayake

Leptospirosis has a high incidence rate and case fatality rate in Sri Lanka. In recent times, the epidemiological and clinicopathological profiles of leptospirosis have undergone significant change, giving rise to more trou- blesome complications, greater need for intensive care and costly treatments, and more deaths in complicat- ed patients. There is a greater need for awareness about these aspects, facilities for diagnosis and treatment, and research. However, in the face of other high-profile infectious diseases, it continues to be neglected. In this talk I will argue the case for greater awareness and involvement of this problem at both policy level, public health and curative services.

INFLUENZA IN THE SETTING OF COVID-19 Dr Chandimani Undugodage

Influenza virus (types A and B) is responsible for the seasonal flu epidemics each year. Influenza virus has caused several pandemics in the past; 1918 (H1N1), 1957-58 (H2N2), 1968 H3N3 and 2009 (H1N1pdm09). 1918 influenza pandemic is considered the most severe pandemic in the recent history. It is estimated that 500 million people were infected with the virus. Social distancing, quarantine, personal hygiene and limitations on public gatherings were practiced, as there was neither a vaccine nor antibiotics to treat secondary bacterial infections. Interestingly more than a century later same principles are followed in the wake of the COVID 19 pandemic.

The most recent influenza pandemic caused by (H1N1)pdm09 virus was much different from the H1N1. It pri- marily affected children, young and middle-aged adults. It is estimated that 0.001-0.007% of the world’s population died as a consequence of respiratory complications associated with the H1N1pdm09 virus during the first 12 months the virus circulated.

This highly contagious airborne disease gives rise to upper respiratory symptoms, pneumonia, respiratory failure and death; a clinical picture similar to SARS COV 2 infection. Although COVID 19 has clearly stolen the thunder, influenza has not taken its leave, thus it is of paramount importance to consider infection with influenza virus when managing such patients.

A BATTLE OF OLD AND NEW - Repercussions of COVID-19 on Tuberculosis Dr Neranjan Dissanayake

COVID 19 appeared out of the blues, even though there were warnings of the pathogenic potential of the Co- rona viruses, the over whelming impact that it made, caught the human civilization in a vulnerable state. The impact on health and economy is unprecedented.

This unexpected situation resulted in many health care delivery systems to fail, causing concerning rises of non COVID related morbidity and mortality.

I will be exploring the effect of this pandemic on one of such health issues. Tuberculosis being the second most common infective cause of death, by itself was a major threat to human well being. Did we neglect its potential impact? were there any benefits that we gained? How can we improve further with the lessons learned? This discussion will focus on these important questions.

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Guest Lecture 1

SUPPORTING PRIMARY CARE DURING COVID-19 PANDEMIC Professor Michael Kidd

Australia has a strong system of primary care provided by doctors, nurses and other health care workers, including allied health professionals, midwives, community pharmacists, dentists, and Aboriginal health workers. Comprehensive primary care services are available to all members of the community through general practice and Aboriginal community-controlled health services, provided by general practitioners, primary care nurses, allied health and other health care professionals working at the forefront of the health system. Many of the nation’s most vulnerable people also access services through aged care, home care and disability care services. Australia’s primary care response to COVID-19 acknowledges the need to protect vulnerable populations, to continue the provision of regular primary care services to the whole community for acute and chronic conditions, preventive care, and mental health concerns, and the need to support and protect healthcare workers in community settings, as well as in the nation’s hospitals.

In early March 2020, a targeted action plan was initiated by the Australian Government Department of Health to develop and refine the National COVID-19 Primary Care Response. This action plan acknowledged the essential, first-contact role of general practice in the nation’s pandemic response, and was informed by lessons from previous epidemics and pandemics where primary care had limited involvement in both planning and response, and by focused consultation with primary care stakeholder organisations.

Issues considered in the framing of the National Primary Care Response included measures required to protect both the public and the primary care workforce from infection, the management of people presenting to general practice with fever and/or respiratory symptoms, the continued health care management of vulnerable people at increased risk of COVID-19, concerns about seasonal influenza in Winter, arrangements for pathology testing in the community, and the impacts on business continuity for community-based health services.

Key components of the National Primary Care Response included: funding of a whole of population model of telehealth (using telephone or video consultations); establishment of call centres to triage people with fever or respiratory symptoms, provide advice and direct them to the most appropriate health services; establishment of a nationwide network of respiratory clinics based in the community to complement state and territory-run fever clinics; development and delivery of online infection prevention and control training for all care workers; measures to safeguard the health of the members of remote Aboriginal and Torres Strait Islander communities across the continent; and ensuring consistent messaging to members of the nation’s primary care workforce.

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Guest Lecture 2

THE SOCIO-POLITICAL ENVIRONMENT MATTERS IN A PANDEMIC: LESSONS FROM COVID-19 Professor Bruce Maycock

Covid-19 has transformed our world, it has exposed weaknesses in our societies that were often dismissed as of limited importance. It has also shown us societal strengths that have aided some countries COVID responses. Diverse issues such as essential manufacturing, housing, contract allocation, community values, trust, communication and most importantly leadership have been shown to be critical to the prevention and control of COVID-19. The role of public health has never been more important and we are being asked to provide leadership and advice beyond our traditional training.

Some high-income countries that one might have expected to provide global leadership have so-far failed in their COVID-19 response. Over the last couple of months APACPH has conducted regional webinars with leaders involved in advising or leading their country’s COVID-19 response. Participants from Sri Lanka, China, Vi- etnam, Hong Kong, Singapore, Taiwan, Malaysia, Thailand, Korea, and Australia gave regional participants insights into the strategies they used, the lessons they have learnt and the influence of socio-political factors on strategy selection. If we look in our region, we will find multiple examples of best practice. We can see countries that have learnt from SARS and MERS, who have maintained strong public health infrastructure and training, who years ago trialled communication and tracking strategies, who have maintained production capacity and stockpiled essential resources and who have leaders willing to make difficult culturally appropriate decisions.

This presentation will discuss these insights, strategies to operate in the politically charged situation, the posi- tives and negatives of some cultural values, the role of respect, equity, trust, leadership, and the communication strategies that may help populations through the turbulent periods of restriction easing and tightening.

Guest lecture 3

MAINTAINING YOUR BEAUTY IN THE “NEW NORMAL” Dr Nayani Madarasinghe

Restarting normal work and social life following the lockdown period due to COVID 19 pandemic necessitate essential hygienic measures, such as social distancing, wearing face masks, frequent hand washing and bath- ing. There are various implications on skin health and beauty imposed by these hygienic measures. When these practices become part of our routine in the “New Normal” we tend to ignore the adverse effects that may manifest due to these. It is important to maintain healthy and beautiful skin while protecting ourselves from the virus.

There are various skin issues related to face masks such as acne, skin irritation, dermatitis and urticaria. Fre- quent hand washing and hand sanitizers disrupt the normal skin barrier and make the skin vulnerable for irritation and hand dermatitis. A brief description of these skin related issues due to preventive hygienic measures of COVID 19, ways to overcome these, and routine skin and hair care tips will be delivered in the lecture.

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Guest Lecture 4

COVID AND SEXUAL HEALTH Dr Lilani Rajapakshe

Lessons from the Ebola and Zika virus disease outbreaks show that during such outbreaks access to sexual and reproductive health (SRH) services can be severely disrupted. A modelling group convened by the WHO and UNAIDS has estimated that a six-month disruption of antiretroviral therapy could lead to more than 500 000 extra deaths from AIDS in sub-Saharan Africa in 2020–2021. Disrupted services could also reverse gains made in preventing mother-to-child transmission of HIV. The failure to protect vulnerable groups put them at a higher risk of infection and undermines the broader COVID-19 response.

When facility-based provision of SRH services is disrupted, WHO recommends prioritizing digital health services, self-care interventions, task sharing and outreach to ensure access to medicines, diagnostics, devices, information and counselling. This prioritization should include ensuring access to contraception, promotion of sexual health and prevention and treatment services for sexually transmitted infections (STIs), including HIV.

It is important to maintain essential commodities such as medicines including ART. During the COVID crisis period National STD AIDS Control Programme maintained services for STI and HIV care through 33 district STD clinics. The continuity of HIV care services was maintained by providing drugs to PLHIV at the closest STD clinics as well as through home deliveries by STD clinic staff and PLHIV support groups.

Condom availability and accessibility needs to be ensured for safer sexual practices. Ensuring availability of menstrual products is important. Future recommendations include Increasing the availability of self-testing for HIV and STI and minimizing provider–client contacts through the use of telemedicine.

