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Biomedical subjects

D J Fernando

Publications and source records attributed to D J Fernando.

At least 37 records · Page 2Linked to original sources
PubMed1997

Limited joint mobility in Sri Lankan patients with non-insulin-dependent diabetes.

Two hundred and sixteen patients with non-insulin-dependent diabetes (NIDDM) and 216 age- and gender-matched controls were studied to assess the prevalence of limited joint mobility (LJM). Joint mobility was measured by goniometry at metacarpophalangeal and subtalar joints, and those in whom a prayer sign was elicited were said to have cheiroarthropathy. Forty diabetic patients and 10 controls had cheirorathropathy. The mean range of motion was reduced at metacarpophalangeal joints in diabetic patients with cheiroarthropathy (36.8 +/- 9.2) and without cheiroarthropathy (45.7 +/- 8.1) when compared to controls (51.4 +/- 9, P < 0.01). Mobility at subtalar joints was reduced in those with cheiroarthropathy (25 +/- 5.3, P < 0.01) when compared to controls (32.4 +/- 4.1) and diabetic patients without cheiroarthropathy (27.4 +/- 4.6). No differences in subtalar mobility existed between diabetic patients without cheiroarthropathy and controls. Significant differences were observed in the presence of foot ulceration (35 vs 16%) in those with and without cheiroarthropathy. We conclude that cheiroarthropathy is seen in Sri Lankan patients with NIDDM and that significant limitation of joint mobility is present in patients with NIDDM who do not have overt cheiroarthropathy and that overt cheiroarthropathy may be a marker for a high risk of foot ulceration.

Adult↗
PubMed1997

Macrovascular disease in Sri Lankan kidney transplant recipients.

INTRODUCTION: Macrovascular diseases such as angina, myocardial infarction, stroke and peripheral occlusive arterial disease are common causes of mortality and morbidity in transplant patients. OBJECTIVES: To study the frequency and determinants if vascular disease in Sri Lankan patients with renal transplants. PATIENTS: A cohort of 237 renal transplant recipients (163 males (76%), mean age 35.09, SD 11.05 years). SETTING: Patients under follow up at the Faculty of Medicine Transplant program. METHOD: Prospective study of a cohort of patients. RESULTS: Macrovascular diseases developed in 42% of transplant recipients. 5.6% had transient ischaemic attacks, 2.8% strokes, 18.2% angina, 8.4% myocardial infarctions, 2.3% underwent lower extremity amputations because of vascular insufficiency, 7% peripheral vascular occlusive disease and 49.5% were hypertensive. Male sex (odds ratio of 2.87, 95% CI 1.33-6.85, p = 0.006), serum cholesterol greater than 6.2 mmol/l at transplant (odds ratio 8.60, 95% CI 2.53-38.9, p = 0.0001) at 5 years after transplant (odds ratio 10.25, 95% CI 1.22-22.9, p = 0.01) were associated with a higher risk of macrovascular disease. Pre-transplant diabetes was associated with a higher risk of macrovascular disease and lower extremity amputation (odds ratio 4.53, 95% CI 1.32-6.76, p = 0.007). CONCLUSIONS: Strategies to screen for and treat potential risk factors should form an integral part of the follow up for Sri Lankan and Asian kidney transplant recipients.

Adult↗
PubMed1997

An audit of structure, process and outcome of care of the diabetic clinic, National Hospital of Sri Lanka.

AIMS: To audit the structure, process and outcome of care. SETTING: The diabetic clinic, National of Hospital Sri Lanka (NHSL). METHODS: A previously validated MCQ paper of 10 questions which assessed knowledge of diabetes on insulin therapy, dietary management, management during acute illness and management of emergencies was administered to all patients. The function of the clinic was assessed using previously validated audit case record forms. MEASURES OF OUTCOME: Diabetes knowledge among patients, waiting times, bypassing of local institutions, availability of diagnostic equipment, screening activities and time spent for consultation. RESULTS: The clinic had a daily average attendance of 186 patients seen between 0800 to 1200 hours. A single medical officer spent 2.1 minutes for each patient. No screening was performed. There were no facilities to examine patients or for them to sit during consultation. The diabetes knowledge score was 15.1 (SD 3) from a maximum score of 40.43% had bypassed a local institution. Reasons for bypass included non-availability of drugs and the expectation of quality care at NHSL. Patients spent a mean of 1.5 (SD 0.7) hours travelling to the clinic and waited a mean of 1.56 (SD 0.4) hours to see the doctor and 1.3, (SD 0.12) hours to obtain drugs. CONCLUSIONS: The services of the diabetic clinic do not meet the standards expected of a clinic at a tertiary referral centre. Lack of planning and resources (space, manpower and management skills) can be identified as principal shortcomings.

