Browsing by Author "Mettananda, C."

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Anaemia among females in child-bearing age: Relative contributions, effects and interactions of α- and β-thalassaemia.
(Public Library of Science, 2018) Mettananda, S.; Suranjan, M.; Fernando, R.; Dias, T.; Mettananda, C.; Rodrigo, R.; Perera, L.; Gibbons, R.; Premawardhena, A.; Higgs, D.
INTRODUCTION: Anaemia in women during pregnancy and child bearing age is one of the most common global health problems. Reasons are numerous, but in many cases only minimal attempts are made to elucidate the underlying causes. In this study we aim to identify aetiology of anaemia in women of child bearing age and to determine the relative contributions, effects and interactions of α- and β-thalassaemia in a region of the world where thalassaemia is endemic. METHODS: A cross sectional study was conducted at the Colombo North Teaching Hospital of Sri Lanka. The patient database of deliveries between January 2015 and September 2016 at University Obstetrics Unit was screened to identify women with anaemia during pregnancy and 253 anaemic females were randomly re-called for the study. Data were collected using an interviewer-administered questionnaire and haematological investigations were done to identify aetiologies. RESULTS: Out of the 253 females who were anaemic during pregnancy and were re-called, 8 were excluded due to being currently pregnant. Of the remaining 245 females, 117(47.8%) remained anaemic and another 22(9.0%) had non-anaemic microcytosis. Of anaemic females, 28(24.8%) were iron deficient, 40(35.4%) had low-normal serum ferritin without fulfilling the criteria for iron deficiency,18(15.3%) had β-haemoglobinopathy trait and 20(17.0%) had α-thalassaemia trait. Of females who had non-anaemic microcytosis, 14(66.0%) had α-thalassaemia trait. In 4 females, both α- and β-thalassaemia trait coexist. These females had higher levels of haemoglobin (p = 0.06), MCV (p<0.05) and MCH (p<0.01) compared to individuals with only β-thalassaemia trait. A significantly higher proportion of premature births (p<0.01) and lower mean birth weights (p<0.05) were observed in patients with α-thalassaemia trait. CONCLUSIONS: Nearly one third of anaemic females in child bearing age had thalassaemia trait of which α-thalassemia contributes to a majority. Both α- and β-thalassaemia trait can co-exist and have ameliorating effects on red cell indices in heterozygous states. α-Thalassaemia trait was significantly associated with premature births and low birth weight. It is of paramount importance to investigate the causes of anaemia in women of child bearing age and during pregnancy in addition to providing universal iron supplementation.
Blood transfusion therapy for β-thalassemia major and hemoglobin E β-thalassemia: adequacy, trends, and determinants in Sri Lanka.
(John Wiley, 2019) Mettananda, S.; Pathiraja, H.; Peiris, R.; Wickramarathne, N.; Bandara, D.; de Silva, U.; Mettananda, C.; Premawardhena, A.
BACKGROUND: Regular blood transfusion therapy still remains the cornerstone in the management of β-thalassemia. Although recommendations are clear for patients with β-thalassemia major, uniform transfusion guidelines are lacking for patients with hemoglobin E β-thalassemia. In this study, we aim to describe the adequacy, trends, and determinants of blood transfusion therapy in a large cohort of pediatric patients with β-thalassemia major and hemoglobin E β-thalassemia. METHODS/PROCEDURE: This cross-sectional study was performed among all regularly transfused patents with β-thalassemia aged 2 to 18 years attending three large thalassemia centers in Sri Lanka. Data were collected using an interviewer-administered questionnaire, perusal of clinical records, and physical examination of patients by trained doctors. RESULTS: A total of 328 patients (male 47%) were recruited; 83% had β-thalassemia major, whereas 16% had hemoglobin E β-thalassemia. Sixty-one percent of patients had low pretransfusion hemoglobin levels (< 9.0 g/dL) despite receiving high transfusion volumes (> 200 mL/kg/year) by a majority (56%). Median pretransfusion hemoglobin was significantly lower in patients with hemoglobin E β-thalassemia compared with β-thalassemia major (P < 0.001); however, there was no difference in requirement for high transfusion volumes over 200 mL/kg/year in both groups (P = 0.14). Hepatomegaly and splenomegaly were more common in hemoglobin E β-thalassemia and were associated with lower pretransfusion hemoglobin. Transfusion requirements were higher among patients with hepatitis C and in those who are underweight. CONCLUSIONS: Over 60% of regularly transfused patients with β-thalassemia have low pretransfusion hemoglobin levels despite receiving large transfusion volumes. Patients with hemoglobin E β-thalassemia are undertransfused and specific recommendations should be developed to guide transfusions in these patients.
