Colombo South Teaching Hospital Research Articles

Pattern of utilization of facilities in the intensive care unit by elective surgical patients in a tertiary care institution: Can the services be provided by high dependency units in surgical wards?

Introduction Intensive care is indicated for patients requiring intensive monitoring and/or organ support. It is a costly and time limited resource utilized by those with reversible pathologies and reasonable likelihood of survival. Patients awaiting elective surgery with preoperative intensive care unit (ICU) bookings need to compete with emergency and unanticipated admissions leading to cancellation and postponement of elective surgery, a disadvantage to both the patient and the institution. Hence this study is aimed at evaluating the extent of ICU care utilized by elective surgical patients and to analyse the indications vs. utilization of ICU care by them. Methods This was a retrospective cross-sectional study carried out in the surgical ICU of Colombo South Teaching Hospital, enrolling 47 elective surgical patients admitted to the ICU over a period of 3 months. Data was collected using a pre structured data collection form. Results Majority of the patients were middle aged, belonged to the American Society of Anaesthesiologists Physical Status 2 (68.1%) and underwent colorectal (26%), upper gastrointestinal (GI) (15%) or hepatobiliary (13%) surgeries. Main comorbidities amongst the study population were diabetes and hypertension. Mean duration of ICU stay was 2 days. Most patients were monitored non-invasively within the ICU (68%). Organ support was required by only 17% of patients. Most frequent indication for preoperative ICU booking was the surgical/anaesthetic complexity determined by British United Provident Association (BUPA) schedule of procedures (83%). However, ICU resources were mainly utilized for provision of analgesia particularly in the form of epidural infusions (52%). Recommendations We recommend the development of level 2 care/high dependency units to reduce the burden on the ICU and a unit-based policy for ICU resource allocation for surgical patients.

Epidemiology, mechanisms and patterns of lower limb fractures at an accident service centre in Colombo, Sri Lanka

Introduction: Lower limb fracture burden overwhelms most of the tertiary care facilities in Sri Lanka. Lack of enough data and a trauma registry in Sri Lanka has masked the associated epidemiology, patterns and the mechanisms of the lower limb fractures. Aim of our study was to analyse the data and put forward an initiative for further studies. Methods: we collected data from the admissions with isolated lower limb fractures to the accident service Colombo South Teaching Hospital for a period of four months with the aid of an interviewer administered questionnaire. Results: we had 323 admissions with lower limb fractures out of 4823 all the admissions. There were 334 fractures. Motor vehicle crashes were the commonest mechanism. Tibia/ fibula were the commonest bones to get fractured. Most of the culprits were in the age range of 21-40. 68% of the males were under the influence of alcohol. 15% of the fractures were open. Conclusion: we were able to emphasize the epidemiology, mechanisms and the fracture types as planned in the objectives.

Work related fatigue and sleepiness at work among intern house officers of four hospitals in Sri Lanka

Introduction: Intern house officers (IHOs) are expected to work long duration shifts with frequent on-calls. Lack of adequate sleep due to prolonged duty hours leads to increase in medical errors. United States and European countries have imposed guidelines to restrict duty hours of IHOs, however no such restrictions are implemented in Sri Lanka. Objectives: The aim of this study was to evaluate fatigability and sleepiness at work among IHOs of four main hospitals in Sri Lanka. Method: IHOs of Colombo South Teaching Hospital, National Hospital Sri Lanka, Lady Ridgway Children’s Hospital and De Soysa Maternity Hospital were recruited. Duty rosters were analysed for the length of duty shifts and night on-calls. Questionnaires were used to record fatiguability, sleepiness at work, medical errors, risk at work and daytime sleepiness. Results: Out of 94 IHOs, 73% worked more than 100 hours and 32% worked more than 125 hours a week. Notably, 38% did three night on-calls per week and 31% did more than three. Subjective fatigue level at work was reported as “most of the time” and “always” by more than 80% of IHOs, 32% had severe day time sleepiness. Fatigue risk assessment score indicated that 97% IHOs were in the high-risk group. Female IHOs were found to be more fatigued. One third of doctors reported medical errors due to fatigue and sleepiness which was significantly high in medicine rotation. Conclusions: IHOs were found to be over working. Majority were fatigued and sleepy at work. Self reported medical errors during internship were found to be high.

HEALTH SYSTEM RESPONSIVENESS AND ITS CORRELATES AT OUTPATIENT DEPARTMENT SERVICE IN DISTRICT GENERAL HOSPITAL, KALUTARA.

