U. Bulugahapitiya - Academia.edu (original) (raw)

Papers by U. Bulugahapitiya

Sri Lanka Journal of Diabetes Endocrinology and Metabolism

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2021

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2016

We describe a one year and seven months old baby girl who presented with a short history of pubic... more We describe a one year and seven months old baby girl who presented with a short history of pubic hair growth. The child was otherwise healthy and there were no other features of virilization. Her axillary hair and breast development were prepubertal (Tanner 1). Hormonal evaluation revealed markedly raised androgen levels.). There were no features of hypercortisolism or hyperaldosteronism. USS abdomen revealed a left sided adrenal mass measuring 6.8cm x 6cm. A left sided adrenalectomy was performed and the histology revealed features of an adrenocortical carcinoma with areas of necrosis, lymphatic and vascular invasion. Child was treated with adrenalectomy followed by mitotane therapy. This case highlights the importance of suspecting ACC in a young child presenting with pubarche in order to avoid delay in making the diagnosis.

Background: Statins are widely used for primary and secondary prevention of cardiovascular diseas... more Background: Statins are widely used for primary and secondary prevention of cardiovascular disease (CVD). European Society of Cardiology / European Atherosclerosis Society (ESC/EAS) guidelines recommend LDL-cholesterol targets based on CVD risk. Objectives: This study aimed to determine whether LDL-cholesterol targets recommended by2016 ESC/EASare achieved in routine clinical practice. Methods: This paper is based on baseline data of patients recruited to a controlled clinical trial conducted at a tertiary care hospital. Participants have been on atorvastatin for >2 months. Demographic and clinical data were obtained using clinic records and interviewer administered questionnaires. LDL-cholesterol was assessed using Friedewald equation (when triglyceride was <400mg/dL) or by direct measurement (when triglyceride was ≥400mg/dL). Each participant’s CVD risk level and appropriate LDL-cholesterol target (very-high CVD risk:<70mg/dL; high CVD risk:<100mg/dL; low to moderate C...

Indian Journal of Endocrinology and Metabolism, 2017

Diabetes prevalence shows a continuous increasing trend in South Asia. Although well-established ... more Diabetes prevalence shows a continuous increasing trend in South Asia. Although well-established treatment modalities exist for type 2 diabetes mellitus (T2DM) management, they are limited by their side effect profile. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) with their novel insulin-independent renal action provide improved glycemic control, supplemented by reduction in weight and blood pressure, and cardiovascular safety. Based on the clinical outcomes with SGLT2i in patients with T2DM, treatment strategies that make a "good clinical sense" are desirable. Considering the peculiar lifestyle, body types, dietary patterns (long duration religious fasts), and the hot climate of the South Asian population, a unanimous decision was taken to design specific, customized guidelines for T2DM treatment strategies in these regions. The panel met for a discussion three times so as to get a consensus for the guidelines, and only unanimous consensus was included. After careful consideration of the quality and strength of the available evidence, the executive summary of this consensus statement was developed based on the American Association of Clinical Endocrinologists/ American College of Endocrinology protocol.

Indian Journal of Endocrinology and Metabolism, 2015

Health issues in general, and endocrine related issues in particular, are vital determinants of t... more Health issues in general, and endocrine related issues in particular, are vital determinants of the prosperity of society. The people of South Asia share many common features and face similar challenges related to endocrine health. These hurdles have been amplified by the rapid socioeconomic and lifestyle changes taking place in the region. Competing priorities and limited resources have prevented the implementation of strategies to meet these obstacles. SAFES wishes to improve endocrine health care delivery in South Asia, using a broad‐based, inclusive strategy, based on scientific evidence.