Diabetes Mellitus↗
PubMed1997

Patient mixed biphasic insulin in a diabetic clinic.

INTRODUCTION: Improved glycaemic control is possible with the use of multiple injections of premixed insulin. These are expensive, and not available in state hospitals. OBJECTIVES: To study the cost, patient acceptance and efficacy of a patient mixed and administered combination of soluble and lente (biphasic) insulin administered twice a day. PATIENTS: A cohort of 25 patients with poor glycaemic control on a single dose of 100 units or more of lente insulin. 25 patients matched for age and glycaemic control were used as a control. SETTING: The diabetic clinic of the National Hospital Sri Lanka. METHOD: A prospective study of a cohort of patients. RESULTS: Mean fasting blood glucose decreased from 8.3 mmol/l (SD 3.1) to 6.9 mmol/l (SD 2.3, p < 0.01) and mean blood glucose levels declined from 12.3 mmol/l (SD 4.1) to 10.1 mmol/l (SD 4.7, p < 0.01) in the biphasic group. Total mean insulin dose fell from 80 units (SD 12) to 61 units (SD 11) in the biphasic group, but increased in the control group from 82 units (SD 16) to 91 units (SD 13.1). The diabetes well-being score in the biphasic group was 91.5 (SD 35.3), while the control group had a score of 63.7 (SD 21.3 p < 0.01). Mean glycosylated haemoglobin (HbA1c %) was 8.1 (SD 2.7) in the biphasic group compared to 9.2 (SD 3.3) in the control group. CONCLUSION: Patient mixed and administered biphasic insulin on a twice daily basis is feasible, acceptable to patients, results in better glycaemic control and affords better patient satisfaction.

Blood Glucose↗
PubMed1996

The prevalence of neuropathic foot ulceration in Sri Lankan diabetic patients.

OBJECTIVE: To determine the prevalence of diabetic neuropathy and neuropathic ulceration among patients with non-insulin dependent diabetes (NIDDM) attending a Sri Lankan diabetic clinic. SETTING: The diabetic clinic of the General Hospital Colombo (Sri Lanka National Hospital). RESEARCH DESIGN AND METHOD: Five hundred randomly selected diabetic patients (mean age 47.4 SD 17.59 years, 275 were males, mean duration of diabetes 5.29, SD 6.44 years) were screened for diabetic neuropathy using a neuropathy symptom score (NSS) neurological disability score (NDS) and pressure preception threshold using Semmes Weinstein monofilaments. RESULTS: Patients with neuropathy were older (mean 55.69 years SD 14.16) than those who did not (mean 47.1 years, SD 15.05 p = 0.001) and had diabetes for a longer period (mean 7.5, SD 8 years vs 4.8 SD 5.66, p = 0.002). 123 (30.6%, 95% CI 28-32%) patients had neuropathy according to the criteria used. 51(10.2%, 95% CI 8.2-12.2%) had a foot ulcer, a history of foot ulceration or a lower extremity amputation due to neuropathic ulceration. 26(5.1%, 95% CI 3.2-7%) patients had neuropathic foot ulcers at presentation and a further 14 (2.8%, 95% CI 1.4-4.2%) had developed an ulcer within one year of diagnosis of diabetes. 24 (4.8%, 95% CI 3-6.8%) had a history of lower extremity amputation. CONCLUSION: Neuropathic ulceration is a significant cause of morbidity in patients with NIDDM. One third of all NIDDM patients attending the clinic had a risk of foot ulceration. Preventive foot care programmes should be implemented at all diabetic clinics in Sri Lanka.

Adult↗
PubMed1994

The prevalence of foot ulceration and its correlates in type 2 diabetic patients: a population-based study.

