Browsing by Author "Peiris, R."

Now showing 1 - 10 of 10

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.
Challenges of costing a surgical procedure: a case study on hysterectomy
(Sri Lanka College of Obstetricians & Gynaecologists, 2018) Ranasinghe, S.W.; Liyanage, L.; Peiris, R.; Bandaranayake, H.; Ekanayake, C.D.; Pathmeswaran, A.; Kularatna, S.; Wijesinghe, P.S.
INTRODUCTION: It is vital to enquire in to cost of healthcare to ensure that maximum value for money is obtained with available resources. However, there is a dearth of information on cost of healthcare in lower-middle income countries. Our aim was to study the costs for three routes of hysterectomy in benign uterine conditions; total abdominal (TAH), non-descent vaginal (NDVH) and total laparoscopic hysterectomy (TLH). METHOD: A societal perspective with a micro-costing approach was applied to find out direct and indirect costs. Patients were recruited from a district general hospital (Mannar) and an urban tertiary care hospital (Ragama). The total cost incurred during pre-operative, operative, post-operative periods and convalescence included direct costs of labour, equipment, investigations, medications and utilities. Indirect costs included of out-of-pocket expenses, productivity losses, carer costs and travelling. Time-driven activity-based costing was used for labour costs and top down micro-costing was used for utilities. RESULTS: The median direct cost [(interquartile range), number] of TAH was Rs. 43054 [(41604 - 46243), n=24] versus Rs. 39430 [(37690 - 43054), n=25] (Mann-Whitney U test, p<0.01), NDVH was Rs. 40590 [(36965 - 44793), n=23] versus Rs.40155 [(36676 - 43779), n=26] (Mann-Whitney U test, p=0.984) and TLH was Rs. 47258 [(44359 - 51897), n=24] versus Rs. 53056 [(48128 - 55811), n=25] (Mann-Whitney U test, p=0.16) at Mannar and Ragama respectively. The median indirect cost (interquartile range) of TAH was Rs. 4204 (2174 12757) versus Rs. 9857 (5219 - 17251) (Mann-Whitney U test, p<0.05), NDVH was Rs.4349 (2174 - 8263) versus Rs. 10872 (5943 - 34646) (Mann-Whitney U test, p<0.01) and TLH was Rs. 6668 (2754 - 12902) versus Rs. 7538 (4929 - 21454) (MannWhitney U test, p=0.28) at Mannar and Ragama respectively. Sensitivity analysis using the best case scenario and a minimum wage of Rs. 1500 per day till time to recovery for TAH, NDVH and TLH showed a total cost of Rs. 87557, 78715 and 79150 respectively. CONCLUSION: Time-driven activity-based costing for labour and top down micro-costing of utilities helped to overcome logistical difficulties. Indirect costs at Ragama were significantly more than that at Mannar. Sensitivity analysis adjusted for the best case scenario and minimum wage suggested that NDVH and TLH may in fact be cheaper than TAH. The costing method used in this study is a simple and reproducible way of calculating costs of a surgical procedure which will serve as a guide for clinicians and policy makers in similar settings.
Comparison of one and two weeks of triple therapy for eradication of H. pylori: a randomized, controlled study in a tropical country
(Wiley Blackwell Scientific Publications, 2004) de Silva, H.A.; Hewavisenthi, J.; Pathmeswaran, A.; Navarathne, N.M.M; Peiris, R.; Dassanayake, A.S.; de Silva, H.J.