Symposium 3 - Challenges in the management of COVID-19 infection

DILEMMAS IN LABORATORY DIAGNOSIS Dr. Jude Jayamaha

Laboratory diagnosis has a major impact on The COVID-19 outbreak in case management and to a greater ex- tent of the public health interventions in the past several months. Sri Lanka was able to establish a PCR assay late January, 2020 first countries to do so in the WHO SEARO region, enabling to detect the first case, thereby increase the awareness of COVID-19. There are many are issues and challenges for the laboratory diagnosis of infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the preanalytical stage, collecting the proper respiratory tract specimen at the right time from the right anatomic site is essential for a prompt and accurate molecular diagnosis of COVID-19. Appropriate measures are required to keep laboratory staff safe while producing reliable test results. In the analytic stage, real-time reverse transcription- PCR (RT-PCR) assays remain the molecular test of choice for the etiologic diagnosis of SARS-CoV-2 infection while antibody-based techniques are being introduced as supplemental tools. In the postanalytical stage, testing results should be carefully interpreted using both molecular and serological findings. Finally, random- access, integrated devices available at the point of care with scalable capacities will facilitate the rapid and accurate diagnosis and monitoring of SARS-CoV-2 infections and greatly assist in the control of this outbreak.

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

PRESCRIBING AS WE GO Professor Chandanie Wanigatunge

The 6 months anniversary of COVID-19, which emerged as a respiratory infection in December 2019, saw over 11 million infected globally, including over 500,00 deaths. Initially an unknown pathogen, most of what is known was inferred from related coronaviruses or severe respiratory infections. With slightly over 2000 confirmed cases and 11 deaths, Sri Lanka has thus far fared quite well in the COVID-19 pandemic.

The rapidity of spread and the associated high mortality challenged the scientists and prescribers to identify effective medicines faster than accepted norms. This resulted in repurposing or repositioning of existing medicines without a clear understanding of the underpinning mechanisms. Clinical trials and observational studies were conducted rapidly but with many methodological flaws. These resulted in questionable data, high- lighting the need for good quality, randomized clinical trials even in the midst of a pandemic. Such trials also created ethical dilemmas hitherto unknown. Health equity was challenged in many countries, resulting in more ethical dilemmas to the clinicians.

Over 90% of clinical trials were conducted in those with severe disease. Extrapolating the findings to those with mild disease, as seen in Sri Lanka, was a challenge. The clinicians could not wait for good quality evidence for treatment and had to prescribe “on the go”.

For the moment management of COVID-19 rests with prevention of infection, case detection and monitoring and supportive care in those with severe illness. Any medicine or treatment modality for COVID-19 is only on compassionate/emergency use or in the setting of a clinical trial.

CHALLENGES IN TREATMENT Dr Ananda Wijewickrama

As the COVID-19 is a new disease and as it looks to be different to other corona virus infections, the understanding the clinicians, virologists, epidemiologists are having is still very limited. It is well known that this has a very high infectivity and a relatively high morbidity and mortality rate. However, the patho-physiology is poorly understood and therefore, clinical management has become a huge challenge and has limited to supportive treatment.

In this circumstance, clinicians all over the world have started using various empirical treatments. These include drugs with possible anti-viral effects, anti-inflammatory drugs and various vitamins. Large number of trials is being conducted but most of the treatment researched had been done on patients with moderate to severe cases. To make the challenge of treating COVID-19 more, the messages getting from researches are also conflicting. Several articles from leading medical journals have been withdrawn putting clinicians in dilemma.

Underlying pathology in severe cases of COVID-19 is now believed to be due to microvascular thrombosis of pulmonary vessels rather than pneumonia. Low molecular weight heparin, oxygen therapy and prone ventilation are probably the only proven beneficial treatment methods. A recent large trial showed that dexame- thasone is beneficial in patients with severe disease. However, to prevention of the progression of the mild disease to severe disease is still a challenge.

In Sri Lanka, use of Hydroxy-chloroquine(HCQ) was recommended and it had been used without any problems. However, several recent trials showed evidence against using HCQ. These results have make continuing use of HCQ a challenge even though these trials were done in patients with severe disease, late in the disease

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or in high doses.

The biggest challenge in managing COVID-19 patients is to handle the ‘COVID phobia’ among doctors and other health care workers. This phobia has led to many un-necessary constructions, equipment and precautions, which at times actually increase the risk of contracting the disease, instead of having traditional open wards with good ventilation and necessary personal protective equipment for health staff which would be beneficial for the patients as well as the staff.

Symposium 4 - Emerging & Re-emerging Infections

EMERGING AND RE-EMERGING INFECTIONS: GLOBAL SCENARIO. Professor Malik Peiris

Containment of infectious diseases has been one of the triumphs of modern medicine. Many of the scourges of “plagues” past were contained by vaccination or antibiotic treatment; small pox eradicated, polio on the way to eradication and the “book on infections disease was (supposedly) closed”. But “Nature always strikes back” it has done so with a vengeance. HIV/AIDS, antimicrobial resistance, SARS, pandemic and zoonotic influ- enzas, MERS, Ebola, Zika, and most recently COVID-19 have illustrated the vulnerability of the human species to rapidly evolving and adapting microbes. The emergence of many emerging infections are facilitated human activity. These include encroachment of ecosystems, land-use changes, urbanization, intensive animal hus- bandry, travel, trade, human demographics and behaviour, breakdown of public health, and others. The emergence and spread of COVID-19, the most recent of these pandemics, is directly attributable to many of these factors. SARS in 2003 made the world sit-up and take notice of the threat from emerging infections and led to the international health regulations 2015, which obligates nations to develop capacity to detect, report and respond to novel epidemics. But while these obligations were “signed-up-to,” they have not been universally implemented. COVID-19 revealed weaknesses, even in affluent developed nations, where public health capacity had been sacrificed in the name of “market-based” and “insurance-driven” models of health care. Global dependence on the pharmaceutical industry for the development of counter-measures for emerging infections failed to provide pre-emptive responses, even when the threats from zoonotic coronaviruses were clearly obvious and well-articulated. COVID-19 provides a wake-up call to re-set priorities, because this pandemic will not be the last. It is also a wake-up call for a global response to the other slowly but inexorably evolving crises of climate change, degradation of biodiversity and the environment. Responding to these challenges requires a multi-disciplinary “One Health” response.

PUBLIC HEALTH RESPONSE TO INFECTION PREVENTION Professor Manuj C Weerasinghe

Emerging and re-emerging infections are becoming a major threat to the existence of a healthy population across the globe. Through the advances in science and technology, solutions are made against the infections at curative level, preventive approach been the best option in protecting the masses. Apart from development of vaccines for mass immunization, most of the preventive strategies are mainly based on the health systems response to keeping away the infective agents from introduction to the communities and containing the infection as far as possible within controllable limits. Importance of such prompt measures are further emphasised with the current pandemic situation owing to SARS-Cov-2 virus, still far from over. This paper will focus on the importance of prompt public health response to infection prevention drawing heavily from the experience from current COVID 19 pandemic.

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

PREVENTING FUTURE PANDEMICS: EXPLORING A PLANETARY HEALTH RESPONSE Professor Saroj Jayasinghe

Covid-19 has caused a pandemic of unprecedented proportions.

There are at least 4 converging systems that are contributing to the emergence of the pandemic: the earth systems, the urbanocene (i.e. the urbanization processes, and spaces that have become the main living space of the human species), the system of mobile humans and objects, and the virus with its potential to infect. Loss of biodiversity it an important change to the earth system that promotes the emergence of zoonotic infections. The urbanocene has resulted in high densities of populations that facilitate spread of epidemics. The infective virus and its transmissibility are other factors promoting the epidemic. Finally, the hyper-connectivity of human species and physical objects it has produced (e.g. planes and cargo) and their movement across thousands of miles often from city-to-city has promoted widespread dissemination of the virus.

These are considered from the perspective of the wider system operating at the planetary health level and a more overarching, comprehensive and generic conceptual model is derived. The proposed model suggests that the COVID-19 pandemic and future similar pandemics emerge due to the ecological processes (climate change), anthropogenic social processes (i.e. corporate interests, culture and globalization) and world population growth. Intervention would, therefore, require modifications or dampening these generators if we are to preserve human health, sustain the planet and prevent future periodic pandemics that would reverse human development.