08Sep 2019 HEALTH SYSTEM RESPONSIVENESS AND ITS CORRELATES AT OUTPATIENT DEPARTMENT SERVICE IN DISTRICT GENERAL HOSPITAL, KALUTARA Kasunee Chamila Kalubowila , Dinesha Perera , Champika Alahapperuma , Inoka Senathilaka , Ramani Devika Withana and Palitha Dharmabandhu Kapparage Senior Registrar in Community Medicine, Anti-malaria campaign, Ministry of Health, Nutrition and Indigenous Medicine. Medical officer, District General Hospital, Kalutara. Medical officer, Base Hospital, Horana. Medical officer, National Hospital of Sri Lanka, 5Medical officer, Colombo South Teaching Hospital.

Knowledge and Practices among Female Nurses on Insertion and Care of Indwelling Urinary Catheter to Female Patients in a Selected Teaching Hospital in Sri Lanka

Globally, catheter-associated urinary tract infection (CAUTI) is one of the most common hospital-acquired infections. By following proper guidelines and recommended practice regarding insertion and care of indwelling urinary catheter, one could prevent and reduce CAUTI. Knowledge and practices among nurses regarding the insertion and care of indwelling urinary catheter in female patients are highly essential to minimize complications related to indwelling urinary catheter among female patients. There are limited data available on this phenomenon in Sri Lanka. The purpose of this study was to determine knowledge and practices among nurses regarding the insertion and care of indwelling urinary catheter in female patients at a selected teaching hospital. A descriptive cross-sectional design was conducted among conveniently selected 122 nurses from a teaching hospital. A pre-tested (n=10), a semi-structured questionnaire, was used to collect data. Ethical approval was obtained from the ethics review committees of the Faculty of Medical Sciences, University of Sri Jayewardenepura, and Colombo South Teaching Hospital, Sri Lanka. Findings revealed that only 36% of the participants had a satisfactory level of knowledge on indwelling urinary catheter insertion. Most of the participants (79.5%) had a satisfactory level of practices regarding indwelling urinary catheter insertion. Majority of the participants (82%) had an unsatisfactory level of knowledge regarding indwelling urinary catheter care. Most of the participants (78.7%) had a satisfactory level of practices regarding indwelling urinary catheter care. In conclusion, the majority of the participants had an unsatisfactory level of knowledge regarding indwelling urinary catheter insertion and care. There is a need for education on indwelling urinary catheterization and care for nurses in Sri Lanka.

SAT-116 Efficacy of Bariatric Surgery in Improving Obesity in South Asians

Obesity and its complications have become a major public health problem. Health risk conferred by obesity can be reduced by sustained weight loss but this is difficult in a majority. Bariatric surgery (BS) has proven to provide an excellent answer to this problem but there is minimal data in South Asians and especially in Sri Lankans. In this study we aimed to find the effect of BS on improving obesity in Sri Lankans. We did a retrospective analysis of medical records of 170 obese patients who underwent BS at the Colombo South Teaching Hospital, Sri Lanka. Overall 74.1% were females. Laparoscopic sleeve gastrectomy (LSG) was the commonest BS (69.5%) performed, followed by laparoscopic mini gastric bypass (LMGB) (24.1%) and laparoscopic Roux-en-Y gastric bypass (4.9%). Mean age was 38.1 ± 10.4 years. Mean pre-operative body weight and body mass index were 115.0 ± 23.0 kg and 45.1 ± 6.8 kg/m2 respectively. The baseline waist circumference (WC) and body fat percentage (BFP) in females and males were 119.0 ± 11.0 cm vs 129.0 ± 14.9 cm, p<0.05 and 45.4% ± 4.8% vs 40.6% ± 6.1%, p<0.005 respectively. At 1 month, 3 months, 6 months, 9 months and 12 months after BS, patients lost 11.3 ± 5.0 kg (female: 10.0 ± 3.9 kg, male: 14.8 ± 6.0 kg, p<0.001), 19.3 ± 6.4 kg (female: 17.8 ± 4.4 kg, male: 25.5 ± 9.2 kg, p<0.01), 26.0 ± 8.8 kg (female: 24.7 ± 6.8 kg, male: 30.1 ± 13.2 kg, p=0.15), 28.7 ± 7.8 kg (female: 28.5 ± 7.8 kg, male: 29.6 ± 8.2 kg, p=0.77) and 30.1 ±8.1 kg (female: 30.0 ±8.2 kg, male: 30.8 ±8.4 kg, p=0.83) of body weight respectively. At 1 month, 3 months, 6 months, 9 months and 12 months after BS the reduction in WC from baseline were 6.1 ± 7.4 cm, 13.7 ± 8.4 cm, 19.1 ± 9.0 cm, 20.4 ± 7.8 cm and 21.1 ±8.2 cm respectively. At 1 month, 3 months, 6 months, 9 months and 12 months after BS the reduction in BFP from baseline were 1.6 ± 4.6%, 4.6 ± 6.6%, 7.5 ± 5.6%, 9.3 ± 9.9% and 9.2 ± 6.5% respectively. There was no significant difference in the reduction of WC and BFP among males and females. Patients who underwent LMGB lost more weight as compared to LSG at 3 months (22.5 ± 8.9 kg vs 18.3 ± 5.2 kg, p=0.07), 6 months (32.6 ± 14.7 kg vs 24.7 ± 7.1 kg, p=0.13) and 12 months (34.6 ± 8.4 kg vs 30.0 ± 8.4 kg, p=0.31) although this difference did not reach statistical significance. Thus BS resulted in a sustained and progressive loss of weight, WC and BFP with rapid improvement in the first 6-9 months and the effect plateauing afterwards. Males lost weight more rapidly than females in the first 6 months after BS, but at 12 months there was no difference in weight loss among the two genders. In conclusion BS provides effective, sustained and progressive weight loss in obese patients with males benefiting more in the short term but with equal efficacy among genders in the long-term. Overall LMBG shows a trend towards better efficacy in weight loss as compared to LSG, especially in the first 6 months but further studies are warranted.

