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Purpose Breast cancer is the most common cancer globally as well as in Sri Lanka. Improvements in cancer care have allowed patients to live to an older age. With advancing age, incidence of non-communicable diseases (NCDs) increases. Cancer diagnoses tend to take attention away from the treatment of other comorbidities, given its importance. The objective of this study was to describe healthcare delivery for NCDs among female breast cancer survivors treated at the National Cancer Institute of Sri Lanka (NCISL) and identify opportunities to optimise non-cancer medical care in this cohort. Methods A total of 420 women were identified from the breast cancer database at the NCISL, who were 50-80 years at the time of their breast cancer diagnosis, were within 12-24 months from the date of diagnosis, had completed their active cancer treatment and were in complete remission. Of this population, 228 (54%) women who had documented NCDs at the time of diagnosis were identified and were followed-up via telephone to collect details regarding existing comorbidities and the screening and development of new comorbidities. Results At the time of cancer diagnosis, 216/228 (95%) of patients had hypertension, 104/228 (46%) had type 2 diabetes and 17/228 (8%) had ischaemic heart disease (IHD). The prevalence of other comorbidities was very low. During the post diagnosis period, 11 patients developed type 2 diabetes, while 2 developed IHD. Osteoporosis screening using dual-energy X-ray absorptiometry scanning was very low at diagnosis 21/228 (9%) but improved in post cancer treatment follow-up 112/228 (49%, p < 0.001). Only 95/228 (42%) were screened for other cancers. Conclusions Hypertension was the most prevalent comorbidity while type 2 diabetes and dyslipidaemia were the most common diagnoses post-treatment. In these patients, screening for osteoporosis and other cancers remains very low, emphasising a missed opportunity.

Background Obesity prevalence has increased during the past few decades, causing a pandemic with an influx in other co-morbidities. Many factors influence weight gain in an obesogenic environment therefore strategies for treating obesity may vary from conventional dietary and physical activity interventions to pharamacotherapy. A shift in unconventional strategies as herbal products for treating obesity have been investigated and one such plant extract is Caralluma fimbriata (C. fimbriata). Further, the studies included were systematically reviewed to gather evidence on potential effects of C. fimbriata as an appetite suppressant and weight loss supplement. Methods A systematic review of clinical trials reporting the effects of C. fimbriata as appetite suppression and anti-obesity supplement was reported according to PRISMA guidelines. Data were obtained by searching three databases: PubMed®, Web of Science® and SciVerse Scopus® for studies published until 30th April 2020. Results A total of 7 articles studying C. fimbriata satisfied the inclusion and exclusion criteria and were sourced from various countries including Australia (3), Cuba (1), India (2) and Spain (1). Almost all studies recruited adults who were overweight or obese with a BMI > 25 kg/m2 (n = 5), with the exception of two studies, one that recruited healthy adults with a BMI average of 26.5 kg/m2 and the second one utilised a population of children and adolescents with Prader-Willis Syndrome (PWS). Parameters assessing obesity, biochemical and appetite factors were analysed by carrying out a meta-analysis. Compared to placebo controlled group, C. fimbriata extract significantly reduced WC by 1.59 cm (95% CI, − 3.07 to − 0.10, p = 0.041) and WHR by 0.06 (95% CI, − 0.12 to − 0.01, p = 0.05) although no significant effects were seen on BW, BMI and HC. Biochemical and appetite parameters outcome on C. fimbriata consumption had no significant changes. Any side effects of individuals who ingested the extract were reported by few studies of which most common effects were constipation, diarrhoea, nausea and rashes. Conclusion Appetite parameters showed no significant changes and metabolic parameters did not improve with C.fimbriata supplementation therefore it is unlikely to recommend C. fimbriata as a weight loss supplement and an appetite suppressant.

Background Management of epilepsy during pregnancy in a resource-limited setting (RLS) is challenging. This study aimed to assess obstetric outcomes and effects on babies of women with epilepsy (WWE) exposed to Anti-epileptic drugs (AEDs) compared to non-exposed controls in a RLS. Methods Pregnant WWE were recruited from antenatal and neurology clinics of a tertiary care hospitals in Sri Lanka. Patients were reviewed in each trimester and post-partum. Medication adherence, adverse effects, seizure control and carbamazepine blood levels were monitored. Post-partum, measurements for anthropometric and dysmorphic features of the babies and congenital abnormalities were recorded. Age and sex matched babies not exposed to AED recruited as controls were also examined. Results Ninety-six pregnant WWE were recruited (mean period of gestation 22.9 weeks). Mean age was 28 years and 48(50%) were primigravidae. Fifty percent (48) were on monotherapy, while 23.8, 15.9 and 4.1% were on two, three and four AEDs respectively. AEDs in first trimester (TM1) were carbamazepine (71%), valproate (25.8%) clobazam (29.5%), lamotrigine (7%) topiramate (5%) and others (3.4%). Sodium valproate use reduced significantly from T1 to T2(p

