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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Cross-fused right-to-left renal ectopia presenting as hypertension in a threeyear-old(Sri Lanka College of Paediatricians, 2023) Sandakelum, U.; Samararathna, R.; Kumarasiri, I.; Balasubramaniam, R.; Mettananda, S.No abstract availableItem Knowledge and practices on childhood anaemia, thalassaemia and iron deficiency among mothers of children aged between 6 and 59 months in a suburban area of Sri Lanka(BioMed Central, London, 2022) Samararathna, R.; Gunaratne, A.V.C.; Mettananda, S.BACKGROUND: Childhood anaemia is one of the most common public health problems worldwide. Here, we aim to describe the knowledge and practices on childhood anaemia, thalassaemia and iron deficiency among mothers of children aged between 6 and 59 months in a suburban district of Sri Lanka. METHODS: We performed a cross-sectional survey in the Gampaha District of Sri Lanka from December 2020 to February 2021. One well-baby clinic each from four Medical Officer of Health areas in the district was selected using stratified random sampling. Mothers of all children aged between 6 and 59 months attending well-baby clinics were recruited until the sample size was achieved. Data were collected using a self-administered questionnaire and analysed using logistic regression. RESULTS: A total of 392 mothers were recruited; 53% of their children were males. Only 33% of mothers had an accurate understanding of anaemia, while 71% and 28%, respectively, could name at least one symptom and two causes of anaemia; 12% could not name a single food rich in iron. Only 13% of mothers knew that thalassaemia is a cause of anaemia, and 14% had been screened for thalassaemia. Logistic regression analysis that examined for factors associated with higher knowledge of anaemia revealed that an accurate understanding of anaemia was associated with maternal age over 30 years (p < 0.05) and maternal education level beyond grade ten (p < 0.001). In contrast, higher knowledge of symptoms of anaemia was associated with maternal employment (p < 0.01). CONCLUSIONS: The knowledge of anaemia and awareness of thalassaemia among mothers was poor. Very few mothers were aware of iron-rich food and feed it to their children. Despite being located in a thalassaemia-endemic region, very few knew that thalassaemia is a cause of anaemia and have got themselves screened for thalassaemia..Item Acute disseminated encephalomyelitis presenting as bilateral ptosis in a Sri Lankan Child(Hindawi Pub. Corp., 2022) Kumarasiri, I.; Samararathna, R.; Sandakelum, U.; Muthukumarana, O.; Balasubramaniam, R.; Mettananda, S.Introduction: Acute disseminated encephalomyelitis is a rare inflammatory demyelinating disease characterized by acute onset polyfocal neurological deficits associated with encephalopathy. It commonly presents with fever, meningism, seizures, ataxia, motor deficits, and bladder dysfunction. Although cranial neuropathies, including optic neuritis and facial nerve palsies, have previously been reported, children presenting with bilateral ptosis is extremely rare. Here, we report a 3-year-old child with acute disseminated encephalomyelitis presenting with acute onset bilateral ptosis due to involvement of the single central levator subnucleus of the oculomotor nerve. Case Presentation. A 3-year-old Sri Lankan boy presented with drooping of the upper eyelids for three days and unsteady gait for two days. He did not have seizures, blurring of vision, limb weakness, swallowing or breathing difficulties, or bladder dysfunction. On examination, he had bilateral ptosis, gait ataxia, and dysmetria. His vision, eye movements, and examination of other cranial nerves were normal. MRI brain revealed high signal intensities involving the subcortical white matter of parietal and occipital lobes, midbrain in the area of single central levator subnucleus of the oculomotor nerve, cerebellar vermis, and right cerebellar hemisphere. Based on the clinical features suggesting polyfocal neurological involvement of the midbrain and cerebellum and characteristic MRI findings, the diagnosis of acute disseminated encephalomyelitis was made. He responded well and rapidly to high-dose intravenous methylprednisolone and showed a complete clinical and radiological recovery. Conclusion: This case report describes a rare presentation of acute disseminated encephalomyelitis, bilateral ptosis due to