Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item A time for change; causes for neonatal eye discharge at university postnatal and paediatric baby unit, Colombo North Teaching Hospital(Sri Lanka College of Obstetricians and Gynaecologists, 2010) Dayasiri, M.B.K.C.; Perera, K.P.J.PURPOSE: Low prevalence of neonatal eye discharge is related to quality obstetric and early neonatal care and absence of maternal sexually transmitted infections. Corneal ulceration and staphyloma formation are already recognized complications of neonatal conjunctivitis and it can also lead to neonatal sepsis and subsequent severe complications. This study was aimed to identify the causes for neonatal eye discharge. METHODS: Retrospective study was carried out involving all the neonates who had eye discharge in the university post natal and pediatric baby unit, during past 2 years. Information was gathered from 138 cases with regard to onset of eye discharge, aetiology for eye discharge as confirmed by eye swab culture and, demographic factors. RESULTS: Majority had been acquired during the early neonatal period {1 st week=88%, 2nd week=8.7%). Common causes for eye discharge had been Staphylococcus aureus (48%), coagulase negative staphylococcus (33%). Methicillin resistant staphylococcal infection was present among 10%. Pseudomonas (1%) and Streptococcus (3%) were also reported in minority. CONCLUSIONS: Majority of the causes had been normal flora of the female genital tract. Prevalence of sexually transmitted infections was 0%. However, prevalence of MRSA was significantly high compared to other studies in literature. The fact that 12% had been occurred after 1 st week would suggest a nosocomial origin and needs revision of the hygienic practice in post natal care.Item Factors affecting the compliance of SLMA asthma prophylactic guidelines in children(Sri Lanka Medical Association, 2001) Karunasekera, K.A.W.; Perera, K.P.J.INTRODUCTION: Guidelines to use prophylactic drugs in childhood asthma were laid down by SLMA in 1995. Yet a fair number of children we come across in clinical practice are not on prophylactic agents, though they are indicated. OBJECTIVE: To determine the compliance with SLMA asthm a prophylactic guidelines among patients admitted with asthma and to determine the socio-demographic factors affecting compliance. METHODS: All consecutive admissions to the university paediatric unit, Ragama Hospital between January 1996 and February 1998 with asthma (356) were included. Children admitted several times during the study period were included only on the 1st admission. Diagnosis of asthma was made clinically by-a consultant paediatrician. Details regarding frequency of asthma, severity, sleep disturbances, number of admissions to hospital, school absenteeism and use of prophylactic agents were obtained together with socio-demographic data. Chi-squared test was used as the statistical test. RESULTS: Only 18.2% of 251 children for whom asthma prophylactics were indicated were using prophylactic agents. 67.3% had one indication, 28.3% had two and 3.98% had three indications to use prophylaxis. Older age, male sex and monthly income of more than Rs.lO,000/= were found as significant factors for adhering to SLMA guidelines for asthma prophylaxis (p<0.05). Parental education and occupation did not show any significant association with the use of prophylaxis (p>0.05). CONCLUSIONS: Among the children in this study, boys older children and children from households with a monthly income over Rs. 10,0007= were more likely to use prophylactics.Item Prevalence of asthma and atopy among primary school children(Sri Lanka Medical Association, 2001) Karunasekera, K.A.W.; Perera, K.P.J.INTRODUCTION : Prevalence of asthma and atopy among school children in Sri Lanka is not known. Objectives : To estimate prevalence of asthma and atopy in children between 5-11 years and to determine the influence of sex and age on the prevalence of asthma. METHODS: A total of 2043 children between 5-11 years of 3 mixed schools in Gampaha district were screened for symptoms of asthma and atopy using a questionnaire in August 1998. Diagnosis of asthma was based on the presence of 3 symptoms of the following 5 in the preceding 12 months; cough at night, breathlessness, wheezing, persistent cough more than a week after common cold and cough and/or chest tightness during