Browsing by Author "Kumanan, T."

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Admission patterns and completeness of documentation of clinical features of head injuries in Accident and Emergency Unit of a Sri Lankan hospital for children
(College of Community Physicians of Sri Lanka, 2009) Kumarendran, B.; Kumanan, T.
INTRODUCTION: Accident and Emergency unit (AEU) of Lady Ridgeway Hospital for Children (LRH) provides outpatient care (OPD) and in-patient care (admissions). OBJECTIVE: To describe the pattern of admissions and completeness of documentation of clinical features of head injury cases admitted to AEU of LRH. METHODS: This was a clinical audit. Data on daily attendance at OPD and admissions from January 2003 - April 2009 were collected using bed head tickets, admission registers and monthly epidemiological reports at LRH. Pattern of admissions from 2003 to 2008 were described on a monthly and those from January to April 2009 on a daily basis. Completeness of documentation of clinical features of head injury was assessed using a check list developed for the purpose for 243 head injury cases admitted during March 2009. RESULTS: During 2003 to 2008, monthly attendance to OPD showed an increasing trend, while a reducing trend was observed in monthly admissions. During January to April 2009, median OPD attendance in morning (8am-2pm), evening (2pm-8 pm) and night (8pm-8am) shifts were 53(IQR:45,59), 35(IQR:32,40) and 15(IQR:12,17) respectively. Median admissions during these shifts was 9(IQR:7,11), 8(IQR:7,10) and 4(IQR:3,6) respectively. Number of medical officers listed for these shifts was 9, 7 and 2 respectively. Most admissions were for males (63.5%; n=445) and commonest age group was 2 to 3 years (26.2%, n=184). Proportion of head injury admissions for March 2009 was 34.7% (243/701). Date, time and signature were documented by, medical officers only in 30.9% (n =75), 10.3% (n=25) and11.1% (n=27) of BHTs. Documentation of presence/absence of selected symptoms on head injury included, nausea or vomiting (80.2%; n=195), unconsciousness (76.1%; n=185), headache (49.4%; n=120), fits (24.7%, n=60) and drowsiness (14.4%, n=35). Documentation of presence/absence of selected signs included site and side of injury in 41.6% (n = 101), diagram on site of injury in 8.6% (n=21), Glasgow Coma Scale (GCS) in 53.1% (n=123), clinical evidence of fracture in 63.8% (n=155) and ENT bleeding in 69.2% (n=178). CONCLUSION: Trend shows a rise in OPD attendance with a decline in IPC admissions. Documentation of clinical features of head injuries needs improvement.
Amoebic liver abscess in northern Sri Lanka: first report of immunological and molecular confirmation of aetiology
(Biomed Central, 2017) Kannathasan, S.; Murugananthan, A.; Kumanan, T.; Iddawala, D.; de Silva, N.R.; Rajeshkannan, N.; Haque, R.
BACKGROUND: Since 1985, amoebic liver abscess (ALA) has been a public health problem in northern Sri Lanka. Clinicians arrive at a diagnosis based on clinical and ultrasonographic findings, which cannot differentiate pyogenic liver abscess (PLA) from ALA. As the treatment and outcome of the ALA and PLA differs, determining the etiological agent is crucial. METHODS: All clinically diagnosed ALA patients admitted to the Teaching Hospital (TH) in Jaffna during the study period were included and the clinical features, haematological parameters, and ultrasound scanning findings were obtained. Aspirated pus, blood, and faecal samples from patients were also collected. Pus and faeces were examined microscopically for amoebae. Pus was cultured in Robinson's medium for amoebae, and MacConkey and blood agar for bacterial growth. ELISA kits were used for immunodiagnosis of Entamoeba histolytica infection. DNA was extracted from selected pus samples and amplified using nested PCR and the purified product was sequenced. RESULTS: From July 2012 to July 2015, 346 of 367 clinically diagnosed ALA patients admitted to Jaffna Teaching Hospital were enrolled in this study. Almost all patients (98.6%) were males with a history of heavy alcohol consumption (100%). The main clinical features were fever (100%), right hypochodric pain (100%), tender hepatomegaly (90%) and intercostal tenderness (60%). Most patients had leukocytosis (86.7%), elevated ESR (85.8%) and elevated alkaline phosphatase (72.3%). Most of the abscesses were in the right lobe (85.3%) and solitary (76.3%) in nature. Among the 221 (63.87%) drained abscesses, 93.2% were chocolate brown in colour with the mean volume of 41.22 ± 1.16 ml. Only four pus samples (2%) were positive for amoeba by culture and the rest of the pus and faecal samples were negative microscopically and by culture. Furthermore, all pus samples were negative for bacterial growth. Antibody against E. histolytica (99.7%) and the E. histolytica antigen were detected in the pus samples (100%). Moreover, PCR and sequencing confirmed these results. CONCLUSION: To our knowledge, this is the first report from Sri Lanka that provides immunological and molecular confirmation that Entamoeba histolytica is a common cause of liver abscesses in the region.
Epidemiology and factors associated with amoebic liver abscess in Northern Sri Lanka
(BioMed Central, 2018) Kannathasan, S.; Murugananthan, A.; Kumanan, T.; de Silva, N.R.; Rajeshkannan, N.; Haque, R.; Iddawela, D.
BACKGROUND: Clinically diagnosed amoebic liver abscess (ALA) caused by Entamoeba histolytica has been an important public health problem in Jaffna district, northern Sri Lanka for last three decades. In order to draw up a control strategy for elimination of this condition, knowledge of its epidemiology and factors associated with this condition in the local context is vital. METHODS: All clinically diagnosed ALA patients admitted to the Teaching Hospital, Jaffna during the study period were included in the study and the data were collected using an interviewer administered questionnaire. One hundred blood samples from randomly selected toddy (a local alcoholic drink consisting of the fermented sap of the Palmyrah palm) consumers and 200 toddy samples were collected. Toddy samples were cultured in Robinson's medium to establish the presence of Entamoeba histolytica in the sample. Climatic data and the total toddy sales in the district were obtained from the Meteorological and Excise Departments respectively. A sub group of randomly selected 100 patients were compared with 100 toddy consumers who were negative for E. histolytica antibody to explore the potential risk factors. RESULTS: Between July 2012 and July 2015, 346 of 367 ALA patients were enrolled in this study. Almost all patients (98.6%) were males with a history of heavy consumption of alcohol (100%). Almost all (94.2%) were within the age group 31-50 years. None of the cultured toddy samples grew E. histolytica. The monthly incidence of disease peaked in the dry season, matching the total toddy sales in the district. Age, type of alcohol and frequency of drinking were identified as potential risk factors whereas frequency of alcohol consumption and type of alcohol (consuming toddy and arrack) were identified as the independent risk factors. Moreover, the knowledge, attitude and practices towards ALA were poor among participants and the control group. CONCLUSIONS: Though the number of cases has declined in recent years, ALA still remains as an important public health problem in Jaffna district. The transmission route of E. histolytica leading to ALA has to be further explored. Moreover, greater awareness among the public who are at risk would be beneficial in order to eliminate the disease.
Persistence of amoebiasis in Northern Sri Lanka - a public health failure
(Ceylon College of Physicians, 2017) Kannathasan, S.; de Silva, N.R.; Kumanan, T.
No Abstract Available