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2014

Disclaimer: Clinical Practice Guidelines are developed to be of assistance to health care profess... more Disclaimer: Clinical Practice Guidelines are developed to be of assistance to health care professionals by providing guidance and recommendations for particular areas of practice. The Guidelines should not be considered inclusive of all proper approaches or methods, or exclusive of others. The Guidelines cannot guarantee any specific outcome, nor do they establish a standard of care. The Guidelines are not intended to dictate the treatment of a particular patient. Treatment decisions must be made based on the independent judgment of health care providers and each patient's individual circumstances. The Endocrine Society makes no warranty, express or implied, regarding the Guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. The Society shall not be liable for direct, indirect, special, incidental, or consequential damages related to the use of the information contained herein.

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2014

Disclaimer: Clinical Practice Guidelines are developed to be of assistance to health care profess... more Disclaimer: Clinical Practice Guidelines are developed to be of assistance to health care professionals by providing guidance and recommendations for particular areas of practice. The Guidelines should not be considered inclusive of all proper approaches or methods, or exclusive of others. The Guidelines cannot guarantee any specific outcome, nor do they establish a standard of care. The Guidelines are not intended to dictate the treatment of a particular patient. Treatment decisions must be made based on the independent judgment of health care providers and each patient's individual circumstances. The Endocrine Society of Sri Lanka makes no warranty, express or implied, regarding the Guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. The society shall not be liable for direct, indirect, special, incidental, or consequential damages related to the use of the information contained herein.

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2014

Phaeochromocytoma is an endocrine tumour that originates in catecholamine producing chromaffin ce... more Phaeochromocytoma is an endocrine tumour that originates in catecholamine producing chromaffin cells of the adrenal medulla. Approximately 10% are malignant but there are no precise histological or biochemical markers to distinguish these from benign ones. The presence of metastases at distant sites is the most reliable clue but histologic features utilized in several scoring systems aid in predicting malignancy. Malignant phaeohromocytoma predominantly secrete noradrenaline and there may be high dopamine levels. Increased levels of chromogranin A, negative staining for inhibin/activin beta subunit and presence of SDHB mutation are the other factors associated with malignant potential. Multi modality evaluation with combination of CT, MRI, SPECT and radionuclide scintygraphy augments the diagnostic yield. Recent advance in molecular diagnostic markers further improved the knowledge in predicting malignant potential. Currently available therapeutic options are surgical debulking, pharmacological therapy for excess catecholamines, radionuclide therapy, antineoplastic therapy and external radiotherapy. These modalities provide symptomatic relief and biochemical control, but with no significant survival benefit. The development in the field of molecular pathway responsible for the malignant potential of phaeochromocytoma gives a hope to future therapy.

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2012

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2013

Clinical guidelines: The Endocrine Society of Sri Lanka Disclaimer: Clinical Practice Guidelines ... more Clinical guidelines: The Endocrine Society of Sri Lanka Disclaimer: Clinical Practice Guidelines are developed to be of assistance to health care professionals by providing guidance and recommendations for particular areas of practice. The guidelines should not be considered inclusive of all proper approaches or methods, or exclusive of others. The guidelines cannot guarantee any specific outcome, nor do they establish a standard of care. The guidelines are not intended to dictate the treatment of a particular patient. Treatment decisions must be made based on the independent judgment of health care providers and each patient's individual circumstances. The Endocrine Society of Sri Lanka makes no warranty, express or implied, regarding the guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. The Society shall not be liable for direct, indirect, special, incidental, or consequential damages related to the use of the information contained herein. Endocrine Society of Sri Lanka thanks Novo Nordisk for funding the development of these.

Diabetes Care, 2007

OBJECTIVE—Strategies for initiating statin use among adult patients with diabetes for primary car... more OBJECTIVE—Strategies for initiating statin use among adult patients with diabetes for primary cardiovascular disease (CVD) prevention include treating all patients (assuming diabetes is a coronary risk equivalent) or treating patients who are at risk of developing CVD. The aim of the study was to combine both strategies to derive an appropriate age cutoff for prescribing statins. By considering different strategies, we also aim to assess the effectiveness and efficiency of different strategies to reduce CVD events. RESEARCH DESIGN AND METHODS—This was a cross-sectional primary care population study using electronic patient files from 304 general practitioner practices in England and Wales. Of 60,258 patients with diabetes, 11,005 men and women aged 30–74 years fullfilled criteria for primary CVD prevention. Model outcomes were extrapolated to an estimated national diabetes prevalence of 3.6%. RESULTS—The age transition from a low-risk to a moderate-risk category for diabetic men and...