or after playing. Chi squared test and Chi squared test for trend were used for analysis. RESULTS: Prevalence of asthma symptoms were cough at night 22.1%, breathiessness 17.2%, wheezing 22.6%, persistent cough after common cold 29.9% and cough or chest tightness with playing 11%. Prevalence of asthma based on questionnaire was 17.1 %, allergic rhinitis 10% and eczema 2.5%. The prevalence of asthma in males was not significantly different from that of females (p=0.4). There was a decreasing trend of the prevalence of asthma with increasing age. This trend was significant in girls (p= 0.01) but not in boys. CONCLUSIONS: Nearly one fifth of primary school children suffer from asthma and 10% have allergic rhinitis. There was no significant gender difference in Jhe prevalence of asthma in primary school children. There was a decreasing trend of the prevalence of asthma with increasing age in girls but not in boys.Item Cut off value of TSH for early prediction of poor neurodevelopment of 5 to 9 year old children in Sri Lanka(Sri Lanka Medical Association, 2012) Abeysuriya, V.; Perera, K.P.J.; Kasturiratne, A.; Wickremasinghe, A.R.INTRODUCTION AND AIMS: To assess the relationship between TSH and neuro-development of children between 5- 9 years of age and to identify the cutoff value of TSH for early prediction of poor neuro developmental outcome. METHODS: A descriptive cross sectional study was carried out in 20 randomly selected estates in the Ratnapura district of Sri Lanka from August to December 2010. A validated neurodevelopment assessment tool was used to assess the neuro-development of 1683 randomly selected children. Neuro¬development was expressed as a General Quotient (GQ) score and a score <100 was identified as evidence of poor neuro-development Of 1683 children screened, 519 were randomly selected with consent from the parents; blood was assayed for TSH using the 3rd generation TSH Chemiluminescent immunometric assay. ROC curve analysis was used to find out the cut off value of TSH that best predicts poor neuro¬development in children. RESULTS: Of 519 children whose TSH levels were assayed, 494 had TSH levels within the normal range between 0.60 to 5.40 ulU/ml, of whom 16% had a GQ score <100. There was a significant association between TSH levels and neuro-development [p=0.0001). The best cutoff value of TSH to predict a GQ score <100 was 1.5 p.IU/ml. [Area under cure=73.4%, sensitivity= 97.0% and specificity =70.6%). CONCLUSIONS: The best cutoff value of TSH for prediction of poor neuro-development in children 5 to 9 years of age is 1.50 p.IU/ml.Item Study on immunity against Hepatitis B in children after vaccination during infancy(Sri lanka Medical Association, 2015) Perera, K.P.J.; Hapugoda, M.; Fernando, K.M.D.; Dimal, D.A.INTRODUCTION AND OBJECTIVES: Hepatitis B vaccine is given in Sri Lanka to all infants at 2, 4,6 months. As a low prevalent country the risk of acquiring Hepatitis B is more likely during adolescence and later. It is important to know whether immunity produced by vaccination during infancy last up to this stage, or a booster dose is needed to augment the immune response. METHOD: With informed written consent and assent from children, 150 ten year old school children with evidence of Hepatitis B vaccination during infancy, were tested for Hepatitis B antibody status using ELISA. Children who had an antibody titre less lOmlU/mL were offered a free booster dose. Antibody levels were retested one month after the booster. RESULTS: 128 (67%) had an antibody titre above 10m ID/ml. All children with a titre <10mlU/ml, accepted the booster dose. All children who received the booster had an antibody response above 10mlU/l, while (72%) had a titre >100mlU/l. CONCLUSION: Vaccination against Hepatitis B during infancy appear to produce protective level of antibodies at ten years of age. Even the children with antibody titres below protective level produced a sharp rise in titres with a booster dose. As this response could be expected with a natural infection, booster dose to augment the immune response produced by vaccination during infancy is not needed.Item The validation of the Sinhala version of the Kessler psychological distress scale (K10) to screen for psychiatric morbidity(Sri Lanka Medical Association, 2008) Wijeratne, L.T.; Williams, S.S.; Peris, M.U.P.K.; de