Browsing by Author "Hathagoda, K.L.W."

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Central nervous system infections in a tertiary care hospital: disease patterns and difficulties in diagnosis
(Sri Lanka Medical Association, 2011) Ranawaka, U.K.; Harshani, M.L.; Fonseka, V.N.R.M.; Hathagoda, K.L.W.; Nawaratne, A.N.H.M.U.K.G.D.B.; Weerasooriya, W.A.L.K.; Samarakoon, S.M.S.B.; Thirumawalawan, K.; Premawansa, G.; Fernando, M.A.M.; de Silva, L.; Perera, K.V.H.K.K.; Dassanayake, K.M.M.P.; Wijesooriya, T.; Rajindrajith, E.G.D.S.
INTRODUCTION AND OBJECTIVES: Central nervous system (CNS) infections produce high morbidity and mortality, and effective treatment and outcome depend on precise microbiological diagnosis. We aimed to describe the pattern of CNS infections and accuracy of diagnosis in patients presenting to a tertiary care hospital. METHODS: We prospectively studied patients with suspected CNS infection admitted to medical and paediatric units of Colombo North Teaching Hospital over three years. Data related to demographic and clinical features, laboratory findings, treatment and immediate outcome. Diagnosis of CNS infection was categorised as definite, probable, possible, and uncertain. RESULTS: 426 patients (293 adults, 133 children) were studied [57.2% males, mean age (SD) years-adults 44(20), children 4(3.15)]. Of them, 27.5% had received antibiotics before admission. Blood cultures were done in 149 (35%) and only 14 were positive. Lumbar puncture was done in 347 (81.4%). CSF culture was positive only in two patients. CSF Gram stains and TB-PCR were all negative. The likely diagnosis was meningitis in 35.4%, encephalitis in 10.6% and a non-specific 'meningo-encephalitis' in 16.7%. A 'definite' microbiological diagnosis was made only in five patients. Diagnosis was considered 'probable' in, 53.7%, 'possible' in 8.7%, and 'uncertain' in 14.8%. An alternative diagnosis was found in 22% (13.6% adults, 40.6% children). Intravenous antibiotics (86.8%) and acyclovir (42.5%) were widely used on empiric grounds. CONCLUSIONS: Diagnosis of CNS infections is highly unsatisfactory with available facilities, even in a tertiary care setting. Better facilities are needed to improve aetiological diagnosis, and are likely to improve care and minimise treatment costs.
Child abuse and abdominal pain - Is there an association?
(Sri Lanka Medical Assosiation, 2012) Devanarayana, N.M.; Rajindrajith, S.; Mettananda, S.; Weerasooriya, W.A.L.K.; Hathagoda, K.L.W.; Lakmini, B.C.; Subasinghe, S.M.V.; de Silva, D.G.H.
INTRODUCTION AND AIMS: It is believed that there is an association between abdominal pain and child abuse. The main objective of this study was to assess this association in Sri Lankan school children. METHODS: Children aged 13-18 years were randomly selected from a semi-urban school in Gampaha district. A previously validated, self administered questionnaire was used to collect socio-demographic data and information on gastrointestinal symptoms, child abuse and exposure to other stressful events. Severity of symptoms was recorded using a validated, visual analogue scale. Children with abdominal pain were categorized into abdominal pain predominant functional gastrointestinal disorders (AP-FGD) using Rome III criteria. RESULTS: A total of 490 children were recruited [males 254 (51.8%), mean age 15.2 years and SD 1.64 years]. Forty eight (9.8%) fulfilled Rome lit criteria for AP- FGD (functional dyspepsia=3, functional abdominal pain=25, irritable bowel syndrome=15 and abdominal migraine=5). The number of children exposed to physical, emotional and sexual abuse, were respectively 119 (24.3%), 109 (22.2%) and 18 (3.8%). Prevalence of AP-FGD was significantly higher in those exposed to sexual (26.7% vs. 9.3% in controls, p=0.42) and emotional (16.5% vs. 8.3%, p=0.046) abuse, but not physical abuse (11.8% vs. 9.2%, p=0.69). AP-FGD type associated with sexual abuse was irritable bowel syndrome (15.4% vs. 2.7%, p=0.02). Mean scores obtained severity of abdominal pain were higher in children exposed to sexual (27.9 vs. 13.2, p=0.002) and emotional abuse (22.1 vs. 11.4, p<0.001). CONCLUSIONS: Chronic abdominal pain prevalence and severity were significantly higher in children exposed to sexual and emotional abuse.
Measles infection in lady Ridgeway hospital in 2013: a case control study
(Sri Lanka College of Paediatricians, 2015) Navageevan, N.; Punchihewa, P.M.G.; Kumarendran, B.; Hathagoda, K.L.W.; Galappaththi, A.G.A.R.; Jayathilaka, A.
