Browsing by Author "Kasturiratne, K.T.A.A."

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Adaptation of "Medical Interview Satisfaction Scale" (MISS-21) for Sri Lankan general practice
(Sri Lanka Medical Association, 2019) de Silva, A.H.W.; Kasturiratne, K.T.A.A.; Seneviratne, A.L.P.; Wickremasinghe, A.R.
INTRODUCTION & OBJECTIVES: Patient satisfaction is an important clinical outcome and a validated Sinhalese tool to measure it is essential. MISS 21 is a tool validated in the British general practice. Objective was to translate, cross-culturally adapt and validate the MISS 21 to for the Sri Lankan Sinhala speaking general practice setting. METHODS: The suitability and relevance of items in MISS-21 were assessed and unacceptable items revised. Translation process involved back translations and synthesis. Conceptual and linguistic equivalence was considered. Accuracy in rephrasing-and semantic adjustments was made following pretest. Operational equivalence was evaluated. A sample size of 300 was estimated and 480 recruited to account for non-respondents. Tool was self-administered amongst literate Sinhala patients of ≥18 years from six general practices. Exploratory factor analysis (EFA) extracted potential components associated with satisfaction. Internal consistency was assessed using Cronbach's alpha. RESULTS: Sixteen items fulfilled 80% acceptance. Four items were retained unchanged on consensus while one item was changed. Operational equivalence was accepted. Only 381 were complete enabling EFA. EFA extracted two components. This model explained 56% of the variability of total patient satisfaction scores. Items exploring communication and distress releasing aspects loaded on component 1 ("communication and comfort"). Items related to unmet expectations of patients and the doctor's regard loaded on component 2 ("regard and clarity"). All items in components 1 and 2 (Cronbach's alpha >0.9 and >0.7) demonstrated good internal consistency. CONCLUSION: The Sinhala version of MISS 21 exhibited high content validity, satisfactory construct validity with an acceptable factor structure, internal consistency and high response rates.
Awareness on dengue and solid waste management among selected school students in Gampaha District of Sri Lanka
(Moleclar Medicine Unit, Faculty of Medicine, University of Kelaniya, Sri Lanka, 2015) Radhika, N.M.L.; Gunathilaka, P.A.D.H.N.; Abeyewickreme, W.; Kasturiratne, K.T.A.A.
BACKGROUND: Community mobilization is often respected as a powerful tool in ensuring the effective controlling of dengue via promoting effective and sustainable dengue vector control strategies. The current study attempts to investigate the level of awareness on dengue and solid waste management, among selected school students in Gampaha District which is the second highest dengue reported district in Sri Lanka. METHODOLOGY: Awareness programmes on dengue (transmission, vector ecology and preventive measures) and solid waste management were conducted in 10 schools belong to Kelaniya Medical Officer of Health (MOH) area selecting a minimum group of 200 students from each school within the age of 13 - 15 years. Tools such audio-visual presentations, leaflets and videos were used for the awareness programmes. A questionnaire was given to each student prior to the awareness and after the awareness programs as pre and post evaluations respectively in order to assess the general awareness on dengue and solid waste management before and after the awareness programme. One-Way ANOVA, paired t-test and multiple regression techniques were utilized in evaluation of the degree of awareness and key factors affecting the level of awareness, prior and after the conducting the awareness programmes. RESULTS: The degree of initial awareness on dengue and solid waste management of the target school community was recognized to be significantly characterized by the grade of the students and the Education Zonal Category [EZU] (into which their school belongs to) in accordance with One-Way ANOVA (p < 0.05). A significant increment in post awareness of the target school community was recognized due to the conducting of awareness programmes in accordance with the statistics of paired t-test (p < 0.05). Furthermore, based on the multiple linear regression modelling, the post awareness was significantly influenced by the grade of the students and the initial awareness (p < 0.05), regardless of the EZU (p > 0.05). CONCLUSIONS: The awareness of school students on dengue and solid waste management is significantly affected by the grade of the students and EZCs. Awareness programmes are an effective media of raising the awareness of school communities on dengue and solid waste management, while motivating them to actively contribute for the controlling of dengue, via establishing a strong inter sectorial network among schools and other relevant institutions within the Gampaha District.