The prevalence of peripheral neuropathy, peripheral vascular disease, and foot ulceration in Type 2 diabetic patients in the community were determined in a community-based study. Eight hundred and eleven subjects (404 male, 407 female, mean age 65.4 (range 34-90) years, diabetes duration 7.4 (0-50) years) from 37 general practices in three UK cities were studied. Neuropathy was diagnosed clinically using modified neuropathy disability scores which were ascertained using structured interviews and clinical examinations by one observer in each city. Peripheral vascular disease was diagnosed if a history of revascularization was present or > or = 2 foot pulses were absent. History of current or previous foot ulceration was recorded. The prevalence of neuropathy was 41.6% (95% confidence limits 38.3-44.9%) and the prevalence of PVD, 11% (9.1-13.7%). Forty-eight percent of neuropathic patients reported significant neuropathic symptoms. Forty-three patients (5.3% (3.8-6.8%)) had current or past foot ulcers; 20 of these were pure neuropathic ulcers, 13 neuroischaemic, 5 pure vascular, and 5 were unclassified. Multiple logistic regression showed history of amputation, neuropathy disability score, and peripheral vascular disease to be significantly associated with foot ulceration after adjusting for age and diabetes duration. A substantial proportion of Type 2 diabetic patients, often elderly patients who do not attend hospitals, suffered from peripheral neuropathy and peripheral vascular disease. These patients are at risk of foot ulceration and may benefit from preventive footcare.

Adult↗
PubMed1994

Impaired glucose tolerance and diabetes mellitus in a suburban Sri Lankan community.

The prevalence of impaired glucose tolerance and diabetes mellitus was studied in a suburban Sri Lankan community using 1985 WHO criteria. Oral 75 g glucose tolerance tests were performed on 633 subjects aged 30-64 years. The age-standardized prevalence rates for diabetes mellitus were 5.02 (95% CI 3.59-6.43) and impaired glucose tolerance 5.27 (95% CI 3.74-6.78). A total of 21% of diabetic patients were not known to have diabetes and were diagnosed for the first time during the survey. Obesity was more common (P < 0.05) in diabetic patients (21%) when compared to non-diabetic subjects (10.5%). Diabetes mellitus is a common health problem in Sri Lanka, and there is a need for developing national policies for its prevention and control.

Adult↗
PubMed1994

The work of a diabetes clinic: an audit.

OBJECTIVE: To audit outcome and process of care at the diabetic and medical clinics. DESIGN: Prospective interventional study with each patient acting as a retrospective control. SETTING: The Sri Jayawardenepura General Hospital (SJGH) diabetic clinic. PATIENTS: 250 consecutive patients with NIDDM transferred to the diabetic clinic from the general medical clinic. INTERVENTION: Participation in a structured scheme of health care delivery which included patient education dietary advice and screening for complications. MEASUREMENTS: Fasting blood glucose, patients' knowledge score, patient satisfaction, frequency of screening. RESULTS: A Significant improvement was seen after attendance at the diabetic clinic in fasting blood glucose (8.7 SD 1.3 vs 12.5 SD 3.2 mmol/l, p < 0.05), body mass index (26.8 SD 0.6 vs 27.4 SD 0.4 kg/m2, p < 0.05), admission rates (10% vs 21%, p < 0.05), patients knowledge score (76 SD 12 vs 42 SD 16%, p < 0.05) rates of screening for retinopathy (88% vs 6%, p < 0.05) and patient satisfaction in clinical care (87% vs 13%, p < 0.05). There was no significant improvement in cholesterol levels (5.7 SD 0.1 vs 5.8 SD 0.9 mmol/l). CONCLUSIONS: The diabetes clinic is a more efficient system and a more appropriate setting to care for patients with NIDDM.

Diabetes Mellitus, Type 2↗
PubMed1993

The prevalence of macrovascular disease and lipid abnormalities amongst diabetic patients in Sri Lanka.

The prevalence of macrovascular disease and hyperlipidaemia was examined in 500 patients with non-insulin-dependent diabetes mellitus attending a diabetic clinic in a Sri Lankan teaching hospital and 250 controls matched for age and gender. Macrovascular disease was assessed using a modified World Health Organisation questionnaire and modified Minnesota coding of electrocardiogram recordings. Twenty-one per cent of diabetic patients and 14.3% of controls had hypercholesterolaemia (P < 0.05). Macrovascular disease was present in 13.4% of diabetic patients and 8.2% of controls. Significant differences were seen in the prevalence of hypertension (15.6% vs 4.8%, P < 0.05), obesity (16.2% vs 9.7%, P < 0.05), peripheral vascular disease (5.6% vs 2%, P < 0.05) and electrocardiographic abnormalities (12% vs 6%, P < 0.05) in diabetic patients when compared to controls. Hyperlipidaemia and macrovascular disease is common in non-insulin-dependent diabetic patients in Sri Lanka and accounts for significant morbidity.

