Conference Papers

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Hepatic and renal status of paediatric patients with thalassaemia
(Sri Lanka Medical Association, 2023) Wijenayake, W.; Pathiraja, H.; Thennakoon, R.; Fernando, M.; Bandara, D.; Mettananda, S.
INTRODUCTION: Thalassaemia is a chronic disorder affecting many organ systems. Although cirrhosis is a well-recognised complication, sub-clinical hepatic and renal dysfunction in thalassaemia are poorly studied. OBJECTIVES: We aimed to describe the hepatic and renal status and dysfunction of paediatric patients with thalassaemia. METHODS: A cross-sectional descriptive study was conducted at Kurunegala and Ragama Thalassaemia Centres during February and March 2023. All patients aged less than 16 years attending the thalassaemia centres were recruited. Data were collected using a data collection form by interviewing parents and perusal of clinical records and analysed using SPSS 27.0. Ethical approval was obtained from the Sri Lanka College of Paediatricians. RESULTS: Sixty-five patients (mean age-7.7; males-46%) were recruited. Of them 48(73%) had homozygous beta-thalassaemia and 17(26%) had HbE thalassaemia; 52(80%) were transfusion-dependent and 13(20%) were non-transfusion-dependent. Hepatomegaly and splenomegaly were found in 45(69%) and 30(46%), respectively. Regarding hepatic status, 34(52%) had high (>40IU/L) alanine transaminases, of which 8(12%) had >3-fold elevation of alanine transaminases. A higher proportion of children with HbE thalassaemia (71%) had elevated alanine transaminases compared to homozygous beta-thalassaemia (46%, χ2=3.0, p=0.07). Also, a higher proportion of children on deferasirox (57%) had elevated alanine transaminases compared to those who were not on the drug (27%, χ2=3.3, p=0.06). Four (5%) had <2+ proteinuria in urinalysis however, the urine protein: creatine ratio was normal in all. CONCLUSION: High alanine transaminases were noted in over 50% of paediatric patients with thalassaemia. HbE thalassaemia type and use of deferasirox were associated with high alanine transaminase levels.
FNAC in the 'field'- a new experience
(Sri Lanka Medical Association, 2008) Fernando, R.; Hewavisenthi, J.; Pathmeswaran, A.; Edirisinghe, D.; Abeysinghe, S.; Atulugama, N.; Bandara, D.; Premathileke, M.
BACKGROUND: Fine needle aspiration cytology (FNAC) is an important diagnostic test in thyroid diseases. It usually is undertaken at a hospital or laboratory setup. As part of an islandwide field based study, FNAC was undertaken in the field. Literature review revealed that FNAC accuracy rate was around 65-70% in most Centres with full-fledged facilities. OBJECTIVES: To determine the effectiveness of FNAC done in the field DESIGN, SETTING AND METHODS: Informed written consent was obtained and the goitre was delineated with a marker pen. FNAC was carried out by a trained team member in the standard manner. Four slides were prepared from each patient. All slides were processed and examined by a cytologist RESULTS: 308 FNAC were done. 226 FNAC were diagnostic (73.36%) and 82(26.64%) were non diagnostic. 62(23.8%) showed benign cells only. The pathological entities detected were: 112 (49.5%) auto immune thyroiditis, 32 (14.1%) colloid storing nodules, 14(6.1%) colloid storing nodules with autoimmune thyroiditis, 5 (2.2%) follicular lesions and one toxic lesion. There were no significant complications noted in any of the patients. CONCLUSIONS: Field FNAC has a high diagnostic accuracy if done by a trained person. It is a safe procedure in the field.
Epidemiology of goitres in Sri Lanka - results of a community based study
(Sri Lanka Medical Association, 2008) Fernando, R.; Pathmeswaran, A.; Edirisinghe, D.; Abeysinghe, S.; Atulugama, N.; Bandara, D.; Premathileke, M.
BACKGROUND: lodization of salt was made mandatory in Sri Lanka in 1995. Data on the current prevalence and geographic distribution of goitre among the general population is not available. Objectives: To describe the epidemiology of goitre in the population over the age of 10 years in Sri Lanka DESIGN, SETTING AND METHODS: The country (excluding the Northern Province) was divided into 6 ecological zones based on annual rainfall and altitude. From each zone, 18 Grama Niladhari (GN) areas were selected, using the probability proportionate to size (PPS) technique. First household to be sampled was selected at random from the list maintained by the midwife and all eligible people in the house were sampled. The closest household, next to the index household,, was visited and sampling carried out next. The process was repeated until 50 subjects were sampled in a GN area. Each subject was examined by at least two researchers for the presence of a goitre. RESULTS: Total of 5200 subjects were assessed. 66 %( 3,433) were females. Mean (SD) age 36.3(17.3) years. 425 subjects had a goitre. The distribution of goitres according to the WHO categorization - Grades 1, 2, 3 and 4 was 18.6, 68.0, 12.5 and 0.9 percent respectively. Adjusted (age and zone) prevalence among females and males was 11.2% and 2.3% respectively. Adjusted (age and sex) prevalence (95% CI) in the different zones varied between 5.34% in the intermediate zone-south to 7.93% in the wet zone-hills. Overall adjusted prevalence was 6.8% (6.0-7.6). CONCLUSIONS: The prevalence of goitres is 6.8%. There is definite female preponderance. No obvious goitre belt can be discerned.

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