Graves' disease is an autoimmune disease characterized by hyperthyroidism due to circulating autoantibodies. Radioactive iodine (RAI) and antithyroid drugs (ATD) are the preferred initial treatment options in Graves' disease in many parts of the world. Long term treatment with methimazole in Grave's disease patients beyond the recommended period is shown to be safe and effective and emerging evidence suggests that continuous methimazole therapy may even be superior to RAI therapy in some aspects. Recent randomized trials comparing long-term methimazole to RAI in patients who relapse, have confirmed these findings Sri Lanka Journal of Diabetes, Endocrinology and Metabolism 2013; 3: 41-44 DOI: http://dx.doi.org/10.4038/sjdem.v3i1.5503

Prevalence of cardio metabolic risk factors in women with newly diagnosed Type 2 DiabetestS.A. Abhayaratna1, N.P. Samasundaram2.1Faculty of Medicine-University of Colombo, Department of Pharmacology, Colombo 08, Sri Lanka.2National Hospital of Sri Lanka, Diabetes and Endocrinology Unit, Colombo 10, Sri Lanka.BackgroundCardiovascular (CV) disease is a major cause of morbidity and mortality among patients with Type 2 Diabetes. Traditionally women (even with type 2 Diabetes) were considered to have a lower cardiovascular risk than men till the time of menopause due to the protective effect of oestrogens. However some of the recent studies have confirmed that women with Type 2 Diabetes has higher cardiovascular risk than age matched men and indeed have higher CV mortality (Dawson SI,2008).This is important finding which needs further confirmation as some medications used in CV risk reduction has shown to work better in men and in addition access to healthcare seems to be limited for women when compared to men.AimTo evaluate the cardio metabolic risk factors present in women with newly diagnosed Type 2 Diabetes.MethodA prospective cross sectional study carried out in a tertiary care hospital diabetic clinic where patients with Diabetes were referred after seen by a medical officer. Consecutive female patients with newly diagnosed Type 2 diabetes(within 12 months) were recruited for this study. Anthropometric, blood pressure measurements and laboratory investigations were carried out following the standard protocols. ResultsThere were 282 women who underwent laboratory evaluations after initial recruitment to the study. Majority were in the 41-60 age group and were obese (BMI >25 kg/m2).Basic characteristics are mentioned in Table 1Table 1:Basic characteristics of the study populationMean Age- yrs (SD)t49.7(10.4)Age groupst18-20 yrs (%)t 1 (0.35)21-40 yrs (%)t 60 (21.2)41-60 yrs (%)t 186 (65.9)61-80 yrs (%)t 35 (12.4)Mean duration of DM(SD)t3.4 months(3.2)BMI category (kg/m2)t< 18.5 (underweight)t 9 (3.1%)18.5-22.9 (normal weight)t67 (23.7%)23-24.9 (Over weight)t59 (20.9 %)More than 25 (Obese)t147 (52.1%) Of the cardio metabolic risk factors following were present (Table 2)in the women with newly diagnosed type 2 DiabetesTable 2 :Prevalence of cardio metabolic risk factorsCardio metabolic risk factorst Number (%)Hypertension (BP >130/85)t 115 (40%)Low HDL (< 50 mg/dL)t 172 (60.9%)High Triglycerides (>150 mg/dL)t 92 (32.2%)Abnormal waist circumference (>80cm)t233 (82.6%)Type 2 DMt 282(100%)All 5 of abovet 23(8.1%)Metabolic syndrome (IDF criteria)t 203 (71.9%)Overweightt 59 (20.9%)Obesityt 147 (52.7%)In addition to Type 2 Diabetes one additional risk factor of Metabolic syndrome was present in 96% while two additional risk factors were present in 76.2 %.Table 3: Other CV risk factorsOther CV risk factors tMean (SD) HbA1c t8.2 (1.8)FBS(mg/dL)t 152 .8( 63)PPBS (mg/dL) 189.2(89)Body fat %t 36.3(4.8)Visceral fat %t 8.8 (4.4) 30 (10.6%) patients were on lipid lowering therapy with a statin and 61(21.63%)patient were on antihypertensive therapy.DiscussionIn this group of women with newly diagnosed Type 2 Diabetes, majority had obesity, low HDL level ,abnormal waist circumference and Metabolic syndrome. Abnormal waist circumference was the most prevalent cardio metabolic risk factor in this group while triglyceride level above 150 mg/dL was the least prevalent risk factor out of the measured risk factors. Alarming number had one and two additional Metabolic syndrome risk factors present in addition to Type 2 Diabetes. Current American Heart association guidelines recommend to start lipid lowering therapy with a statin in Type 2 Diabetes patients above 40 years of age. Out of the 221 patients above 40 years in this study only 30 (13.5%)received a statin after they have been seen by a medical officer and started on antihyperglycaemic therapy( in 70% of the patients) prior to referring them to this tertiary care hospital. High prevalence of cardio metabolic risk factors at a very early stage of Type 2 Diabetes in this group of women remains to be a significant concern. It is even more worrying to note that effective therapy in reducing the cardio metabolic risk is not employed at a early stage when these women posses a high risk for future CV events.