Journal/Magazine Articles

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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine

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Bacterial growth in expressed mother's milk stored and transported under different simulated conditions in a tropical country
(Mary Ann Liebert, 2021) Rodrigo, R.; Badanasinghe, N.; Abayabandara-Herath, T.; Forster, D.A.; Amir, L.H.
BACKGROUND: Research on how storage and transport of expressed human milk in a tropical country affect the milk bacterial count is limited. MATERIALS AND METHODS: A cross-sectional descriptive study of 50 mothers of infants in a Sri Lankan tertiary neonatal unit was performed. Expressed mother's milk was divided into three bottles and kept under varied environmental conditions to simulate different storage and transport methods. Initial bacterial culture of milk was performed <30 minutes after expression, with further cultures at predetermined times. Bottles A and B were stored at room temperature and in a cool bag for the first 6 hours, respectively, and then refrigerated; and bottle C was refrigerated for 24 hours, transported in a cool bag for 6 hours, and rerefrigerated until 72 hours. Total colony counts >105 colony-forming units (CFU)/mL of viable microorganisms or >104 CFU/mL of either Enterobacteriaceae or Staphylococcus aureus were considered positive. RESULTS: Initial culture was positive in 30% (15/50) of samples; majority, 87% (13/15), of these were S. aureus. For bottle A, 26% (13/50), 36% (18/50), 34% (17/50), and 26% (13/50) of samples were positive at 4, 6, 24, and 72 hours, respectively. For bottle B, positive cultures were found in 26% (13/50) and 17% (8/47) of samples at 24 and 72 hours, respectively. For bottle C, results were similar to bottle B. CONCLUSIONS: Transportation of expressed mother's milk for 4 hours in a tropical climate using a low-cost cool bag, with refrigeration at other times, maintained acceptable bacterial counts for up to 72 hours after expression. Hygienic practices at collection are extremely important as most samples with significant bacterial growth were positive on initial culture. KEYWORDS: expressed breast milk; expressed mother's milk; storage; transport; tropical country.
Hypothermia for moderate or severe neonatal encephalopathy in low-income and middle-income countries (HELIX): a randomised controlled trial in India, Sri Lanka, and Bangladesh
(Elsevier Ltd., 2021) Thayyil, S.; Pant, S.; Montaldo, P.; Shukla, D.; Oliveira, V.; Ivain, P.; Bassett, P.; Swamy, R.; Mendoza, J.; Moreno-Morales, M.; Lally, P.J.; Benakappa, N.; Bandiya, P.; Shivarudhrappa, I.; Somanna, J.; Kantharajanna, U.B.; Rajvanshi, A.; Krishnappa, S.; Joby, P.K.; Jayaraman, K.; Chandramohan, R.; Kamalarathnam, C.N.; Sebastian, M.; Tamilselvam, I.A.; Rajendran, U.D.; Soundrarajan, R.; Kumar, V.; Sudarsanan, H.; Vadakepat, P.; Gopalan, K.; Sundaram, M.; Seeralar, A.; Vinayagam, P.; Sajjid, M.; Baburaj, M.; Murugan, K.D.; Sathyanathan, B.P.; Kumaran, E.S.; Mondkar, J.; Manerkar, S.; Joshi, A.R.; Dewang, K.; Bhisikar, S.M.; Kalamdani, P.; Bichkar, V.; Patra, S.; Jiwnani, K.; Shahidullah, M.; Moni, S.C.; Jahan, I.; Mannan, M.A.; Dey, S.K.; Nahar, M.N.; Islam, M.N.; Shabuj, K.H.; Rodrigo, R.; Sumanasena, S.; Abayabandara-Herath, T.; Chathurangika, G.K.; Wanigasinghe, J.; Sujatha, R.; Saraswathy, S.; Rahul, A.; Radha, S.J.; Sarojam, M.K.; Krishnan, V.; Nair, M.K.; Devadas, S.; Chandriah, S.; Venkateswaran, H.; Burgod, C.; Chandrasekaran, M.; Atreja, G.; Muraleedharan, P.; Herberg, J.A.; Chong, W.K.K.; Sebire, N.J.; Pressler, R.; Ramji, S.; Shankaran, S.; HELIX consortium
BACKGROUND: Although therapeutic hypothermia reduces death or disability after neonatal encephalopathy in high-income countries, its safety and efficacy in low-income and middle-income countries is unclear. We aimed to examine whether therapeutic hypothermia alongside optimal supportive intensive care reduces death or moderate or severe disability after neonatal encephalopathy in south Asia. METHODS: We did a multicountry open-label, randomised controlled trial in seven tertiary neonatal intensive care units in India, Sri Lanka, and Bangladesh. We enrolled infants born at or after 36 weeks of gestation with moderate or severe neonatal encephalopathy and a need for continued resuscitation at 5 min of age or an Apgar score of less than 6 at 5 min of age (for babies born in a hospital), or both, or an absence of crying by 5 min of age (for babies born at home). Using a web-based randomisation system, we allocated infants into a group receiving whole body hypothermia (33·5°C) for 72 h using a servo-controlled cooling device, or to usual care (control group), within 6 h of birth. All recruiting sites had facilities for invasive ventilation, cardiovascular support, and access to 3 Tesla MRI scanners and spectroscopy. Masking of the intervention was not possible, but those involved in the magnetic resonance biomarker analysis and neurodevelopmental outcome assessments were masked to the allocation. The primary outcome was a combined endpoint of death or moderate or severe disability at 18-22 months, assessed by the Bayley Scales of Infant and Toddler Development (third edition) and a detailed neurological examination. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02387385. FINDINGS: We screened 2296 infants between Aug 15, 2015, and Feb 15, 2019, of whom 576 infants were eligible for inclusion. After exclusions, we recruited 408 eligible infants and we assigned 202 to the hypothermia group and 206 to the control group. Primary outcome data were available for 195 (97%) of the 202 infants in the hypothermia group and 199 (97%) of the 206 control group infants. 