Cerebrovascular Disorders↗
PubMed1993

Prevalence of retinopathy in a Sri Lankan diabetes clinic.

OBJECTIVE: To determine the prevalence of diabetic retinopathy among patients with non-insulin dependent diabetes (NIDDM) attending a Sri Lankan diabetes clinic and assess the skills of non-ophthalmologist in screening for retinal disease. RESEARCH DESIGN AND METHOD: One thousand and three consecutive diabetic patients were screened for diabetic eye disease using a standardised technique based on the WHO Multinational Study. RESULTS: 31.3% (95% confidence intervals 28.0% to 31.6%) had retinopathy, 23% (95% confidence intervals 21% to 25%) had cataract and 20% (95% confidence intervals 17% to 23%) had previously undetected refraction errors. 4.1% (95% confidence intervals 2.1% to 6.0%) of patients were blind due to advanced retinal disease while 6.2% (95% confidence intervals 5.0% to 7.2%) were blind as a result of cataract. General physicians had a 90.6% sensitivity and 100% specificity in screening for retinal disease. CONCLUSIONS: Retinopathy accounts for significant visual handicap. Untreated cataract is more commonly associated with blindness. Undiagnosed errors of refraction account for significant visual handicap in Sri Lankan diabetic patients. Physicians trained in techniques of retinal screening can correctly assess diabetic retinal changes in a high proportion of patients.

Clinical Competence↗
PubMed1993

Knowledge about diabetes and metabolic control in diabetic patients.

It is widely accepted that patient education is an essential adjunct to the care of diabetic patients. A randomised controlled clinical trial in patient education was conducted at a diabetic and general medical clinic in Sri Jayawardenepura General Hospital. Two groups of diabetic patients matched for age, gender and duration of diabetes were allocated randomly to conventional care at general medical clinics or to a diabetes clinic where specific educational objectives were defined and patients trained to achieve these objectives. The doctors treating these patients were not 'blinded' to treatment groups. Diabetes knowledge was assessed using a diabetes knowledge scale and metabolic control assessed by mean fasting blood glucose. The patients attending the diabetic clinic showed significant improvement in both knowledge scores (67% vs 34%, p < 0.01) and mean fasting blood glucose 6.38 +/- 0.85 mmol/l vs 9.7 +/- 1.7 mmol/l, p < 0.01) at 6 months. We conclude that diabetes education improves patient knowledge and diabetes control.

Blood Glucose↗
PubMed1992

Diabetes in the elderly in a developing country.

In developing countries diabetes in the elderly is thought to be uncommon and is consequently ignored by health planners. We assessed the prevalence of complications of diabetes mellitus and frequency of hospital admissions in patients aged 60 and over in a hospital diabetic clinic in Sri Lanka. Elderly diabetic patients, though comprising only 23% of clinic patients, accounted for 46% of admissions. The prevalence of coronary artery disease, peripheral vascular disease, cerebrovascular disease, hypertension and visual handicap was increased in the diabetic patients when compared to age and gender matched controls. We conclude that diabetes in the elderly is a significant cause of morbidity in Sri Lanka.

Aged↗
PubMed1991

Semmes-Weinstein monofilaments: a simple, effective and inexpensive screening device for identifying diabetic patients at risk of foot ulceration.

Both vibration perception threshold (VPT) by biothesiometry and pressure perception using Semmes-Weinstein monofilaments (filaments) have been proposed to identify diabetic patients at risk of foot ulceration. The two methods were compared in 182 subjects attending a national patients conference. Both measures were made over the great toe. Filaments of three calibres were used: 4.17, 5.07 and 6.10 bending with 1, 10 and 75 g force, respectively. Pressure perception was normal (4.17) in 122 patients (group 1) whereas in 45 patients it was grade 5.07 (group 2) and 6.10 or greater in 15 (group 3). The corresponding mean VPT (+/- SD) for the three groups were 10.6 (+/- 6.7), 22.8 (+/- 12.7) and 32 (+/- 14.3), respectively. The mean VPT for the 3 groups were significantly different (P less than 0.001). The filaments were more sensitive (100%) but less specific (77.7%) in identifying patients who had foot ulcers compared to biothesiometry which was less sensitive (78.6%) but more specific (93.4%). The filaments are therefore reliable and may be superior to biothesiometry in screening for patients at risk of foot ulceration since sensitivity is the more important parameter. In addition, they are inexpensive (12 pounds) compared to the biothesiometer (400 pounds) and are simple and easy to use.

Adult↗