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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Pediatric emergencies(Samudra Medical Publications, 2022) Perera, P.; Rajindrajith, S.No abstract availableItem The establishment of a population-specific reference value for the ruler drop test for the clinical assessment of reaction time(Elsevier, 2023) Rajapaksha, S.; Kitulwatte, I.; Senarathne, U.; Edirisinghe, A.; Perera, P.BACKGROUND: Reaction time (RT) is the interval between a stimulus and an appropriate voluntary response in an individual. Alcohol is known to result in delayed RT. In Sri Lanka, an alleged drunken driver is legally subjected to a medico-legal examination to confirm or exclude impairment. The guideline for examining a drunk person in Sri Lanka includes the ruler drop test (RDT) as a test of RT. RDT is a simple test of visual reaction time in which the subject attempts to stop a falling ruler, and the height fallen is used to determine the time taken to react to the event. However, a formal study has yet to be carried out to establish population-specific reference values to interpret RDT results. METHODS: A cross-sectional descriptive study was conducted using 903 adults ≥18 years. A nonparametric approach was applied for deriving the reference values based on an inter-percentile interval. RESULTS: The study population consisted of 56.6% females, and the mean age of the participants was 41.6 years. Most (95%) of the study population could catch the ruler at or less than 40.0 cm of average height. The average height on RDT increased from younger to older age groups. However, subgrouping based on other variables, including sex, age, and alcohol consumption, did not show any statistically significant difference. CONCLUSIONS: The population-specific cut-off limit to identify alcohol intoxication by RDT in a Sri Lankan adult is 'average height' >40 cm.Item Efficacy of hydroxyurea in reducing the erythropoietic stress of ineffective erythropoiesis in transfusion dependent beta thalassaemia: A randomised, double-blind placebo-controlled clinical trial(Sri Lanka Association for the Advancement of Science, 2021) Yasara, N.; Premawardhena, A.; Perera, P.; Manamperi, A.; Mettananda, S.The unbalanced synthesis and accumulation of a-globin chains due to impaired synthesis of 0- globin results in the destruction of red blood cells (RBC) and erythroid precursors of patients with P-thalassaemia. This leads to an increased erythropoietic activity and ineffective erythropoiesis in the bone marrow of these patients. Hydroxyurea is a licenced medication that decreases the RBC destruction of patients with p-thalassaemia. However, its effect on erythropoietic stress is unclear. In this study, our objective was to evaluate the effect of hydroxyurea on erythropoietic stress of ineffective erythropoiesis in transfusion-dependent (TD) p-thalassaemia. This experimental study was carried out at the Thalassaemia Unit of Colombo North Teaching Hospital as part of a randomised, double-blind placebo-controlled clinical trial that evaluates the efficacy of hydroxyurea. We recruited 24 patients with TD p-thalassaemia who were taking hydroxyurea IQ- 20 mg/kg/day and 16 patients who were receiving a placebo. The erythropoietic stress of ineffective erythropoiesis was assessed by measuring serum soluble transferrin receptor (sTfR) levels before and six months after taking either hydroxyurea or placebo. Levels of sTfR were measured using a validated enzyme-linked immunosorbent assay. Paired t-test was used in the statistical analysis. Nineteen (79%) out of 24 patients who received hydroxyurea showed a reduction in sTfR level, of which 8 (33%) and 6 (25%) showed >25% and 10-25% reductions, respectively. A significant reduction in mean sTfR level was observed after hydroxyurea treatment (72.3±SD25.9) compared to pre-treatment levels (89.6士SD22.9), (pv0.01). Conversely, no difference in sTfR levels was seen in patients who received the placebo pre・(91.9土SD24.7) and post-treatment (96.4±SD19.4), (p=0.17). In conclusion, oral hydroxyurea significantly reduced the erythropoietic stress of ineffective erythropoiesis in patients with TD p-thalassaemia showing a promise as a treatment modality.Item Effects of indoor air pollution on the development of children under five years of age in Sri Lanka(MDPI, 2022) Ranathunga, N.; Perera, P.; Nandasena, S.; Sathiakumar, N.; Kasturiratne, A.; Wickremasinghe, R.Air pollution is a multifaceted environmental toxin affecting the Central Nervous System (CNS) through diverse pathways. The CNS of young children is particularly susceptible to the detrimental effects of toxins, as brain development continues postnatally with the formation of interneuronal connections, glial cell proliferation and myelination of axons. Indoor air pollution (IAP) from solid fuel combustion is more harmful than outdoor air pollution. Numerous air pollutants hazardous to health are released during the burning of unprocessed biomass. The primary source of fuel in Sri Lanka for cooking is biomass, mainly wood. In this study, we evaluated the influence of IAP resulting from biomass combustion on the neurodevelopment of children. In