Medicine
Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12
This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
Browse
8 results
Search Results
Item Quality of care in the management of asthmatic children with regard to compliance with the guidelines in in-ward setting in a district of Sri Lanka: a descriptive study(College of Community Physicians of Sri Lanka, 2020) Abeysena, C.; Perera, N.INTRODUCTION: The quality of paediatric asthma management in the in-ward settings has not been assessed in Sri Lanka. OBJECTIVES: To describe the quality of care in the management of asthmatic children with regard to compliance with the guidelines. METHODS: A descriptive cross-sectional study was carried out in state hospitals with paediatric units in a district of Sri Lanka. A sample of 577 children diagnosed by a consultant paediatrician was selected. Eleven indicators were chosen by modified Delphi technique. Data collection instruments were an interviewer-administered questionnaire and a record sheet. Compliance with guidelines according to 11 indicators was expressed in percentages. RESULTS: The assessment of acute severity was 100%. The use of systemic corticosteroid at first prescription was 88.9% (n=513), whereas it was 69% (n=398) with oral steroid therapy and 54.5% (n=315) with long-term use of steroid inhaler. Assessment of chronic asthma severity was 31.2% (n=180). Caregivers who had received health education on triggering factors of asthma, on what to do during an asthma attack, and how to use the inhaler were 62.0% (n=358), 37.1% (214) and 68.8% (n=217), respectively. All patients have been issued a diagnosis card on discharge and among them, 74.4% (n=429)received a complete discharge summary and 90.6% (n=523) were scheduled for follow up appointments. CONCLUSIONS: Assessment of acute severity of asthma and the provision of diagnosis card on discharge were exceptional. Assessment of the severity of chronic asthma and providing health education for caregivers should be improved. Prescribing long term use of a steroid inhaler is to be revised. KEYWORDS: Children, Clinical, Indicators, Medication, PerformanceItem Knowledge on primary and secondary prevention of asthma among caregivers of asthmatic children admitted to paediatric wards in Gampaha District.(College of Community Physicians of Sri Lanka., 2019) Perera, N.; Abeysena, C.INTRODUCTION: Asthma is considered to be one of the major public health problems. The accurate knowledge of caregiver on asthma is important for the management. OBJECTIVES: To describe the knowledge on primary and secondary prevention of asthma among caregivers of asthmatic children admitted to the paediatric wards in the district of Gampaha. METHODS: A descriptive cross-sectional study was carried out among 577 caregivers of inward asthmatic children. Pre-tested interviewer- and self-administered questionnaires were used to assess the knowledge on asthma. The grand score of knowledge on asthma was calculated out of 34. The 75th percentile value was considered to differentiate ‘good’ knowledge from ‘poor’ knowledge. Multiple logistic regression was applied to determine the factors associated with poor knowledge on asthma. Results were expressed in adjusted odds ratio (aOR) and 95% confidence interval (CI). RESULTS: The mean score for knowledge on asthma was 20.6 (SD=4.42) ranging from 7 to 30. Among the caregivers, 369 (64%) had poor knowledge on asthma. Low educational level of the caregiver (aOR=2.48; 95% CI=1.59, 3.86) and being under prophylaxis treatment for less than one year (aOR=2.49; 95% CI=1.50, 4.13) were the determinants of poor knowledge on asthma. CONCLUSIONS: Majority of the caregivers’ knowledge on asthma was poor. The caregivers’ low educational level and shorter duration of prophylaxis treatment for the children were associated with poor knowledge on asthma.Item Association between functional abdominal pain disorders and asthma in adolescents: A cross-sectional study(Baishideng Publishing Group, 2018) Kumari, M.V.; Devanarayana, N.M.; Amarasiri, L.; Rajindrajith, S.AIM: To find the association between asthma and different types of functional abdominal pain disorders (FAPDs) among teenagers. METHOD : A cross-sectional study was conducted among 13 to 15-year-old children from six randomly selected schools in Anuradhapura district of Sri Lanka. Data were collected using translated and validated self-administered questionnaires (Rome III questionnaire, International Study on Asthma and Allergies in Childhood questionnaire, and Pediatric Quality of Life Inventory 4.0) and administered under an examination setting after obtaining parental consent and assent. RESULTS: Of the 1101 children included in the analysis, 157 (14.3%) had asthma and 101 (9.2%) had at least one FAPDs. Of children with asthma, 19.1% had at least one type of FAPDs. Prevalence rates of functional abdominal pain (FAP)(8.9% vs 3.3% in non-asthmatics), functional dyspepsia (FD) (2.5% vs 0.7%), and abdominal migraine (AM) (3.2% vs 0.4%) were higher in those with asthma (P < 0.05, multiple logistic regression analysis), but not in those with irritable bowel syndrome (4.5% vs 3.1%, P = 0.2). Severe abdominal pain (10.8% vs 4.6%), bloating (16.6% vs 9.6%), nausea (6.4% vs 2.9%), and anorexia (24.2% vs 16.2%) were more prevalent among