INTRODUCTION: Resistance of H. pylori to antibiotics may be particularly high in parts of the tropics. Infection may prove difficult to eradicate in such situations, and there is some evidence of benefit in increasing duration of treatment (triple therapy) from one week to two or three weeks. AIM : To assess the efficacy and tolerability of one-week versus two weeks triple therapy for eradication of H. pylori in a Sri Lankan population. METHODS: 82 consecutive patients aged 18–70 years with peptic ulcer disease testing positive for H. pylori infection (histology and rapid urease test on gastric antral biopsies) were randomly allocated to two treatment groups. The baseline characteristics of the two groups were similar. Both groups received omeprazole 20mg, clarithromycin 250mg, and tinidazole 500mg. Group A (n = 42) received the trial medication twice daily for one week and the Group B (n = 40) twice daily for two weeks. H. pylori eradication was defined as a negative 14C labeled urea breath test at two weeks after completion of therapy. The assessors were blind to randomization and other patient information. RESULTS; All patients presented for follow up after completion of therapy. H. pylori infection was eradicated in 36 (85.7%) patients in group A and 36 (90%) patients in group B (p = 0.9; 95% CI: -19.1 to 10.8). 23 (55%) patients in group A and 17 (43%) in group B reported adverse effects attributable to trial medication (p = 0.387); none were serious. 3 (7.5%) patients in group B discontinued treatment due to adverse events that developed on days 7, 9 and 10. CONCLUSION: Twice daily treatment with clarithromycin, tinidazole, and omeprazole for one-week is well tolerated and provides as good a rate of H. pylori eradication as two weeks therapy in Sri Lankan patients.
Comparison of one week and two weeks of triple therapy for the eradication of Helicobacter pylori in a Sri Lankan population: a randomised, controlled study
(Sri Lanka Medical Association, 2004) de Silva, H.A.; Hewavisenthi, J.; Pathmeswaran, A.; Dassanayake, A.S.; Navarathne, N.M.M.; Peiris, R.; de Silva, H.J.
INTRODUCTION: Resistance of Helicobacter pylori to antibiotics may be particularly high in parts of the tropics. Infection may prove difficult to eradicate in such situations, and there is some evidence of benefit in increasing the duration of treatment (triple therapy) from 1 week to 2 or 3 weeks. AIM: To assess the efficacy and tolerability of 1 week versus 2 weeks of triple therapy for eradication of H. pylori in a Sri Lankan population. METHODS: Eighty two patients aged 18-70 years with gastritis or peptic ulcer and testing positive for H. pylori infection were randomly allocated totwo treatment groups. Both groups received omeprazole 20 mg, clarithromycin 250 mg, and tinidazole 500 mg. Group A (n = 42) received the trial medication twice daily for 1 week and the Group B (n = 40) twice daily for 2 weeks. H. pylori eradication was defined as a negative 14C labelled urea breath test at 2 weeks after completion of the therapy. RESULTS: H. pylori infection was eradicated in 36 (85.7%) patients in Group A and 36 (90%) patients in Group B (p = 0.9). Twenty three (55%) patients in Group A and 17 (43%) in Group B reported adverse effects attributable to trial medication (p = 0.387); none were serious. Three (7.5%) patients in Group B discontinued treatment due to adverse events that developed on days 7, 9 and 10. CONCLUSION: Twice daily treatment with clarithromycin, tinidazole, and omeprazole for 1 week is well tolerated and provides as good a rate of H.pylori eradication as 2-week therapy in Sri Lankan patients.
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.
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.
Psychological morbidity among children with transfusion dependent β-thalassaemia and their parents in Sri Lanka
(Public Library of Science, 2020) Mettananda, S.; Peiris, R.; Pathiraja, H.; Chandradasa, M.; Bandara, D.; de Silva, U.; Mettananda, C.; Premawardhena, A.
BACKGROUND: Thalassaemia is a chronic disease which requires lifelong treatment in a majority. Despite recent advances in the medical care, minimal attempts are made to improve psychological health in these patients. In this study, we aim to describe the psychological morbidity in patients with transfusion dependent β-thalassaemia and their mothers in Sri Lanka. METHODS: This case control study was conducted in the three largest thalassaemia centres of Sri Lanka. All patients with transfusion dependent β-thalassaemia aged 4-18 years were recruited as cases whilst a randomly selected group of children without chronic diseases were recruited as controls. Psychological morbidity of children was assessed using the Strengths and Difficulties Questionnaire and depressive symptoms of mothers was assessed by the Centre for Epidemiological Studies Depression Scale. RESULTS: 288 transfusion dependent β-thalassaemia patients and equal number of controls were recruited. Abnormal emotional, conduct, hyperactivity and peer relationship symptom scores were reported by 18%, 17%, 9% and 14% of patients with thalassaemia respectively. Prevalences of abnormal psychological symptom scores in all domains were significantly higher among patients compared to controls. Abnormal conduct symptoms were significantly more prevalent among patients with HbE β-thalassaemia and those with suboptimal pretransfusion haemoglobin levels, lower transfusion volumes, hypothyroidism and undernutrition. Short stature was associated with abnormal emotional and hyperactivity scores. Depressive symptoms were significantly higher among mothers of patients with thalassaemia. Higher depressive symptom scores in mothers were significantly associated with abnormal emotional, conduct and peer relationship symptom scores in children. CONCLUSIONS: A higher proportion of patients with transfusion dependent β-thalassaemia had abnormal psychological symptom scores. Abnormal conduct symptoms were more prevalent among patients with HbE β-thalassaemia, those who were inadequately transfused and having hypothyroidism and undernutrition. Mothers of the children with transfusion dependent β-thalassaemia had significantly higher depressive symptoms which were significantly associated with psychological symptoms among children.