a cohort of children under five years living in a semi-urban area of Sri Lanka, neurodevelopment was assessed using Denver II developmental screening test. Air quality levels were measured (Carbon Monoxide (CO) and Particulate Matter 2.5 (PM2.5)) in a subsample. There were significantly high levels of CO and PM2.5 in the ambient air of households using biomass as the primary fuel for cooking. Children living in these households had a significantly higher number of children with ‘suspect’ developmental assessment scores in the language, social behavior and play and gross motor development domains.Item Effects of indoor air pollution due to solid fuel combustion on physical growth of children under 5 in Sri Lanka: A descriptive cross sectional study(Public Library of Science, 2021) Ranathunga, N.; Perera, P.; Nandasena, S.; Sathiakumar, N.; Kasturiratne, A.; Wickremasinghe, A.R.ABSTRACT: Solid fuel combustion is an important risk factor of morbidity. This study was conducted to determine the effect of indoor air pollution (IAP) due to solid fuel combustion on physical growth in 262 Sri Lankan children under five. Exposure was defined by the type of fuel used for cooking. Pollutant levels were measured in a subsample of households. "High" exposure group (households using biomass fuel/kerosene oil for cooking) comprised 60% of the study population; the prevalence of wasting was 19.7% and underweight was 20.4% in the entire population where 68% were from the high exposure group. Children from the "high" exposure group had significantly lower mean z-scores for weight-for-height (p = 0.047), height-for-age (p = 0.004) and weight-for-age (p = 0.001) as compared to the "low" exposure group (children of households using liquefied petroleum gas and/or electricity) after adjusting for confounders. Z-scores of weight-for-age, height-for-age and weight-for-height were negatively correlated with CO (p = 0.001, 0.018, 0.020, respectively) and PM2.5 concentrations (p<0.001,p = 0.024 p = 0.008, respectively). IAP due to combustion of biomass fuel leads to poor physical growth.Item Effect of household air pollution due to solid fuel combustion on childhood respiratory diseases in a semi urban population in Sri Lanka.(BioMed Central, 2019) Ranathunga, N.; Perera, P.; Nandasena, S.; Sathiakumar, N.; Kasturiratne, A.; Wickremasinghe, R.BACKGROUND:Household air pollution from combustion of solid fuels for cooking and space heating is one of the most important risk factors of the global burden of disease. This study was aimed to determine the association between household air pollution due to combustion of biomass fuel in Sri Lankan households and self-reported respiratory symptoms in children under 5 years. METHODS: A prospective study was conducted in the Ragama Medical Officer of Health area in Sri Lanka. Children under 5 years were followed up for 12 months. Data on respiratory symptoms were extracted from a symptom diary. Socioeconomic data and the main fuel type used for cooking were recorded. Air quality measurements were taken during the preparation of the lunch meal over a 2-h period in a subsample of households. RESULTS: Two hundred and sixty two children were followed up. The incidence of infection induced asthma (RR = 1.77, 95%CI;1.098-2.949) was significantly higher among children resident in households using biomass fuel and kerosene (considered as the high exposure group) as compared to children resident in households using Liquefied Petroleum Gas (LPG) or electricity for cooking (considered as the low exposure group), after adjusting for confounders. Maternal education was significantly associated with the incidence of infection induced asthma after controlling for other factors including exposure status. The incidence of asthma among male children was significantly higher than in female children (RR = 1.17; 95% CI 1.01-1.37). Having an industry causing air pollution near the home and cooking inside the living area were significant risk factors of rhinitis (RR = 1.39 and 2.67, respectively) while spending less time on cooking was a protective factor (RR = 0.81). Houses which used biomass fuel had significantly higher concentrations of carbon monoxide (CO) (mean 2.77 ppm vs 1.44 ppm) and particulate matter2.5 (PM2.5) (mean 1.09 mg/m3 vs 0.30 mg/m3) as compared to houses using LPG or electricity for cooking. CONCLUSION: The CO and PM2.5 concentrations were significantly higher in households using biomass fuel for cooking. There was a 1.6 times higher risk of infection induced asthma (IIA) among children of the high exposure group as compared to children of the low exposure group, after controlling for other factors. Maternal education was significantly associated with the incidence of IIA after controlling for exposure status and other variables.Item Moving from oral poliovirus vaccine to inactivated poliovirus vaccine in Sri Lanka: The rationale and challenges(Sri Lanka College of Paediatricians, 2017) Perera, P.Item Sequelae of BCG vaccination and effects of cleaning vaccine site with alcohol(Sri Lanka Medical Association, 2012) Perera, P.; Samaranayaka, G.; Samaranayaka, R.; Ranathunga, N.INTRODUCTION: In Sri Lanka, BCG vaccine is given during neonatai period. There are many myths regarding BCG vaccine among general public and sequelae of vaccination is not well documented in medical literature. AIMS: Objectives of this study were to describe the sequelae of BCG vaccination when given at neonatal period and to find out whether cleaning the vaccine site with 70% alcohol, affect its potency. METHODS: A prospective observational study was carried out at Ragama teaching hospital and 2 private hospitals in Gampaha district. 