Barriers for cataract treatment among elderly in Sri Lanka
(Hindawi Publication Corporation, 2019) Nishad, N.; Hewage, S.A.; Arulmoly, K.; Amaratunge, M.S.; de Silva, J.; Kasturiratne, K.T.A.A.; Abeysundara, P.K.; Wickremasinghe, A.R.
Cataract is still the leading cause of blindness. Many government institutes and voluntary organizations in Sri Lanka are providing free treatment services to patients with cataract. Still people are not patronizing the available free services; thus they have to live with impaired vision or blindness. This paper describes the barriers for cataract treatment among the population over 60 years of age. Out of 470 elders, 379 were found to have some kind of cataract. This study demonstrated lack of awareness and knowledge, socioeconomic factors, and misconceptions as the main barriers for cataract treatment which has led to a lower cataract surgery rate irrespective of the high cataract prevalence reported. Findings of this study highlight the importance of cataract as a common health problem in elderly and need for removal of the barriers for its treatment which should be given due prominence in the formulation of public health policy in Sri Lanka at the earliest.
Compliance with the mass chemotherapy program for lymphatic filariasis
(Sri Lanka Medical Association, 2001) Kasturiratne, K.T.A.A.; Premaratna, B.A.H.R.; Pathmeswaran, A.; de Silva, N.R.; de Silva, H.J.
OBJECTIVE: To evaluate compliance with the single dose mass chemotherapy program for control of filariasis, and to determine factors influencing compliance in the Gampaha district. DESIGN: A prospective study employing a pre-tested self-administered questionnaire. METHODS: Four groups comprising individuals over one year old with residence in the Gampaha district for over one year were surveyed. Data collection was started two weeks after the mass chemotherapy program. RESULTS: 2300 questionnaires were distributed, 1983 (86.2 percent) were returned, and 1935 (84.1 percent) were sufficiently complete for analysis (857 males; mean age 39 years, SD equal 19.5). Over 96 percent had heard of filariasis and the mass chemotherapy program, but only 60.3 percent of those over 11 years of age were aware of asymptomatic carriage of the parasite. 1289 (66.6percent) out of the total sample surveyed (1935 individuals) had obtained the diethylcarbamazine tablets, and 1221 (63.1 percent) had taken the drug. Of the possible demographic factors that could have influenced compliance only educational level seemed to play an independent significant role, compliance being lowest at both extremes of educational level. The main problem with compliance was obtaining the drug from distribution centres. CONCLUSIONS: Compliance with the mass chemotherapy program to control filariasis needs improvement. Strategies should include a better system for distributing the drug, and altering the content of the publicity material used by the program to target less compliant groups, and improve aspects of knowledge regarding filariasis that seem inadequate at present.
A Descriptive study of deep vein thrombosis (DVT) in a tertiary care hospital
(Sri Lanka Medical Association, 2008) Botheju, W.I.K.; Navaratne, A.C.R.; Somarathne, C.K.; Balasooriya, B.L.P.P.; Wijebandara, R.J.K.S.; Mandawala, M.B.S.N.; Ruwanpathirana, T.; Kasturiratne, K.T.A.A.; Hewawitharana, C.P.; Rathnasena, B.G.N.; Fernando, P.; Wijesinghe, P.S.; Premawardhena, A.
OBJECTIVE: The incidence and risk factors for DVT are not well established for the Sri Lankan population. Though believed to be an effective screening tool for DVT, the Well's Clinical score is not widely used in Sri Lankan hospitals. DESIGN, SETTING AND METHODS: Over a period of 8 months, a total of 23274 patients who presented to four units (including one general medical, one general surgical, one Gynaecology & Obstetrics, and the Orthopedic ward) of the North Colombo (Teaching) Hospital were screened for asymmetrical limb swelling more than 2 cm. The latter group were subjected to risk assessment for DVT, Well's scoring and CDU (Colour Duplex Ultrasound). RESULTS: Of the 23274 patients, 93 (0.4%) had unilateral limb swelling of which 12 (12.9%) were CDU confirmed to have DVT (0.5 per 1000). Limb swelling for more man two weeks was significantly commoner among DVT patients when compared to those without DVT (75% Vs 25.9%: p=0.001). None of the patients had been evaluated with the Well's score as a guide to refer for CDU by the relevant clinical teams. In 55 (59.1%) subjects, Well's score was 0 or less (minimum probability of DVT) and there were no subjects with DVT in this group. All 12 patients with DVT had a moderate or high probability Wells score. CONCLUSIONS: Overall incidence of DVT in the study population was lower than in other comparable published studies from Asia. Well's score which was underused by the clinicians is a highly sensitive screening tool for DVT.
