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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 A study on adolescent sexual & violent behaviour, drugs & alcohol abuse and its relationship to the past experiences(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Mettananda, D.S.G.; de Silva, D.G.H.; Jayasinghe, Y.C.; Waduge, T.R.W.; Pathmeswaran, A.; Abeysinghe, A.P.S.D.Item Neonatal deaths in a tertiary care hospital in Sri Lanka: a clinical audit(Sri Lanka Medical Association, 2008) Pannala, W.S.; Adikari, A.M.C.; Mettananda, D.S.G.; Rajindrajith, S.; Devanarayana, N.M.OBJECTIVE: To describe the clinical characteristics, timing and causes of neonatal deaths in a tertiary can centre in Sri Lanka. DESIGN, SETTING AND METHODS: A clinical audit was conducted on all neonatal deaths occurred at specia care baby unit of the university pediatric unit of North Colombo Teaching Hospital from January 2006 tc June 2007. Data were extracted from hospital records using a data collection form. RESULTS: Fifty-nine neonatal deaths were audited. All baies were born in hospitals and there were no home deliveries. Thirty (51%) were males and 42% were first borns. Sixty-six percent were delivered preterm while 13% were delivered even before 28 weeks. Mean birth weight was 1.81(SD=0.87) kg. Twenty-eight (47%) were delivered following an uncomplicated antenatal period while 9(15%) mothers had pre-labour rupture of membranes, 8( 14%) had pregnancy induced hypertension and 6( 10%) had antepartum haemorrhages. 54% were delivered vaginally and 41% were delivered by emergency caesarian section. Forty-five (76%) needed resuscitation at birth. Eight (14%) newborns did not survive more than an hour and 16 more (27%) died within the first 24-hours; 44(75%) died within one week. Twenty-six (44%) died of complications of prematurity of which half had surfactant deficient lung disease. Other causes of death were sepsis (20%), congenital abnormalities (14%), meconium aspiration syndrome (12%) and birth asphyxia (10%). Pathological postmortems were done on 17(29%). CONCLUSIONS: Three-quarters of deaths were early neonatal deaths and over 40% occurred within the first 24 hours. Nearly half died of complications of prematurity and asphyxia accounted only for 10% of deaths.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.Item Impact of overcrowding on paediatric health problems in Chandigarh, India(Sri Lanka Medical Association, 2008) Mettananda, D.S.G.; Mettananda, K.C.D.; Thakur, J.S.; Kumar, R.OBJECTIVE: To determine the relationship between overcrowding and acute respiratory infections (ART) and diarrhoea in children. DESIGN, SETTING AND METHODS: A cross-sectional analytical study was conducted at the Urban Health Training Centre, Indira Colony, and Chandigarh, India in December 2004. All children under the age of 2 years attending the immunization clinic were recruited into the study. An interviewer schedule was used to collect data. Overcrowding, ARI and diarrhoea were defined using standard WHO definitions. RESULTS: Sixty children were recruited into the study. Mean age was 5.95 months. Thirty-three (55%) were boys. Forty-eight (80%) children belonged to the lowest social class. Thirty-five (58.3%) houses had only a single room and 39 (65%) households were overcrowded. Twenty-one (35%) children were exposed to passive smoking. Incidences of ARI and diarrhea during the past one month were 61.7% and 35% respectively. Children from overcrowded houses had significantly higher incidence of ARI compared to children from non-overcrowded houses (x2=4.5, p<0.05) but there was no such relationship with the incidence of diarrhoea (x2==1.3, p>0.05). There was no significant association between the incidence of ARI and passive smoking (x2= 1.239, p>0.05). CONCLUSION: Sixty-five percent of households in Indira Colony, Chandigarh are overcrowded. The study identified a significant association between overcrowding and the incidence of ARI but not with the incidence of diarrhoea.Item Incidental finding of occult carcinoma in histology in total thyroidectomy for benign thyroid disease(2006) Fernando, R.; Mettananda, D.S.G.; Kariyakarawana, L.OBJECTIVES: The incidence of occult carcinoma of thyroid varies from 1%-10% in the literature. These unexpected cancers do not show any pre or intra-operative indication of malignancy. Total thyroidectomy in benign thyroid disease is receiving wider acceptance. If a lesser surgery is performed and an occult carcinoma is detected a difficult therapeutic dilemma ensues. This study presents the incidence and clinical presentation of occult carcinomas in a series of total thyroidectomies performed for benign disease. METHODS: Analysis was performed on 55 patients who have undergone total thyroidectomy for benign diseases. Surgeries were performed at the University Surgical Unit of North Colombo Teaching Hospital by a single surgeon from January 2000 to August 2005. Clinical manifestations, surgical details and histological findings were obtained from the patients' records. RESULTS: Five cases of occult carcinomas were discovered with an incidence of 9.1%. Histology confirmed 2 papilary, 2 medullary and 1 follicular carcinomas. Mean age was 52.0 (SD ±13.3) years and 80% were females. Majority (80%) presented with multinodular goiters; 60% were euthyroid and 40% were hyperthyroid. Fine needle aspiration cytology confirmed benign aetiology in all. None of these patients developed transient or permanent complications following total thyroidectomy. CONCLUSIONS: Incidence of occult thyroid carcinoma is 9.1% in this series. None of the patients had problems following total thyroidectomy. The policy of performing total thyroidectomy in benign disease appears to be beneficial as it obviate the need for further surgery if an occult carcinoma is found.Item Psychosocial outcomes of children and parents after renal transplantation.(Sri Lanka College of Paediatricians., 2015) Ranawaka, P.R.D.; Abeysekera, C.K.; Gamage, M.P.; Illangasekara, O.R.; Silva, G.R.C.; Mettananda, D.S.G.; Pathmanathan, T.; Abeyagunawardena, A.S.Introduction: Although some highlighted problems such as parental stress, child behavioural problems and financial instability occur after transplantation, much still remains unknown about the extent, nature, reasons and implications of family difficulties caused by renal transplantation in childhood. Objectives: To examine the psychosocial aspects, levels of parental stress and behavioural problems among children after renal transplantation and to study the predictors of psychosocial issues in the study sample. Design, setting and method: A cross sectional analytical study was conducted at the University Paediatric Unit of the Teaching Hospital, Peradeniya in September-October 2012. All patients who are being followed up at the post renal transplant clinic were recruited to the study. Data was collected using an interviewer-administered questionnaire and analyzed using SPSS 16.0. Results: Thirty-eight recipients of paediatric renal transplants were recruited. 67.5% were males. Feeling of happiness constantly or regularly was reported by 82.5% of children while irritability was a significant problem in 47.5%. Sleep disturbance was a recognized problem in 50% of children. At 2 years of transplantation 85 % of children had not attended school but at 5 years after transplantation school dropout was 10 %. This difference was statistically significant [X2=25.8, p<0.001]. 52.5% of parents had expressed their stress on a constant or regular basis. 37.5% of fathers had lost their jobs consequent to renal transplantation and 30% of families had a monthly income less than LKR 10, 000. Conclusions: 82.5% of children reported feelings of happiness on a constant or regular basis after renal transplantation. Non-attendance at school was observed in 85% at 2 years of transplantation but the school dropout was 10% at 5 years after transplantation. 52.5% of parents had expressed their stress on a constant or regular basis.