Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Fate of premature neonates born before 34 Weeks of gestation: experience at a tertiary Care centre in sri lanka(The Sri Lanka College of Paediatricians, 2008) Mettananda, D.S.G.; Rajindrajith, S.; Adhihetty, D.; Goonewardena, A.R.; Adikari, A.M.C.; Pannala, W.S.; Devanarayana, N.M.; Mettananda, K.C.D.BACKGROUND: Neonates bom before 34 weeks of gestation are at risk of numerous complications and their management is technologically demanding. Despite advancements in other areas of medicine, neonatal intensive care facilities are still at a primitive stage even in tertiary care hospitals in Sri y Lanka, OBJECTIVE: To describe the clinical characteristics, problems and outcome of premature neonates born before 34 weeks of gestation. DESIGN, SETTING AND METHOD:A descriptive study was conducted in the Special Care Baby Unit (SCBU) of the North Colombo Teaching Hospital. All babies born before 34 weeks of gestation during me year 2006 were recruited, after obtaining maternal consent. Data was collected by interviewing mothers and using patient's records. RESULTS: Seventy neonates were recruited (male 57%). Of them 42 (60%) were delivered vaginally and 10 (14%) were born before 28 weeks of gestation. Mean birth weight was 1.44 (SD = 0.46) kg. All were admitted to the SCBU and were kept in incubators. The stay in SCBU ranged from 1 to 110 days (mean 15 days) and they were kept in incubators for an average of 5,8 days. Thirty seven (53%) had jaundice of whom 25 (36%) needed phototherapy but only one required exchange transfusion. Sepsis, surfactant deficient lung disease and apnoea were seen in 45.7%, 28.6% and 24.3% respectively. Four neonates each developed hypoglycaerma, anaemia and retinopathy of prematurity. Sixty seven (96%) neoaates needed oxygen, 13% were ventilated and 80% were given antibiotics. In 63% blood was taken for investigations more than 5 times. Twelve (17%) died while the rest (83%) were discharged. CONCLUSIONS: Jaundice, sepsis, surfactant deficient lung disease and apnoea were the commonest problems in babies born before 34 weeks of gestation. Nearly one fifth of them died during the neonatal period.Item Socio-demograpfflc and clinical Characteristics of neonates born before 34 Weeks of gestation: a case control study(The Sri Lanka College of Paediatricians, 2008) Mettananda, D.S.G.; Rajindrajith, S.; Adhihetty, D.; Goonewardena, A.R.; Adikari, A.M.C.; Pannala, W.S.; Devanarayana, N.M.; Mettananda, K.C.D.BACKGROUND: Management of neonates born before 34 weeks of gestation demands special resources and'' facilities which are limited in Sri Lanka. Identification of pregnancies at risk of preterm deliveries will enhance the optimal use of these neonatal facilities by appropriate and timely referrals. Objective: To compare th'e socio-demographic and clinical characteristics of neonates born before 34 weeks of gestation with those of term neonates. DESIGN, SETTING AND METHOD: A case-control study was conducted at the university obstetric unit of the North Colombo Teaching Hospital in the year 2006. All neonates born before 34-weeks of gestation were recruited as cases and a randomly selected group of term neonates was recruited as controls into the study after obtaining maternal consent. Data was collected by interviewing mothers and using patient records. RESULTS: Seventy cases and an equal number of controls were recruited. Forty (57%) cases and 30 (43%) controls were males. Mean birth weight was 1.44 (SD=0.46) kg for cases and 2.94 (SD=0.35) kg for controls. Previous history of preterm deliveries was found in 06 (8.6%) cases and. 01 (1.4%) control. Multiple pregnancy [OR=14.3,95% 01=1.8-113] and monthly family income less than Rs.lO,000/= [OR=2.6, 95% Cr^Ll-5.8] carried a significantly higher risk of_deliveries before 34 weeks. Increased risk was also detected in subjects with obstetric [OR=4.2, 95% CI=2.0-8.8)] and fetal [OR=11.0, 95% CI=3.6-33.6] complications. Maternal blood group, maternal education level and social class assessed by father's occupation did not have any association with deliveries before 34 weeks. Mean 1-minute APGAR was significantly lower in neonates born before 34 weeks [7.2 (SD=2.9)] than controls [9.7 (SD=0.5)], (pO.OOl) and the same was true for the score at 5 minutes. CONCLUSIONS: Multiple pregnancies, presence of maternal or fetal complications and low family income were associated with increased risk of deliveries before 34 weeks of gestation. Apgar scores at 1 and 5 minute were lower in neonates born before 34 weeks of gestation.Item Outcome of children transported for pediatric intensive care to a tertiary care setting in Sri Lanka(Sri Lanka College of Paediatricians, 2016) Adhihetty, D.; Kitulwatte, N.C.; Hathagoda, K.L.W.; Weeraratne, C.T.; de Silva, S.; Ediriweera, E.P.D.S.INTRODUCTION: Patient transport remains a necessary facet of today’s health care environment and transport conditions bear a major impact on the outcome. There is a recent move in Sri Lanka to establish retrieval teams. Thus, identifying problems faced by the present system will be of utmost importance in development of transport teams. OBJECTIVE: To evaluate the present system of transportation of sick children to the Medical Intensive Care Unit (MICU), Lady Ridgeway Hospital for Children (LRH), Colombo. METHOD: A prospective, descriptive, observational study of transferred patients was conducted at the MICU LRH, Colombo. All children admitted to MICU from 1st March 2014 to 1st June 2014 were included in the study. Data was collected using a self-administered questionnaire. The Wilcoxon significant rank test and the Chi squared test were utilized in statistical analysis. RESULTS: There were 200 patients comprising 105 (52.5%) out-of-hospital transfers and 95 (47.5%) in-hospital transfers. Of the admissions, 72% were live discharges while 28% expired; 42.5% of transfers were from the Colombo district. Pneumonia was the commonest diagnosis, occurring in 38.5%. The pre-transfer Paediatric Risk Mortality (PRISM) scores had a median of 12, mean of 13.7±7.8 and Q1-8 to Q3-18. The 12 hour PRISM scores, after excluding patients with PRISM scores of less than 5, showed a median of 14, mean of 18.5±11.7 and a ‘p’ value 0.0002. There was no outcome difference between in-hospital vs out-of-hospital transfers based on the Chi squared test. A written summary was available only in 61 (30.5%) patients. CONCLUSION: A rise in the PRISM score after transfer indicates that the patients had deteriorated during the transfer and transfer conditions need to be improved.Item Projected cost- effectivenes of rotavirus vaccination in Sri Lanka(The Bulletin of the Sri Lanka College of Microbiologists, 2007) Chandrasena, T.G.A.N.; Rajindrajith, S.; Gunawardane, R.; Adhihetty, D.; Ahmed, K.; Pathmeswaran, A.; Nakagomi, O.OBJECTIVES: The disease and economic burden of rotavirus infection among children hospitalised for gastroenteritis in Sri Lanka was assessed, in anticipation of the availability of new rotavirus vaccines. METHODS: A prospective gastroenteritis case surveillance was conducted between April 2005-October 2006 at the paediatric units of the Colombo North Teaching Hospital. Stool samples of children admitted with diarrhoea were screened for group A rotavirus antigens by enzyme-immuno assay (ElA)(Rotaclone®).Information regarding medical and non- medical costs during the event was obtained among randomly selected rotavirus cases (n=45) through an interviewer administered questionnaire. Cost effectiveness of universal rotavirus vaccination was investigated assuming a cost Of ≤ US$.7 per vaccine dose (two dose regime) in accordance with the World Bank cost effectiveness standard for low-income countries. RESULTS: Total of 606 children (335 males)[ mean age 27.3 months,(range 1-144) were analyzed. 116 (19.1%) had rotavirus antigens. The prevalence among the 0-5 years age group was 20.8. The average cost per episode of rotavirus gastroenteritis was Rs. 3004(US$ 27). Estimated initial and recurrent expenditure of universal vaccination was US$ 23.7 and five million respectively. Costs saved through averting rotavirus diarrhoea hospitaljsations per year (assuming a vaccine of 100% efficacy) were US$ 0.21 million. Deaths averted were eight per year. CONCLUSION: Universal rotavirus vaccination at 5 US$.7 per dose may not be cost-saving in Srilanka. However decisions regarding vaccine use should be based not only on whether the intervention provides cost savings but also on the value of preventing associated morbidity and mortality.Item Animal bites in children: reasons for delay in seeking medical help(Sri