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 Knowledge, attitude and practices on universal micronutrient supplementation among mothers of infants in the Kurunegala district of Sri Lanka(Sri Lanka Medical Association, 2023) Bandara, E.R.S.; Wijekoon, J.; Mettananda, S.INTRODUCTION: Multiple micronutrient (MMN) supplementation programme was commenced to combat micronutrient deficiencies among children in Sri Lanka. However, its acceptance is not evaluated properly. OBJECTIVES: To describe the knowledge, attitude and practices of MMN supplementations among mothers of infants aged 9-12 months in the Kurunegala district. METHODS: A cross-sectional descriptive study was conducted in four randomly selected Medical Officer of Health (MOH) areas in Kurunegala district from January to March 2023. All mothers of infants aged 9-12 months attending the well-baby clinic were recruited. Data were collected using an interviewer-administered questionnaire and analyzed using SPSS 22.0. RESULTS: A total of 395 children (males-49.4%) were recruited. A majority (223[56.5%]) of mothers stated that their children had shown less acceptance of food after mixing MMN. 299(75%) noted that it reduced the food taste and 175(44.3%) said that it gave a bad smell upon mixing. 385(97.5%) mothers knew the correct dosage of MMN and 376(95.2%) knew the correct frequency. However, only 219(55.4%) were aware of the correct duration that MMN should be given and only 285(72.2%) had continued MMN when the child is sick. 376(95.2%) thought that MMN is beneficial to their child but only 276(69.9%) were aware on its benefits. 134(33.9%) mothers said that adequate information was not provided when receiving MMN. CONCLUSION: Most mothers perceived that children showed less acceptance of food after mixing MMN into the food. MMN had alyered the taste of food and introduced a bad smell to food. One-third of mothers stated that adequate information was not provided when receiving MMN.Item 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.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.