asthmatics (P < 0.05). Lower gastrointestinal symptoms did not show a significant difference. Scores obtained for health related quality of life (HRQoL) were lower in those with asthma and FAPDs (P < 0.05, unpaired t-test). CONCLUSION: Asthma is associated with three different types of FAPDs, namely, FD, AM, and FAP. HRQoL is significantly impaired in teenagers with asthma and FAPDs.Item The Prevalence of asthma in Sri Lankan adults((Wiley Blackwell Scientific Publications, 2016) Amarasiri, D.L.; Undugodage, U.C.M.; Silva, H.K.M.S.; Sadikeen, A.; Gunasinghe, W.; Fernando, A.; Wickremasinghe, A.R.; Gunasekera, K.D.BACKGROUND AND AIMS: Data on adult asthma is scarce in Sri Lanka. The objective of this study was to estimate the prevalence of asthma and related symptoms amongst adults in the general population. METHODS: A multi-centered, cross-sectional study was conducted using an interviewer-administered translated version of the screening questionnaire of the European Community Respiratory Health Survey from June to December 2013 in 7 provinces of Sri Lanka. Subjects were selected randomly from different regions by stratified sampling. The prevalence of asthma was defined as "wheezing in the past 12 months (current wheeze)", 'self-reported attack of asthma in the past 12 months' or 'current asthma medication use'. RESULTS: The study comprised 1872 subjects (45.1% males, 48.8% aged18-45 years) of which 12.2% were current smokers. In the total population, the prevalence of current wheeze was 23.9% (95% CI: 22.0%-25.9%), of self-reported asthma was 11.8% (95% CI: 10.3%- 13.2%) and of current asthma medication use was 11.1% (95% CI: 9.6%- 12.5%). The prevalence of asthma according to a positive response to either of the above questions was 31.4% (95% CI: 29.3%-33.4%) The prevalence of symptoms was higher in adults aged >45 years. Of those with current wheeze, 60.9% denied a diagnosis of asthma and only 38.2% admitted to use of asthma medication. In those with current wheeze, wheezing was the only symptom in 19.9% whereas 80.1% had at least one other respiratory symptom (tightness of chest, cough or shortness of breath) of which cough was the most common symptom. In those without current wheeze, self-reported asthma and current asthma medication use, 30%, 35.9% and 36.6% respectively had at least one other respiratory symptom. CONCLUSIONS: The prevalence of asthma in Sri Lankan adults is high in comparison with global data. A significant percentage of symptomatic individuals deny having asthma and are not on medication.Item Prevalence and correlates of asthma among selected garment factory workers at the Free Trade Zone, Ekala(College of Community Physicians of Sri Lanka, 2015) Jayawardana, P.; Abeysena, C.Objective To determine prevalence of bronchial asthma (BA) and its correlates and respiratory functions among selected garment factory workers (GFW) at the Free Trade Zone, Ekala. Methods This consisted of a cross sectional descriptive and an analytical study. It was conducted at three selected garment factories and a clinic setting in Ekala. Study group for first component included 674 GFW who have worked for 1 or more years at the current garment factories. Control group for second component included 100 participants who have never worked in garment factories. Study instruments consisted of an interviewer administered questionnaire and spirometry. Bivariate analysis was followed by multiple logistic regressions. Results were expressed as odds ratios (OR) and 95% Confidence intervals (CI). Results Overall prevalence of BA among GFW was 32.3% (95% CI:28.8-36.0%). Prevalence of “probable occupational asthma” among asthmatic GFW was 49.5% (95% CI:42.7-56.4%). Being a GFW (OR=3.5, 95% CI:1.9-7.2) and age >30 years (OR=1.5; 95% CI:1.1-2.1) were significantly associated with prevalence of BA. Among GFW, FEV1.0 and PEFR were significantly lower among asthmatics compared to non asthmatics, and FVC, FEV1.0, and PEFR among those exposed to dust for >3 years compared to ≤3 years. Conclusions Prevalence of bronchial asthma was higher among Garment Factory Workers. However, respiratory functions were lower only among those who were asthmatics.Item The Prevalence of reflux oesophagitis in adult asthmatics(Wiley- Blackwell, 2009) Amarasiri, L.; Ranasinha, C.D.; de Silva, H.J.BACKGROUND/PURPOSE: Asthma and gastro-oesophageal reflux disease are known to be associated. The severity of asthma is related to the degree of reflux. This relationship has been little studied in South Asia. METHODS: Thirty asthmatics underwent a reflux symptom assessment using a validated questionnaire assessing 7 upper gastro-intestinal (UGI) symptoms graded on a 5-point Likert scale (Amarasiri LD 2009). They further underwent UGI endoscopy. RESULTS: All asthmatics had mild stable asthma. 20 of the 30 asthmatics had apositive GORD symptom score. 27 asthmatics consented to UGI endoscopy. The grade of oesophagitis was classified using Savary Miller criteria. 