Browsing by Author "Costa, Y. J."

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    An audit of patients' compliance with the standards for warfarin therapy
    (Sri Lanka Medical Association, 2018) Fernando, C. H. K. A.; Costa, Y. J.; Williams, H. S. A.; Moratuwagama, D.
    INTRODUCTION AND OBJECTIVES: Warfarin is an oral anticoagulant with complex pharmacokinetics and pharmacodynamics. Therefore close monitoring is essential. Strict adherence to therapy depends on the patient's knowledge regarding anticoagulation. The objective was to assess patients' essential knowledge on warfarin with regard to anticoagulation therapy. METHODS: An audit was conducted over 6 months at Colombo North Teaching Hospital. 50 consecutive patients, of both genders, who had been on warfarin for at least 1 month were recruited. Their knowledge of warfarin therapy was evaluated using a 10 item questionnaire. Results were analyzed and compared against standards. RESULTS: Male:female ratio was 4:6 and mean age was 59.7 years. 46 % of patients had completed education up to Ordinary Level, 6% had never attended school. Indications for warfarin included: VTE 46 %, atrial fibrillation 28%, chronic cardiac dysfunction 22%, prosthetic heart valves 2%, and pulmonary hypertension 2%. 62% knew their current dose of warfarin, 4% were aware of their therapeutic INR, 68% knew what remedial action should be taken in the event of a haemorrhage, 48% were aware of effects of over anticoagulation, 22% were aware of effects of subtherapeutic anticoagulation, 86% were aware of interference of green leaves with therapy, 40% were aware ofNSAID affect anticoagulation, 70% were aware of alcohol effect on anticoagulation. CONCLUSION: As results did not meet standards, we suggest there should be better patient education regarding warfarin therapy. Patient information leaflets as well as information of this audit be made aware to teams concerned for better care of patients.
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    Genetic origin and clinical variability of sickle cell disease in Sri Lanka
    (Sri Lanka Medical Association, 2018) Darshana, L.G.T.; Bandara, W.D.M.S.; Nawaratna, U.S.B.; Costa, Y. J.; Nizri, A.H.M.; Silva, D.P.S. l.; de Silva, T.U.N.; Pushpakumara, K.P.C.; Pathirage, S.P.; Manamperi, A.; Premawardhena, A.P.
    INTRODUCTION AND OBJECTIVES: Sickle cell disease (SCD) is found at a low prevalence In Sri Lanka. A recent hospital based survey identified 60 patients in the country The clinical spectrum of SCD in Sri Lanka has not been studied and its genetic origin remains unknown.We envisaged to study the genetic origin and to carry out a clinical description ofSCD in Sri Lankan patients. METHODS: Patients were recruited from Ragama, Anuradhapura Hambantota and Kurunegala thalassaemia centres. All patients were examined and clinical details recorded. Genetic analyses were performed to identify the haplotype of HbS, Xmn I polymorphism gene deletions and mutations. RESULTS: A total of 49 SCD patients were studied Ages ranged from 5 - 47 years (mean 20.4) 91.8% of the patients were Sinhalese and the rest were Muslims. 87.7% of the patients had sickle-thalassaemia (SBT) and 6 were homozygous (HbSS) Joint pains were the commonest symptom in patients with SBT Clinical presentations in SBT varied from those with none to frequent crises Clinical management varied with only 42.86% of patients being on hydroxyurea. Most patients had not inherited disease ameliorating genetic factors with 95 9% not having gene deletions and 89 8% not having Hb F up-regulators Three Sickle haplotypes were identified including; Arab• Indian, Benin and Bantu.CONCLUSION: There appears to be at-least three genetic origins of HbS in Sri Lanka SCD is extremely clinically variable in Sri Lanka. The reason for this variation needs further study as most patients seem not to have common inherited modifiers