Diabetes and Vascular Disease Research, 2007

Dear Sirs, The metabolic syndrome (MetS) denotes a clustering of cardiovascular disease (CVD) ris... more Dear Sirs, The metabolic syndrome (MetS) denotes a clustering of cardiovascular disease (CVD) risk factors, thought to be pathophysiologically linked by insulin resis-tance. Recent evidence suggests a strong association between cigarette smoking with insulin resistance1 and the ...

Sri Lanka Journal of Diabetes Endocrinology and Metabolism

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2017

Thyrotoxic cardiomyopathy (TCM) is a potential life threatening complication of thyrotoxicosis wh... more Thyrotoxic cardiomyopathy (TCM) is a potential life threatening complication of thyrotoxicosis which is potentially reversible with early achievement of euthyroid state. Management of severe thyrotoxicosis in the presence of TCM is a challenging task, especially when thioamides are contraindicated. A 58 yr old male with poorly controlled Grave’s disease of 10 years presented with worsening symptoms of thyrotoxicosis and leg swelling. On examination he was thyrotoxic with a smooth diffuse goiter and also had inactive Grave’s orbitopathy. He had irregularly irregular pulse rate, grossly elevated jugular venous pulses, enlarged heart with tricuspid regurgitation and pulmonary hypertension. FT4 was >8.34 ng/dl (0.8-1.6 ng/dl), free T3 was 20.39 pg/ml (2.3-4.3 pg/ml) and TSH was 0.01 mU (0.5-5.0 mU/L). Serial ECGs showed slow atrial fibrillation with transient complete hear block and echocardiogram showed dilated TCM. He had pancytopenia, most likely resulting from concurrent carbimaz...

World Academy of Science, Engineering and Technology, International Journal of Medical and Health Sciences, 2018

Sri Lanka Journal of Diabetes Endocrinology and Metabolism

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2021

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2016

We describe a one year and seven months old baby girl who presented with a short history of pubic... more We describe a one year and seven months old baby girl who presented with a short history of pubic hair growth. The child was otherwise healthy and there were no other features of virilization. Her axillary hair and breast development were prepubertal (Tanner 1). Hormonal evaluation revealed markedly raised androgen levels.). There were no features of hypercortisolism or hyperaldosteronism. USS abdomen revealed a left sided adrenal mass measuring 6.8cm x 6cm. A left sided adrenalectomy was performed and the histology revealed features of an adrenocortical carcinoma with areas of necrosis, lymphatic and vascular invasion. Child was treated with adrenalectomy followed by mitotane therapy. This case highlights the importance of suspecting ACC in a young child presenting with pubarche in order to avoid delay in making the diagnosis.

Background: Statins are widely used for primary and secondary prevention of cardiovascular diseas... more Background: Statins are widely used for primary and secondary prevention of cardiovascular disease (CVD). European Society of Cardiology / European Atherosclerosis Society (ESC/EAS) guidelines recommend LDL-cholesterol targets based on CVD risk. Objectives: This study aimed to determine whether LDL-cholesterol targets recommended by2016 ESC/EASare achieved in routine clinical practice. Methods: This paper is based on baseline data of patients recruited to a controlled clinical trial conducted at a tertiary care hospital. Participants have been on atorvastatin for >2 months. Demographic and clinical data were obtained using clinic records and interviewer administered questionnaires. LDL-cholesterol was assessed using Friedewald equation (when triglyceride was <400mg/dL) or by direct measurement (when triglyceride was ≥400mg/dL). Each participant’s CVD risk level and appropriate LDL-cholesterol target (very-high CVD risk:<70mg/dL; high CVD risk:<100mg/dL; low to moderate C...