Body iron status of children and adolescents with transfusion dependent β-thalassaemia: trends of serum ferritin and associations of optimal body iron control
(Biomed Central, 2018) Suriyapperuma, T.; Peiris, R.; Mettananda, C.; Premawardhena, A.; Mettananda, S.
OBJECTIVE: This cross sectional study aims to describe the body iron status, trends of serum ferritin and associations of optimal body iron control in patients aged below 16 years with transfusion dependent β-thalassaemia attending Paediatric and Adolescent Thalassaemia Centres of the Colombo North Teaching Hospital of Sri Lanka. RESULTS: Out of 54 children, 51% were males and a majority were aged 11-16 years; 83% had β-thalassaemia major while 13% had HbE β-thalassaemia. Mean serum ferritin was 1778(± 1458) µg/l and 29% had optimal serum ferritin (below 1000 µg/l). Trend of mean serum ferritin over time showed gradual decline between 2011 and 2017 and longitudinal trend of individual patients at yearly intervals showed gradual rise until 5 years of age and plateauing thereafter. All except two patients were receiving iron chelator medication of which the most commonly used was oral deferasirox (92%). The most common iron-related complications were short stature (24.1%) and pubertal delay (42.8% of > 14 years). None of the patients had hypothyroidism, hypoparathyroidism or diabetes. Optimal serum ferritin levels were significantly associated with the diagnosis of thalassaemia at a later age (23.6 vs 9.0 months) and higher family income (OR-4.81;95%CI 1.17-19.67) however was not associated with the age of the patient or duration of transfusion.
Cardiovascular risk stratification in primary prevention of non-communicable diseases
(Ceylon College of Physicians, 2022) Mettananda, C.
No abstract available
Comparison of Risk Factors for Stroke Subtypes versus Acute Coronary Syndrome: A Population-Based Study
(Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2016) Mettananda, C.; Rothwell, P.; Li, L.; Mehta, Z.; Gutnikov, S.
Stroke and acute coronary syndromes (ACS) share risk factors, but population-based data on differential associations with stroke subtype and ACS are limited. We studied pre-morbid risk factors in stroke subtypes and acute coronary syndrome. We studied all first-ever TIA/strokes and ACS from 2002-2012 in a population-based cohort (Oxford Vascular Study). Risk associations were compared by logistic regression, adjusted for age and sex, for hypertension, diabetes mellitus, hyperlipidaemia, atrial fibrillation, current smoking and over-weight (BMI > 25). 1913 TIA/ischaemic strokes (mean age 71.6 years, women 53.9%), 112 intracerebral haemorrhages (ICH) (mean age 71.0 years, 51.8% women) and 1191 ACS (mean age 71.35 years, 35.4% women) were studied. Compared to ACS, hypertension (adjusted OR=1.34, 95%CI=1.15-1.56, p < 0.001), hyperlipidaemia (1.27, 1.07-1.50, p=0.006) and atrial fibrillation (1.40, 1.12-1.76, p=0.004) were more strongly associated with TIA/ischemic stroke than with ACS. However, diabetes mellitus (0.71, 0.57-0.88, p=0.002), current smoking (0.62, 0.51-0.75, p= < 0.001) and over-weight (0.78, 0.65-0.93, p=0.007) were negatively associated with TIA/ischemic stroke compared with ACS. For ICH, hypertension (1.85, 1.22-2.81, p=0.004) was more strongly associated than with ACS, whereas hyperlipidaemia (0.56, 0.32-0.97, p=0.039), current smoking (0.40, 0.21-0.74, p=0.004) and over-weight (0.64, 0.42-0.99, p=0.045) were negatively associated. When ICH was compared with TIA/ischemic stroke, the negative associations with hyperlipidaemia (0.43, 0.25-0.74, p=0.002) remained. Results were unchanged after exclusion of TIA. Diabetes mellitus, current smoking and obesity are more strongly associated with ACS than with stroke, whereas hypertension is a stronger risk factor for ischaemic and haemorrhagic stroke. Hyperlipidaemia is negatively associated with ICH.
Development and validation of a cardiovascular risk prediction model for Sri Lankans using machine learning.
(Public Library of Science, 2024-10) Mettananda, C.; Sanjeewa, I.; Arachchi, T.B.; Wijesooriya, A.; Chandrasena, C.; Weerasinghe, T.; Solangaarachchige, M.; Ranasinghe, A.; Elpitiya, I.; Sammandapperuma, R.; Kurukulasooriya, S.; Ranawaka, U.; Pathmeswaran, A.; Kasturiratne, A.; Kato, N.; Wickramasinghe, R.; Haddela, P.; De Silva, J.
