Medicine
Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12
This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
Browse
6 results
Search Results
Item Deferoxamine, deferasirox, and deferiprone triple iron chelator combination therapy for transfusion-dependent β-thalassaemia with very high iron overload: a randomised clinical trial(Elsevier Ltd, 2024-10) Premawardhena, A.; Wanasinghe, S.; Perera, C.; Wijethilaka, M.N.; Rajakaruna, R.H.M.G.; Samarasinghe, R.A.N.K.K.; Williams, S.; Mettananda, S.BACKGROUND Many patients with β-thalassaemia die prematurely due to iron overload. In this study, we aim to evaluate the efficacy and safety of the triple combination of deferoxamine, deferasirox and deferiprone on iron chelation in patients with transfusion-dependent β-thalassaemia with very high iron overload.METHODS This open-label, randomised, controlled clinical trial was conducted at Colombo North Teaching Hospital, Sri Lanka. Transfusion-dependent β-thalassaemia patients with ferritin >3500 ng/mL were randomised 2:1 into intervention (deferoxamine, deferasirox and deferiprone) and control (deferoxamine and deferasirox) arms. Reduction in serum ferritin after six months was the primary outcome measure. Reduction in liver iron content, improvement in cardiac T2∗, and adverse effects were secondary outcome measures.FINDINGS Twenty-three patients (intervention-15, control-8) were recruited. 92% and 62% in the intervention and control arms showed a reduction in ferritin, respectively. The mean reduction of ferritin was significantly higher in intervention (−1094 ± 907 ng/mL) compared to control (+82 ± 1588 ng/mL) arm (p = 0.042). There was no statistically significant difference in the liver iron content in two arms. In the intervention arm, 67% improved cardiac T2∗ (mean change +6.72 ± 9.63 ms) compared to 20% in the control arm (mean change −3.00 ± 8.24 ms). Five patients discontinued deferiprone due to arthralgia, which resolved completely after stopping the drug.INTERPRETATION Triple combination therapy with deferoxamine, deferasirox and deferiprone is more efficacious in reducing iron burden measured by serum ferritin and showed a positive trend in reducing myocardial iron content in patients with transfusion-dependent β-thalassaemia with very high iron overload. Deferiprone has the disturbing side effect of reversible but severe arthropathy.Item Efficacy and safety of deferoxamine, deferasirox and deferiprone triple iron chelator combination therapy for transfusion-dependent β-thalassaemia with very high iron overload: a protocol for randomised controlled clinical trial(BMJ Publishing Group Ltd, 2024) Premawardhena, A.; Perera, C.; Wijethilaka, M.N.; Wanasinghe, S.K.; Rajakaruna, R.H.M.G.; Samarasinghe, R.A.N.K.K.; Williams, S.; Mettananda, S.INTRODUCTION: Despite the improvement in medical management, many patients with transfusion-dependent β-thalassaemia die prematurely due to transfusion-related iron overload. As per the current guidelines, the optimal chelation of iron cannot be achieved in many patients, even with two iron chelators at their maximum therapeutic doses. Here, we evaluate the efficacy and safety of triple combination treatment with deferoxamine, deferasirox and deferiprone over dual combination of deferoxamine and deferasirox on iron chelation in patients with transfusion-dependent β-thalassaemia with very high iron overload. METHODS AND ANALYSIS: This is a single-centre, open-label, randomised, controlled clinical trial conducted at the Adult and Adolescent Thalassaemia Centre of Colombo North Teaching Hospital, Ragama, Sri Lanka. Patients with haematologically and genetically confirmed transfusion-dependent β-thalassaemia are enrolled and randomized into intervention or control groups. The intervention arm will receive a combination of oral deferasirox, oral deferiprone and subcutaneous deferoxamine for 6 months. The control arm will receive the combination of oral deferasirox and subcutaneous deferoxamine for 6 months. Reduction in iron overload, as measured by a reduction in the serum ferritin after completion of the treatment, will be the primary outcome measure. Reduction in liver and cardiac iron content as measured by T2* MRI and the side effect profile of trial medications are the secondary outcome measures. ETHICS AND DISSEMINATION: Ethical approval for the study has been obtained from the Ethics Committee of the Faculty of Medicine, University of Kelaniya (Ref. P/06/02/2023). The trial results will be disseminated in scientific publications in reputed journals.Item Tobacco industry targeting political giants in Sri Lanka: Presidential candidates 2019(EUEP European Publishing, 2021) Kandeepan, S.; Perera, C.; Wijesuriya, H.; Dias, I.S.; Periyannan, D.; Perera, K.M.N.; Rajasuriya, M.INTRODUCTION: The presidential election to elect the 7th Executive President of Sri Lanka was held on November 2019. Ceylon Tobacco Company (CTC), a subsidiary of British American Tobacco (BAT), holds the monopoly of manufacturing and selling cigarettes in Sri Lanka, which has a comprehensive ban on tobacco advertisement, promotion and sponsorship under the National Authority on Tobacco and Alcohol (NATA) Act. OBJECTIVES: To explore tobacco industry (TI) engagements of the 2019 presidential election candidates. METHODS: Investigative research techniques were used. Key informant interviews, news reports, online content, industry reports and community-level documentary evidence were used. A deductive data analysis approach was used based on the themes ‘type of engagement’, ‘TI investment’ and ‘potential impact’. RESULTS: All three top ranked candidates depicted a positive result. Two had a history of direct engagement with the CTC and the other declared support for beedi industry during the election campaign. The engagements of the candidate who was a former Defence Secretary included accepting sponsorships to construct police stations and Army welfare shops. Police are one of the authorized officers of the NATA Act and Sri Lanka Army distributed tax