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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Item Respiratory problems since birth to 12 years: What is causing morbidity and mortality in Sri Lanka?(Sri Lanka College of Paediatricians, 2014) Karunasekera, K.A.W.; Fernando, A.F.; Subasinghe, S.M.V.; Lakmini, B.C.Background: Respiratory tract disorders cause significant mortality and morbidity in children worldwide. Objectives: To study the pattern of respiratory diseases and its seasonal variation amongst children admitted to hospital and assess causes of mortality due to respiratory diseases especially in children less than 5 years of age. Method: A descriptive study was conducted at the University Paediatric Unit, Colombo North Teaching Hospital during 2010 and 2011. All children below 12 years admitted with respiratory tract disease (ICD-10 classification) were recruited into the study. Data collection forms were filled by medical officers using patient records. Results: Out of 13,356 admissions, 2,651 (19.8%) were admitted with respiratory disease. Highest number of admissions (30.5%) was in the 1 month to 2 year age group and 4.4% of admissions were neonates. Common causes of admission included unspecified lower respiratory tract infections (LRTI) (44.1%), upper respiratory tract infections (URTI) (25.2%), bronchial asthma (11.5%) and bronchiolitis (7.0%). Incidence of bacterial pneumonia was 0.95%. Admissions due to respiratory diseases peaked in June (2010-20%, 2011-16%). Admissions with bronchial asthma were higher during the first half of year (2010-86.3%, 2011-80.5%). The total number of deaths was 24 and 87.5% of these deaths were in children under 5 years. Out of under 5 year deaths 17 (94.5 %) were early neonatal deaths. The common causes of mortality under 5 years were surfactant deficient lung disease (43%), meconium aspiration syndrome (24%) and severe respiratory failure due to hypoxic ischaemic encephalopathy (19 %). Conclusions: LRTI, URTI, bronchial asthma and bronchiolitis were the main contributory factors to the morbidity. Mortality due to respiratory causes was 0.9 % and was confined mainly to the neonatal period. Common causes of under-5 year deaths were surfactant deficient lung disease, meconium aspiration syndrome and respiratory failure due to hypoxic ischaemic encephalopathyItem Impact of corticosteroid therapy on lifestyles in asthmatic children from Sri lanka(Indian Pediatrics, 2010) Karunasekera, K.A.W.; Fernando, A.D.; Jayasinghe, C.Y.This study was conducted to ascertain the impact of inhaled corticosteroids therapy (ICS) in alleviation of lifestyle restrictions in 200 asthmatic children. 90 children on ICS were reviewed at 3 months. Restrictions on bathing, food, play activities and school attendance were found in <70%. These were not related to asthma severity. Following ICS, reduction in symptoms, hospital admissions, outpatient visits and nebulizations were noted between 67% -73%. Restrictions on bathing, food, play activities and school attendance had been waived off in 23% -55%. We conclude that ICS significantly alleviated symptoms and lifestyle restrictions. However, the reduction on lifestyle restrictions was less than symptom control.Item Genetic and environmental risk for asthma in children aged 5-11 years(Sri Lanka College of Paediatricians, 2005) Karunasekera, K.A.W.; Perera, K.P.J.; Perera, M.T.P.R.; Abeynarayana, J.DESIGN: A cross sectional analytical study. METHOD: Data were collected from children aged 5-11 years in 3 schools in Gampaha District. 441 children with asthma and 1510 without asthma were evaluated for following risk factors viz. family history of atopy, gender, duration of breast feeding, commencement of formula in infancy, dusty home environment, passive indoor cigarette smoking, presence of firewood smoke in bedroom when cooking, burning of mosquito coil and incense stick/powder and presence of pets at home. Data were analyzed using Epi info version 6 and SPSS package. Chi Squared test was used in bivariate analysis and forward logistic regression was used to adjust confounding factors. RESULTS: Risk of asthma in child (on bivariate analysis) was increased when father has a history of asthma (odds ratio (OR) 6.4 (95% confidence interval (CI) 3.2 -13.2), mother has a history of asthma (OR 4.4, CI 2.6 -7.5), sibling has asthma (OR 4.3, CI 2.0 - 9.7), father has a history of allergic rhinitis (OR 2.0, CI 1.5-2.8), mother has a history of allergic rhinitis (OR 2.5, CI 1.9-3.4) and sibling has allergic rhinitis (OR 3.4, CI 2.1-5.4). Asthma risk was significantly increased with following environmental factors: non continuation of breast feeding beyond first 6 months in infancy (OR 1.5, CI 1.2-1.9), presence of firewood smoke in bedroom when cooking (OR 1.4, CI 1.1- 1.9), use of mosquito coil (OR 1.5, CI 1.2 -1.9) and dusty home environment (OR 1.8, CI 1.4-2.3). After adjusting for confounding factors, paternal history of asthma, maternal history of asthma, allergic rhinitis in mother and sibling, non continuation of breastfeeding beyond first 6 months of life and dusty environment remained significant with increased risk of asthma (p < 0.01). CONCLUSIONS: This study reinforces that asthma has a multifactorial aetiology. Childhood asthma is influenced by paternal asthma more than maternal asthma. Significant modifiable environmental factors in this study were duration