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C J Seneviratne

Publications and source records attributed to C J Seneviratne.

4 recordsLinked to original sources

Ethnic trends in lipid tests in general practice.

BACKGROUND: South Asian migrants have a higher cardiovascular mortality than the indigenous population. Contributory factors may include a lower rate of cardiovascular risk assessment uptake and compliance. AIM: To compare rates of lipid testing, follow-up and patterns of dyslipidaemia in South Asian and non-South-Asian populations in Manchester. DESIGN: Retrospective cross-sectional survey. METHODS: Lipid requests from 14 general practices were analysed, using name recognition software to assign ethnicity. RESULTS: Compared with non-South-Asians, the age-standardized rate of lipid testing in South Asians was similar in men at 12.1% (95%CI 11.6-12.6) vs. 11.2% (9.5-13.0), but higher in women at 18.6% (15.9-21.2) vs. 13.2% (12.6-13.7). Trends of cholesterol with repeat testing were similar in the two populations. However, South Asian women had lower mean levels of total cholesterol (5.50 vs. 5.68 mmol/l, p = 0.021), lower levels of HDL (1.20 vs. 1.46 mmol/l, p < 0.001), an excess of hypertriglyceridaemia (1.62 vs. 1.45 mmol/l, p = 0.035) and a greater proportion with cholesterol > 5.2 mmol/l combined with low HDL (43.1% vs. 20.2%, p = 0.002). South Asian men had lower levels of total cholesterol (5.17 vs. 5.37 mmol/l, p = 0.048) and lower levels of HDL (1.07 vs. 1.64 mmol/l, p < 0.001). There was no difference in the proportion of South Asians men and women with cholesterol < 5.2 mmol/l combined with low HDL. DISCUSSION: The rate of lipid testing and change in cholesterol levels with repeated testing did not differ between South Asian and non-South-Asian groups. The pattern of dyslipidaemia seen in this South Asian population, especially women, was different from that of the non-South-Asian population, with possible implications for cardiovascular risk assessment.

Asia↗

Is it possible to exclude a diagnosis of myocardial damage within six hours of admission to an emergency department? Diagnostic cohort study.

OBJECTIVE: To assess the clinical efficacy and accuracy of an emergency department based six hour rule-out protocol for myocardial damage. DESIGN: Diagnostic cohort study. SETTING: Emergency department of an inner city university hospital. PARTICIPANTS: 383 consecutive patients aged over 25 years with chest pain of less than 12 hours' duration who were at low to moderate risk of acute myocardial infarction. INTERVENTION: Serial measurements of creatine kinase MB mass and continuous ST segment monitoring for six hours with 12 leads. MAIN OUTCOME MEASURE: Performance of the diagnostic test against a gold standard consisting of either a 48 hour measurement of troponin T concentration or screening for myocardial infarction according to the World Health Organization's criteria. RESULTS: Outcome of the gold standard test was available for 292 patients. On the diagnostic test for the protocol, 53 patients had positive results and 239 patients had negative results. There were 18 false positive results and one false negative result. Sensitivity was 97.2% (95% confidence interval 95.0% to 99.0%), specificity 93.0% (90.0% to 96.0%), the negative predictive value 99.6%, and the positive predictive value 66.0%. The positive likelihood ratio was 13.9 and the negative likelihood ratio 0.03. CONCLUSIONS: The six hour rule-out protocol for myocardial infarction is accurate and efficacious. It can be used in patients presenting to emergency departments with chest pain indicating a low to moderate risk of myocardial infarction.

Adult↗

Detection, significance and treatment of paraprotein in patients presenting with 'idiopathic' proteinuria without myeloma.

This paper describes the detection of a paraprotein in blood or urine in 12 of 260 patients with 'idiopathic' proteinuria, most of whom presented with the nephrotic syndrome. None had myeloma at presentation and only two have developed it. Initial clinical and biochemical findings did not suggest paraprotein-associated disease, total serum globulins and individual immunoglobulin levels usually being in the normal range. In seven of the 12 cases the paraprotein was detected only after repeated analysis of serum and urine specimens over months or years. Renal histopathology varied from case to case and is described in detail; amyloid deposition did not occur in patients who excreted kappa chain Bence Jones protein and was extensive in only three. One of these eventually developed myeloma. Patients were aged 27--69 years at onset and were observed without specific therapy for up to 56 months. Glomerular filtration rate tended to decline and proteinuria persisted. All patients have now been treated by a chemotherapeutic regimen consisting of 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU), cyclophosphamide, melphalan, and prednisolone, in repeated short courses. In some patients, particularly those who had kappa Bence Jones protein, there was striking improvement. Overall survival is good, eight patients being alive 17--90 months after the onset of symptoms. The importance of repeated search for paraprotein in apparently idiopathic renal disease in adults is emphasized.

Adult↗