Indian Journal of Endocrinology and Metabolism, 2017

Diabetes prevalence shows a continuous increasing trend in South Asia. Although well-established ... more Diabetes prevalence shows a continuous increasing trend in South Asia. Although well-established treatment modalities exist for type 2 diabetes mellitus (T2DM) management, they are limited by their side effect profile. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) with their novel insulin-independent renal action provide improved glycemic control, supplemented by reduction in weight and blood pressure, and cardiovascular safety. Based on the clinical outcomes with SGLT2i in patients with T2DM, treatment strategies that make a "good clinical sense" are desirable. Considering the peculiar lifestyle, body types, dietary patterns (long duration religious fasts), and the hot climate of the South Asian population, a unanimous decision was taken to design specific, customized guidelines for T2DM treatment strategies in these regions. The panel met for a discussion three times so as to get a consensus for the guidelines, and only unanimous consensus was included. After careful consideration of the quality and strength of the available evidence, the executive summary of this consensus statement was developed based on the American Association of Clinical Endocrinologists/ American College of Endocrinology protocol.

Indian Journal of Endocrinology and Metabolism, 2015

Health issues in general, and endocrine related issues in particular, are vital determinants of t... more Health issues in general, and endocrine related issues in particular, are vital determinants of the prosperity of society. The people of South Asia share many common features and face similar challenges related to endocrine health. These hurdles have been amplified by the rapid socioeconomic and lifestyle changes taking place in the region. Competing priorities and limited resources have prevented the implementation of strategies to meet these obstacles. SAFES wishes to improve endocrine health care delivery in South Asia, using a broad‐based, inclusive strategy, based on scientific evidence.

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2014

Disclaimer: Clinical Practice Guidelines are developed to be of assistance to health care profess... more Disclaimer: Clinical Practice Guidelines are developed to be of assistance to health care professionals by providing guidance and recommendations for particular areas of practice. The Guidelines should not be considered inclusive of all proper approaches or methods, or exclusive of others. The Guidelines cannot guarantee any specific outcome, nor do they establish a standard of care. The Guidelines are not intended to dictate the treatment of a particular patient. Treatment decisions must be made based on the independent judgment of health care providers and each patient's individual circumstances. The Endocrine Society makes no warranty, express or implied, regarding the Guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. The Society shall not be liable for direct, indirect, special, incidental, or consequential damages related to the use of the information contained herein.

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2014

Disclaimer: Clinical Practice Guidelines are developed to be of assistance to health care profess... more Disclaimer: Clinical Practice Guidelines are developed to be of assistance to health care professionals by providing guidance and recommendations for particular areas of practice. The Guidelines should not be considered inclusive of all proper approaches or methods, or exclusive of others. The Guidelines cannot guarantee any specific outcome, nor do they establish a standard of care. The Guidelines are not intended to dictate the treatment of a particular patient. Treatment decisions must be made based on the independent judgment of health care providers and each patient's individual circumstances. The Endocrine Society of Sri Lanka makes no warranty, express or implied, regarding the Guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. The society shall not be liable for direct, indirect, special, incidental, or consequential damages related to the use of the information contained herein.

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2014

Phaeochromocytoma is an endocrine tumour that originates in catecholamine producing chromaffin ce... more Phaeochromocytoma is an endocrine tumour that originates in catecholamine producing chromaffin cells of the adrenal medulla. Approximately 10% are malignant but there are no precise histological or biochemical markers to distinguish these from benign ones. The presence of metastases at distant sites is the most reliable clue but histologic features utilized in several scoring systems aid in predicting malignancy. Malignant phaeohromocytoma predominantly secrete noradrenaline and there may be high dopamine levels. Increased levels of chromogranin A, negative staining for inhibin/activin beta subunit and presence of SDHB mutation are the other factors associated with malignant potential. Multi modality evaluation with combination of CT, MRI, SPECT and radionuclide scintygraphy augments the diagnostic yield. Recent advance in molecular diagnostic markers further improved the knowledge in predicting malignant potential. Currently available therapeutic options are surgical debulking, pharmacological therapy for excess catecholamines, radionuclide therapy, antineoplastic therapy and external radiotherapy. These modalities provide symptomatic relief and biochemical control, but with no significant survival benefit. The development in the field of molecular pathway responsible for the malignant potential of phaeochromocytoma gives a hope to future therapy.