of breastfeeding in infancy and dusty home environmentItem Successfull pneumatic dilatation of acalasia cardia in a preschool child(Sri Lanka College of Paediatricians, 2003) Karunasekera, K.A.W.; Fernando, R.; Jayasinghe, J.C.; Rajendran, S.No Abstract AvailableItem Prevalence of asthma and atopic symptoms in children aged 5-11 years(Sri Lanka College of Paediatricians, 2003) Karunasekera, K.A.W.; Perera, K.P.J.; Perera, M.T.P.R.; Abeynarayana, J.OBJECTIVE: To assess prevalence of asthma and atopic symptoms in a group of school children aged 5-11years and to look at prevalence of usage of asthma medications. SETTING: Three schools in Gampaha District in August 1998. METHOD: A questionnaire translated into Sinhala was distributed to parents/guardians of 2195 children aged 5-11 years in Grades 1-5 of the schools and the filled questionnaires were collected through class teachers. Asthma, allergic rhinitis and eczema were defined using the clinical criteria of the International Study of Asthma and Allergic Conditions (ISAAC). Data was analysed using Epi Info version 6. Chi squared test and Chi squared test for trend were used for significance testing. RESULTS: Return rate of questionnaire was 93%. Sixty six percent were completed by mother, 30% by father and rest by guardian. Prevalence of asthma was 23% and of exercise induced asthma 11%. Prevalence rate of allergic rhinitis was 10% and eczema 3%. Within the specific group of asthma, in response to leading question "Has your child had asthma" only 19% of parents gave a positive answer. Prevalence of asthma in males did not significantly differ from that in females (p=0.5). A decreasing trend of asthma was observed with increasing age in girls (p less than 0.05). Eighty four percent of asthmatic children were using salbutamol orally and 9% without asthma in study population were also using salbutamol. CONCLUSIONS: One in 5 children aged 5-11 years in study population had asthma but parental perception about asthma was poor. More than 80% of asthmatics had some medications for the disease.Item How accurate is the postnatal estimation of gestational age?(Oxford University Press, 2002) Karunasekera, K.A.W.; Sirisena, J.; Jayasinghe, J.A.C.T.; Perera, G.U.I.The aim of the present study was to determine the accuracy of postnatal gestational age assessment of babies using three different methods. Two hundred women attending the university obstetric unit of North Colombo Teaching Hospital, Ragama, Sri Lanka whose expected date of delivery (EDD) by early ultrasonography fell within a week of EDD by dates were included in the study. Postnatal assessment was performed within 24 h of birth. Two co-researchers performed Dubowitz and Parkin methods separately without prior knowledge of menstrual gestation. Data was analysed using EpiInfo 6 and SPSS packages. The mean difference between menstrual gestation and Dubowitz physical criteria was -0.45 weeks; between menstrual gestation and classical Dubowitz method, +2.18 weeks; and between menstrual gestation and Parkin's method, +0.34 weeks. It was concluded that postnatal assessment of gestational age by the Parkin's method is much closer to menstrual gestation than the classical Dubowitz method and is also easier and quicker to perform.Item Risk factors of childhood asthma: a Sri lankan study(Oxford University Press, 2001) Karunasekera, K.A.W.; Jayasinghe, J.A.C.T.; Alwis, L.W.G.R.A case-control study was carried out to evaluate the genetic and environmental risk factors of childhood asthma in a group of Sri Lankan children. Three hundred cases (admitted with symptoms of asthma) and 300 age-matched controls were compared over a period of 23 months commencing in January 1996. Family history of atopy, feeding habits in infancy, bronchiolitis in infancy, passive smoking, exposure to dust and dampness, and exposure to pet animals were studied as risk factors for asthma. The risks associated with social factors were also studied. The risk associated with variables were calculated using the chi-squared test in the bivariate analysis and the forward logistic regression model in the multivariate analysis. Parental asthma, asthma in a sibling and in a relative, parental allergic rhinitis, discontinuation of breastfeeding after 6 months in infancy, bronchiolitis in infancy, living in a dusty environment, and a father with primary education compared to secondary education were independently associated with an increased risk of asthma (p 0.05). This study reinforces the view that asthma has a multifactorial aetiology. Influence of paternal asthma is more than that of maternal asthma. As a preventive measure continuation of breastfeeding beyond 6 months is important.Item The Use of commercially prepared 10 percent dextrose reduces the incidence of neonatal septicaemia(Sri Lanka Medical Association, 1997) Karunasekera, K.A.W.; Jayawardena, D.R.K.C.; Sunil-Chandra, N.P.Septicemia is an important cause of mortality morbidity among babies in neonatal care units. The Special Care Baby Unit, University Paediatric Unit of the Colombo North Teaching Hospital, Ragama experienced two out breaks of Klesbiella, between February and May 1996. Suspects the transmission of Klesbiella would have occurred as a result of contamination of intravenous fluid. Suggests use of commercially prepared dextrose as against making it for new born babies as a preventive measure. (letter to editor)