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DAY THREE 25th July 2020

Plenary 1

DIGITAL DELIGHTS AND SPECTACULAR SOCIAL MEDIA IN CONTIN- UING PROFESSIONAL DEVELOPMENT Dr Lawrence Sherman

Digital teaching, e-learning, and other forms of remote education have been used effectively and often in Continuing Professional Development (CPD) and Continuing Medical Education (CME) for more than 20 years. More recently, social media have been incorporated into all time points in the design, delivery, and assessment of CPD and CME activities. Many of the best practices that have developed over this time were able to be used by health professions educators across the educational continuum: undergraduate, postgraduate, and CPD/CME as they had to adapt to the new normal of teaching during the COVID-19 pandemic.

This interactive session will feature a journey through the landscape of digital educational delivery, high- lighting best practices in preparing and delivering presentations and courses, as well as using social media in the CPD setting. The learnings will be relevant to all health professions educators, and practical tips and tricks will be provided to facilitate transfer of what is learned into their educational practice the next day!

Participants should come to the session with any questions or challenges that they have with digital teaching and using social media to enhance their educational practice.

Plenary 2

PROMOTING ETHICS & PROFESSIONALISM DURING COVID-19 PANDEMIC Dr Henrik Syse

How do we respond ethically and responsibly to a crisis of the magnitude of Covid-19? How are our professional ethical standards challenged – and hopefully reinforced and improved – during the pandemic? Henrik Syse, a philosopher, peace researcher, and member of the Norwegian Nobel Committee, will share his thoughts and critical reflections on what professional medical ethics most basically consists of, and how we can use tools from ethics in the current situation.

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Symposium 5

RIGHT-BASED APPROACH TO DELIVERING COMPREHENSIVE SRH SERVICES FOR ALL IN THE NEW NORMAL

Panellists Professor Susan Sawyer Dr Suchitra Dalvie Professor Hemantha Senanayake Ms. Tanzila Khan

The ICPD Programme of Action represents the commitment of 179 governments to ensure that all people have access to quality, comprehensive sexual and reproductive health (SRH) care and SRH rights are upheld. It is the obligation of every country and community. This means that countries need to ensure that the SRH needs of all it’s different population cohorts (by generation, gender, marital status, sexual orientation, disabilities, including sitgamitized/marginalised groups such as sex workers, people living with HIV, sexual minorities and those in extreme poverty, ) are met throughout their life course. This requires a comprehensive approach to SRH with a life course approach, applying equity in access, quality of care, without discrimination, and ac- countability.

While progress has been made over the years, challenges still exist in delivering comprehensive nondiscrimi- natory SRH services and access to the same as it remains controversial and contested. Age, disability, gender identity, sexual orientation, ethnicity, poverty, class, stigma, discrimination and other social, cultural and economic barriers pose major challenges to implementation of SRH care. Further, pandemics such as COVID 19 make existing inequalities and discrimination of marginalized groups worse and services including reduced access to health services, SRH and GBV services can impact how they receive treatment and care, and creates greater need for protection. The need for comprehensive quality SRH care is now more important than ever before.

During the pandemic the relationship between the healthcare delivery systems, health promotion, and quality of care is dynamic and critical. The responsibility of healthcare workers to promote the well-being of their patients and provide high quality care can be undermined by the complexities of the healthcare systems therefore, innovative solutions for client centered service provision is urgently called for. Current examples of effective systems theory applications in improving quality of care include information technology applied to key clinical systems. These systems include medication administration, electronic documentation, patient order entry, and physiological monitoring. Currently social distancing and telecommuting have become the new norm, the COVID 19 pandemic has changed the way we operate in the present and the near future. Moving forward, it is essential that delivery of rights based SRH services and interventions adapt to this new normal to ensure achievement of universal access to SRH.

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Symposium 6 - Impact of COVID-19: Policy Implications

FIVE SHIFTS REQUIRED BY HEALTH SYSTEMS: 5 SHIFTS REQUIRED BY HEALTH SYSTEMS Dr Mickey Chopra

This talk will highlight the shifts required to build a more resilient PHC system following the challenges wrought by the COVID-19 outbreak. If the PHC system is unable to maintain access to essential services, the negative health impact, including mortality, attributable to a reduced use of routine care can exceed that attributable to the emergency In addition, PHC systems provide services related to the emergency to prevent hospitals from breaching their capacity during the crisis. Previous outbreaks suggest that task shifting, sup- ported by adequate training, is necessary to cope with the emergency challenges. One of the lessons learned from the SARS outbreak in Hong Kong concerns the need for a wider involvement of the General Practitioners (GPs), who could contribute to the response as educators, triage decision makers, and vaccines administra- tors. Patient management and triage strategies need to be adapted, health workers need to be trained in the specifics of the response and patient care and heightened safety precautions need to be implemented. Litera- ture from natural disasters emphasized that the PHC utilization patterns increase substantially after the emergency and, therefore, PHC facilities should plan to ensure they have adequate surge capacity in the recovery phase. Additionally, resilient PHC systems are also able to incorporate into their routine care, the continued services required by those afflicted by the emergency as well as the delivery of newly available preventive and treatment services related to the emergency. This requires adjustments to the required inputs to satisfy changed demand and service scope as well as the guidelines, supervision and financing to support these adjustments.

IMPACT OF COVID-19: POLICY IMPLICATIONS FOR NON- COMMUNICABLE DISEASES (NCD) Dr Vindya Kumarappeli

Sri Lanka has a high burden of NCD, estimated to account for 83% of all deaths in Sri Lanka in 2016. Due to stern action taken on restricting people’s movements, NCD services: essential medicines, investigations, interventions became less accessible; maintaining a healthy lifestyle was challenging due to lack of physical activity and unbalanced diet; routine capacity building programmes on NCD prevention & control for staff and monitoring and supervision of NCD service provision were postponed. Maintenance of NCD related services was identified as a priority in the national COVID19 response plan. Ensuring continuous supply of medicines for patients followed up at government and private sector was overcome by home delivery of medicines operat- ed through health/non-health staff or web-based mechanisms. Provision of inward, emergency and essential palliative care for NCD patients was uninterrupted while unnecessary admissions were discouraged. Tele- medicine and digital solutions were introduced with financial and technical support of WHO and private sector organizations for consultations, preventing overcrowding at the clinics and minimizing unnecessary clinic visits of high risk or immunocompromised patients, connected through their mobile phone while at home or by referring to PHC hospital closest to residence. Mass/social media were extensively used for the promotion of health lifestyle and for patient information on NCD services. Virtual learning management system was introduced at NCD Bureau/Central Hub connecting nine provincial Teleconferencing Units/peripheral spokes for capacity building and monitoring of NCD services at primary care level using zoom technology. These innovative public health approaches ensured continuation of routine service for NCD which can be adopted into policy option in future.

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

COVID-19 AND MIGRATION Dr Razia Pendse

Migrants include a diverse group of persons who move away from her or his usual place of residence and include - migrant workers and families, students, displaced persons, refugees and asylum seekers. In the COVID- 19 pandemic, migrants face the triple burden of health crisis, socio-economic crisis and protection crisis, and are affected disproportionately due to their inherent vulnerabilities – these include linguistic barriers, crowded places of living, lack of access to healthcare, stigma and discrimination. Migrant workers are facing loss of livelihoods and are returning to native countries. Aside of personal losses, there is loss to national incomes, especially for countries like Sri Lanka where the revenue share of remittances is significant. Added to the de- creasing revenue is the need for safe repatriation, health care for the returnees and job creation. It is recommended that countries integrate migrants and displaced populations as part of the comprehensive COVID-19 response.