An exploratory qualitative study on marriage and pregnancy of adolescent females in the Hikkaduwa Medical Officer of Health (MOH) area
(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Kasturiratne, K.T.A.A.
INTRODUCTION: Marriage in adolescence before 18 years is prohibited in Sri Lanka. However, marriages of adolescent females are not rare in some areas in Sri Lanka. OBJECTIVE: To describe the factors associated with marriage of and pregnancy among adolescent females (14-17 years) in a village in the Hikkaduwa Medical Officer of Health (MOH) area. METHODS: This exploratory qualitative study was conducted in Angankanda in the Kalupe PHM division in the Hikkaduwa MOH area in November 2007. Data were collected through focus group discussions and key informant interviews and analysed using qualitative content analysis. RESULTS: Fourteen females who had been married during adolescence (14-17 years) and five key informants participated in the study. Marriages of adolescent females have taken place following emotional relationships. Married adolescents have a low level of education and reduced awareness about health issues. Death or separation of a parent, poverty and lack of security within the family unit are important predisposing factors to adolescent marriages. Elopement is common following which parents or relatives from both parties collaborate to register the marriage to avoid litigation on the male partner. Most male partners are above 18 years of age at the time of the marriage. The age of the adolescent provided at registration of the marriage was false. Public health field staff of the area were aware of the problem and have taken preliminary steps to focus on this group. The services provided by the Public Health Midwife for married females are sought and acknowledged but not strictly adhered to, due to negative pressures or lack of motivation from the family. Delaying of the first pregnancy is not a common practice. Exposure to other modes providing awareness on health issues is limited. CONCLUSION: Despite legislature, marriages of adolescent females are a common occurrence in this community. Targetted interventions to prevent these marriages and to upgrade the overall health of adolescent females are necessary in areas where this problem is prevalent.
Health related quality of life and its correlates among elderly in a selected MOH area of Colombo
(Sri Lanka Medical Association, 2016) Wijesundara, C.R.; Kasturiratne, K.T.A.A.
INTRODUCTION AND OBJECTIVES: Ageing is a universal phenomenon and enhancement of healthy life expectancy is an issue of immense public health importance. The objective of the study was to describe health related quality of life (HRQoL) and its correlates among elderly in the Kaduwela MOH area. METHOD: A community based descriptive cross sectional study was conducted on 460 elders selected through a cluster sampling method. WHOQOL-BREF questionnaire was the instrument used. t- test and multiple linear regression were used for the univariate and multivariate analysis respectively. RESULTS: The mean score for physical health domain was 58.84, and its individual correlates (R2=0.457) were age (p<0.001), employment (p<0.001), morbidity (p<0.001) and ADL (p<0.001). The psychological domain had a mean of 46.75 and its individual correlates (R2=0.324) were age (p=0.013), income (p<0.001), morbidity (p<0.001) and ADL (p<0.001) while co- residency (p=0.029) and standard of living were significant household correlates (R2=0.172). The mean of the social relationships domain was 45.93 and civil status (p=0.024) and ADL (p<0.001) were determined to be its individual correlates (R2=0.185), while co-residency (p<0.001) and standard of living (p<0.001) were the household correlates (R2=0.103). Environment domain reported a mean of 50.02. Its individual correlates (R2=0.282) were income (p<0.001), morbidity (p<0.001) and ADL (p<0.001), while the household correlates (R2=0.217) were ownership of the house (p<0.001), co-residency (p<0.001) and standard of living (p<0.001). CONCLUSIONS: The level of HRQoL among elders appears to be relatively low. The individual and household factors both seems to play a vital role for most of the facets of HRQoL, but the individual correlates varied according to the domains.
How do Men who Choose Not to Participate in Healthy Lifestyle Centres Reason About Their Decision?
(Sri Lanka Medical Association, 2020) Herath, H.M.T.P.; Perera, K.M.N.; Kasturiratne, K.T.A.A.
