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Background Management of cardiovascular disease (CVD) in patients with haemophilia is extremely challenging. Therefore, knowing the prevalence of CVD and risk factors in this population is imperative. Methods All consented patients ≥ 18 years of age attending the haemophilia clinic at a tertiary care centre were recruited to the study. Data were collected using a pretested, investigator administered questionnaire. Seated blood pressure, anthropometric measurements and blood samples were obtained using standard techniques. Lipid profile and fasting plasma glucose were estimated. Prevalence of risk factors for CVD was compared with those of age matched males in the general population. P values Results Of the total 109 participants, 92 (84.4%) had haemophilia A. The median age of the study group was 36 years. Three (2.8%) had at least one cardiovascular disease. There were 10 (9.2%), 30 (27.5%), 13 (11.9%) and 4 (3.7%) participants with diabetes, hypertension, current smoking and obesity (Body Mass Index (BMI) ≥ 30 kg/m2) respectively. 32 (29.4%) and 37 (33.9%) participants had waist circumference ≥ 90 cm and waist hip ratio ≥ 0.9 respectively. 38 (34.9%) had total cholesterol ≥ 200 mg/dl, 43 (39.5%) had low density lipoprotein (LDL) cholesterol ≥ 130 mg/dl, 25 (22.9%) had triglycerides (TG) ≥ 150 mg/dl and 58 (53.2%) had High density lipoprotein (HDL) cholesterol Conclusion The study signifies an increased prevalence of risk factors for CVD among patients with haemophilia and the need for preventive measures.

Background Male sexual dysfunction in diabetes is often an unrevealed clinical issue. Though many publications report the prevalence, there is limited data on its associations, impact, and health-seeking behaviour. The objectives were to assess the prevalence of male sexual dysfunction, its associations, impact and treatment-seeking among men with diabetes in a selected tertiary care Diabetes Clinic. Methods A cross-sectional study was conducted at the Diabetes Clinic, National Hospital of Sri Lanka, from January to September 2020. Men with diabetes aged 18 to 70 years undergoing annual assessment were recruited consecutively. Socio-demographic and clinical information were collected using an interviewer-administered questionnaire. Erectile dysfunction (ED), premature ejaculation, mental health and quality of life were assessed using validated self-administered questionnaires. Cardiovascular autonomic reflex tests and total testosterone levels were performed. Penile colour Doppler ultrasonography was performed on consenting participants with erectile dysfunction. Associations were assessed using the chi-square test or Fisher’s exact for dichotomous variables and independent sample t-test for continuous variables. Results Two hundred and twelve participants were recruited with a mean age of 54.1 (SD = 10.1) years. Erectile dysfunction was present in 168 (79.2%), (mild: 45, mild-moderate: 56, moderate: 26, severe: 41). Premature ejaculation was present in 26 (18.7%). Libido was low among 16%. Sexual dysfunction was not revealed to a health provider by 85.6% despite 60.5% experiencing psychological and/or relationship effects. Out of 18 who sought treatment, only 4 achieved a good response. Mean age (55.4 ± 9.5 vs 48.7 ± 10.6 years, p p p p p = 0.041) and lower limb arterial disease (0% vs 12.2%, p = 0.04) were associated with ED. Arterial insufficiency was seen among 50% of the participants who underwent penile colour Doppler ultrasonography. Conclusions Male sexual dysfunction is a pervasive yet underappreciated problem in diabetes care despite its effect on the individual. Patient and disease characteristics would guide the identification of high-risk individuals for targeted screening in clinical practice.

Establishing the burden of undiagnosed CVD risk factors is critical to monitoring public health efforts related to screening and diagnosis.To assess the proportion and determinants of undiagnosed diabetes, hypertension, and hypercholesterolaemia, among overweight or obese adults.A sample of 1200 participants aged 35-64 years with a BMI ≥25 kg/m2 was selected from the Colombo district. Data were collected through a questionnaire, anthropometry, blood pressure measurement, and blood sampling for fasting plasma glucose, HbA1c, and lipid profile. Undiagnosed diabetes, hypertension, and hypercholesterolaemia were defined as fasting plasma glucose ≥126 mg/dL or HbA1c ≥6.5%; systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg; total cholesterol ≥240 mg/dl respectively, in a person without a previous diagnosis. Multiple logistic regression analyses were carried out to identify determinants.The prevalence (95%CI) of diabetes was 28% (25.5, 30.5), hypertension, 33.4% (30.7, 36.1) and hypercholesterolaemia, 31.9% (29.2, 34.5). The proportion of undiagnosed diabetes was 13.8% (11.9, 15.8), undiagnosed hypertension 11.3% (9.5, 13.1), and undiagnosed hypercholesterolaemia 17.8% (15.6, 19.9). Undiagnosed cases accounted for almost half of all diabetes cases, one-third of all hypertension cases, and more than half (56%) of all high cholesterol cases. The key determinants for undiagnosed CVD risk were: male sex, low or middle income, rural residence, and relatively younger age.CVD screening programmes should be tailored to target populations based on these determinants and provide basic diagnostic facilities in all health centres. The 'proportion undiagnosed' in the population may be a useful indicator to evaluate their effectiveness.