BACKGROUND:A measles outbreak was reported in 2013 in the Lady Ridgeway Hospital for Children (LRH).OBJECTIVES:To describe the epidemiology of measles among paediatric patients admitted to LRH. DESIGN, SETTING AND METHOD:This case control study, conducted among patients admitted to LRH, recruited 167 clinical cases and 693 controls of six to 24 months age. All the clinically positive cases admitted to any of the six paediatric medical units during January to June 2013 and four patients admitted following each case were included. Data was gathered from the bed head tickets using data extraction sheet and by telephone interview. Significance was assessed at 5% level.RESULTS:Of the 140 clinical cases with available reports, 126 (90%) were positive for measles lgM (confirmed cases - CC). The CC included 75 (60%) males, 48 (38%) aged up to 9 months and 50 (40%) aged 10 to 12 months. Clinical features among the CC include high fever (100%), rash (100%), cough (94%), coryza (83%), conjunctivitis (63%), Koplik spots (14%), post measles staining (31%), diarrhoea (48%) and vomiting (31%). Complications among the CC included at least one complication (68%), pneumonia (65%) and 2 cases of death. Of the 47 CC with positive contact history, 41 had contacts in the hospital. Of the 28 cases aged above 12 months, 23 did not receive measles vaccine.Measles status was associated with measles vaccination status among children above 12 months of age (P<0.001), contact history (P<0.001), ethnicity (P<0.001) and mother's education (P<0.01). There was no evidence for an association of measles infection status with sex (p=0.9), income (p=0.3) and weight for age (p=0.2). CONCLUSIONS: • Around 78% cases were below 12 month old. • Majority of cases above 12 month of age did not receive measles vaccine. • Majority of cases had contact history in the hospital.
Outcome of children transported for pediatric intensive care to a tertiary care setting in Sri Lanka
(Sri Lanka College of Paediatricians, 2016) Adhihetty, D.; Kitulwatte, N.C.; Hathagoda, K.L.W.; Weeraratne, C.T.; de Silva, S.; Ediriweera, E.P.D.S.
INTRODUCTION: Patient transport remains a necessary facet of today’s health care environment and transport conditions bear a major impact on the outcome. There is a recent move in Sri Lanka to establish retrieval teams. Thus, identifying problems faced by the present system will be of utmost importance in development of transport teams. OBJECTIVE: To evaluate the present system of transportation of sick children to the Medical Intensive Care Unit (MICU), Lady Ridgeway Hospital for Children (LRH), Colombo. METHOD: A prospective, descriptive, observational study of transferred patients was conducted at the MICU LRH, Colombo. All children admitted to MICU from 1st March 2014 to 1st June 2014 were included in the study. Data was collected using a self-administered questionnaire. The Wilcoxon significant rank test and the Chi squared test were utilized in statistical analysis. RESULTS: There were 200 patients comprising 105 (52.5%) out-of-hospital transfers and 95 (47.5%) in-hospital transfers. Of the admissions, 72% were live discharges while 28% expired; 42.5% of transfers were from the Colombo district. Pneumonia was the commonest diagnosis, occurring in 38.5%. The pre-transfer Paediatric Risk Mortality (PRISM) scores had a median of 12, mean of 13.7±7.8 and Q1-8 to Q3-18. The 12 hour PRISM scores, after excluding patients with PRISM scores of less than 5, showed a median of 14, mean of 18.5±11.7 and a ‘p’ value 0.0002. There was no outcome difference between in-hospital vs out-of-hospital transfers based on the Chi squared test. A written summary was available only in 61 (30.5%) patients. CONCLUSION: A rise in the PRISM score after transfer indicates that the patients had deteriorated during the transfer and transfer conditions need to be improved.
A study to assess knowledge and attitudes on breast feeding of postnatal mothers in district General Hospital, Monaragala
(Sri Lanka Medical Association, 2011) Fernando, S.D.L.; Mettananda, S.; Hathagoda, K.L.W.; Weerasooriya, W.A.L.K.
INTRODUCTION AND OBJECTIVES: To describe the attitudes and knowledge on breast feeding of the postnatal mothers at District General Hospital (DGH), Monaragala. METHODS: Descriptive study was conducted at DGH-Moneragala from October to December 2010. Mothers of alternate babies admitted to the postnatal ward or mother baby unit were recruited to the study after obtaining written consent. Data were collected using an interviewer-administered, pre-tested questionnaire containing questions on socio-demographic data and attitudes and knowledge related to breast feeding on discharge or on the 7 postnatal day. Knowledge on breast feeding was scored from 0-10 using a 10-item questionnaire, with higher scores representing better knowledge. Ethical approval was obtained from the Ethics Committee of Uva Clinical Society. RESULTS: Data on 405 mothers were analysed of which 14.1% were aged less than 20 years, 80.5% had studied beyond grade 11, 54.8% had a monthly income more than Rs.l0, 000/=. Majority (89.6%) had received advice on breast feeding from midwife or nurse. Over 90% were aware of the concepts of exclusive breast feeding and demand feeding. But only 60% knew that the breast milk could be kept in the room temperature for 6 hours. 254 (62.7%) obtained a score above 8 on knowledge on breast feeding. Significantly higher proportion of mothers below the age of 20 years (X 2=10.0, /7=0.002), educated below grade 11 (Z 2=25.6, p<0.001), from families with monthly income Rs<10,000/= (X 2-9.3, p-0.003) and with one child (X 2=6.29,p=0.013) had scores below 8. CONCLUSIONS: Mothers with lower educational level, lower family income, aged below 20 years and with a single child had worse knowledge on breast feeding. Nearly half of the mothers did not have a good knowledge on storage of expressed breast milk.