INTRODUCTION AND BJECTIVES: In Sri Lanka, both women and men are expected to visit a cost-free population-based cardio-vascular screening programme held at a specific centre called the Healthy Lifestyle Centre (HLC) at their nearest primary health care institution. However, screened male to female ratio in 2016 first quarter was approximately 3:7 portraying that many men choose not to visit HLC compared to their female counterparts. This study explored how men who declined participation in the healthy lifestyle centre reasoned out their choice. METHODS: This qualitative study was conducted using constructivist grounded theory in Gampaha and Kalutara districts in Sri Lanka. Three focus group discussions (n= 7) and six interviews from men who actively declined participation in the healthy lifestyle centre were analysed using thematic analysis. RESULTS: Factors related to men’s decision not to participate in HLC included masculine perceptions such as male having a lower risk for diseases compared to a female, poor perceived susceptibility due to absence of symptoms, previous negative experiences related to health care services, lack of confidence in the tests conducted at the HLC and barriers due to their employment as HLC is being conducted in a fixed day and a time. CONCLUSION: Men’s decision not to participate in screening at HLC is linked with individual attitudes and influence by masculinity. The existing male-unfriendly nature of the health-care services also had a significant impact on the decision. Thus, targeted interventions are urgently needed to improve utilization of HLCs by men addressing these identified reasons.
Incidence and prevalence of stroke and time trends in vascular risk factors among urban/semi-urban Sri Lankans: A population-based cohort study
(Ceylon College of Physicians, 2020) Mettananda, K.C.D.; Ranawaka, U.K.; Wickramarathna, K.B.; Kottahachchi, D.C.; Kurukulasuriya, S.A.F.; Matha, M.B.C.; Dassanayake, A.S.; Kasturiratne, K.T.A.A.; Pathmeswaran, A.; Wickremasinghe, A.R.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Incidence of stroke is declining in developed countries, but is increasing in developing countries. There is no data on incidence of stroke in Sri Lanka, and only limited data on prevalence of stroke. METHODS: We studied a population-based cohort (35-64 years) selected by stratified random sampling from an urban/semi-urban health administrative area (Ragama Health Study) in 2007, and evaluated them again in 2014 with regard to new onset stroke and prevalence of vascular risk factors. Possible stroke patients were independently reviewed by a neurologist and a physician with regard to the diagnosis of stroke. The prevalence of stroke (at baseline) was estimated. Prevalence of vascular risk factors in the population were compared between 2007 and 2014. RESULTS: The baseline cohort in 2007 consisted of 2985 individuals (females 54.5%, mean age 52.4 ± 7.8 years). Of them, 2204 attended follow-up in 2014 (female 57.6%, mean age 59.2±7.6 years). 19 had a history of strokes at enrolment (stroke prevalence 6.37/1000 population) and 24 episodes of strokes occurred over the 7 years (annual incidence of stroke 1.56/1000 population). Risk factor prevalence in 2007 and 2014 were; hypertension 48.7% and 64.3%; hyperlipidaemia 35.5% and 39.3%; diabetes mellitus 28.2% and 35.7%; and obesity 2.6% and 17.9%, respectively. CONCLUSION: Stroke incidence and prevalence rates of Sri Lanka lie between those of developed and developing countries. Prevalence of vascular risks have increased over time in this urban/semi urban Sri Lankan population.
Mortality in an urban cohort in Ragama, Sri Lanka
(BMJ Publishing Group, 2011) Vithanage, P.V.T.S.; Panapitiya, P.A.S.; Padmakumara, N.; Hemantha, S.; Kasturiratne, K.T.A.A.; Wickremasinghe, A.R.; Pathmeswaran, A.; Pinidiyapathirage, M.J.
INTRODUCTION: The leading causes of mortality in Sri Lanka are due to chronic diseases. We describe the mortality patterns in a 35–64-year-old urban cohort resident in Ragama, Sri Lanka and followed over 3 years. METHODS: A follow-up study was conducted among 2986 35–64 year olds randomly selected from the Ragama Medical Officer of Health area, Sri Lanka. A baseline survey was conducted from January to September 2007 and a follow-up survey was conducted from March to November 2010. Mortality data were obtained from next of kin and cause of death was verified from death certificates. RESULTS: There were 49 deaths during 9186.46 person years of observations. Of the 49 deaths, 11 were due to myocardial infarctions, 5 were due to strokes, 5 were due to other ischaemic heart disease and the rest included 6 due to cancer and 2 due to train accidents. The increase in mortality in men occurs after 45 years and in females it is observed later on. Mortality among men was more than twice as much as females (RR 7.96 vs 3.17 per 1000 person years). All cause mortality was significantly higher in diabetics. Mortality was not associated with hypertension, dyslipidaemia, smoking, central obesity, obesity or physical activity. Conclusions Diabetes Mellitus was significantly associated with all cause mortality. Other associations may have not been significant due to the small number of deaths.