INTRODUCTION AND OBJECTIVES Sri Lankans do not have a specific cardiovascular (CV) risk prediction model and therefore, World Health Organization(WHO) risk charts developed for the Southeast Asia Region are being used. We aimed to develop a CV risk prediction model specific for Sri Lankans using machine learning (ML) of data of a population-based, randomly selected cohort of Sri Lankans followed up for 10 years and to validate it in an external cohort.MATERIAL AND METHODS The cohort consisted of 2596 individuals between 40-65 years of age in 2007, who were followed up for 10 years. Of them, 179 developed hard CV diseases (CVD) by 2017. We developed three CV risk prediction models named model 1, 2 and 3 using ML. We compared predictive performances between models and the WHO risk charts using receiver operating characteristic curves (ROC). The most predictive and practical model for use in primary care, model 3 was named "SLCVD score" which used age, sex, smoking status, systolic blood pressure, history of diabetes, and total cholesterol level in the calculation. We developed an online platform to calculate the SLCVD score. Predictions of SLCVD score were validated in an external hospital-based cohort.RESULTS Model 1, 2, SLCVD score and the WHO risk charts predicted 173, 162, 169 and 10 of 179 observed events and the area under the ROC (AUC) were 0.98, 0.98, 0.98 and 0.52 respectively. During external validation, the SLCVD score and WHO risk charts predicted 56 and 18 respectively of 119 total events and AUCs were 0.64 and 0.54 respectively.CONCLUSIONS SLCVD score is the first and only CV risk prediction model specific for Sri Lankans. It predicts the 10-year risk of developing a hard CVD in Sri Lankans. SLCVD score was more effective in predicting Sri Lankans at high CV risk than WHO risk charts.
Efficacy and safety of oral hydroxyurea in transfusion-dependent β-thalassaemia: a protocol for randomised double-blind controlled clinical trial
(BMJ Publishing Group Ltd., 2020) Yasara, N.; Wickramarathne, N.; Mettananda, C.; Manamperi, A.; Premawardhena, A.; Mettananda, S.
INTRODUCTION: Despite being one of the first diseases to be genetically characterised, β-thalassaemia remains a disorder without a cure in a majority of patients. Most patients with β-thalassaemia receive only supportive treatment and therefore have a poor quality of life and shorter life spans. Hydroxyurea, which has shown to induce fetal haemoglobin synthesis in human erythroid cells, is currently recommended for the treatment of sickle cell disease. However, its clinical usefulness in transfusion-dependent β-thalassaemia is unclear. Here, we present a protocol for a randomised double-blind controlled clinical trial to evaluate the efficacy and safety of oral hydroxyurea in transfusion-dependent β-thalassaemia. METHODS AND ANALYSIS: This single-centre randomised double-blind placebo-controlled clinical trial is conducted at the Thalassaemia Centre of Colombo North Teaching Hospital, Ragama, Sri Lanka. Adult and adolescent patients with haematologically and genetically confirmed transfusion-dependent β-thalassaemia are enrolled and randomised into the intervention or control group. The intervention group receives oral hydroxyurea 10-20 mg/kg daily for 6 months, while the control group receives a placebo which is identical in size, shape and colour to hydroxyurea without its active ingredient. Transfused blood volume, pretransfusion haemoglobin level, fetal haemoglobin percentage and adverse effects of treatment are monitored during treatment and 6 months post-treatment. Cessation or reduction of blood transfusions during the treatment period will be the primary outcome measure. The statistical analysis will be based on intention to treat. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Ethics Committee of Faculty of Medicine, University of Kelaniya (P/116/05/2018) and the trial is approved by the National Medicinal Regulatory Authority of Sri Lanka. Results of the trial will be disseminated in scientific publications in reputed journals.
Epidemiology of stroke subtypes and aetiology among Sri Lankan stroke patients
(Sage Publishing, 2020) Mettananda, C.; Wettasinghe, L,; Eshani, M.D.P.; Ranawaka, U.