Quality of life and psychological morbidity among children with transfusion dependent thalassaemia and their parents
(Sri Lanka Medical Association, 2018) Mettananda, S.; Pathiraja, H.; Peiris, R.; Bandara, D.; de Silva, T.U.N.; Mettananda, K.C.D.; Premawardhena, A.
INTRODUCTION AND OBJECTIVES: Thalassaemia is a chronic illness which requires life-long supportive care. We aim to describe quality of life and psychological morbidity among children with transfusion-dependent thalassaemia and their parents.METHODS: This case-control study was conducted from September to December 2017. All patients with transfusion-dependent thalassaemia aged 2-18 years attending three largest thalassemia centers of Sri Lanka (Kurunegala, Anuradhapura and Ragama) were recruited as cases Children without chronic diseases admitting to same hospitals for acute non-life threatening illnesses were recruited as controls. Data were collected using an interviewer-administered questionnaire with validated questionnaires to measure quality of life (PedsQL 4.0 Generic core scales) and psychological morbidity (Strengths and difficulties questionnaire) of children and depressive symptoms of parents (Centre for epidemiological studies depression scale). Ethical approval was obtained from Ethics Committee of University of Kelaniya. RESULTS: 321 (male-46.4%; mean age-9 9±4 2years) cases and 194 (male-47.4% mean age- 8.9±3 7years) controls were recruited Mean quality of life score was significantly lower in cases (72.6±12.0%) compared to controls (88.6±11.6%), (p<0 001) Prevalence of psychological issues were significantly higher among patients with thalassaemia compared to controls in emotional (17 6% vs 0%; 2=32.8, p<0 001), conduct (18.6% vs 0 6%;2=35.4, p<0 001), hyperactive (9 5% vs 0%; 2=18 9 p<0.001) and peer relationship (14.4% vs 2 5%; 2=15 7 p<0 001) domains Significantly higher proportion of mothers of cases reported depressive symptoms compared to controls (40 1% vs 8.9%; 2=57 0 p<0.001).CONCLUSION: Patients with transfusion-dependent thalassaemia experience a poor quality of life and are victims of psychological and behavioural problems compared to their peers. Similarly, mothers of children with thalassaemia have higher prevalence of depression Psychological support should be an essential component in management of thalassaemia
The Role of private pesticide vendors in preventing access to pesticides for self-poisoning in rural Sri Lanka
(London : BMJ Pub. Group, 2014) Weerasinghe, M.; Pearson, M.; Peiris, R.; Dawson, A.H.; Eddleston, M.; Jayamanne, S.; Agampodi, S.; Konradsen, F.
In 15% to 20% of self-poisoning cases, the pesticides used are purchased from shops just prior to ingestion. We explored how pesticide vendorsinteracted with customers at risk of self-poisoning to identify interventions to prevent such poisonings. Two strategies were specifically discussed: selling pesticides only to farmers bearing identity cards or customers bearing pesticide 'prescriptions'. Vendors reported refusing to sell pesticides to people thought to be at risk of self-poisoning, but acknowledged the difficulty of distinguishing them from legitimate customers; vendors also stated they did want to help to improve identification of such customers. The community did not blame vendors when pesticides used for self-poison were purchased from their shops. Vendors have already taken steps to restrict access, including selling low toxic products, counselling and asking customer to return the next day. However, there was little support for the proposed interventions of 'identity cards' and 'prescriptions'. Novel public health approaches are required to complement this approach.