Prevalence and risk factors for metabolic syndrome among aging adults in an urban Sri Lankan population
(Sri Lanka Medical Association, 2015) Kasturiratne, K.T.A.A.; Niriella, M.A.; de Silva, S.T.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Piyaratna, T.A.C.L.; Vithiya, K.; Kottachchi, D.; Ranawaka, U.K.; Jayasinghe, C.; Rajindrajith, S.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Metabolic syndrome (MetS) is assumed to be of high prevalence in the Asian region. However, its community prevalence and risk factors in South Asia is poorly studied. We determined the prevalence and risk factors for MetS among adults in an urban Sri Lankan population. METHOD: The study population consisted of 42-71 year old adults, selected by stratified random sampling from the Ragama Medical Officer of Health area. MetS was defined by the International Diabetic Federation criteria with ethnic specific cutoffs. Anthropometric measurements, blood pressure (BP) and body fat distribution estimates were made. Glycosylated hemoglobin, fasting serum lipids, serum alanine aminotransferase (ALT) and serum creatinine (SCr) with estimated glomerular filtration rate (eGFR) were determined. CKD was defined as GFR<60ml/min/1.72m2 (KDIGO/KDOQI classification), USS abdomen was performed to detect fatty liver and non-alcoholic fatty liver disease (NAFLD) was diagnosed on safe alcohol consumption (< 14 units/week for men, < 7 units/week for females) and absence of hepatitis B and C markers. RESULTS: 2155 (1244 [57.7%] women, mean age 59.2 years [SD, 7.7]) participated. 1014 (47.1%) [mean age 59.2 years (SD, 7.7), 256 (28.1%) men; 758 (60.9%) women] had MetS. On multivariate analysis female gender, abnormal total body fat and abnormal visceral fat level (>10%) and presence of NAFLD were independently associated with MetS. Age 65 or more, raised ALT and CKD were not associated with MetS. CONCLUSION: The prevalence of MetS among adults in this aging urban Sri Lankan community was high and is independently associated with female gender, abnormal body fat distribution and presence NAFLD.
Prevalence of dengue vector breeding habitats among selected Schools in Gampaha District of Sri Lanka
(Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2016) Radhika, N.M.L.; Gunathilaka, P.A.D.H.N.; Kasturiratne, K.T.A.A.; Abeyewickreme, W.
Aedes aegypti and Aedes albopictus are the vectors responsible for the transmission of dengue viruses in Sri Lanka. Gampaha District has been ranked as the second most Dengue affected area. Recently, health authorities have identified that over 54 percent of schools have dengue mosquito breeding sites. However, the entomological information on the dengue vectors in School premises are not available. Therefore, the present study was carried out to identify the different breeding sites of dengue vector mosquitoes within school premises of randomly selected schools in Gampaha District of Sri Lanka. The premises of the selected schools (n= 34) were surveyed from May to October in 2016 for the availability of potential breeding habitats and the presence of vector breeding through entomological surveys. Collected vectors were identified morphologically and categorized inn to species level. All data on breeding habitats and number of vectors identified were recorded. According to survey, out of 34 schools surveyed; infested water-holding containers by Ae. albopictus were observed at 16 schools (47, 05%). Tree holes (Bridelia retusa tree), leaf axils of banana tree and fallen leaves were observed as natural breeding sites while, discarded plastic food containers plastic paint containers, broken pet bottles, tire marks on the ground, water retaining flower pots and plastic barrels were observed as artificial breeding sites. Breeding of Ae. aegypti was not identified among the school premises surveyed. Improper management of solid waste has affected positively in creating suitable habitats for vector breeding. Therefore, continuous monitoring of dengue vector breeding habitats and school based vector controlling interventions should be implemented through proper awareness and active participation for eliminating breeding habitats.
Reasons for underutilization of healthy lifestyle centers: Perceptions of health care providers
(Sri Lanka Medical Association, 2019) Herath, H.M.T.P.; Perera, K.M.N.; Kasturiratne, K.T.A.A.