Guest Lecture 5

GENDER EQUITY & RIGHTS DURING EMERGENCIES Professor Liesl A Nydegger

Emergencies, disasters, pandemics, crises—they often demonstrate the already existing inequities in our structural systems. While some emergencies immediately affect more men (e.g., higher COVID-19 rates among men), immediate and long-term consequences of emergencies disproportionately affect women. Women experience gender-based violence, economic insecurity, and inequity in healthcare. Worldwide, 1 in 3 women experience gender-based violence. Emergencies increase gender-based violence, particularly intimate partner violence. Sheltering-in-place has further increased intimate partner violence around the world as women and girls are literally trapped with their abusers, and have less access to already limited resources. Women tend to be employed in more insecure, informal, and low-paying jobs compared to men. Emergencies exacerbate these economic inequities from loss of these insecure or informal jobs and women often have less money saved. Women are disproportionately impacted by inequitable healthcare. Nurses, a majority of which are women, tend to work the front lines during emergencies and crises. In the face of COVID-19, that increases women and their family’s risk of contracting COVID-19. Emergencies also lead to decreased access to quality health services and reproductive healthcare; there is less access to contraception and increases in maternal mortality. Global emergencies bring inequities to the forefront and provide an opportunity for action such as 1) increasing women’s voices, 2) supporting access to resources, 3) end gender-based violence, and 4) develop emergency response protocols that emphasize gender equity. Women make up less than a quarter of political leaders and decision-makers throughout the world; we can increase the voices of women by promoting leadership and including us in all levels of government. We must focus on providing equal education and em- ployment opportunities for women. We must work together to fight gender-based violence, including challenging repressive social norms and policies. All countries must engage in emergency preparedness and priori- tize equitable responses for everyone, paying attention to the unique needs of women. We, as a global society, must work together to increase gender equity and challenge inequitable practices and policies to create a healthier world for everyone.

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Guest Lecture 6

NUTRITION FOR INFANTS DURING EMERGENCIES Professor Colin Binns

The world is enduring an increasing number of disasters as the population has grown, global climate is chang- ing, and people are crowding into cities and live in marginal environments and in many places conflicts continue. In the past year the increasing severity of wildfires, has joined a long list of emergencies caused by floods, droughts, conflicts, epidemics and other disasters. Increased knowledge of the importance of the first 1000 days of development and epigenetics and lead to more understanding of risks to infants and young children from nutritional problems. With changes to climate and environmental degradation children will suffer more than other segments of society. They are the most at-risk group for waterborne diseases after floods and tsu- namis and in times of potable water shortages are more vulnerable to dehydration.

The Asia-Pacific region experiences 45% of natural disasters, has 61% of the world’s population and 86% of the population affected by disasters. The foundation of nutrition and long-term health is breastfeeding during infancy. After natural disasters and emergencies, it is important to keep mothers and infants together and to enable breastfeeding to continue. Infants separated from their mothers require a wet nurse (rarely available) or feeding with infant formula and sterile water. The distribution and/or donation of supplies of infant formula should follow strict ethical principles. Mothers who are injured or short of food can still continue breastfeeding and their infant don’t need formula. Breastmilk from mothers suffering from food shortages may have slightly lower nutrient content and it is important to provide them with water and food are provided. Careful advanced planning is required before emergencies occur to ensure that the delivery of assistance to infants and child is appropriate and timely.

Symposium 7 - Fast Forward to the “Future”

GO BACK TO HUMAN MODE FROM AUTO MODE Professor Rangika Halwathura

Nature is a huge teaching space that offers many lessons for those who take the time to reflect and discover. In decades ago, scientists and inventors studied characteristics of things in nature and came up with amazing technologies and products invented as a result of studying nature. However, in the recent past we forgot this simple fact and started ruling the nature. As a result, the human factor was deteriorating more than inventions/ innovation, Instead the disruptions have come in to the picture. This was evident immensely in recent past. Nature has started responding and that will hint us to recheck our actions. It was well known that any civilization can’t exist without novelty. However, if that goes against the nature and natural justice, a reversal of whole process should be expected soon. That was again evident with COVID 19.

Sustainability has become the most important challenge not just for the present, but also for the decades to come. Scientifically-based solutions should drive technological innovations that enable compliance with the still-growing environmental constraints. Research in this particular field of interest is advanced from the physical, chemical, biological, lifecycle assessment, engineering, and materials science perspective, often leading to synergistic approaches. Nothing has no meaning unless human factor is added in to it and except we move from auto mode to human mode this so called development ends with a disruption.

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

ADVANCES IN DELIVERY OF EDUCATION Dr Dujeepa D. Samarasekera

" Advances in delivery of Education- Medical education and training of future doctors are entering a new phase. This is in view of the rapid changes to the practice environment as well as to incorporate newer peda- gogies to drive students and residents learning. The learning environments for medical, nursing and health professionals students and residents are moving towards integrated curricula and assessment processes en- hanced by leveraging on modern technologies. Areas such as the humanistic approach to patient care, promotion of health, wellbeing and safety; early exposure to clinical practice environment with longitudinal integra- tion of curricular, patient experience and supervision and the focus beyond patient care facilities such as hospitals to the promotion of health in the community and society are some of the significant changes seen in medical education. The presentation will also focus on these changes and the recent challenge of the COVID crisis and how medical training institutions successfully mitigated the issues posed by the pandemic."

NEW FRONTIERS IN HEALTH COMMUNICATION Dr Dinil Abeygunawardane

Why should we bother about communication in general and medical communication in particular? What are the general principles of communication? Is medical communication different from other forms and modalities of communication? What are the new frontiers in communication, and why should the stakeholders in the medical fraternity bother?

Symposium 8 - Impact of COVID-19: Policy Implications

LIVELIHOODS AND MENTAL HEALTH Dr Vajira Dharmawardene

Disasters that take a toll on human life are characterized by a change in status quo, a high level of uncertainty, and complexity. They threaten personal safety, disrupts livelihoods and results in personal and societal loss creating demands that exceed existing resources. Pandemic disasters pose serious challenge to global public health and the world economy and result in unique psychological and behavioral responses. The mitigating interventions like lock downs and quarantine measures lead to a major disruption of livelihoods and routines. The effects may be more on urban crowded populations and particularly poor involved in informal work.

The mental health fall out from this scenario could range from transient subsyndromal problems to precipita- tion of major clinical disorders. Disasters however can lead to positive outcomes as well. Disruption of the pre -existing systems can result in emergence of more sustainable livelihoods, resilient to similar disasters in future.

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BURNOUT AMONG HEALTHCARE WORKERS DURING THE COVID- 19 PANDEMIC Professor Wah-Yun LOW

Globally, the COVID-19 pandemic has led to high levels of panic and anxiety and has taken a tremendous toll not only on the healthcare systems but also on the healthcare workers. Also some of the confirmed cases also include the healthcare workers. The high rate of infection and mortality among healthcare workers create feelings of anxiety and stress in the medical, nursing and auxiliary staff. Challenges that the healthcare workers experienced and struggled to cope, such as the heavy workload, physical exhaustion, hospital patients’ overload, insufficient of personal protective self-care for their own safety, fear of contagion, social stigmatization all threaten their physical and their mental wellbeing, such as depression, anxiety, post- traumatic stress disorder and burnout. Burnout, fatigue and stress can have serious consequences for both patients and the healthcare workers themselves. It results in poor physical and at risk of developing unfavora- ble mental health outcomes and associated with suboptimal patient care and affecting quality care of their patients and thus needing psychological support or interventions. Understanding and protecting health care workers from the mental health consequences of COVID-19 pandemic is warranted.

THE NATURE OF, AND COPING WITH, FAMILY CONFLICT DURING A LOCKDOWN Professor Piyanjali de Zoysa

Aristotle’s quote - “The whole is greater than the sum of its parts” - is relevant to families too. Families takes on the nature of its individual members, and in turn impact these very members. It’s a complex system, impacted by external challenges, such as wars and pandemics. This impact could be for better or for worse. Hence, just as with individuals, families too could grow, for better, in the face of external challenges. Such growth is much to do with the pre-pandemic psychological milieu of the family, such as its communication patterns and mutual respect between family members. External challenges are associated with family conflict too. For instance, increased rates of marital separation and divorce have been reported from COVID-19 effect- ed countries, such as China. And, violence against women (VAW) has had an increase, in the world, including Sri Lanka, where the number of calls to VAW hotlines have significantly increased. Hence, VAW is considered the shadow pandemic. Violence against children is another form of family violence that increases in times of external challenges. The roots of such types of marital and family conflict precede the challenging event, and cannot be attributed to it. Rather, it may have come to the forefront, due to the challenging event. Other than these family conflicts, there could be low-grade family tensions due to discomforts such as extended periods of lockdown. Families could learn ways to manage these tensions, such that the family’s and the individual member’s mental wellbeing is preserved.