BACKGROUND AND AIMS: Prevalence of stroke is on the rise in south Asia and the epidemiology is different to western countries. However, prevalence of stroke subtypes and aetiology is not reported of Sri Lanka. Therefore, we aimed to describe the same of Sri Lanka. METHODS: We analyzed all the acute stroke admissions to a stroke unit of a tertiary care hospital in Sri Lanka over 5 year from October 2013 to 2018. Data were collected prospectively using an interviewer administered questionnaire by interviewing patients and perusing medical records. Ischaemic strokes were classified on OCSP (Oxfordshire Community Stroke Project) and TOAST(Trial of Org 10172 in Acute Stroke Treatment) classifications RESULTS: 891 patients were admitted to stroke unit over 5 years; 765(85.5%) ischaemic strokes, 129 (14.5%) intracerebral haemorrhages (ICH), and 0(0%) sub-arachnoid haemorrhages (SAH). Of the ischemic strokes 16(1.8%) were total anterior circulation, 253(29.0%) partial anterior circulation, 543(62.3%) lacunar, 59(6.8%) posterior circulation infarcts on OCSP classification. 542 of ischaemic stroke patients who had complete investigations for TOAST classification were studied for aetiology of stroke. Atrial fibrillation was reported in only 14(2.7%) and more than 50% carotid stenosis was seen in 22(4.1%) ischaemic stroke patients. 17(3.1%) were of large artery atherosclerosis, 369(68.1%) small vessel occlusion, 11(2.0%) cardioembolic and 145(26.8%) undermined aetiology. CONCLUSIONS: Prevalence of ischaemic strokes, ICH and SAH were not different to western statistics in this Sri Lankan cohort of stroke patients. However, cardio-embolic and large artery strokes were less common compared to west and lacunar strokes were the commonest of ischemic strokes.
Glycaemic control and avenues for improvement among people with type 2 diabetes mellitus from rural Sri Lanka – a retrospective cohort study
(Elsevier, 2023) Mettananda, C.; Chathuranga, U.; Rathnayake, T.; Luke, N.; Meegodavidanage, N.
BACKGROUND The majority of Sri Lankans and South Asians are rural dwellers but follow-up data on glycaemic control and its associations in rural communities are sparse. We followed up a cohort of hospital-based rural Sri Lankans with diabetes from diagnosis up to 24-months. METHODS We conducted a retrospective cohort study of people with type-2 diabetes (T2DM) diagnosed 24 months before enrolment who were being followed up at Medical/Endocrine clinics of five hospitals selected by stratified random sampling in Anuradhapura, a rural district of Sri Lanka from June 2018 to May 2019 and retrospectively followed them up to the diagnosis of the disease. Prescription practices, cardiovascular risk factor control and their correlates were studied using self-administered and interviewer-administered questionnaires and perusing medical records. Data were analysed using SPSS version-22. FINDINGS A total of 421 participants [mean age 58.3 ± 10.4 years, female 340 (80.8%)] were included in the study. Most participants were started on anti-diabetic medications in addition to lifestyle measures. Of them, 270 (64.1%) admitted poor dietary-control, 254 (60.3%) inadequate medication-compliance and 227 (53.9%) physical inactivity. Glycaemic control was assessed mainly on fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c) data were available in only 44 (10.4%). Target achievements in FPG, blood pressure, body mass index and non-smoking at 24-months following initiation of treatment were 231/421 (54.9%), 262/365 (71.7%), 74/421 (17.6%) and 396/421 (94.1%) respectively. INTERPRETATION In this cohort of rural Sri Lankans with type-2 diabetes mellitus, all were started on anti-diabetic medications at the diagnosis, but glycaemic target achievement was inadequate at 24 months. We identified the major patient-related reasons for poor blood glucose control were poor compliance with diet/lifestyle and/or medications and misconceptions about antidiabetic medications.
Health related quality of life among children with transfusion dependent β-thalassaemia major and haemoglobin E β-thalassaemia in Sri Lanka: a case control study.
(BioMed Central, 2019) Mettananda, S.; Pathiraja, H.; Peiris, R.; Bandara, D.; de Silva, U.; Mettananda, C.; Premawardhena, A.