Silva, N.R.; Hapuarachchi, H.A.C.; Perera, K.P.J.; Kawamura, N.; Wickremasinghe, A.R.BACKGROUND: The Kessler psychological distress scale (K10), used in epidemiological surveys, measures psychological distress. High scores in community surveys are associated with anxiety and affective disorders, and to a lesser extent, with other psychiatric disorders. OBJECTIVE: To validate the Sinhala translations of the long (K10) and short (K.6) versions of the Kessler psychological distress scale. DESIGN, SETTING AND METHODS: The English version of K10 was translated into Sinhala. Content and face validity was assessed by experts. The scales were pre-tested and modified accordingly. The Sinhala versions of K6 and K10, and the Structured Clinical Interview Schedule were administered to 20 adults with major psychiatric illnesses diagnosed by two clinicians independently, and to a random sample of 25 apparently normal people from the community. SPSS (Version 11) was used for the analysis. RESULTS: The ROC curve for the K10 contained 96.1% of the area under the curve of 0.961 (95% CI 90.4%-100%). A cut off score of 22 for the K10 yielded a sensitivity of 93.8% and a specificity of 82.6%. The ROC curve for the K6 contained 90.1% (95% CI 80.5% - 99.7%) of the area under the curve. For the K6, a cut off score of 13 gave a sensitivity of 88.2% and a specificity of 72%, The total number of days that the patient could not attend to regular work and responsibilities was significantly correlated with both the K10 (p=0.041) andK6 (p=0.023). CONCLUSION: The Sinhala version of the K10 and K6 questionnaires can be used to screen for psychological distress.Item Animal bites in children: reasons for delay in seeking medical help(Sri Lanka Medical Association, 2008) Peiris, M.A.C.; Perera, K.P.J.; Adhihetty, D.; Goonewardena, A.R.; Mettananda, D.S.G.OBJECTIVE: To describe the clinical characteristics of animal bites in children and to determine the reasons for delay in seeking medical help DESIGN, SETTING AND METHODS: A descriptive study was conducted at the North Colombo Teaching Hospital in 2007. Consecutive children admitted following animal bites were recruited into the study until a sample of 100 was achieved. Children with snake and insect bites were excluded from the study. Data on clinical characteristics and treatment were obtained using an interviewer schedule. RESULTS: Sixty-five (65%) subjects were males. Mean age of children was 6.8(SD=3.2) years. Majority (88%) of bites were by dogs while cats, rats, monkeys and squirrels were responsible for the others. 68% of animals (67% of dogs) were domestic animals but only 14% were vaccinated. None of the domestic cats or squirrels was vaccinated. 72% were provoked bites and 81% had major exposures. Face, hands and fingers were the commonest places of bites. Following the bite 89% had washed the bite-site with soap and water and 6% had used antiseptics for cleaning. 75% came to the hospital within 24-hours while 16% presented after 72 hours. Commonest reason for delay was ignorance. There was no significant association between the delay in presentation and age or sex of the child, maternal educational level, number of children in the family, distance to the hospital, type of animal or the degree of exposure. CONCLUSION: Eighty-six percent of animal bites in children were by unvaccinated animals. One-fourth of children were brought to the hospital after 24 hours and the commonest reason for delay was ignorance.Item Community prevalence of childhood asthma and atopy(Sri Lanka Medical Association, 2005) Perera, K.P.J.; Rathnayake, A.; Wickramasinghe, N.; Muthukumarana, S.OBJECTIVES: To estimate prevalence of childhood asthma, allergic rhino conjunctivitis and eczema in the community using an interviewer administered questionnaire. To estimate the extent of prophylaxis usage in asthma. SETTINGS: A cross sectional descriptive study in 2003. METHOD: Sample consists of children between 6 months to 13 years (n=2005) in 4 PHM areas randomly selected from Ragama. Diagnosis was based on presence of symptoms in preceding 12 months. Information gathered using a pre-tested questionnaire. Study was ethically approved. Data analysis - Epi Info version 6. RESULTS: Mean age was 6.7 years and 52% were males. Asthma prevalence was 13%. Prevalence in infancy - 4%, 1-5 years -13%, 5-10 years - 15% and 10- 13 years - 11%. Prevalence in males -14%. In females -11% (p=0.03). Lifetime prevalence - 19%. Current wheezing rate - 1.6%. Prevalence of allergic rhinitis - 5%, allergic conjunctivitis 3% and eczema 0.8%. Of all asthmatics, 70% were mild intermittent, 23% mild persistent and 7% moderate persistent. 