Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item 6379 Pre-admission management of children presenting with febrile illness in a tertiary hospital of Sri Lanka(BMJ, 2024) Arunath, V.; Mettananda, S.OBJECTIVES To describe the symptoms and pre-admission management of children presenting with febrile illness to the Colombo North Teaching Hospital, Ragama, Sri Lanka.METHODS A retrospective descriptive study was conducted at University Paediatric Unit of Colombo North Teaching Hospital, Ragama, Sri Lanka. Data on pre-admission management of all children admitted with febrile illness from July to December 2019 were extracted from patient records. Children who were transferred from other units, children with chronic illnesses and children developed fever following vaccinations were excluded. Ethical approval was obtained from Ethics Review Committee of Sri Lanka College of Paediatricians and data was analysed using SPSS version 22.RESULTS A total of 366 children were admitted; 56% were males. Mean age was 53.5 ± 41.7 months and the majority were from Gampaha district. Mean duration of illness on admission was 3.6 ± 2.5 days. 236 (65.6%) patients had recorded fever spikes at home while 150 (60.7%) reported a contact history of fever. Common associated symptoms were cough (62.3%), cold (56%) and vomiting (39.6%). 199 (54.5%) underwent investigations prior to admission and full blood count was the commonest (47.5%) investigation. Although 357 (97.8%) had taken medication prior to admission, only 87.3% had consulted a doctor. 356 (97.3%) received paracetamol at home of which 24 (7.9%) and 123 (40.6%) received sub-therapeutic and supra-therapeutic doses respectively. Significantly higher proportion (44.9%) of children who consulted a doctor received appropriate dose of paracetamol compared to others (3.7%), (c2=11.9, p=0.003, p<001). Higher proportion children who had recorded fever spikes consulted a doctor (c2=3.99, p=0.046, p<0.05) and received therapeutic doses of paracetamol prior to admission (c2=4.94, p=0.026, p<0.05).CONCLUSION Use of sub- and supra-therapeutic doses of paracetamol was common before admission to the hospital. Recording temperature at home and medical consultation prior to admission were associated with appropriate dose paracetamol usage (p<005).Item A clinical audit in the practice of delayed cord clamping in peripheral unit in the eastern province.(Sri Lanka College of Paediatricians, 2022) Rathnasiri, G.B.A.M.; Thudugala, K.K.; Mettananda, S.Item Feeding practices of neonates admitted to the neonatal intensive care unit of colombo north teaching hospital, Sri Lanka(Sri Lanka College of Paediatricians, 2022) Suriapperuma, T.; Mettananda, S.Item A clinical audit on antibiotic prescribing in the neonatal intensive care unit of colombo north teaching hospital Sri Lanka.(Sri Lanka College of Paediatricians, 2022) Suriapperuma, T.; Madushani, D.; Mettananda, S.Item Kagami-Ogata-Syndrome:A rare cause for neonatal respiratory distress(Sri Lanka College of Paediatricians, 2022) Suriapperuma, T.; Randeny, S.; Mettananda, S.Item Knowledge practices, perception and barriers of paediatric pain management among paediatric healthcare providers at Colombo North teaching hospital Ragama(Sri Lanka College of Paediatricians, 2022) Suriapperuma, T.; Dassanayeke, S.; Mettananda, S.Item Impact of covid-19 on the education and health of schooling children in Sri Lanka; A multi-provincial study(Sri Lanka College of Paediatricians, 2022) Dayasiri, K.; Thadchanamoorthy, V.; kankananarachchi, I.; Umasankar, N.; Dassanayake, S.; Gunasekara, S.; Mettananda, S.Item Efficacy of hydroxyurea in reducing the erythropoietic stress of ineffective erythropoiesis in transfusion dependent beta thalassaemia: A randomised, double-blind placebo-controlled clinical trial(Sri Lanka Association for the Advancement of Science, 2021) Yasara, N.; Premawardhena, A.; Perera, P.; Manamperi, A.; Mettananda, S.The unbalanced synthesis and accumulation of a-globin chains due to impaired synthesis of 0- globin results in the destruction of red blood cells (RBC) and erythroid precursors of patients with P-thalassaemia. This leads to an increased erythropoietic activity and ineffective erythropoiesis in the bone marrow of these patients. Hydroxyurea is a licenced medication that decreases the RBC destruction of patients with p-thalassaemia. However, its effect on erythropoietic stress is unclear. In this study, our objective was to evaluate the effect of hydroxyurea on erythropoietic stress of ineffective erythropoiesis in transfusion-dependent (TD) p-thalassaemia. This experimental study was carried out at the Thalassaemia Unit of Colombo North Teaching Hospital as part of a randomised, double-blind placebo-controlled clinical trial that evaluates the efficacy of hydroxyurea. We recruited 24 patients with TD p-thalassaemia who were taking hydroxyurea IQ- 20 mg/kg/day and 16 patients who were receiving a placebo. The erythropoietic stress of ineffective erythropoiesis was assessed by measuring serum soluble transferrin receptor (sTfR) levels before and six months after taking either hydroxyurea or placebo. Levels of sTfR were measured using a validated