BACKGROUND:Thalassaemia is a chronic disease without an effective cure in a majority. The clinical management has improved considerably during recent years; however, minimal attempts are made to up lift the quality of life among patients, especially in developing countries. Here we aim to describe and compare and to determine factors associated with health related quality of life among patients with transfusion dependent β-thalassaemia major and haemoglobin E β-thalassemia in Sri Lanka.METHODS:A case control study was conducted in the three largest thalassaemia centres of Sri Lanka. All patients with transfusion dependent β-thalassaemia (β-thalassaemia major and haemoglobin E β-thalassaemia) aged 5-18 years were recruited as cases whilst a randomly selected group of children without chronic diseases were recruited as controls. Socio-demographic and clinical data were collected using an interviewer-administered questionnaire and health related quality of life was measured using the validated Paediatric Quality of Life Inventory Version 4.0.RESULTS:Two hundred and seventy one patients with transfusion dependent β-thalassaemia (male-49.1%; mean age- 10.9 ± 3.6 years) and 254 controls (male-47.2%; mean age- 10.4 ± 3.5 years) were recruited. Mean health-related quality of life scores were significantly lower in patients compared to controls (72.9 vs. 91.5, p < 0.001). Of the patients, 224 (84%) had β-thalassaemia major and 43 (16%) had haemoglobin E β-thalassaemia. Quality of life scores in psychological health (p < 0.05), emotional functioning (p < 0.05) and social functioning (p < 0.05) were significantly lower in patients with haemoglobin E β-thalassaemia compared to β-thalassaemia major. Splenectomy (p < 0.05), short stature (p < 0.05), under nutrition (p < 0.05) and longer hospital stays (p < 0.05) were significantly associated with lower quality of life scores.CONCLUSIONS:Despite improvements in management, the quality of life among patients with β-thalassaemia still remains low. This is more pronounced in the subset of patients with haemoglobin E β-thalassaemia. Splenectomy, short stature, undernutrition and longer hospital stays were significantly associated with poor quality of life. It is timely, even in developing countries, to direct emphasis and to take appropriate steps to improve standards of living and quality of life of patients with β-thalassaemia.
Hypoglycaemia and fits in a thyrotoxic man
(BMJ Publishing Group, 2009) Mettananda, C.; de Silva, H.J.; Fernando, R.
We report prolonged severe hypoglycaemia with raised serum insulin levels in a Sri Lankan man with recently diagnosed Graves disease being treated with carbimazole. We diagnosed insulin autoimmune syndrome on the basis of raised anti-insulin antibody levels, and this diagnosis was supported by the subsequent course of the illness. The patient recovered completely after carbimazole was replaced with propylthiouracil and he was treated with dextrose infusions, frequent high-carbohydrate meals and a course of prednisolone.
Identification of patients with type 2 diabetes with non-alcoholic fatty liver disease who are at increased risk of progressing to advanced fibrosis: a cross-sectional study
(BMJ Publishing Group Ltd, 2023) Mettananda, C.; Egodage, T.; Dantanarayana, C.; Fernando, R.; Ranaweera, L.; Luke, N.; Ranawaka, C.; Kottahachchi, D.; Pathmeswaran, A.; de Silva, H.J.; Dassanayake, A.S.
INTRODUCTION: Identification of advanced hepatic fibrosis in non-alcoholic fatty liver disease (NAFLD) is important as this may progress to cirrhosis and hepatocellular carcinoma. The risk of hepatic fibrosis is especially high among patients with diabetes with NAFLD. Annual screening of patients with diabetes for fatty liver and calculation of Fibrosis-4 (FIB-4) score and exclusion of significant fibrosis with vibration-controlled transient elastography (VCTE) have been recommended. However, VCTE is expensive and may not be freely available in resource-limited settings. We aim to identify predictors of significant liver fibrosis who are at increased risk of progression to advanced liver fibrosis and to develop a prediction model to prioritise referral of patients with diabetes and NAFLD for VCTE. METHODS AND ANALYSIS: This cross-sectional study is conducted among all consenting adults with type 2 diabetes mellitus with NAFLD at the Colombo North Teaching Hospital, Ragama, Sri Lanka. All patients get the FIB-4 score calculated. Those with FIB-4 ≥1.3 undergo VCTE (with FibroScan by Echosens). Risk associations for progression to advanced liver fibrosis/cirrhosis will be identified by comparing patients with significant fibrosis (liver stiffness measure (LSM) ≥8 kPa) and without significant fibrosis (LSM <8 kPa). A model to predict significant liver fibrosis will be developed using logistic regression. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Ethics Committee of the Faculty of Medicine, University of Kelaniya (P/66/07/2021). Results of the study will be disseminated as scientific publications in reputable journals.
Incidence and time trends in prevalence of stroke and vascular risk factors in an urban Sri Lankan population: A population- based cohort study
(Asia Pacific Stroke Organization, Hong Kong Stroke Society and Jiangsu Stroke Association & karger publishing, 2017) Mettananda, C.; Wickramarathna, B.; Pathmeswaran, A.; Ranawaka, U.