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2012

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2013

Clinical guidelines: The Endocrine Society of Sri Lanka Disclaimer: Clinical Practice Guidelines ... more Clinical guidelines: The Endocrine Society of Sri Lanka Disclaimer: Clinical Practice Guidelines are developed to be of assistance to health care professionals by providing guidance and recommendations for particular areas of practice. The guidelines should not be considered inclusive of all proper approaches or methods, or exclusive of others. The guidelines cannot guarantee any specific outcome, nor do they establish a standard of care. The guidelines are not intended to dictate the treatment of a particular patient. Treatment decisions must be made based on the independent judgment of health care providers and each patient's individual circumstances. The Endocrine Society of Sri Lanka makes no warranty, express or implied, regarding the guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. The Society shall not be liable for direct, indirect, special, incidental, or consequential damages related to the use of the information contained herein. Endocrine Society of Sri Lanka thanks Novo Nordisk for funding the development of these.

Diabetes Care, 2007

OBJECTIVE—Strategies for initiating statin use among adult patients with diabetes for primary car... more OBJECTIVE—Strategies for initiating statin use among adult patients with diabetes for primary cardiovascular disease (CVD) prevention include treating all patients (assuming diabetes is a coronary risk equivalent) or treating patients who are at risk of developing CVD. The aim of the study was to combine both strategies to derive an appropriate age cutoff for prescribing statins. By considering different strategies, we also aim to assess the effectiveness and efficiency of different strategies to reduce CVD events. RESEARCH DESIGN AND METHODS—This was a cross-sectional primary care population study using electronic patient files from 304 general practitioner practices in England and Wales. Of 60,258 patients with diabetes, 11,005 men and women aged 30–74 years fullfilled criteria for primary CVD prevention. Model outcomes were extrapolated to an estimated national diabetes prevalence of 3.6%. RESULTS—The age transition from a low-risk to a moderate-risk category for diabetic men and...

Diabetes and Vascular Disease Research, 2007

Dear Sirs, The metabolic syndrome (MetS) denotes a clustering of cardiovascular disease (CVD) ris... more Dear Sirs, The metabolic syndrome (MetS) denotes a clustering of cardiovascular disease (CVD) risk factors, thought to be pathophysiologically linked by insulin resis-tance. Recent evidence suggests a strong association between cigarette smoking with insulin resistance1 and the ...

Sri Lanka Journal of Diabetes Endocrinology and Metabolism

Sri Lanka Journal of Diabetes Endocrinology and Metabolism, 2017

Thyrotoxic cardiomyopathy (TCM) is a potential life threatening complication of thyrotoxicosis wh... more Thyrotoxic cardiomyopathy (TCM) is a potential life threatening complication of thyrotoxicosis which is potentially reversible with early achievement of euthyroid state. Management of severe thyrotoxicosis in the presence of TCM is a challenging task, especially when thioamides are contraindicated. A 58 yr old male with poorly controlled Grave’s disease of 10 years presented with worsening symptoms of thyrotoxicosis and leg swelling. On examination he was thyrotoxic with a smooth diffuse goiter and also had inactive Grave’s orbitopathy. He had irregularly irregular pulse rate, grossly elevated jugular venous pulses, enlarged heart with tricuspid regurgitation and pulmonary hypertension. FT4 was >8.34 ng/dl (0.8-1.6 ng/dl), free T3 was 20.39 pg/ml (2.3-4.3 pg/ml) and TSH was 0.01 mU (0.5-5.0 mU/L). Serial ECGs showed slow atrial fibrillation with transient complete hear block and echocardiogram showed dilated TCM. He had pancytopenia, most likely resulting from concurrent carbimaz...

World Academy of Science, Engineering and Technology, International Journal of Medical and Health Sciences, 2018