INTRODUCTION & OBJECTIVES: Healthy lifestyle centers (HLC) for screening for non-communicable diseases (NCDs) and providing referrals for management and lifestyle modification advice are a response to the growing burden of NCDs in Sri Lanka. Currently HLCs are underutilized by its target population (adults >35 years). The aim of this study was to explore the health care providers' perceptions reasons for underutilization of HLCs in Gampaha district of Sri Lanka. METHODS: Ten key informant interviews were held with health care providers of HLCs in Gampaha district selected by judgmental sampling. The data collected via semi-structured interviews were analyzed using thematic analysis. RESULTS: Perceived reasons emerged in-eight categories: Sense of healthiness - absence of symptoms stimulating deviations from a healthy lifestyle; Negative past experiences - related to individual health seeking behaviours and outcomes; Clients' attitudes - dissatisfaction and mistrust towards the services provided; Client's employment related - loss of income for daily wagers and difficulties in obtaining leave; Lack of awareness - as promotions have been confined in health care setup and no community level mechanisms; Service provider related - opening times of the center and lack of basic facilities for screening; Gender and social norms such as falling ill being an insult to masculinity and elderly women exercising being considered strange; Private sector - clients being able to afford and feasibly access private sector services. CONCLUSION: Service providers believe underutilization of HLCs is due to a diverse range of individual, service related, and societal level factors, some of which can be easily addressed.
Role of red cell distribution width in screening for Hb Etrait in population ccreening for hemoglobin disorders
(Lippincott Williams and Wilkins, 2014) Nishad, A.A.N.; de Silva, I.S.; Perera, H.L.; Pathmeswaran, A.; Kasturiratne, K.T.A.A.; Premawardhena, A.P.
The national screening policy for hemoglobinopathies uses the cutoffs for red cell indices mean corpuscular volume >80 and mean corpuscular hemoglobin >27, a strategy known to miss some individuals with Hb E trait (EBT), the most common abnormal hemoglobin in Sri Lanka. We wanted to determine if red cell distribution width (RDW) cutoff values would help in increasing the sensitivity of screening for Hb E trait. High-performance liquid chromatography was carried out as the gold standard to detect hemoglobinopathies and red blood cell parameters with colter counter. Receiver operating characteristic curve was drawn to determine the cutoff value for EBT against β-trait (BTT) and other anemias. Of the 504 patients, 246 had BTT, 110 had EBT, and 151 had other types of anemias. Mean (SD) RDW among patients with BTT was 16 (2.8), with EBT 14.5 (2.9), and with other anemias 15.8 (4.2) (P>0.001). With 14.45 as the cutoff for RDW and considering accepted values for mean corpuscular volume >80 and mean corpuscular hemoglobin >27, it gave a predictive sensitivity of 98.2% for EBT. By using RDW cutoff at 14.45 in addition to the accepted screening indices, sensitivity of Hb E trait detection went up to 98.2% from 86.6%. This study highlights the importance of taking RDW into consideration for screening
Safety of low dose subcutaneous adrenaline used as prophylaxis against acute reactions to anti-venom serum (AVS) in patients bitten by snakes
(Sri Lanka Medical Association, 2002) Dassanayake, A.S.; Karunanayake, P.; Kasturiratne, K.T.A.A.; Fonseka, M.M.D.; Wijesiriwardena, B.; Gunatilake, S.B.; de Silva, H.J.
INTRODUCTION: Low dose subcutaneous adrenaline significantly reduces acute adverse reactions to AVS in patients envenomed following snake bite. OBJECTIVES: To further study the safety of low dose subcutaneous adrenaline. METHODS: We prospectively studied patients with snake bite envenoming in two units of the Colombo North Teaching Hospital, Ragama, from April 2000 to October 2001. Patients who satisfied inclusion criteria were given 0.25ml 1:1000 adrenaline subcutaneously immediately before administration of AVS. They were observed for adverse effects, and pulse and blood pressure (BP) were recorded before and at frequent intervals for one hour after giving adrenaline. In patients who developed reactions to AVS, subsequent pulse and BP measurements were not included for analysis. Results: 51 patients [M:F=35:16; mean age 34.8yrs (SD 14)] were included in the study. No significant changes in mean pulse rate or BP were observed following administration of subcutaneous adrenaline. Adverse reactions to AVS occurred in 15 (29.4%) patients. There were 4 (7.8%) other complications: one (2%) death due to suspected intracerebral haemorr-hage in a 65yr old man who also had coagulopathy, and developed an adverse reaction to AVS which required treatment with adrenaline; 3 (5.9%) patients, who also had coagulopathy, developed small haematomas at the subcutaneous injection site. CONCLUSIONS: Low dose subcutaneous adrenaline did not cause significant changes in pulse rate or BP. The 3 small haematomas could be directly attributed to the injection. Although the death is unlikely to be directly related to subcutaneous adrenaline, we suggest further studies on the safety of this prophylactic treatment before recommending its routine use.