BACKGROUND AND RATIONALE: Prevalence of stroke is increasing in developing countries. However, population data on time trends in prevalence of stroke in Sri Lanka not. METHODS: We screened a population-based cohort 35–64 year selected by stratified random sampling from an urban health administrative area in 2007 evaluated them again in 2014. Identified possible stroke patients were independently reviewed by a Neurologist and a Physician with regard to diagnosis and vascular risk factors. Incidence and time trends in prevalence of stroke and vascular risk factors in 50–65-year age group were compared between 2007 and 2014. RESULTS: Of 2985 baseline study population in 2007 (females 54.5%, mean age 52.4 ± 7.8 years), 2204 attended follow-up in 2014. Of them, 45 have had a stroke/TIA, (female 51.1%, mean age 52.9 ± 5.4 years). 25 (55.6%) of them were strokes within the 7 year follow up (annual incidence-1.66 per 1000 population). Prevalence of stroke in 50–65-year age group was of the 45 stroke patients reviewed in 2014, 28 (62.2%) had. Of 27 were definite strokes, 15 probable strokes and 3 TIAs. CONCLUSION: Prevalence has increased over time in urban Sri Lanka lie between developed and developing counties.
Inhaled beclomethasone in the treatment of early COVID-19: a double-blind, placebo-controlled, randomised, hospital-based trial in Sri Lanka
(BMJ Publishing Group Ltd, 2023) Mettananda, C.; Peiris, C.; Abeyrathna, D.; Gunasekara, A.; Egodage, T.; Dantanarayana, C.; Pathmeswaran, A.; Ranasinha, C.
OBJECTIVES: To study if early initiation of inhaled beclomethasone 1200 mcg in patients with asymptomatic, mild or moderate COVID-19 reduces disease progression to severe COVID-19. DESIGN: Double-blinded, parallel-groups, randomised, placebo-controlled trial. SETTING: A hospital-based study in Sri Lanka. PARTICIPANTS: Adults with asymptomatic, mild or moderate COVID-19, presenting within the first 7 days of symptom onset or laboratory diagnosis of COVID-19, admitted to a COVID-19 intermediate treatment centre in Sri Lanka between July and November 2021. INTERVENTIONS: All participants received inhaled beclomethasone 600 mcg or placebo two times per day, for 10 days from onset of symptoms/COVID-19 test becoming positive if asymptomatic or until reaching primary endpoint, whichever is earlier. PRIMARY OUTCOME MEASURE: Progression of asymptomatic, mild or moderate COVID-19 to severe COVID-19. SECONDARY OUTCOME MEASURES: The number of days with a temperature of 38°C or more and the time to self-reported clinical recovery. RESULTS: A total of 385 participants were randomised to receive beclomethasone(n=193) or placebo(n=192) stratified by age (≤60 or >60 years) and sex. One participant from each arm withdrew from the study. All participants were included in final analysis. Primary outcome occurred in 24 participants in the beclomethasone group and 26 participants in the placebo group (RR 0.90 ; p=0.763). The median time for self-reported clinical recovery in all participants was 5 days (95% CI 3 to 7) in the beclomethasone group and 5 days (95% CI 3 to 8) in the placebo group (p=0.5). The median time for self-reported clinical recovery in patients with moderate COVID-19 was 5 days (95% CI 3 to 7) in the beclomethasone group and 6 days (95% CI 4 to 9) in the placebo group (p=0.05). There were no adverse events. CONCLUSIONS: Early initiation of inhaled beclomethasone in patients with asymptomatic, mild or moderate COVID-19 did not reduce disease progression to severe COVID-19. TRIAL REGISTRATION NUMBER: Sri Lanka Clinical Trials Registry; SLCTR/2021/017.
Knowledge and adherence to National Institute of Clinical Excellence 2020, dyslipidaemia management guidelines and its associations among medical officers in Gampaha district, Sri Lanka: a descriptive study
(Sri Lanka College of Internal Medicine, 2023) Ansy, A.; Angunawala, A.; Anushika, E.; Ariyasena, S.; Aryachandra, S.; Fernando, K.; Mettananda, C.
INTRODUCTION: Dyslipidaemia is an important risk factor for cardiovascular diseases(CVD) and optimal management helps prevent CVD burden in a country. Knowledge of medical officers(MOs) on dyslipidaemia management is critical in this regard. We assessed knowledge and adherence of MOs of Gampaha district to the National Institute of Clinical Excellence (NICE) guideline 2020 on management of dyslipidaemia. METHODS: We conducted a cross-sectional study at five secondary/tertiary-care hospitals in Gampaha District in January 2022. Knowledge and adherence were studied using a self-administered questionnaire consisting of 25 multiple-choice questions. Each question was scored "1" and the cumulative score was converted to 100. A score >80 was considered "good knowledge and adherence" and its associations were studied using logistic regression. RESULTS: A total of 413 MOs (63.4% females, mean age 45±7.6 years) participated in the study. Of them, 73.1% had worked in a medical ward previously. The mean knowledge and adherence score was 77±9.3. Only 30% had a score >80. Good knowledge and adherence was significantly associated with being <45 years (p .004) in age, having work experience in a medical ward (p<.001), having post-graduate training (p<.001), working in a tertiary care hospital(p=.007), and involved in private practice(p=.002). There was no significant association with attendance at continuing medical education programmes (p=.320) or the duration of service(p=.120). CONCLUSIONS: Only a third of MOs of Gampaha district had good Knowledge and adherence to NICE-2020 dyslipidaemia guidelines. Knowledge and adherence to the guideline was better in MOs who are young, in postgraduate training, with previous experience in medical wards, working in tertiary care hospitals or engaged in private practice.