free cigarettes for its soldiers until recent past. The candidate who was a former Agriculture Minister accepted CTC sponsorships for renovation of water reservoirs. CTC cultivates almost all tobacco they need for manufacturing cigarettes and is accused of exploiting the Sri Lankan farmers during the process. One candidate was the guest of honour of the opening ceremony of a pilgrim’s rest in a Buddhist shrine constructed with CTC sponsorship (around 70% of Sri Lankans are Buddhists). All TI engagements of these leading politicians received positive media coverage. CONCLUSION(S): TI engaging main political figures in Sri Lanka has potential to cause serious policy implications, thus, highlights the need for a national policy for implementation of the FCTC Article 5.3.Item Effectiveness of early stretching exercises for range of motion in the shoulder joint and quality of functional recovery in patients with burns - a randomized control trial(Tirupati: IJPHY publishers, 2017) Perera, A.D.; Perera, C.; Karunanayake, A.L.BACKGROUND; This study evaluated the effects of an early stretching exercises programme on the range of motion of the shoulder joint and functional recovery in patients with burns. METHODS; A randomized controlled study was conducted. Patients from 15 to 55 years of age with a total burn injury surface area (TBSA) of 10% to 45% involving the shoulder joint including axilla were eligible. Participants were randomized into two groups&59; intervention and a usual care control group, with 110 patients in each group. A standardized protocol was used in the management of intervention group for 14 days. The control group was subjected to usual protocol currently used. The range of Motion (ROM) was measured, and Functional recovery (FR) was assessed with the Quick DASH questionnaire and the Abduction Ladder. Data were obtained before and after the intervention phase and at 3, 6 and 12 months of post-burn period. RESULTS; The mean (SD) age of intervention group and control group were 29.76 &91;9.81&93; and 30.31 &91;9.45&93; respectively. The mean (SD) TBSA% of intervention group and control group was 26.15&91;9.45&93; and 24.60&91;9.56&93; respectively. There is a significant beneficial difference (p&61;&60;0.0001) in ROM and FR between the intervention group and the control group. CONCLUSION; This study demonstrated that an early sustained stretching exercise regime significantly improved the ROM and functional recovery of the shoulder joint after a severe burn involving the axilla.Item Reducing the public health expenditure through a surgical method that facilitates early mobilization of lower limb burns(Sri Lanka Medical Association, 2017) Perera, C.; Hajith, Z.M.; Mahendra, B.A.G.G.INTRODUCTION & OBJECTIVES: Grafted skin in the conventional way tends to contract towards the midline bridging across the joints. Prolonged immobilization following skin grafting promotes contracture across the joints. In the advanced graft orientation technique (AGOT) devised by the Burns Unit of the National Hospital of Sri Lanka (BU-NHSL), the graft is orientated in a tension free direction. This method does not require prolonged splinting or immobilization. The aim of the study was to assess the impact of graft orientation on early mobilization and prevention of contracture in lower limb (LL) burn patients. METHODS: A total of 61 patients treated with AGOT for LL burns at BU-NHSL (study group-SG) were compared with 21 patients who were primarily treated with conventional skin grafting for LL burns at local hospitals and referred for reconstruction at BU-NHSL (control group-CG). Vancouver Scar Scale (VSS) and range of motions (ROM) of involved joints were measured one year following the date of burn in the SG. These were measured prior to reconstructive surgery in the CG. Comparison was done using independent t-test. RESULTS: Mean value of VSS in the SG and the CG were 2.8889 (SD+1.65878) and 9.4074 (SD+3.21366) respectively. Spared normal joint ROM was seen in 95.6% of the SG. 100% in the CG had reduced joint ROM. CONCLUSION: AGOT has a lesser possibility of contracture across the grafted joints. Lower VSS value in the SG suggests that the quality of grafted skin is closer to normal skin. This technique is beneficial in low and middle income countries where access to specialized burn rehabilitation and health budget is limited.Item Microbiology of hand towels on surgical wards.(Sri Lanka Medical Association, 1998) Deen, K.I.; Welgama, V.; Perera, C.INTRODUCTION : Frequent ablution followed by hand drying is recommended in surgical wards as prophylaxis against cross infection. It is recommended that hands are dried using " clean" towels. Aim : This study was designed to evaluate the microbiological flora of towels routinely used for hand drying in surgical wards at General Hospital Ragama. METHODS : Fifteen towels which were in use from 15 wards visited on a single occasion were sampled using a sterile microbiological swab (one swab per towel). Each towel was sampled on both sides and at 20-24 randomly chosen sites. Four laundered towels were also sampled in a similar manner prior to use in the wards. Specimens were transported in brain heart infusion and plated on culture media within 2 hours. RESULTS : All towels used in the wards compared with none of the laundered towels revealed either mild or moderate growth of micro-organisms, (test of proportions P -0.00025 Organisms isolated number of towels were Acinetobacter species (10 ). Enterococcus species (14), Bacillus species (5) , Klcbsiella species (2), Staphylococcus aureus (2) and Escherichia coli species in one towel. Only one towel appeared clean. Fourteen appeared stained and visibly dirty to the naked eye. All 15 towels were damp. All control towels appeared clean and dry. CONCLUSION : All towels sampled in this study were found to harbour micro-organisms. This may contribute to cross infections on surgical wards. We believe, hand wiping using towels is unsafe-and suitable alternative methods should be sought.