125 babies each from government and private sector were recruited for the study with the consent from parents. Vaccine was administered in the morning as well as evening, as required by the patient, by a consultant Paediatrician. Vaccine site was cleaned with 70 % alcohol and allowed to dry before vaccination. All babies were bathed on same day. Babies were followed up periodically until a scar was detected. RESULTS: 182 babies completed the follow up and all babies developed a scar. Time taken for a reaction varied but all babies had a reaction by 8 weeks and a scar by 14 weeks. 6 babies had fever within one week of vaccination but it was due to feeding failure or sepsis. None had adverse reactions attributable to the vaccine. CONCLUSIONS: Cleaning the vaccine site with alcohol does not affect the potency of BCG vaccine. Proper technique of administration is important for successful vaccination. Time of vaccination and bathing had no effect on efficacy or side effects.Item Knowledge of mothers regarding helminth infections and patterns of anthelminthic usage in children(Sri Lanka Medical Association, 2012) Perera, P.; Dissanayaka, D.; Fernando, M.; Ranathanga, N.INTRODUCTION: Intestinal helminth infections are a global problem. There are lot of misbelieves among people regarding helminth infections, which often leads to inappropriate use of anthelmintics. AIMS: To assess the knowledge of mothers regarding helminth infections and to describe the patterns of anthelmintic usage in children. METHODS: A descriptive cross sectional study was carried out at University Paediatric unit. Teaching hospital Ragama, during September 2011 to November 2011. Two Hundred children and their mothers admitted to the Paediatrics university unit with at least one child above 18 months were recruited with informed written consent. Socio-demographic data, availability of sanitary facilities and safe drinking water, knowledge on intestinal infections and practices related to anthelmintic treatment were collected using a pretested Interviewer administered questionnaire. RESULTS: Nearly all families had access to a safe toilet and 62% had safe drinking water. 84% of children had regular anthelmintic treatment and out of them 39.3% had 3 monthly, 55.3% six monthly and 5.3% annually. Out of them only 81.4% had risk factors to get helminth infections, while 36,9% had no evidence in the past of worm infection. There was no statistically significant association between regular anthelmintics usage and presence of risk factors (odds ratio 1.799, CI 0.849-3.815). Knowledge of mothers regarding transmission of worm infections and clinical features was poor. CONCLUSIONS: Considering the high literacy rate among Sri Lankan mothers knowledge about worm infections was surprisingly poor. A lot of children are receiving unnecessary anthelmintic treatment. Health education programs addressing these issues are indicated.Item Dental hygiene practices and the pattern of dental caries in preschool children in Ragama(Sri Lanka Medical Association, 2012) Perera, P.; Abeweera, N.; Fernanado, M.; warnakulasuria, T.W.; Ranathunga, N.INTRODUCTION: Dental caries is a common problem among preschool children, but often neglected as deciduas teeth are replaced later by permanent teeth. However, for many reasons, protecting deciduas teeth is very important. AIMS: The objectives of this study were to describe the prevalence of dental caries among preschool children and assess the utilization of dental care facilities. METHODS: A descriptive cross sectional study was done between August 2010 and October 2010 at child welfare clinics held in the Ragama MOH area. Consecutive children aged between 2 and 5 years attending the clinics were recruited with the consent of parents. An interviewer administered questionnaire was used to obtain data and the mouth was examined for caries. Total decayed-missing-filled (dmft) score and significant caries index (SIC) were calculated to describe the prevalence of dental caries. Care index was calculated to describe the use of dental services. RESULTS: Out of 410 children recruited, none had routine visits to a dentist. Though practices related to brushing teeth were satisfactory, 37.8% children in the study sample had caries. This increased to 68.8% by 5 years of age. Mean dmft score for the whole sample was 1.41 and SIC index was 4.09. The Care index was 4.72. The dmft score in girls was higher than boys. Incisors of the upper jaw were the mainly affected teeth. CONCLUSIONS: Prevalence of dental carries among this cohort of Sri Lankan preschool children is very high. The level of dental care for preschool children at present appears to be unsatisfactory.