Knowledge and expectations of parents regarding the role of antibiotic treatment of upper respiratory tract infections - a survey among parents attending a tertiary care institution with a sick child
(Sri Lanka Medical Association, 2006) Premaratna, R.; Rajindrajith, S.; Mettananda, C.; Balasooriya, H.; Fonseka, J.; Randeny, S.; de Silva, H.J.
INTRODUCTION: Parents' knowledge and expectations regarding antibiotics contribute for antibiotic misuse inpaediatric practice. METHODS: Parents of children suffering from URTI, attending the OPD and Professorial Paediatric Unit of the Teaching Hospital, Ragama, were interviewed for knowledge, attitudes and practices during URTI pre-tested questionnaire by doctors from February to July 2005. Results: 235 parents (230 mothers) mean age 31.9 years (SD: 7.33) participated in the study. The level of education was; below grade 5:11 (4.7%), Grade 5-10: 142 (60.4%), grade 10-12:71 (30.2%) and higher education: 11 (4.7%). Of the 235,201 (85.1%) identified antibiotics as a component of treatment. However only 11 (4.7%) knew that antibiotics were against bacterial infections; 212 (90.3%), 189 (80.8%), 176 (75%), 165 (70.4%), 130(55,4%), 77 (32.8%) and55 (23.6%) identified them as treatment for cough, fever, phlegm, cold, sore throat, ear ache and headache either alone or combination. 116 (49.3%) and 119 (50.3%) thought that antibiotic treatment was important to cure the illness or for early recovery respectively. The expectation of being given an antibiotic for an URTI (always, 75%, 50% and 25% of the time and never) was 28 (12%), 39 (17%), 23 (10%), 119 (51%) and 23 (10%) respectively. Twenty (8.5%) had requested an antibiotic when it had not been prescribed; 12(60%) from apharmacy and 8 (40%) from the doctor. 172 (73%) claimed to complete the full course of treatment, while 18 (7.8%) kept the 'excess' antibiotics for future use. CONCLUSIONS: Knowledge, expectations, demand and self medication with antibiotics seems to be low among parents in our population.
Maternal knowledge on curative therapies and its impact on medical care and psychological health among children with thalassaemia in Sri Lanka
(Sri Lanka College of Paediatricians, 2022) Mettananda, S.; Pathiraja, H.; Peiris, R.; Bandara, D.; de Silva, U.; Mettananda, C.; Premawardhena, A.
Background: b-thalassaemia is an inherited disorder of haemoglobin synthesis which results in severe transfusion-dependent anaemia from infancy. Although considered a life-limiting disease, it can be cured by allogeneic haematopoietic stem cell transplantation and gene therapy. However, many patients and their families in developing countries are unaware of these treatment options. Objectives: To assess the maternal knowledge on curative therapies and to determine its association with the adequacy of current medical treatment and psychological health among children with b-thalassaemia. Method: We conducted a cross-sectional study at the three largest thalassaemia centres of Sri Lanka. All patients with transfusion-dependent b-thalassaemia aged 2-18 years were eligible for the study. Data were collected using an interviewer-administered questionnaire by interviewing mothers and from medical records. The questionnaire contained questions to gather information on socio-demographic background, clinical details and maternal knowledge on curative therapies for thalassaemia. The psychological morbidity of children was assessed using the previously validated ‘strengths and difficulties questionnaire’. Binary logistic regression was used in the analysis. Results: A total of 304 patients (mean age 9.8years; females 54%) were recruited. A majority (86%) of mothers knew that b-thalassaemia can be cured by haematopoietic stem cell transplantation; however, only 1% were aware of gene therapy. Detailed knowledge on curative therapies was lacking in most mothers; only 22% could identify suitable donors for transplantation. Maternal knowledge on curative therapies was associated with higher educational level and income of parents. Accurate maternal knowledge on haematopoietic stem cell transplantation was significantly associated with lower rates of hepatomegaly, splenomegaly, emotional symptoms, conduct symptoms, hyperactive symptoms and abnormal peer relationships in patients. Conclusions: This study demonstrated that maternal knowledge on curative therapies among patients with b-thalassaemia is sub-optimal. It further demonstrated that having an accurate maternal knowledge is associated with improved medical care and a lower prevalence of psychological symptoms among patients.