Background: The indigenous population in Sri Lanka called “Veddas” estimated to be around 0.05% of the total population in the island. This population is unique that they used to live mostly in jungles with primitive lifestyles. The objective was to study the cardiovascular risk factors in this indigenous (Vadda) community.Methods: A descriptive cross-sectional study was carried out with convenience sampling method, by inviting all adults (> 18 years) in the indigenous village Pollebedda. Height, weight and blood pressure was measured, and fasting blood samples were analyzed for glucose, lipids and haemoglobin. Data were analyzed using SPSS (version 22)0.Results: Response rate was approximately 39%. Out of total 121 participants 47 were males and 74 were females. The mean age was 44.29 +14.75 years and 12 were elders> 65 years of age. In the sample 17.3% were obese (BMI>27.5) while 24.8%% were overweight (BMI 23-27.5). The crude prevalence of diabetes, hypertension and raised total cholesterol were 7.2%, 12.4% 7.7% respectively. Prevalence of low HDLC (< 40mg/dL in men,< 50 mg/dL in women), high LDLC (>160 mg/dL) and elevated triglycerides (>150mg/dL) were 75.2%, 7.7% and 25.6% respectively. Isolated hypertriglyceridemia was present in 20.5%.Conclusions: There is a rising trend of obesity and diabetes in this indigenous community compared to previous study. This highlights that the indigenous peoples in Sri Lanka share the relatively high rates of coronary artery risk factors observed among other indigenous groups around the world. Changes in lifestyle and diet, poverty, poor health seeking behavior and limited access to health care due to limitation in transport are possible risk factors for this trend which needs to be further evaluated. A local and global initiative is required to control cardiovascular disease risk factors among indigenous groups.

Background Dyslipidemia is a major risk factor for cardiovascular disease. Prevalence patterns and determinants of dyslipidemia in Sri Lanka are unkown. Objectives We aimed to determine the prevalence and correlates of dyslipidemia among Sri Lankan adults. Methods A nationally representative sample was recruited by multistage random cluster sampling in Sri Lanka Diabetes and Cardiovascular Study, a cross-sectional study. Data collected by an interviewer-administered questionnaire, physical examination, anthropometric measurements lipid analysis from take 12-hour fasting blood samples were used. Results Among 4451 participants 60.5% were women and mean age was 46 years. Mean (standard deviation) total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), triglycerides (TGs), and TC/HDLC levels were 206.7 mg/dL (±43.5), 46.8 mg/dL (±10.6), 135.5 mg/dL (±37.6), 121.7 mg/dL (±66.8), and 4.6 (±1.1), respectively. Women had higher mean TC, HDLC, LDLC, and TG values compared to men across all age groups. Mean TC, LDLC, and TGs increased with age in both genders; 77.4% of participants had some form of dyslipidemia. Low HDLC was the commonest type (49.6%) of dyslipidemia. Increasing age, female sex, living in urban sector, high body mass index, central obesity, diabetes, hypertension, insufficient physical activity, and smoking were associated with having some form of dyslipidemia. Conclusion Three in four Sri Lankan adults have some form of dyslipidemia. Physical inactivity, obesity, hypertension, and diabetes are the leading modifiable risk factors.

Neuroleptic malignant syndrome is a rare, fatal antipsychotic-induced idiosyncratic reaction characterised by hyperthermia, altered consciousness, autonomic instability and rigidity with elevated creatine kinase levels and leukocytosis. Neuroleptic malignant syndrome and antipsychotics are significant causes for elevated creatine kinase among the extensive list of differential diagnoses. Risperidone is an atypical antipsychotic drug with anti-serotonergic and anti-dopaminergic properties which has a wide range of side effects, including neuroleptic malignant syndrome. Though the rise in creatine kinase in neuroleptic malignant syndrome is commonly around 2000 to 15,000 IU/L due to myonecrosis, ischaemia and heat production, normal creatine kinase levels in neuroleptic malignant syndrome were also reported. Up to now, only two cases have been reported with creatine kinase levels of more than 50,000 IU/L in neuroleptic malignant syndrome, but neither of them was risperidone-induced. We report the first case of an exceptional rise in creatine kinase levels more than 250-fold in a 16-year-old girl following low-dose risperidone-induced neuroleptic malignant syndrome.

