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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 An islandwide hospital based epidemiological survey of haemoglobinopathies and an assessment of standards of care in 23 centres(Sri Lanka Medical Association, 2017) Premawardhena, A.P.; Mudiyanse, R.M.; Jifri, M.N.; Nelumdeniya, U.B.P.; Silva, D.P.S.I.; Nizri, A.H.M.; Rajiyah, M.O.F.; de Silva, T.U.N.; Pushpakumara, K.R.C.; Dissanayake, D.M.R.; Jansz, M.; Rifaya, M.I.; Navarathne, N.M.U.S.B.; Arambepola, W.W.M.M.; Thirukumaran, V.; Mendis, D.; Weerasekara, K.P.; de Silva, N.N.; Vaidyanatha, U.S.de.S.; Mettananda, D.S.G.; Oliveri, N.F.; Weatherall, D.J.INTRODUCTION & OBJECTIVES: There is no database for haemoglobinopathy patients in Sri Lanka resulting in imprecise knowledge about the distribution and standards of care among patients managed in different centres in the island. The prevention programme commenced in 2007 is not centrally monitored. METHODS: We carried out centre-wise visitation and data gathering of patients with haemoglobinopathies in 2015. 23 centres were visited by researchers who gathered information from patient records. RESULTS: Data was obtained of 1768 patients. Three centres had over 200 patients each and another three centres had between 50-100 patients. There were 8 centres with less than 10 patients each. Beta thalassaemia major (BTM) accounted for 1207 (68.26%) patients. There were 363 patients (20.53%) with Haemoglobin E-β thalassaemia. Sickle cell-β thalassaemia accounted for 51 patients (2.88%). The mean age of BTM patients was 13 years (range 2-44). Ethnic distribution of the haemoglobinopathies (82.5% Sinhalese, 12% Muslims and 5.2% in Tamils) was discrepant to the national ethnic data. Islandwide mean number of new births of all thalassaemics recorded showed a reduction from 66/year between 2004 - 2009 to 48/year between 2010 to 2015.Clinical record keeping was not systematic in most units thus complication rates were hard to obtain. Death data were available only in two units. CONCLUSION: This study identified significant inconsistencies in haemoglobinopathy care between centres. Existence of small centres needs to be recognized by the Ministry of Health. A reducing trend of new births over the last decade was observed.Item Neonatal deaths in a tertiary care hospital in sri lanka(The Sri Lanka College of Paediatricians, 2008) Pannala, W.S.; Adikari, A.M.C.; Mettananda, D.S.G.; Rajindrajith, S.; Devanarayana, N.M.BACKGROUND: Neonatal mortality rate reliably assesses the level of perinatal care in a country. Lethal congenital malformations and extreme prematurity are the main causes of neonatal mortality in developed countries. Developing countries continue to lose neonates due to infections, malnutrition and birth asphyxia. OBJECTIVE: To describe the clinical characteristics, timing and causes of neonatal deaths Jn a tertiary care hospital in Sri Lanka, DESIGN, SETTING AND METHOD: A descriptive study was conducted at the Special Care Baby Unit of the University Paediatric Unit of North Colombo Teaching Hospital, Ragama. Data on all neonatal deaths which occurred from January 2006 to June 2007 were extracted from hospital records using a data collection form. RESULTS: Fifty-nine neonatal deaths were studied. All babies were born at hospitals and there were no home deliveries. Thirty (51%) were males and 42% were first born. Sixty six percent were deliveredpreterm including 13% delivered before 28 weeks. Mean birth weight was 1.81 (SD^O.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. Fifty four percent were delivered vaginally and 41% by emergency caesarean section. Forty five (76%) needed resuscitation at birth. Eight (14%) newborns did not survive more than an hour and a further 16 (27%) died within the first 24 hours. Forty four (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: Seventy five percent of deaths occurred in the first week of life, 41% occurring within the first 24 hours. Forty four percent died of complications of prematurity. Birth asphyxia accounted for only 10% of deaths.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 Recurrent urinary tract infections in females - a prospective analysis(Sri Lanka Medical Association, 2012) Mettananda, K.C.D.; Ranaweera, A.; Mettananda, D.S.G.INTRODUCTION: Urinary tract infection (UTI) is the commonest infection in women worldwide. Patients with co-morbidities or predisposing factors are at risk of developing recurrent UTI. They require hospitalisation, since causative organisms acquire resistance to first-line antibiotics and intravenous second-line antibiotics are indicated for complete eradication. Consequently, there is disturbance to lifestyle and loss of productivity for the patient. AIMS: To describe clinical profile and risk factors of female patients with recurrent UTI. Methods: All females admitted to the University Medical Unit at Teaching Hospital, Ragama from April 2011- March 2012, with >2 UTI occurring within the previous 12-months, were recruited. Data was collected using an interviewer-administered questionnaire. Results: 22 patients [mean age 48.8 years (SD+16.8, range 14-73]] fulfilled inclusion criteria. 16 (73%) were post-menopausal.13(59%) had diabetes, with poor control in 12. Other risk factors were constipation (27%), cystocele (14%), urinary calculi (9%) and hydronephrosis (9%). Urine culture was performed before antibiotics in 17(77%). 88% pre-treatment cultures were positive. 11(50%) had pyelonephritis during the current admission. 85% of diabetics had positive cultures compared to non-diabetics (77%) (p=0.55). Escherichia coll was the commonest pathogen (in 67.5%). Pyelonephritis was commoner among diabetics (61%) than non-diabetics (33%) 0=0.193). CONCLUSIONS: Post-menopausal women with poorly controlled diabetes are likely to have pyelonephritis when they develop recurrent UTI. Better glycaemic control, avoiding constipation and early treatment of structural abnormalities will reduce recurrent UTI in the at-risk population.Item Recurrent urinary tract infections in females - a prospective analysis(Sri Lanka Medical Association, 2012) Mettananda, K.C.D.; Ranaweera, A.; Mettananda, D.S.G.INTRODUCTION: Urinary tract infection (UTI) is the commonest infection in women worldwide. Patients with co-morbidities or predisposing factors are at risk of developing recurrent UTI. They require hospitalisation, since causative organisms acquire resistance to first-line antibiotics and intravenous second-line antibiotics are indicated for complete eradication. Consequently, there is disturbance to lifestyle and loss of productivity for the patient. AIMS: To describe clinical profile and risk factors of female patients with recurrent UTI. Methods: All females admitted to the University Medical Unit at Teaching Hospital, Ragama from April 2011- March 2012, with >2 UTI occurring within the previous 12-months, were recruited. Data was collected using an interviewer-administered questionnaire. Results: 22 patients [mean age 48.8 years (SD+16.8, range 14-73]] fulfilled inclusion criteria. 16 (73%) were post-menopausal.13(59%) had diabetes, with poor control in 12. Other risk factors were constipation (27%), cystocele (14%), urinary calculi (9%) and hydronephrosis (9%). Urine culture was performed before antibiotics in 17(77%). 88% pre-treatment cultures were positive. 11(50%) had pyelonephritis during the current admission. 85% of diabetics had positive cultures compared to non-diabetics (77%) (p=0.55). Escherichia coll was the commonest pathogen (in 67.5%). Pyelonephritis was commoner among diabetics (61%) than non-diabetics (33%) 0=0.193). CONCLUSIONS: Post-menopausal women with poorly controlled diabetes are likely to have pyelonephritis when they develop recurrent UTI. Better glycaemic control, avoiding constipation and early treatment of structural abnormalities will reduce recurrent UTI in the at-risk population.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.