49% of those who required prophylaxis were already on prophylaxis. Of them, 92% on steroid inhalers. CONCLUSIONS: Prevalence of asthma and allergic rhinitis and eczema are less than when reported by parents (Parent reported prevalence were 23%, 11% and 3% respectively). The majority of asthma was mild intermittent type. Usage of prophylactic medications was nearly 50%.Item Feeding practices of children attending well baby clinics in Ragama MOH area: a descriptive cross sectional study(Sri Lanka Medical Association, 2011) Perera, K.P.J.; Fernando, M.; Warnakulasuria, T.; Ranathunga, N.INTRODUCTION AND OBJECTIVES: Feeding during early childhood is important for growth and health. Objectives of this study were to evaluate the current feeding practices during first few years of life among Sri Lankan children. METHODS: A descriptive cross sectional study conducted in Ragama MOH area during the period of 10th august 2010 and 30th October 2010. 410 children between 2 -5 years of age, attending well baby clinics were included in the study. Interviewer administered questionnaire was used to collect data regarding socio-demographic characteristics and feeding practices. Open ended questions were used. SSPS version 16 was used for data analysis. RESULTS: The study population consisted of 208 boys and 202 girls. 62.2% children were exclusively breastfed for 6 months. 351 have received formula milk. 61 had formula milk started before the age of 6 months and 212 by one year. 330 children had sugar added to formula milk. 144 of them had sugar added within first year. 29 children had complementary food started before 4 months. 294 mothers continued to breastfeed beyond 2 years and 41.6% of them were breast feeding at regular intervals. 82.5% children were receiving overnight feeding either as breast milk or formula beyond 2 years. . CONCLUSIONS: Though high rate of exclusive breast feeding is prevalent in Sri Lanka, there seem to be other issues related to feeding. Too early introduction of complementary food, adding sugar to formula, prolonged breast feeding too frequently and prolonged overnight feeding are among them.Item Prevalence of poor neuro-developmental outcome and hypothyroidism among 5-9 year-old children in the plantation sector of Sri Lanka(Sri Lanka Medical Association, 2011) Abeysuriya, V.; Perera, K.P.J.; Kasturiratne, A.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: To describe the prevalence of poor neuro-developmental outcome and its relationship to hypothyroidism among 5-9 year-old children in the plantation sector of Sri Lanka. METHODS: This descriptive cross-sectional study was conducted in 20 randomly selected estates in the Ratnapura district. Using a validated tool based on Griffiths mental development scale, neruo-developmental outcome of 1683 children aged 5-9 years was assessed. The results were expressed using the General Quotient (GQ) score [GQ score<100 = poor neruo-developmental outcome]. A 2ml blood sample was obtained from a sub-sample of 519 children after obtaining informed written consent from the parents/guardians and TSH level was assayed. Presence of clinical symptoms of hypothyroidism and visible/palpable goitre were assessed among those who had a TSH>5.4 u-IU/ml (biochemical hypothyroidism). RESULTS: GQ<100 was identified in 9.4% of children and a high TSH (>5.4uTU/ml) was detected in 3.7% of children. Low TSH (<0.6uiU/ml) was detected in 1.2%. The prevalence of poor neuro-developmental outcome with high TSH was 2.1%. There was no association between TSH levels and age and sex. TSH level was significantly associated with neuro-developmental outcome (p<0.001). 15.8% of children with biochemical hypothyroidism had clinical symptoms of hypothyroidism and goitre was visible or palpable in 15.7%. Poor neuro-developmental outcome was present in 58% of these children. CONCLUSIONS: Poor neuro-developmental outcome was evident in a large proportion of children with biochemical hypothyroidism without clinical features of hypothyroidism. These findings indicate a link between poor neuro-development and sub clinical hypothyroidism which has not been described before.