Lanka Medical Association, 2008) Peiris, M.A.C.; Perera, K.P.J.; Adhihetty, D.; Goonewardena, A.R.; Mettananda, D.S.G.OBJECTIVE: To describe the clinical characteristics of animal bites in children and to determine the reasons for delay in seeking medical help DESIGN, SETTING AND METHODS: A descriptive study was conducted at the North Colombo Teaching Hospital in 2007. Consecutive children admitted following animal bites were recruited into the study until a sample of 100 was achieved. Children with snake and insect bites were excluded from the study. Data on clinical characteristics and treatment were obtained using an interviewer schedule. RESULTS: Sixty-five (65%) subjects were males. Mean age of children was 6.8(SD=3.2) years. Majority (88%) of bites were by dogs while cats, rats, monkeys and squirrels were responsible for the others. 68% of animals (67% of dogs) were domestic animals but only 14% were vaccinated. None of the domestic cats or squirrels was vaccinated. 72% were provoked bites and 81% had major exposures. Face, hands and fingers were the commonest places of bites. Following the bite 89% had washed the bite-site with soap and water and 6% had used antiseptics for cleaning. 75% came to the hospital within 24-hours while 16% presented after 72 hours. Commonest reason for delay was ignorance. There was no significant association between the delay in presentation and age or sex of the child, maternal educational level, number of children in the family, distance to the hospital, type of animal or the degree of exposure. CONCLUSION: Eighty-six percent of animal bites in children were by unvaccinated animals. One-fourth of children were brought to the hospital after 24 hours and the commonest reason for delay was ignorance.Item Clinical characteristics and fate of neonates born before 34 weeks of gestation: a case-controlled study(Sri Lanka Medical Association, 2008) Mettananda, D.S.G.; Rajindrajith, S.; Adhihetty, D.; Goonewardena, A.R.; Adikari, A.M.C.; Pannala, W.S.; Devanarayana, N.M.; Mettananda, K.C.D.OBJECTIVES: To describe and compare the socio-de mo graphic and clinical characteristics, problems and outcome of premature neonates born before 34 weeks of gestation. DESIGN, SETTING AND METHODS: A case-controlled study was conducted at the special care baby unit (SCBU) and the university obstetric unit of North Colombo Teaching Hospital from January to December 2006. All neonates born before 34 weeks of gestation were recruited as cases and a randomly selected group of term neonates were recruited as controls into the study after obtaining maternal consent. Data were collected by interviewing mothers and using patient records, RESULTS: Seventy cases and an equal number of controls were recruited. 40(57.1%) cases and 30(42.9%) controls were males. Mean birth weight was 1.44(SD=0.46) kg for cases and 2.94(SD=0.35) kg for controls. Multiple pregnancy [OR-14.3, 95%CI=1.8-113.1] and monthly family income less than Rs.l0, 000/= [OR=2.6, 95%CI:=l.l-5.8] carried a significantly higher risk of deliveries before 34 weeks. Increased risk was also detected in subjects with obstetric [OR=4.2, 95%CI=2.0-8.8)] and fetal [OR=11.0, 95%CI=3.6-33.6] complications. Maternal blood group, maternal education level and social class assessed by father's occupation did not have any association with deliveries before 34 weeks. Mean 1-minute APGAR was significantly lower in neonates born before 34 weeks [7.2(SD=2.9)] than controls [9.7(SD=0.5) J (p<0.001), and the same was true for the score at 5 minutes. All cases were admitted to the SCBU and were kept in incubators. The stay in SCBU ranged from 1 to 110 days (mean 15.1, median 9.0 & mode 1, 0 days). 37(53%) had jaundice whereas 45.7%, 28.6% and 24.3% had sepsis, surfactant deficient lung disease and apnoea respectively. 67(95.7%) neonates needed oxygen, 12.9% were ventilated and 80% were given antibiotics. Twelve (17.1%) died while the rest (82.9%) were discharged. CONCLUSIONS: Multiple pregnancies, presence of maternal or fetal complications and low family income were associated with increased risk of deliveries before 34 weeks of gestation. Jaundice, sepsis, surfactant deficient lung disease and apnoea were the commonest problems in babies born before 34 weeks of gestation. Nearly one fifth of them died during the neonatal period.