10 of the 27 asthmatics had evidence of mucosal damage (see Table 1). There was no correlation between the grade of oesophagitis and the GORD score (r = 0.025; P = 0.896, Spearman Rank correlation). CONCLUSIONS: The prevalence of reflux oesophagitis in asthmatics was 37%. There was no association of severity of oesophagitis with symptoms. Both these findings are consistent with the global data, but have not previously been described in a South Asian population.Item Prevalence of asthma and comparison of ventilator capacity of asthmatics (when free of asthma) and non asthmatics among workers in selected garment factories(College of the Community Physicians of Sri Lanka, 2009) Abeysena, C.; Jayawardana, P.; Wickramasinha, W.P.K.; Dassanayake, I.S.INTRODUCTION: Asthma has been reported to be common among garment factory workers. Objective: To determine the prevalence of asthma and to compare the lung functions among asthmatics and non asthmatics among garment factory workers. METHODS: A descriptive comparison study was conducted among 774 workers of selected garment factories in the Ekala Industiral Area, Ja ela. All workers who have served for a minimum period of one year in the factory were included in the study. An interviewer administered questionnaire was used to assess personal details and presence of wheezing, dysponoea and cough and other relevant data. All those with wheezing and those with presence of both cough and dyspnoea in the absence of wheezing during the past one year were considered as asthmatics. Spirometry was performed using an electronic spirometer. Forced Vital Capacity (FVC), Forced Expiratory Volume in first second of FVC (FEV) and Peak Expiratory Flow Rate (PEFR) were assessed. The ventilatory capacity was compared among asthmatics and non asthmatics using Student T test, Mann Whitney U test or chi-squired test. Results: The prevalence of asthma was 30% (95%CI: 26.7%, 33%). The mean ventilator capacity of asthmatics and non asthmatics respectively were as follows FVC: 2.24 L versus 2.39 L (p<0.05), FEV-i.o: 2.17 L versus 2.37 L (p<0.001), PEFR {geometric mean): 5.87 L/sec versus 7.17 L/sec (p<0.001). The mean difference between the predicted normal values and observed values among asthmatics and non asthmatics were as follows: FVC: 0.53 L versus 0.58 L (p>0.05), FEVro: 0.30 L versus 0.25 L (p>0.05), PEFR (median): 1.21 L/sec versus 0.45 L/sec (p<0.001). Ninety three (40.3%) of asthmatics and 149 (27.5%) non-asthmatics had PEFR <80% of the predicted which was statistically significant (p<0.001). CONCLUSION: Prevalence of asthma was high among garment factory workers. Ventilatory capacity and predicted normal values of asthmatics when free of asthma were affected in comparison to non asthmatics.Item Peristaltic dysfunction in asthma is secondary to increased Gastro-Oesophageal Reflux(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2010) Amarasiri, L.; Pathmeswaran, A.; Ranasinha, C.D.; de Silva, A.P.; Dassanayake, A.S.; de Silva, H.J.BACKGROUND: Vagal dysfunction and prolonged intra-oesophageal acidification cause oesophageal hypomotility. Asthmatics have ineffective oesophageal motility, but demonstrate increased vagal activity. Whether oesophageal hypomotility in asthmatics is a primary abnormality or secondary to pathological gastro-oesophageal reflux is unclear. Our aim was to investigate the relationship of oesophageal motility and gastro-oesophageal reflux (GOR)to vagal function in asthmatics. METHODS: Thirty consecutive mild, stable asthmatics (ATS criteria) and 30 healthy volunteers underwent 24-hour ambulatory dual-sensor oesophageal monitoring, stationary oesophageal manometry and autonomic function testing. They also underwent gastro-oesophageal reflux disease (GORD) symptom assessment. Twenty seven of the thirty asthmatics underwent gastroscopy. A parasympathetic autonomic function score was calculated from vagal function tests (valsalva manouvre, heart rate variation to deep breathing, heart rate and blood pressure response to standing from a supine position) and correlated with gastro-oesophageal function parameters. RESULTS: Age and sex of asthmatics (mean age(SD), 34.8 years (8.4); 60% female) and controls (mean age(SD), 30.9 years (7.7); 50% female) were comparable. Asthmatics had a higher frequency and severity of GORD symptoms and 10/27 (39%) had oesophageal mucosal damage. Twenty two (69%) asthmatics showed a hypervagal response and none had a hyperadrenergic response. Manometrically, LOS and UOS parameters were similar in the two groups, but 14 asthmatics had ineffective oesophageal motility. Asthmatics with higher GORD symptom scores had a significantly lower percentage of peristaltic contractions and a higher percentage of simultaneous contractions than controls. They also had higher total and upright oesophageal acid contact times in the proximal oesophagus than those with low symptom scores. All reflux parameters were significantly higher in asthmatics. Twenty (66.7%) asthmatics had abnormal distal acid reflux and 22 (73.3%) had abnormal proximal acid reflux. Asthmatics also had significantly prolonged proximal and distal acid clearance times than controls. There was no association between parasympathetic function and either oesophageal motility or reflux parameters. CONCLUSIONS: Asthmatics with mild, stable asthma have abnormal oesophageal motility and pathological GOR. The asthmatics did not show any evidence of vagal dysfunction nor did the vagal function score correlate with oesophageal motility parameters. It seems likely that the peristaltic dysfunction is secondary to damage due to GOR and not primary vagal dysfunction.