Safety of subcutaneous adrenaline as prophylaxis against acute adverse reactions to anti-venom serum in snakebite
(Sri Lanka Medical Association, 2002) Dassanayake, A.S.; Karunanayake, P.; Kasturiratne, K.T.A.A.; Fonseka, M.M.D.; Wijesiriwardena, B.; Gunatilake, S.B.; de Silva, H.J.
OBJECTIVES: To study the safety of low dose subcutaneous adrenaline given as prophylaxis against acute adverse reactions to anti-venom serum(AVS) in patients bitten by snakes. METHODS: Patients admitted with snakebite envenoming who satisfied inclusion criteria were given 0.25 ml of 1:1000 adrenaline subcutaneously immediately before administration of AVS. They were observed for adverse effects, and pulse and blood pressure (BP) were monitored. RESULTS: 51 patients [35 males, mean age 34.8 years (SD 14)] were included in the study. Adverse reactions to AVS occurred in 15 (29.4%) patients. There was one death from suspected cerebral haemorrhage, and 3 (5.9%) patients developed small haematomas at the subcutaneous injection site. There were no significant changes in mean pulse or BP following administration of subcutaneous adrenaline. CONCLUSIONS: Low dose subcutaneous adrenaline did not cause significant changes in pulse rate or BP. Although the death was unlikely to be directly related to subcutaneous adrenaline, we suggest further studies on the safety of this prophylactic treatment before its routine use.
Stress level and associated factors among parents having a child with congenital heart disease less than six years of age attending the Lady Ridgeway Hospital for children
(Sri Lanka Medical Association, 2016) Athukorala, K.M.; Kasturiratne, K.T.A.A.
INTRODUCTION: Parents of children with Congenital Heart Disease (CHD) are easy victims of psychological ill-health. Assessment of stress level and its associated factors among them is vital to recognize high risk parents and to prevent them from becoming psychologically ill persons so that planning long term care for children for better outcome is feasible. OBJECTIVES: To determine the level of stress and associated factors among parents who are having children with congenital heart disease less than six years of age attending the cardiology clinic at the Lady Ridgeway Hospital for children (LRH). METHOD: A descriptive cross-sectional study was conducted among 380 parents of children with congenital heart disease less than six years of age attending the cardiology clinic at LRH, using an interviewer administered questionnaire based on the parental stress scale, perceived stress scale and the cardiologists’ perception on the medical severity scale. RESULTS: In the unemployed female predominate sample, the mean score on the parental stress scale was 29.95 (SD 7.3), while the mean score on the perceived stress scale was 14.37 (SD 5.1). Parental stress level was significantly higher with advanced age of parents and children, poor parental knowledge on CHDs and presence of extra cardiac deformities (p<0.01). CONCLUSIONS: Parents of children with CHDs are experiencing varying degrees of stress levels which are related to their age, age of the child, knowledge on CHDs and co-existing genetic disorders. When long term care for children with CHDs is planned, these parent related factors should be considered for better outcome.