involvement of the single central levator subnucleus of the oculomotor nerve. It highlights that the presenting manifestations of acute disseminated encephalomyelitis can be subtle and vary; however, timely diagnosis and treatment result in complete recovery.Item A study on maternal knowledge and practices on childhood anaemia and iron deficiency among mothers of children under 5 years in the Gampaha District(Sri Lanka Medical Association, 2021) Samararathna, R.; Gunaratne, A.V.C.; Mettananda, S.Introduction and objectives Childhood anaemia is a common health problem worldwide. Here, we aim to describe the maternal knowledge and practices on childhood anaemia among mothers of children under five years in the Gampaha district. Methods We performed a cross-sectional descriptive study in Gampaha district from December 2020 to February 2021. One immunisation clinic each from four Medical Officer of Health areas in the district was selected using stratified random sampling. Parents of all children aged between 6 months to 5 years attending clinics were recruited until the sample size was achieved. Data were collected using a self-administered questionnaire and analysed using multiple logistic regression. Ethics approval was obtained from Sri Lanka College of Paediatricians. Results A total of 392 mothers were recruited; 53% of their children were males. Only 131(33.4%) mothers had an accurate understanding of anaemia, while only 278(70.9%) and 113(28.8%) respectively could name at least one symptom and two causes of anaemia. 49(12.5%) could not name a single food rich in iron. Accurate understanding of anaemia was associated with maternal age over thirty years [OR=1.73(1.03-2.89);p<0.05] and maternal education level beyond grade ten [OR=3.20(1.90-5.40);p<0.001] whereas higher knowledge on symptoms of anaemia was associated with maternal employment [OR=2.39(1.31-4.37);p<0.01]. Acceptance of multiple micronutrient supplements was higher among mothers with accurate understanding of anaemia [OR=1.68(1.08-2.60);p<0.05]. Conclusion The knowledge of anaemia was higher among mothers who are older than thirty years, educated beyond grade ten and employed. Mothers with an accurate understanding of anaemia showed better compliance with multiple micronutrient supplements.Item COVID 19: Downstream effects on developmental care - A case report(College of Community Physicians of Sri Lanka, 2021) Samararathna, R.; Sandakelum, U.; Mettananda, S.Introduction: COVID-19 pandemic has had a global impact resulting in increased demand on health systems worldwide. This has invariably resulted in major downstream effects to paediatric developmental care that focuses on identifying and making early interventions to optimize the developmental potential of infants with neurological impairment. Here we present a patient with global developmental delay who had unacceptable delays in getting access to intervention programs due to COVID-19. Case study: A 14-month old girl is admitted with fever and two episodes of right-sided focal convulsions. She was born to healthy non-consanguineous parents without perinatal complications. She had subtle dysmorphism, central hypotonia, microcephaly and global developmental delay. Her developmental age was 6-8 months. Biochemical and microbiological investigations, including SARSCoV- 2 PCR and cerebrospinal fluid analysis, were negative. Her EEG showed theta waves suggesting a structural brain pathology. Further questioning revealed that the baby had not attended well-baby clinics as the clinics were not held due to the COVID-19 pandemic. The mother had identified the baby's developmental delay and had gone to a paediatric tertiary care centre three times. However, she was sent back without a proper assessment claiming that the baby's condition is non-urgent and advised to come back when the COVID-19 pandemic ends. Conclusions/ Lessons learnt: This case illustrates the impact of the COVID-19 pandemic on chronic disabling conditions of children. To minimise these downstream effects, the public health sector should create programs to improve family visits and increase the availability of staff-delivered developmental care.Item Multisystem inflammatory syndrome in children: A Sri Lankan case series(Sri Lanka College of Paediatricians, 2021) Sandakelum, U.; Samararathna, R.; Pathiraja, H.; de Silva, L.; Balasubramaniam, R.; de Abrew, G.; Adihetty, D.; Fernando, M.; Randeny, S.; Mettananda, S.No Abstract Available