enzyme-linked immunosorbent assay. Paired t-test was used in the statistical analysis. Nineteen (79%) out of 24 patients who received hydroxyurea showed a reduction in sTfR level, of which 8 (33%) and 6 (25%) showed >25% and 10-25% reductions, respectively. A significant reduction in mean sTfR level was observed after hydroxyurea treatment (72.3±SD25.9) compared to pre-treatment levels (89.6士SD22.9), (pv0.01). Conversely, no difference in sTfR levels was seen in patients who received the placebo pre・(91.9土SD24.7) and post-treatment (96.4±SD19.4), (p=0.17). In conclusion, oral hydroxyurea significantly reduced the erythropoietic stress of ineffective erythropoiesis in patients with TD p-thalassaemia showing a promise as a treatment modality.Item In vitro study to identify effects of fetal haemoglobin inducing agents on primary human erythroid cells(Sri Lanka Association for the Advancement of Science, 2021) Yasara, N.; Manamperi, A.; Mettananda, S.Beta-thalassemia is an autosomal, recessively inherited monogenic disorder characterized by defective beta-globin synthesis. Deposition of excess alpha-globin in erythrocytes and their precursors due to unbalanced globin synthesis is the main underlying pathophysiology. Clinical data show that induction of fetal haemoglobin (HbF) in erythroid cells ameliorates the disease severity and associated complications. Hence, improving HbF via up-regulating gamma-globin gene expression has been identified as a novel treatment. The aim of our in vitro study was to identify the effects of fetal haemoglobin inducing agents in human erythroid cells. Haematopoietic stem cells (HSC) from umbilical cord blood samples collected from three healthy human placentas were isolated. Firstly, mononuclear cells were separated from the interface after fractionation on Histopaque®-1077 Hybri-Max and CD34+ HSCs were isolated using positive selection by magnetic activated cell sorting. HSCs were then expanded and differentiated into mature erythroid cells using a three-phase liquid culture protocol. Primary human erythroid cells at day 7 of the culture were incubated with hydroxyurea (20 pM), butyric acid (10 ^M), 5-azacystidine (10 pM), decitabine (5 pM), busulfan (30 pM), vorinostat (2.5 pM) and valproic acid (1000 pM) for 72 hours. Effects of these compounds on cell expansion, viability, morphology, as well as a-, P- and y-globin mRNA levels were measured using standard laboratory methods. Negative controls were tested in parallel. Compared to other compounds, hydroxyurea and butyrate treated erythroid cells displayed a significantly high mean fold expansion and viability. Significantly higher gamma-globin mRNA levels were observed in hydroxyurea treated cells (Mean relative expression: 186 ± SEM16) compared to negative control cells (Mean relative expression: 137 ± SEM14). Highest y/p globin mRNA ratios were observed in busulfan (12.6 ± SEM2.9) and decitabine (12.1 ± SEM3.3) treated erythroid cells. In conclusion, hydroxyurea induces gamma-globin expression and decitabine and busulfan favourably alter the y/P-globin mRNA ratios in vitro in human erythroid cells.Item Oxidative stress and antioxidant deficiency in the β-thalassaemia in Sri Lanka(Sri Lanka Medical Association, 2021) Perera, S.; Allen, A.; Mettananda, S.; Rodrigo, R.; Perera, L.; Darshana, T.; Moggach, F.; Jackson-Crawford, A.; Heirene, L.; Fisher, C.; Olivieri, N.; Rees, D.; Allen, S.; Premawardhena, A.Introduction In the β thalassaemias oxidative stress is potentially high and this could be further exacerbated in the absence of robust antioxidant defences, such as nutritional vitamin C and E deficiencies. We undertook a comprehensive assessment of oxidant, antioxidant and inflammatory status in patients with subtypes of β-thalassaemia to study these factors in detail. Methods Consenting patients attending the thalassaemia centre in Ragama, (between November 2017 and June 2018) were assessed for the following: methaemoglobin, plasma haemoglobin, heme and ferritin as sources of oxidants, plasma haptoglobin, hemopexin and vitamins C and E as markers of antioxidants, plasma interleukin-6 and C-reactive protein for inflammation. Fruit and vegetable intake was determined by dietary recall. Results 162 patients were recruited. (59 HbE β-thalassaemia, 50 β-thalassaemia major, 40 β-thalassaemia intermedia, 13 HbS β-thalassaemia. Median age was 26.0 years (IQR 15.3-38.8), 101 (62.3%) were female. Oxidants were frequently increased and antioxidants depleted with high levels of oxidant damage, hypoxia and inflammation. Abnormalities were most severe in HbE-β thalassaemia and least severe in β thalassaemia intermedia. Oxidative stress was also more severe in splenectomised patients. Plasma vitamin C concentration was below the lower level of quantitation in 86/160 (53.8%) patients and vitamin E in 130/160 (81.3%) patients. Less than 15% of patients ate fresh fruits or raw vegetables frequently. Conclusion Markedly increased oxidative stress and antioxidant deficiency were observed in this study group, especially in those with HbE β-thalassaemia. Vitamin C & E supplementation may have a role in the long-term management of thalassaemia syndromes.