Validation of the World Health Organization/ International Society of Hypertension (WHO/ISH) cardiovascular risk predictions in Sri Lankans based on findings from a prospective cohort study
(Public Library of Science, 2021) Thulani, U.B.; Mettananda, K.C.D.; Warnakulasuriya, D.T.D.; Peiris, T.S.G.; Kasturiratne, K.T.A.A.; Ranawaka, U.K.; Chakrewarthy, S.; Dassanayake, A.S.; Kurukulasooriya, S.A.F.; Niriella, M.A.; de Silva, S.T.; Pathmeswaran, A.; Kato, N.; de Silva, H.J.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: There are no cardiovascular (CV) risk prediction models for Sri Lankans. Different risk prediction models not validated for Sri Lankans are being used to predict CV risk of Sri Lankans. We validated the WHO/ISH (SEAR-B) risk prediction charts prospectively in a population-based cohort of Sri Lankans. METHOD: We selected 40-64 year-old participants from the Ragama Medical Officer of Health (MOH) area in 2007 by stratified random sampling and followed them up for 10 years. Ten-year risk predictions of a fatal/non-fatal cardiovascular event (CVE) in 2007 were calculated using WHO/ISH (SEAR-B) charts with and without cholesterol. The CVEs that occurred from 2007-2017 were ascertained. Risk predictions in 2007 were validated against observed CVEs in 2017. RESULTS: Of 2517 participants, the mean age was 53.7 year (SD: 6.7) and 1132 (45%) were males. Using WHO/ISH chart with cholesterol, the percentages of subjects with a 10-year CV risk <10%, 10-19%, 20%-29%, 30-39%, ≥40% were 80.7%, 9.9%, 3.8%, 2.5% and 3.1%, respectively. 142 non-fatal and 73 fatal CVEs were observed during follow-up. Among the cohort, 9.4% were predicted of having a CV risk ≥20% and 8.6% CVEs were observed in the risk category. CVEs were within the predictions of WHO/ISH charts with and without cholesterol in both high (≥20%) and low(<20%) risk males, but only in low(<20%) risk females. The predictions of WHO/ISH charts, with-and without-cholesterol were in agreement in 81% of subjects (ĸ = 0.429; p<0.001). CONCLUSIONS: WHO/ISH (SEAR B) risk prediction charts with-and without-cholesterol may be used in Sri Lanka. Risk charts are more predictive in males than in females and for lower-risk categories. The predictions when stratifying into 2 categories, low risk (<20%) and high risk (≥20%), are more appropriate in clinical practice.
Validation of the World Health Organization/ International Society of Hypertension (WHO/ISH) cardiovascular risk predictions in Sri Lankans based on findings from a prospective cohort study
(Ceylon College of Physicians, 2020) Thulani, U.B.; Mettananda, K.C.D.; Warnakulasuriya, D.T.D.; Peiris, T.S.G.; Kasturiratne, K.T.A.A.; Ranawaka, U.K.; Chackrewarthy, S.; Dassanayake, A.S.; Kurukulasooriya, S.A.F.; Niriella, M.A.; de Silva, S.T.; Pathmeswaran, A.P.; Kato, N.; de Silva, H.J.; Wickremasinghe, A.R.
INTRODUCTION AND OBJECTIVES: There are no cardiovascular(CV)-risk prediction models specifically for Sri Lankans. Different risk prediction models not validated among Sri Lankans are being used to predict CV-risk of Sri Lankans. We validated the WHO/ISH (SEAR-B) risk prediction charts prospectively in a population-based cohort of Sri Lankans. METHOD: We selected participants between 40-64 years, by stratified random sampling of the Ragama Medical Officer of Health area in 2007 and followed them up for 10-years. Risk predictions for 10-years were calculated using WHO/ISH (SEAR-B) charts with- and without-cholesterol in 2007. We identified all new-onset cardiovascular events(CVE) from 2007-2017 by interviewing participants and perusing medical-records/death-certificates in 2017. We validated the risk predictions against observed CVEs. RESULTS: Baseline cohort consisted of 2517 participants (males 1132 (45%), mean age 53.7 (SD: 6.7 years). We observed 215 (8.6%) CVEs over 10-years. WHO/ISH (SEAR B) charts with and without-cholesterol predicted 9.3% (235/2517) and 4.2% (106/2517) to be of high CV-risk ≥20%), respectively. Risk predictions of both WHO/ISH (SEAR B) charts with- and without-cholesterol were in agreement in 2033/2517 (80.3%). Risk predictions of WHO/ISH (SEAR B) charts with and with out-cholesterol were in agreement with observed CVE percentages among all except in high risk females predicted by WHO/ISH (SEAR B) chart with-cholesterol (observed risk 15.3% (95% Cl 12.5 - 18.2%) and predicted risk 2::20%). CONCLUSIONS: WHO/ISH (SEAR B) risk charts provide good 10-year CV-risk predictions for Sri Lankans. The predictions of the two charts, with and without-cholesterol, appear to be in agreement but the chart with-cholesterol seems to be more predictive than the chart without-cholesterol. Risk charts are more predictive in males than in females. The predictive accuracy was best when stratified into two categories; low (<20%) and high (≥20%) risk.