98 (50%) infants in the hypothermia group and 94 (47%) infants in the control group died or had a moderate or severe disability (risk ratio 1·06; 95% CI 0·87-1·30; p=0·55). 84 infants (42%) in the hypothermia group and 63 (31%; p=0·022) infants in the control group died, of whom 72 (36%) and 49 (24%; p=0·0087) died during neonatal hospitalisation. Five serious adverse events were reported: three in the hypothermia group (one hospital readmission relating to pneumonia, one septic arthritis, and one suspected venous thrombosis), and two in the control group (one related to desaturations during MRI and other because of endotracheal tube displacement during transport for MRI). No adverse events were considered causally related to the study intervention. INTERPRETATION: Therapeutic hypothermia did not reduce the combined outcome of death or disability at 18 months after neonatal encephalopathy in low-income and middle-income countries, but significantly increased death alone. Therapeutic hypothermia should not be offered as treatment for neonatal encephalopathy in low-income and middle-income countries, even when tertiary neonatal intensive care facilities are available. FUNDING: National Institute for Health Research, Garfield Weston Foundation, and Bill & Melinda Gates Foundation. TRANSLATIONS: For the Hindi, Malayalam, Telugu, Kannada, Singhalese, Tamil, Marathi and Bangla translations of the abstract see Supplementary Materials section.
Improving psychological well-being among healthcare workers during the COVID-19 pandemic with an online mindfulness intervention: A randomised waitlist-controlled trial
(Wiley, 2024) Baminiwatta, A.; Fernando, R.; Solangaarachchi, I.; Abayabandara-Herath, T.; Wickremasinghe, A.R.; Hapangama, A.
The high prevalence of psychological problems observed among healthcare workers (HCWs) during the COVID-19 pandemic called for interventions to safeguard their mental health. We assessed the effectiveness of a 6-week online mindfulness-based intervention in improving well-being and reducing stress among HCWs in Sri Lanka. Eighty HCWs were recruited and randomised into two groups: waitlist-control (WLC) and intervention groups. In the intervention, 1-hour online sessions were conducted at weekly intervals and participants were encouraged to do daily home practice. Stress and well-being were measured pre- and post-intervention using the Perceived Stress Scale and WHO-5 Well-being Index, respectively. One-way analysis of covariance was used to evaluate the effectiveness, in both intention-to-treat (ITT) and complete-case (CC) analyses. A significantly greater improvement in well-being occurred in the intervention arm compared to WLC on both ITT (p = .002) and CC analyses (p < .001), with medium-to-large effect sizes (partial η2 = .117-.278). However, the reduction in stress following the intervention was not significant compared to the WLC group on both ITT (p = .636) and CC analyses (p = .262). In the intervention arm, the median number of sessions attended by participants was 3. Low adherence to the intervention may have contributed to the apparent non-significant effect on stress.
Psychological impact of COVID-19 among a cohort of Sri Lankan medical students: Preliminary results
(Sri Lanka College of Psychiatrists, 2022) Abayabandara-Herath, T.; Premaratne, I.; Ediriweera, D.; Chandratilake, M.; Hapangama, A.
Previous studies report that the COVID-19 pandemic has a negative effect on the psychological wellbeing of medical students. We aimed to determine the psychological impact of COVID-19 and its associated factors among a cohort of Sri Lankan medical students, using online versions of a demographic questionnaire and the validated Sinhala and Tamil versions of the DASS-21. Of the 418 students, majority were females, aged between 20-25 years. In the study group, 40 (9.6%), 105 (25.1%) and 7 (1.6%) of participants scored above the cut-offs for the depression, anxiety and stress subscales of the DASS-21 respectively. The COVID-19 pandemic appears to be associated with a negative impact as measured by the DASS-21 scale among this group of medical students.
Validation of the Sinhala version of tinnitus handicap inventory.
(Korean Audiological Society, 2023) Rodrigo, A.; Abayabandara-Herath, T.
BACKGROUND AND OBJECTIVES: Tinnitus is a common and disabling condition that largely remains undertreated in Sri Lanka. Currently, standardized tools that assess and monitor the treatment of tinnitus or the distress it causes are unavailable in either of the two main vernacular languages prevalent in Sri Lanka. The Tinnitus Handicap Inventory (THI) is used internationally to measure tinnitus-induced distress and to monitor treatment efficacy. In this study, we validated the Sinhala version of the THI (THI-Sin). SUBJECTS AND METHODS: The THI was translated into Sinhala and back translated into English and finalized by independent translators. The THI-Sin questionnaire and the 12-item General Health Questionnaire (GHQ-12) and Visual Analog Scale of tinnitus annoyance (VAS) were administered to 122 adults who visited the otolaryngology clinic of Colombo North Teaching Hospital, Ragama, Sri Lanka. RESULTS: THI-Sin scores showed satisfactory internal consistency (Cronbach's α=0.902) and were significantly correlated with the GHQ-12 and VAS scores. Factor analysis of the THI-Sin confirmed a three-factorial structure, which did not correspond to the original THI subscales. CONCLUSIONS: We observed significant reliability and validity of the THI-Sin tool for evaluation of tinnitus-induced handicaps among the Sinhalese-speaking population of Sri Lanka.