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Knowledge of the high-sensitivity cardiac troponin assay among medical officers in Gampaha District, Sri Lanka
(The Kandy Society of Medicine, 2023) Fernando, N.; Fernando, K.; Gallage, T.; Dayanath, B.K.T.P.; de Silva, S.T.
INTRODUCTION: The high-sensitivity cardiac troponin (hs-cTn) assay is a crucial diagnostic test that is obligatory in the triage of patients presenting with chest pain. It is essential for medical officers to have adequate knowledge regarding the procedures for testing and the interpretation of test outcomes to deliver optimal healthcare for patients. It has been observed that medical officers are lacking in awareness regarding this testing method, resulting in a greater likelihood of errors in testing and interpretation. This study aims to evaluate the level of understanding among medical officers regarding the hs-cTn assay in relation to the most recent European Society of Cardiology guideline released in 2020. METHODOLOGY: We conducted a cross-sectional study at two government hospitals in Gampaha District in June 2022. A self-administered e-questionnaire was used to assess knowledge regarding hs-cTn. Knowledge was measured by calculating a cumulative score for the answers to a questionnaire and categorised into good or poor knowledge. A score less than 60% was categorized as poor and vice versa. Descriptive statistics were used to summarize the data. RESULTS: Of the 227 medical officers, only 14.5% (n=33) had good knowledge of the analytical component while 41.9% (n=95) had good knowledge on the clinical component. A score ≥60% on the analytical component knowledge was significantly associated with designation being a senior registrar or consultant (p<0.001), postgraduate enrolment (p<0.001), participation in continuous professional development programmes (p<0.001), and employment in a teaching hospital (p=0.025), but not with age (p=0.066) or private practice (p=0.118). Clinical component knowledge score ≥60% was significantly associated with age between 25 and 35 years (p=0.006), designation being a consultant (p<0.001), postgraduate enrolment (p<0.001), participation in continuous professional development programs (p<0.001), and employment in a teaching hospital(p=0.001) but not with doing private practice (p=0.170). CONCLUSIONS: In Sri Lanka, medical officers’ general knowledge on the hs-cTn assay seems lacking. There is a need for continuous training to improve knowledge on hs-cTn testing among medical officers.
Milky pleural effusion in a neonate and approach to investigating chylothorax
(BMJ Publishing Group, 2021) Senarathne, U.D.; Rodrigo, R.; Dayanath, B.K.T.P.
Neonatal chylothorax is a rare presentation leading to significant respiratory distress, thus requiring timely diagnosis. A preterm neonate was resuscitated and ventilated, following which she clinically improved but subsequently developed respiratory distress with a right-sided pleural effusion. Interestingly, thoracentesis fluid appeared 'milky' with elevated triglycerides and lymphocytes, suggesting chylothorax. As fluid triglyceride level was lower than the established diagnostic criterion for chylothorax (1.24 mmol/L), a high fluid-to-serum triglyceride ratio was used as a surrogate diagnostic marker, later confirmed by lipoprotein electrophoresis. As observed in the index patient, a critically ill neonate would have a lower-than-average fat intake leading to less chylomicron production, thus lower triglyceride levels in chyle than expected, which may still fail to meet the amended cut-off limit. This case highlights the challenges in diagnosing neonatal chylothorax due to the lack of age-specific triglyceride levels in chyle and low oral fat intake in critically ill patients.
Microcytic anemia in children: Parallel screening for iron deficiency and Thalassemia provides a useful opportunity for Thalassemia prevention in low- and middle-income countries
(Hemisphere Pub. Corp., 2020) Mettananda, S.; Paranamana, S.; Fernando, R.; Suranjan, M.; Rodrigo, R.; Perera, L.; Vipulaguna, T.; Fernando, P.; Fernando, M.; Dayanath, B.K.T.P.; Costa, Y.; Premawardhena, A.
ABSTRACT:Microcytic anemia in children is commonly attributed to iron deficiency without attempting to find the cause. Inadequate investigations to exclude hemoglobinopathies lead to missed opportunities for identification of thalassemia carriers. Here we aim to describe the relative contribution of iron deficiency and thalassemia to microcytic anemia in children. This hospital-based prospective study was conducted at the Colombo North Teaching Hospital, Ragama, Sri Lanka. All newly diagnosed patients with microcytic anemia were recruited and data were collected using an interviewer-administered questionnaire. Full blood count, blood film, serum ferritin, c-reactive protein, quantification of hemoglobin sub-types and α-globin genotype were performed using 4 ml of venous blood. A total of 104 children (Male- 60.5%) were recruited. Iron deficiency was the cause for anemia in 49% whilst 16% and 10% had α- and β-thalassemia trait respectively. Seven (6.7%) children had co-existing iron deficiency and thalassemia trait while two coinherited α- and β-thalassemia trait. Children with β-thalassemia trait had significantly higher red cell count and lower mean corpuscular volume compared to children with iron deficiency. However, none of the red cell parameters were significantly different between children with α-thalassemia trait and iron deficiency. Iron deficiency contributes only to half of children with microcytic anemia; one-fourth had thalassemia trait. Co-existence of iron deficiency and thalassemia trait or co-inheritance of α- and β-thalassemia trait were found in 9%. Parallel investigation of children with microcytic anemia to diagnose iron deficiency and thalassemia provides an opportunity to identify thalassemia carriers which is beneficial for thalassemia prevention.

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