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

LIST OF ORAL PRESENTATIONS

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OP: 01 Practice and Socio-Demographic Determinants of Diabetes Self-Care among Patients with Type 2 Diabetes Mellitus Fernando SSW, Danansuriya MN

OP: 02 A Retrospective Comparative Study on the Outcomes of a Low Dose and High Dose Cyclophosphamide Regimen in the Management of Class III and IV Lupus Nephritis in Sri Lanka Wijayaratne DR, Atukorala I, Gunawardena NS, Wijesundara DA, Gunarathna K, Lanerolle RD

OP: 03 Clinico-Epidemiology of Hypnale zara (Hump-Nosed Viper) Envenoming in Sri Lanka Rathnayaka RMMKN, Ranathunga PEAN, Kularatne SAM

OP: 04 Use of Antibiotics among Office Workers in a Private Company Saneeja MAF, Sampath RW, Sampath PKI, Alagiyawanna D

OP: 05 EEG Patterns during Mindfulness Meditation Marasinghe MGCP, Tennakoon V, Mahawithanage STC

OP: 06 Efficacy and Safety of Oral Hydroxyurea in Patients with Transfusion Dependent β Thalassaemia: a Randomized Dou- ble-Blind Placebo-Controlled Clinical Trial Yasara N, Wickramarathne N, Silva I, Hameed N, Attanayaka AMKR, Jayasinghe VL, Wickramasinghe N, Rodrigo R, Perera L, Mettananda KCD, Manamperi A, Premawardhena A, Mettananda S

OP: 07 Duration before Hospitalization, Hospital Stay and the Clinical Course of COVID-19 Patients in Sri Lanka: Evidence from First 100 Patients Following Discharge or Death Wickramasinghe ND, Jayakody S, Hewage SA, Wijewickrama A, Gunewardena NS, Idampitiya D, Palihawadana P, Jasinghe A, Prathapan S, Arambepola C

OP: 08 Impact of COVID-19 on Postgraduate Surgical Training - a Global Perspective Wijerathne HGPK

OP: 09 Training of Medical Officers in Peripheral Medical Clinics to Screen for Diabetic Retinopathy using Direct Ophthalmos- copy Wewalwala WHD, Fonseka HCN, Aryasinghe JAD, Amarasinghe BA, Piyasena MMPN

OP: 10 Online Clinical Cased Based Discussions as a Novel Education Tool Jayarathne YGSW, Pilapitiya SD, Lokunarangoda NC, Sarathchandra RDNC, Chandrakumara WAJC, Amarakoon GGGT, Srishankar S, Wickramasinghe BAM, Kumara DMA

OP: 11 Graduate Perceptions on Teaching of Clinical Relevance in Different Components of the Colombo MBBS Curriculum Uthpala LWDD, Olupeliyawa AM, Monarawila MWST

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

OP: 14 Assessment of Plate Waste in Base Hospital, Warakapola Mallawarachchi SMNSM, Mallawarachchi CH, Dalpatadu KCS

OP: 15 Viability of the Amniotic Membrane in Several Solutions Suraji LHH, Adhikarie AAAP, Wijeyaratne SM, De Silva MVC, Ranaweera GG

OP: 16 Surgery for Insulinomas – a Single Unit Experience Jayasinghe R, Subasinghe D, Sivaganesh S

OP: 17 Upper Limb Vascular Injuries, a Unique Problem. A Single Unit Experience in a Tertiary Care Centre Kapilan G, Arudchelvam J

OP: 18 A Seasonal Killer; Variability of the Incidence of Necrotizing Fasciitis with the Weather Pattern De Silva GPUP, Bandara HMC, Rathnayake RMSSB, Karunadasa MSE

OP: 19 Outcome of Open Live Donor Nephrectomies in 258 Cases Laksiri HPW, Arudchelvam J OP: 20 Endoscopic Ultrasound-Guided Transmural Drainage of Pancreatic Fluid Collections. A Study to Analyze its Efficacy and Complications Fernandopulle N

OP: 21 Anatomical Variations of the Renal Vasculature and its Association with the Outcome of Live Donor Nephrectomies Laksiri W, Arudchelvam J

OP: 22 Screening for Future Metabolic and Cardiovascular Risks: a Missed Opportunity During Pregnancy Jayasinghe HMIU, Hettiarachchi DAU, Koralegedara KIS, Amarasinghe GS, Warnasekara YPJN, Wickramasinghe ND, Ku- mara DMA, Agampodi TC, Agampodi SB

OP: 24 Assessment of Direct Out of Pocket Expenditure of Tuberculosis Treatment in Intensive Phase in Kalutara District Ranawaka N, Nandasena YLS

OP: 25 Prevalence and Correlates of Smoking, Alcohol Consumption and Illicit Substance Abuse in School Adolescents in Sri Lanka Kumbukage MP, Senanayake SJ, Gunawardena SRHP, Wickramasinghe SC, Lokubalasooriya A, Gunawardena NS, Pieris R, Wickramasinghe SA, Maddumahewa CV

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OP: 26 Prevalence of Cardiovascular Conditions among First Trimester Pregnant Females in Anuradhapura District Hettiarachchi DAU, Lokunarangoda NC, Agampodi TC, Jayasinghe HMIU, Koralegedara KIS, Warnasekara YPJN, Madhushika MMH, Agampodi SB

OP: 27 Quality of Life in Elderly in Rural Sri Lanka: a Large Community-Based Cross-Sectional Study Wickramasinghe ND, Perera RA, Agampodi SB

OP: 28 Balance, Hand Grip Strength and Risk of Falling in Children with Visual Impairment Ruwanmali PAS, Dissanayake WDN OP: 29 Childhood Asthma and its Association with Selected Obstetric and Neonatal Factors among Children Aged 3 -10 Years in Tertiary Care Hospitals in Colombo District Deen FAH, Kottahachchi KC, Perera SS, Dissanayake DMOC, Jayakaduwa JS, Undugodage C, Jayakody S

OP: 31 Gender Difference in Accuracy Error in Bioelectrical Impedance Analysis Compared to Dual Energy X-Ray Absorptiome- try in the Measurement of Body Composition Indices in Obese Children de Silva MHAD, Hewawasam RP, Lekamwasam S

OP: 33 Association of Severe Asthma with Allergic Rhinoconjunctivitis and Eczema in a Cohort of Preschool Children of Anura- dhapura District, Sri Lanka Rajapakse RMSI, Amarasiri WADL, Yasaratne BMGD, Warnasekara YPJN, Agampodi SB

OP: 34 Early Pregnancy Mental Health Reflecting Health System Deficits and the Need for Psychosocial Support in Anuradha- pura, Sri Lanka Amarasinghe GS, Senanayeka TD, Wijesinghe ADN, Sundharum R, Herath KM, Malasekera C, Wickramasinghe A, Agampodi TC

OP: 35 Translation and Validation of Abnormal Involuntary Movement Scale (AIMS) into Sinhala Baminiwatte ,A Bandara T, Liyanage H, Perera M, Kuruppuarachchi KALA, Hapangama A

OP: 36 Association between Toxoplasmosis and Schizophrenia - Preliminary Findings of a Case Control Study Dayabandara LRM, Galhenage J, Perera I, Gange Y, Dayananda S, Gunatillake H, Gunawardena S

OP: 37 Randomized Controlled Trial Investigating the Effectiveness of Cognitive Behaviour Group Therapy Compared to a Waitlist Control in the Treatment of University Students with Social Phobia Hapangama A, de Silva BGR, de Zoysa PT, Kuruppuarachchi KALA, Ravindran A, Wickremasinghe AR, Williams SS

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

OP: 40 Prevalence of Geriatric Depression and Associated Factors in Institutionalized Elders: a Descriptive Study in Galle Dis- trict Abeysekera NWBY, De Zoysa GED

OP: 43 Endoscopic Ultrasound Guided Fine Needle Aspiration in Patients with Pancreatic Masses: a Study to Assess its Effica- cy and Complications Fernandopulle N, Matthias T

OP: 44 The Incidence and Patterns of Lung Cancers in Sri Lanka from 2001-2010: Analysis of National Cancer Registry Data Jayarajah U, Arulprashanth A, Fernando A, Ilangamge S, Seneviratne SA

OP: 46 Unintentional Injuries Among In-School Adolescents in Sri Lanka Gallage AOP, Wickramasinghe SA, Senanayake SJ, Kumbukage MP, Gunawardena SRHP, Wickramasinghe SC, Loku- balasooriya A, Gunawardena NS, Peries R, Maddumahewa CV

OP: 47 Epidemiological and Clinical Characteristics of Covid-19 Patients: the Initial Experience of Sri Lanka Hewage SA, Wickramasinghe ND, Jayakody S, Arambepola CA, Gunewardena NS, Wijewickrama A, Narangoda EM, Dhanapala S, Jasinghe A, Prathapan S