Novel therapies in clinical use for the management of hyperlipidaemia
(Sri Lanka College of Internal Medicine, 2023) Mettananda, C.
Optimal control of low-density lipoprotein cholesterol (LDLc) is identified as a major target in reducing cardiovascular disease burden globally. However, existing lipid-lowering therapies have not been able to achieve LDLc targets even in developed countries. Therefore, novel therapies for the management of hyperlipidaemia are being trialled. Currently, there are three main groups of newer medicines; bempedoic acid, PCSK9 inhibitors and inclisiran, in addition to statins and ezetimibe in use for the management of hyperlipidaemia. This article aims to introduce these newer medicines and their clinical use in the treatment of hyperlipidaemia.
Patient perspectives on barriers to participating in cardiac rehabilitation
(Ceylon College of Physicians, 2020) Mettananda, C.; Ismail, I.; Mettananda, S.
ABSTRACT: Despite proven benefits, attendance at cardiac rehabilitation (CR) is poor worldwide. We aimed to describe patient perspectives on barriers to attend CR in Sri Lanka. A cross-sectional study was conducted at cardiothoracic outpatient clinics of the National Hospital of Sri Lanka from May to July 2019. Post-cardiac surgery patients who were referred to CR but not attending them were recruited. 80 patients (male-51.3%, mean age 59.5±11.7 years) who were not attending CR were studied. 60% had to travel more than 50 km to attend CR. Main reasons for non-attendance were transportation difficulties (36%), non-availability of nearby CR centres (36%), unaware of being referred to CR due to communication lapses (35%) and lack of awareness of the importance of CR (31%). Therefore, providing clear information on cardiac rehabilitation, incorporating patient education programmes in cardiac surgery protocols and establishing new cardiac rehabilitation centres are recommended. KEYWORDS: Cardiac rehabilitation, Patient perspectives, Barriers, Sri Lanka
Perception of Sri Lankan medical students about teaching methods in medical schools.
(Yong Loo Lin School of Medicine., 2016) Mettananda, C.; Perera, S.; Jayakody, K.; Palihana, A.
AIMS: Although English is a second language, Sri Lankan medical students are also taught using the same teaching methods used in developed countries where English is the 1st language because there are no data on Sri Lankan medical students' views and expectation about the teaching methods used in medical schools. Therefore, we aimed to evaluate Sri Lankan Medical students perception on teaching methods used in medical schools. METHODS: We evaluated views and expectations on teaching methods of 3rd and 4th year medical students of Faculty of Medicine, University of Kelaniya, Sri Lanka in an observational study using a self-administered questionnaire. RESULTS: 102 3rd-year (mean age 23.4 years, female 64.7%) and 96 4th-year (mean age 24.3 years, female 74.0%) medical students volunteered for the study. All students have had> 55/100 marks for English language at Ordinary level (O/L) (year 11) exam, but only 88% had > 55/100 marks for English language at Advanced level (NL) (year 13) exam. Majority of students were form not so rural areas; Gampaha - 33%, Kurunegala -15% and Colombo - 14%. Half of the students were from families where their parents have studied only up to O/L. 78% students preferred lectures while 10%, 7% and 6% liked problem based learning (PBL), practical sessions and tutorials respectively as the teaching method of choice, but there was no significant association with their English results. The main reasons why they liked lectures were that they can get expert knowledge (57%) by attending lectures and that the lecturer knows the subject well (12%) than when it is taught as a PBL by few non-experts. Majority preferred to have 45 minutes long (74%), multimedia assisted (89%), interactive (75%) lectures. More than 85% students liked if the lecturer highlights the important aspects and especially if they relate it to exam and to practice as a doctor, use simple language to explain the subject and if handouts were given at the end. However, only 52% and 57% students viewed respecting students and giving cognitive breaks in-between lectures are important. The main reasons for students to attend a particular lecture depended on if the lecturer is a good teacher (87%), importance of topic to exam (82%) and to carrier as a doctor (74%). But the decision to attend lecture was not much related to appearance of the lecturer (13%), how famous the lecturer is (29%), the fact that lecture handouts are not given (18%) or the lecture being compulsory (39%). CONCLUSION: Views and expectations of this sample Sri Lankan medical students on teaching methods used in medical schools are more or less similar to that of developed world.