Background: Incidentalomas of endocrine glands are a common problem in endocrine practice. Data on their prevalence are limited from South Asian settings. Objective: We aimed to describe incidentalomas and other histopathological abnormalities in an autopsy series of Sri Lankans. Methods: Consecutive autopsies performed at Judicial Medical Office, Colombo from December 2014 to December 2016 were screened and the deceased without a diagnosed endocrinopathy (except diabetes) were included in the study. Pituitary, thyroid, adrenal, pancreas and ovarian specimens were sampled and examined both macroscopically and under light microscopy with Haemotoxylin Eosin stain. Results: Among 441 autopsies (mean age 52.5 years, male 77.8%) examined, pituitary, thyroid, adrenal, pancreatic and ovarian nodules were detected in 0.8%, 37.2%, 1.8%, 1.3% and 18.4% respectively. Thyroid neoplasms were present in 6.4%, of which 87.5% were papillary carcinoma or papillary microcarcinoma and it was associated with background thyroiditis (χ2 = 4.05, p = 0.04) or nodular thyroid enlargement (χ2 = 32.68, p Conclusions: In this population of Sri Lankan adults, prevalence of thyroid incidentalomas, neoplasms and thyroiditis are comparable to published studies from the West. Papillary carcinoma or microcarcinoma was the commonest type and it showed a predilection to affect thyroid glands with background thyroiditis. Pituitary, pancreatic and adrenal incidentalomas and neoplasms were less prevalent.

Introduction Establishing the burden of undiagnosed CVD risk factors is critical to monitoring public health efforts related to screening and diagnosis. Objective To assess the proportion and determinants of undiagnosed diabetes, hypertension, and hypercholesterolaemia, among overweight or obese adults. Methods A sample of 1200 participants aged 35-64 years with a BMI ≥25 kg/m2 was selected from the Colombo district. Data were collected through a questionnaire, anthropometry, blood pressure measurement, and blood sampling for fasting plasma glucose, HbA1c, and lipid profile. Undiagnosed diabetes, hypertension, and hypercholesterolaemia were defined as fasting plasma glucose ≥126 mg/dL or HbA1c ≥6.5%; systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg; total cholesterol ≥240 mg/dl respectively, in a person without a previous diagnosis. Multiple logistic regression analyses were carried out to identify determinants. Results The prevalence (95%CI) of diabetes was 28% (25.5, 30.5), hypertension, 33.4% (30.7, 36.1) and hypercholesterolaemia, 31.9% (29.2, 34.5). The proportion of undiagnosed diabetes was 13.8% (11.9, 15.8), undiagnosed hypertension 11.3% (9.5, 13.1), and undiagnosed hypercholesterolaemia 17.8% (15.6, 19.9). Undiagnosed cases accounted for almost half of all diabetes cases, one-third of all hypertension cases, and more than half (56%) of all high cholesterol cases. The key determinants for undiagnosed CVD risk were: male sex, low or middle income, rural residence, and relatively younger age. Conclusion CVD screening programmes should be tailored to target populations based on these determinants and provide basic diagnostic facilities in all health centres. The 'proportion undiagnosed' in the population may be a useful indicator to evaluate their effectiveness.

Metabolic syndrome (MetS) is a risk factor for cardiovascular disease (CVD). Apolipoproteins are emerging as powerful predictors of CVD. We aimed to study associations of metabolic syndrome and apoB, apoAI, apoB/AI ratio in young Sri Lankans with type 2 diabetes.Blood samples were available from 690 patients with type 2 diabetes in Sri Lanka Young Diabetes Study, and were analysed for apoB, apoAI, total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), triglycerides (TG) and glycated haemoglobin (HbAMetS was present in 60.9% of subjects. Of those with MetS, 76.0% were women. Those with MetS had higher apoB (1.27 V s 1.19 mmol/L; p = 0.001), apoB/AI (0.80 V s 0.75; p = 0.001), non-HDL cholesterol (NHDLC) (4.15 V s 3.98 mmol/L; p = 0.002),and triglycerides (1.51 V s 1.31 mmol/L; p 0.001) and lower apoAI (1.58 V s 1.60 mmol/L; p = 0.03) and HDLC (1.02 V s 1.16 mmol/L, p 0.001). ApoB and apoB/AIlevels increased significantly as the number of MetS components increased. ApoB and apoB:AI ratio were independently associated with MetS and components.MetS showed a high prevalence among young Sri Lankans with diabetes. Elevated apoB is commonly clustered with other risk indicators in MetS.