OP: 48 Economic Burden of Out-Of-Pocket Expenditure During Early Pregnancy: Evidence from a Pregnancy Cohort in the Anuradhapura District Gunarathne SP, Wickramasinghe ND, Agampodi TC, Prasanna RPIR, Agampodi SB

77 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

OP: 51 Evaluation of the Effectiveness of Counselling for the Correct Inhaler Techniques among Asthmatic Patients Madushika KBP, Pathiraja VM, Jayasinghe C, Dhanarisi HKJ, Mohamed F

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

LIST OF POSTER PRESENTATIONS

79 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

PP: 001 Post-Viral Fatigue in Dengue Infection Sigera PC, Rodrigo C, Rajapakse S, Weerathunga P, De Silva NL, Fernando SD

PP: 002 Prevalence and knowledge of hypoglycaemia among type 2 diabetes patients on insulin therapy, attending a tertiary care diabetic clinic Priyadarshani SMS, Abhayaratna SA, Garusinghe GJC

PP: 003 Impact of Fluid and Dietary Non-Compliance on Morbidity and Mortality in Haemodialysis Patients Erandika HGN, Wazil AWM, Mahanama RMBSS, Gajanayake SS, Nanayakkara N, Yatawara MDMLDK

PP: 004 Ischemic Stroke following Multiple Wasp Bites Gunathilake KUIS, Rifath MIM, Perera M, Jayarathne SR, Hennayake A, Caldera MC

PP: 005 Does Lymphopenia Indicate the Disease Outcome? An Analysis of the First 100 Patients Discharged or Dead Following COVID-19 Disease in Sri Lanka Jayakody S, Hewage SA, Wickramasinghe ND, Wijewickrama A, Gunewardena NS, Narangoda E, Idampitiya D, Arambepola C, Prathapan S

PP: 006 Statin Eligible Patient Not Receiving Statins: an Analysis of Usage of Statins for Primary Prevention of Cardiovascular Disease Risk in Sri Lanka Matthias AT, Padmasiri MSN, Pathirana NSW, Somathilake G

PP: 007 Design and Implementation of Novel Pharmacogenomic Assays for CYP2C19*17 Variant to Predict Response to Clopidogrel Therapy in Patients Thillainathan K, Noordeen N, Wetthasinghe TK, Sirisena ND, Dissanayake VHW

PP: 008 Characteristics of Chronic Renal Failure in Giradurukotte, Sri Lanka Nayanamali MAA, Hettiarachchi TW, Gunarathne L, Elladeniya N, Sonnadara T, Liyadipitiya M, Nanayakkara N

PP: 009 Community Prevalence of Chronic Kidney Disease among Wet Zone Farming Population in Sri Lanka Nayanamali MAA, Earandika HGN, Hewapathirane HPM, Pushpakumara WRAMDRN, Basnayake BMDB, Nanayakkara N

PP: 010 Pulmonary Tuberculosis among Patients Attending the Diabetes Clinic of the National Hospital of Sri Lanka: a Guide to Implement a National Policy on Active Screening Somasundaram NP, Hewage SA, Ratnasamy V, Ranatunga I, Perera KMIC, Pallewatte N, Vidanagam D, Fernando A, Cader M, Rathnayaka RMADL, Perera UE, Fernando P, Jayawardhana JMDD, Danansuriya M, Gunewardena NS

PP: 011 Acute Renal Vein Thrombosis – a Rare and Unusual Initial Presentation of Systemic Lupus Erythematosus in the Emer- gency Department Willaraarachchi WAMA, Wickramarathne AAML, Perera NJAHD, Perera ND

PP: 12 Common Knee Ligament Injury Patterns and Hamstring:Quadriceps (H:Q) Functional Strength Ratio in Injured Athletes from Universities in the Colombo District Ruwani JMR, Wickramasinghe WWCA, Wanigasinghe J

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

PP: 013 Twenty Long Years on Haemodialysis – a Case Report on Longest Dialysis Survivor in Sri Lanka Perera NJAHD, Willaraarachchi WAMA, Galahitiyawa MCB, Herath CA

PP: 014 A Case Report on Acute Pulmonary Oedema Following an Anaphylactic Shock Munasinghe BM, Subramaniam N, Nimalan S, Abeysekara TS, Gnanapragash N

PP: 015 Reference Intervals and Age Related Trends of Bone Turnover Markers in Adult Women Rathnayake H, Lekamwasam S, Wickramatilake CM, Lenora J, De Zoysa E

PP: 016 Risk of Obstructive Sleep Apnoea in Chronic Liver Cell Disease Patients Admitted to a Tertiary Care Centre Pathirana NSW, Indrakumar J, Matthias T, Priyacharana P, Wijekoon SL, Yashodara BMAC, Ranasinghe TAB

PP: 017 Gender Differences in Presentations of ST Segment Elevation Myocardial Infarction (STEMI) to the Accident and Emer- gency Department in a Tertiary Care Hospital of a Developing Country Jayasekera MMPT, Adikari AMSB, Wijewardhana MGDD, Wijewardhana MGDD

PP: 018 Allergy and Anaphylaxis Among Pre-Intern Medical Graduates of Three Universities in Sri Lanka Thenuwara PM, Gunawardana M, Minuwanpitiya G, Wettasinghe I, Dissanayake AS, Fernando ADA, Jayawardane P, Wi- jekoon CN PP: 019 Adherence to Surviving Sepsis Campaign Bundle at a Tertiary Care Hospital in Sri Lanka Matthias AT, Ranasinghe T, Mallawaarachchi C, Wijekoon S, Indrakumar J

PP: 020 Epidemiology of Stroke Subtypes and Aetiologies Among Sri Lankan Stroke Patients Mettananda KCD, Eshani MDP, Wettasinghe LM, Ranawaka UK

PP: 021 Developing and Pilot-Testing an Oropharyngeal Dysphagia Screening Tool for Children with Cerebral Palsy Aged 4 – 6 Years Hettiarachchi S,Ravihari MGI

PP: 022 Prevalence of Excessive Weight and Level of Physical Activity and Knowledge on Perceived Need on Physical Activity Among 10-19 Years Aged Visually or Hearing Disabled Adolescents in All Special Education Schools in the Western Province of Sri Lanka Jayasena AKSS, Alagiyawanna MAAP

PP: 023 Readiness of Medical Students for Online Learning during COVID-19: Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka (FMAS, RUSL) Jayararathne YGSW, Pilapitiya SD, Kumari TMDD, Gunathilaka JAMTP

PP: 024 Graduate Perceptions on Factors Contributing to Stress During Different Components of the Colombo Medical Curricu- lum Uthpala LWDD, Olupeliyawa AM, Saneeja MAF, Monarawila MWST

PP: 025 Burnout Syndrome, Associated Factors and Coping Strategies Adopted by Medical Students of the University of Jaffna Weerasinghe RHM, Lakmali JMD, De Silva BHKG, Ramya K, Sathiadas MG

PP: 026 Prevalence of Stress and its Associated Factors Among Medical Students of the Faculty of Medicine, Colombo Lakmal RSPK, Jayarajah U, Athapathu AS, Jayawardena BAAJ, de Silva V

81 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

PP: 027 Validation of the Medical Students’ Stress Questionnaire (MSSQ) in a Cohort of Medical Students from the Faculty of Medicine, Colombo Lakmal RSPK, Jayarajah U, Athapathu AS, Jayawardena BAAJ, de Silva V

PP: 028 Risk Factors and School Absenteeism in Children with Asthma from an Urban Area of Sri Lanka Fernando YN, Anuradha KWDA, De Silva U, Alahakoon M, Handunnetti S, Wickramasinghe P

PP: 029 Study of Mental Health, Anxiety and Depression among Medical Students of the Faculty of Medicine, Colombo Lakmal RSPK, Jayarajah U, Athapathu AS, Jayawardena BAAJ, de Silva V

PP: 030 The Relationship Between Learning Styles and Academic Performance among BSc. Nursing Undergraduates in a Sri Lankan Defence University Gamage GP, Kumara WGC, Sudusinghe WS

PP: 031 Implementation and Evaluation of an Electronic Case Management System for the Anti-Malaria Campaign Ashoranga IKR, Piyasena MGY, Wickramarathna GMJC, Ranaweera KDNP

PP: 032 Pattern of Occlusive Arterial Disease in Patients Presenting to a Single Vascular Unit, a Cohort Study De Soyza MD, Arudchelvam J