Mobile phone-based health interventions (mHealth) are viewed as an attractive approach to foster behaviour change, and found to be effective in promoting physical activity and healthy diets. The present study aims to investigate whether mHealth with advice for dietary and lifestyle modifications would reduce 10-year cardio vascular disease (CVD) risk among overweight or obese adults aged 35–64 years in Sri Lanka. A two-group parallel-arm randomized controlled trial (RCT) was conducted in Colombo district, recruiting 1200 individuals aged 35–64 years with a body mass index (BMI) of ≥25 kgm−2. Participants were randomly assigned either to mHealth package (intervention arm, n = 600) or usual care (control arm, n = 600). The intervention package contains a series of dietary and lifestyle improvement messages, a mobile application to register participants, and a web application to deliver these messages. Participants in the intervention arm receive 2 voice and 2 text messages per week to their mobile phones for a period of 12 months. The primary outcome (10-year CVD risk) will be assessed according to sex, age, smoking status, blood pressure, serum cholesterol and glycaemic status. Data are collected at enrollment and after 12 months of intervention on: dietary practices, physical activity, smoking, anthropometry, body composition, blood pressure, fasting plasma glucose, HbA1c and lipid profile. Analysis of effect will be performed by intention-to-treat principle, comparing the outcomes between intervention and control arms. The study resulted in a comprehensive mHealth nutrition and lifestyle package (mHENAL) and successfully completed recruitment and baseline assessment of participants. The message delivery is in progress. Keywords: mHealth, Mobile phone-based, Nutrition intervention, Lifestyle, Cardiovascular disease, Obesity

Introduction: Congenital adrenal hyperplasia (CAH) requires lifelong glucocorticoid therapy (GCT). Long- term use of GCT is known to adversely affect bone metabolism. Vitamin D synthesis in the skin can be impaired by the hyperpigmentation seen in CAH patients. Objectives: To describe the effects of glucocorticoid therapy and vitamin D status on the bones in children with CAH. Method: Children with CAH followed up in the University Unit at the Lady Ridgeway Hospital, Colombo were studied. Mean values of the daily dose of hydrocortisone received, serum calcium, intact parathormone (iPTH) and 25-hydroxy vitamin D levels were compared with the duration of therapy categorized into 3 groups. Skin pigmentation was graded using the Fitzpatrick scale and was described with the biochemical parameters according to vitamin D status (sufficiency >50nmol/L). Results: Thirty eight children were studied. Mean daily dose of hydrocortisone of children treated for less than 4 years (n=6), 4 to 7 years (n=6) and more than 7 years (n=26) were 14.0, 13.4, and 14.0 mg/m2/day respectively (recommended dose 10-15 mg/m2/day). Mean serum calcium levels (2.53, 2.41, 2.28mmol/L) and iPTH levels (3.59, 4.46, 6.30pmol/L) were in the normal range and vitamin D levels (47.55, 47.97, 44.44nmol/L) were in the insufficient range. The differences between the groups were not significant. However, the difference seen in alkaline phosphatase (ALP) was significant (p=0.026). There was also an apparent inverse association of ALP with the total average daily dose of glucocorticoids (R2=0.077, F=3.0, p=0.092). Vitamin D deficiency (≤37.5nmol/L) was seen in 8 (21.1%) patients. Degree of pigmentation and biochemical parameters assessed were not significant according to vitamin D status. Conclusions: Serum ALP levels show an inverse relationship with the duration of glucocorticoid therapy indicating possible adverse outcome on bones. The apparent inverse relationship of total average daily dose of glucocorticoids with ALP failed to reach statistical significance. No relationship was found with vitamin D status and other parameters assessed.

Background Apolipoproteins B (apoB) and AI (apoAI) are strong predictors of cardiovascular disease (CVD). We describe apolipoprotein distributions and their associations with lipids and diabetes subtype in diabetic young adult South Asians. Methods In 995 subjects with diabetes, we measured fasting total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), triglycerides (TG), apoB and apoAI, glycosylated haemoglobin (HbA1c) and glutamic acid decarboxylase antibodies (GADA). Low-density lipoprotein cholesterol (LDLC) and non-HDLC (NHDLC) were calculated. We compared values in subjects aged 15–50 y from the United States National Health and Nutrition Examination Survey (NHANES). Results Median age and duration of diabetes were 38 (range 14–45) and 4 (0–24) y. Men had significantly higher TC, TG, NHDLC, TC/HDLC, apoB/AI and NHDLC/apoB, and lower apoAI than women. Compared with the reference group, patients with type 1 diabetes had lower TG, apoB:apoAI and HDLC:apoAI, and higher HDLC and apoAI. Patients with type 2 diabetes had higher TG, TC, LDLC, NHDLC, TC:HDL, apoB, apoAI and apoB:apoAI, and lower HDLC, LDLC:apoB and HDLC:apoAI. Among patients with type 2 diabetes, 54% had high apoB (>1.2 g/L) and 33% also had high TG (>1.5 mmol/L). Measures of obesity (body mass index and waist circumference) were weakly correlated with lipid and apoprotein parameters, suggesting a modest contribution to dyslipidaemia. Conclusions A large proportion of young adult Sri Lankan patients with type 2 diabetes has a low LDLC:apoB and high apoB and/or TG, suggesting that these patients are at increased risk of CVD.