PP: 033 Jackstone in the Kidney: a Case Report of an Unusual Calculus Jayarajah U, Goonewardena SAS, Kuruppu SN, Fernando DMH

PP: 034 Lower Limb Arterial Spasm following Trauma: a Common and an Important Cause for Diagnostic Dilemma Kapilan G, Arudchelvam J

PP: 035 Study of Outpatient Department Surgical Unit Services at the Lady Ridgeway Hospital for Children, Colombo Ranawaka UARS

PP: 036 Lower Limb Vascular Injuries - a Single Unit Experience in a Tertiary Centre Kapilan G, Arudchelvam J

PP: 037 Endoscopic Ultrasound Guided Biliary Drainage in Patients with Inoperable Malignant Biliary Obstruction and Failed ERCP: a Study to Assess its Efficacy and Complications Fernandopulle ANR

PP: 038 Developing a Wound Dressing Based on Human Amniotic Membrane: a Pilot Study Suraji LHH, Adhikarie, AAAP, Wijeyaratne SM

PP: 039 Squamous Cell Carcinoma of the Uterine Cervix Metastasising to Bilateral Cervical Lymph Nodes and Thyroid: a Case Report Ravindrakumar S, Thalahitiyage N, Jayarajah U, Rodrigo VSD

PP: 040 A patient with Multiple Gastrointestinal Carcinoid Tumours presenting with Jejunal Intussusception: a Case Report Ravindrakumar S, Bandara GBKD, Jayarajah U, Rodrigo VSD

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

PP: 041 Developing a Novel Device for Harvesting Pinch Skin Grafts Adhikarie AAAP, Suraji LHH, Wijeyaratne SM, De Silva AC

PP: 042 Pattern, Related Conditions and Factors Associated with the Severity of Unintentional Home Injuries among Elderly in the Battaramulla Medical Officer of Health (MOH) Area Ananda AKASK, Kumarapeli V

PP: 043 Factors Affecting Overcrowding of the Preliminary Care Unit of District General Hospital, Gampaha, Sri Lanka Mallawarachchi SMNSM, Dharmaratne GSK, Mallawarachchi CH, Nissanka VN

PP: 045 Morbidities amongst the Late Postpartum Mother and Associated Factors de Lanerolle ND, Arambepola C

PP: 046 Violence Seen on Facebook and YouTube Videos: a Qualitative Study Harshani P, Jayananda C, Hapuarachchi N, Harshana U, Kularathna H, Athauda L

PP: 047 The Impact of Digitalizing the Satellite Laboratory Service (SLS) of Base Hospital Warakapola over Clients’ Satisfaction Mallawarachchi SMNSM, Mallawarachchi CH, Wickramasinghe SC

PP: 048 Bypassing Primary Health Care Institutions: a Case Study from Sri Lanka Soysa EPN, Sumitha S, Suraweera SADA, Weerasinghe MC

PP: 049 Assessment of Drug Dispensing Practices at the Outdoor Pharmacy of Base Hospital Tangalle Yaddehige IS, Dharmagunawardene PVDS, Galappatthy P

PP : 050 Knowledge on Epilepsy and its Associated Factors among Parents of Children Attending Epilepsy Clinics at the Premier Paediatric Hospital in Sri Lanka Ranasinghe D, Rathnayake D.R.D, Padeniya A, Buddhika Mahesh

PP: 051 Soft Drinks Consumption Practices, Awareness of Ill Effects, Sugar Content of Soft Drinks and the Factors Influencing Soft Drink Consumption amongst Students in the Kotelawala Defence University Karunathilaka KWAN, Karunajeewa KGSH, Kulasinghe IRRP, Dolkar D, Liyanage SD, Jayasekera MMPT

PP: 052 Awareness on Malaria among Public and Healthcare Providers during the Prevention of Re-Introduction Phase in Sri Lanka Hamsananthy J, Wickremasinghe AR

PP: 053 Healthcare Seeking Pathway and Perceived Severity on Heath Seeking among Antenatal Mothers Admitted to the Anuradhapura Teaching Hospital Dilhari GI, Adhikari AMKM, Gunathilaka KRUS, Wijerathna MND, Dias WPN, Wickramasinghe KST, Ellewela EVI, Mahana- ma MGGNN, Agampodi SB

PP: 054 How do Men who Choose Not to Participate in Healthy Lifestyle Centres Reason About Their Decision? Herath HMTP, Perera KMN, Kasturiratne KTAA

83 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

PP: 055 Maternal Anaemia in Anuradhapura and Thalassemia; the Elephant in the Room Amarasinghe GS, Wijesinghe UKIU, Nawinne NMAS, Ilangasinghe IKMAU, Srimantha S, Niroshani C, Mendis V, Agampodi TC

PP: 056 High Scores in the Edinburg Postpartum Depression Scale in Early Pregnancy is Not Showing Depression! Agampodi TC, Wickramasinghe BAM, Wicramasinghe WAND, Wickramasinghe KST, Nazreen LZ, Samarasinghe A, Crishan EGC, Agampodi SB

PP: 057 Effect of COVID-19 on Routine Healthcare: an Experience of a Tertiary Care Unit Gamakaranage C, Wijesundara D, Jayasinghe S

PP: 058 Unmet Need for Family Planning and Contraceptive Failure: an Experience of a Large Pregnancy Cohort in the Anura- dhapura District, Sri Lanka Jayasinghe HMIU, Sarathchandra CS, Idamgedara MPB, Kumara KGC, Sendanayake SU, Dissanayake DSRL, Delay SC, Hil- ma MTF, Wickramasinghe ND

PP: 059 Estimation of Burden and Impact of Unplanned Pregnancies in a Cohort of Pregnant Females in the Anuradhapura District Hettiarachchi DAU, Dissanayake DSYKK, Somasiri DADK, Perera TGRM, Sooriyahetti SAMSA, Pravanan S, Wijerathna MSL, Chandrananda WMDN

PP: 060 Improving Participation of Clinicians in Hospitals in the Malaria Awareness Programs Conducted During the Preven- tion of Re-Introduction Phase of Malaria in Sri Lanka Jayasena AKSS, Ranaweera KDNP, MM Muzrif, Karunaratna S, Ratnayake KASD

PP: 061 Prevalence of Musculoskeletal Symptoms in Drivers due to Prolonged Work Related Sitting Posture Madushani EAPN, Dissanayake WDN

PP: 062 Prevalence of Postural Changes in Drivers due to Prolonged Work Related Sitting Posture Madushani EAPN, Dissanayake WDN

PP: 063 Timing of Starting a Family, the Desired Family Size and their Associated Factors among Women attending Antenatal Clinics at the Colombo South Teaching Hospital Ranasinghe AM, Hettiarachchi HTA, Harshana WAP, Gamalath NR, Hapuarachchi NHKSD, Beneragama DH, Seneviwick- rama KLMD

PP: 064 The Increasing Burden and Complexity of Multimorbidity in Sri Lanka Prathapan S, Fernando GVMC, Matthias AT, Somathilake BGGK

PP: 065 Screening of High Risk Groups: a Key Strategy in the Prevention of Reintroduction of Malaria to Sri Lanka Silva DPRC, Munas MM, Gunasekera WMKTdeAW, Rajakaruna BVC, Silva MDP, Ranaweera KDNP, Fernando SD

PP: 066 Preventing the Threat of Malaria Reintroduction through Military Personnel arriving from Malaria Endemic Countries Booso BR, Fernando SD, Ranaweera P

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

PP: 067 Knowledge and Practices of Mothers Regarding Multiple Micronutrient (MMN) Supplementation in the Boralesgamu- wa Medical Officer of Health Area, Sri Lanka Bandara JMSV, Jayawardhana SMNDM, Chamodani WP, Samagi VWS, Kariyawasam KMGIB, Weerawardhana SDPL, Jay- asekara JMKB

PP: 068 Knowledge, Attitudes and Practices on Dengue and its Control Among Grade 9 Students in the Horana Educational Zone Bandara TD, Cader M, Dheerasinghe DSAF

PP: 069 Factors Associated with Selected Maternal and Foetal Outcomes Among Mothers with Gestational Diabetes Mellitus, Delivering at Two Selected Tertiary Care Maternity Hospitals in Colombo Wickramarachchi WATK, Samaranayake DBDL

PP: 070 Factors Associated with the Utilization of the Dengue School Card for the School Based Dengue Control Programme among Grade 9 Students in the Horana Educational Zone Bandara TD, Cader M, Dheerasinghe DSAF

PP: 071 Body Weight Perception among Treatment Seeking Obese Young Adults in the Colombo District Gamage GP, Hettiarachchi P, Jayewardene R, Wasalathanthri S

PP: 072 Shortage of Public Health Midwives in Sri Lanka De Silva MDK, Thalagala NI, Karthikeyan P, Rubasinghe MS

PP: 073 Role of Inventions to Tackle the COVID-19 Epidemic in Sri Lanka: Patent Law Perspective Weerakoan TP, Punchihewa NS

PP: 074 Vascular Endothelial Growth Factor Receptor - 02 Expression on Oral Squamous Cell Cancer – an Immunohistochemi- cal Assessment Edirisinghe EAST, Anuradha M, Weerasekera MM, Rich A, de Silva H, Hussaini M, de Silva K, Gunasinghe R, Yasawardene SG

PP: 075 Knowledge, Experience and Self-Perceived Barriers for Engaging in Clinical Audits among Medical Officers in Paediatric Setup Sandamal LYS, Jayamanne C, Weerasinghe K

PP: 076 Knowledge and Practices on Antipyretics among Caregivers of Paediatric Patients at Teaching Hospital Ragama Darshika GHI, Rathnayaka HGHK, Mettananda S

PP: 077 Clinical Characteristics, Antibiotic Susceptibilities and Treatment Outcome in Paediatric UTI- Comparison of E. coli and Non E. coli Group in a Single Centre Galappaththige AGAR1, Karunanayake MCG2, Chandrasiri A3

PP: 078 Neonatal Hypothermia and its Aftermath in Babies less than 34 Weeks Gestation Nawarathne MVD, De Silva LSD, Kumuduni DGK, Lucas NM, Saman Kumara LPC

PP: 079 Level of Stress, Factors Associated with Stress and Coping Strategies among Advanced Level Students Attending Tui- tion Classes in a Selected Educational Zone in Sri Lanka Athukorale UP, Balasooriya BANP , Jayasinghe LPS, Nagawegedara PM, Ranasinghe EDCY, Perera R, Goonewardena CSE

85 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

PP: 080 Psychological Morbidity and Correlates of Patients Presenting with Burn Injuries to a Tertiary Care Hospital in Sri Lanka Galhenage JS, Perera NIC, Amarasuriya M, Dayabandara M

PP: 081 A Preliminary Study of the Effectiveness of Locally Composed Receptive Music Medicine on Short Term Symptomatic Relief of Sri Lankan Patients with Mild to Moderate Depression Herath HMSA, Hewage SHJB, Horadugoda HGDH, Perera M, Fernando TAH, Weeratunga PN

PP: 082 Stress across Different Social Demographic Groups in Suburban Areas of Sri Lanka Mendis BILM, Palihaderu PADS, Satharasinghe DA, Premarathne JMKJK, Dissanayake AS, Rajapaksha IH, Karunanayake P, Senarath U, Wijesuriya W, Swee YK, Ho WY, Dias WKRR

PP: 083 Psychological Morbidity and Associated Factors Among Perinatal Patients Referred for Psychiatry Assessments at a Tertiary Care Centre in Sri Lanka Galhenage JS, Perera NIC, Senanayake SM, Hanwella R

PP: 084 Are Future Nurses Knowledgeable on Known Risk Factors of Blood Borne Viruses to Combat with Blood Borne Virus- es? Isuruni NAY, Abeyrathne GNU, Piyumanthi RAP, Rupasinghe SR, De Silva LN, Kottahachchi J, Goonewardena CSE

PP: 085 Haplotypes of TMPRSS6 Gene are Associated with Iron Deficiency among Urban Sri Lankan Pregnant Women: Prelimi- nary Evidence Wickramarachchi IWUP, Abeywickrama HLTC, Galhena GH, Rabindrakumar MSK, Thoradeniya T

PP: 086 Design and Implementation of Novel Pharmacogenomic Assays for CYP2D6*10 and CYP2D6*41 Variants to Predict Response to Tamoxifen Therapy in Breast Cancer Patients Ranadeva NDK, Noordeen N, Wetthasinghe TK, Sirisena ND, Dissanayake VHW

PP: 087 Preliminary Data from Genetic Screening of the Parents of Children with Retinoblastoma Associated with Germline RB1 Mutations Panchananthan N, De Silva D, Abeysekara H, Nanayakara DPS, Tirimanne TLS, Chandrasekharan NV

PP: 088 Development of a Taqman Based Multiplex Quantitative PCR Assay for the Molecular Diagnosis of Williams Beuren Syndrome Ranaweera DM, de Silva D, Panchananthan N, Kajan M, Samarasinghe D, Perera S, Morawakkorala R, Gunewardene S, Chandrasekharan NV

PP: 089 OCT and Threshold Visual Field Test in Diagnosis of Anterior Visual Pathway Tumours Wewalwala WHD, Banagala CPB

PP: 090 The use of Ultrasound Scanning (USS) to Determine the Association of Non-Alcoholic Fatty Liver Disease (NAFLD) with Impaired Glucose Tolerance in Pregnancy (IGTIP); does the use of USS increase IGTIP Detection? Koralegedara KIS, Dayaratne KG, Warnasekara YPJN, Jayasinghe HMIU, Hettiarachchi DAU, Premadasa AJK, Aberathna DMPLK, Rathnayake PPASK, LAPNF De Silva, Agampodi SB

PP: 091 Rapid Increase of Prescription Drug Abuse Potential in Sri Lanka Muthumala KM, Athauda ADYK, Suaris VD, Weerasinghe DPP, Welagedara RL

133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

PP: 092 Emerging Trend of Adulteration of “Street” Heroin with Legitimate Pharmaceutical Drugs Suaris VD, Muthumala KM, Weerasinghe DPP, Welagedara RL

PP: 093 Pharmacists’ Interventions in the Management of Drug Related Problems Mamunuwa AMVGN, Coombes J, Lynch CB, De Silva A, Wickramasinghe NDD, Jayamanne SF

PP: 094 A Double Blind Randomized Placebo Controlled Clinical Trial of Coccinia grandis (L.) in Patients with Newly Diagnosed Type 2 Diabetes Mellitus Wasana KGP, Attanayake AP, Weeraratna TP, Jayatilaka KAPW

PP: 095 School Environment Factors Associated with Eating Behaviours among Adolescents in Government Schools in the Rathnapura District Ranasinghe PMCM, Seneviwickrama KLMD

PP: 096 A Study on Prevalence and Factors Associated with Flat Feet in a Selected Group of Female Nurses in the National Hospital of Sri Lanka Ranathunga LK, Jayawardene DMS, Jayasinghe S

PP: 097 A Case of Recurrent Multiple Evanescent White Dot Syndrome -Truly Evanescent! Wewalwala WHD

PP: 098 In Vitro Anti-Lipase Potential of Five Sri Lankan Medicinal Plants De Zoysa MHN, Sandamali JAN, Hewawasam RP

PP: 099 Clinico-Epidemiology of Washing Powder (‘Prinso’) Poisoning Rathnayaka RMMKN, Ranathunga PEAN

PP: 100 Clinico-Epidemiology of Drug Overdose in a Tertiary Care Hospital in Sri Lanka Rathnayaka RMMKN, Ranathunga PEAN

PP: 101 The Effect of Music Tempo on Heart Rate, Blood Pressure and Respiratory Rate Changes in Submaximal Treadmill Walking Exercise of Untrained Undergraduates Kumaradasa PP, Siridewa K, Ranasinghe DC

PP: 102 Effectiveness of an Aerobic Exercise Programme on Cardiovascular Endurance and Body Weight in Sedentary Over- weight Females of the University of Colombo and their Knowledge Regarding Aerobic Exercises Weeraratne C, Premarathna MMLD

PP: 103 Morbidity Status and its Association with Activities of Daily Living among the Elderly Living in Informal Caregiving Settings in the Colombo District Wijesiri HSMSK, De Silva Weliange SH, Wijeyaratne CN, Wasalathanthri S

PP: 104 Impact of a 6-Month Combined Exercise Regimen on Taste Perception for Sucrose in Patients with T2DM Vidanage D, Hettiarachchi P, Prathapan S, Wasalathanthri S

87 133rd ANNIVERSARY INTERNATIONAL MEDICAL CONGRESS

PARTNERS AND SPONSORS

PARTNERS

Ministry of Health United Nation Population Fund World Health Organization World Bank Sri Lanka Telecom