SAT-104 Reversal of Nonalcoholic Fatty Liver Disease with Bariatric Surgery in South Asians: Has the Cure Been Finally Found? Real World Data From a Sri Lankan Tertiary Care Setting

Nonalcoholic fatty liver disease (NAFLD) ranges from non-progressive simple steatosis to progressive nonalcoholic steatohepatitis and can eventually progress to cirrhosis and even be complicated with hepatocellular carcinoma. The prevalence of NAFLD is alarming and is approximately 65-85% among obese individuals. In the United States, NAFLD is the commonest cause of chronic liver cell disease and it is predicted to become the most common indication for liver transplantation within the next 5 years. Unfortunately NAFLD has limited treatment options with generally suboptimal results. Although bariatric surgery has been found to have impressive rates of reversal of NAFLD in Caucasians, there is limited data on its effects among South Asians. In this study we aimed to find the effect of bariatric surgery on reversal of NAFLD among obese Sri Lankan patients. We did a retrospective analysis of medical records of 170 obese patients who underwent bariatric surgery at the Colombo South Teaching Hospital, Sri Lanka. Out of the patients 74.1% (n = 126) were females. The mean age was 38.1 ± 10.4 years. The mean pre-operative body weight and body mass index were 115.0 ± 23.0 kg and 45.1 ± 6.8 kg/m2 respectively. Laparoscopic sleeve gastrectomy was the commonest type of bariatric surgery (69.5%) performed, followed by laparoscopic mini gastric bypass (24.1%) and laparoscopic Roux-en-Y gastric bypass (4.9%). One patient underwent open sleeve gastrectomy. NAFLD was detected in 88.7% pre-operatively, according to ultrasound scan (USS) imaging (grade 1 fatty liver 29.8%, grade 2 fatty liver 58.9%). On USS imaging at 6 months after the procedure, the prevalence of fatty liver reduced to 29.4% (grade 1 fatty liver 19.6%, grade 2 fatty liver 9.8%). The pre-operative mean AST and ALT values showed a significant reduction at 6 months after the procedure (30.4 ±18.6 U/L vs 22.1 ±8.9 U/L, p<0.005 and 39.1 ±28.3 U/L vs 19.8 ±9.6 U/L, p< 0.001) as compared to baseline. The percentage of patients who had AST or ALT elevation, showed significant reduction at 6 months postoperatively as compared to baseline (35.2% vs 6.9%, p<0.01). In conclusion, bariatric surgery fully reversed NAFLD in 68.1% (p<0.001) and reduced the grade of NAFLD in 87.2% (p<0.001) of patients according to USS imaging. It significantly reduced baseline AST and ALT values by 27.3% and 49.3% respectively at 6 months post procedure. Thus bariatric surgery shows impressive levels of complete reversal and downgrading of NAFLD biochemically as well as ultrasonically in Sri Lankan patients with comparable efficacy to studies done in Caucasian populations. Bariatric surgery should be considered as a potential therapeutic option in obese South Asian patients with NAFLD, especially when it is of a higher grade.

SAT-111 Reversal of Nonalcoholic Fatty Liver Disease with Bariatric Surgery in South Asians: Does the Type of Surgery Matter?

Nonalcoholic fatty liver disease (NAFLD) is a common complication of obesity with prevalence rates of 65 - 85% in obese individuals. It can be associated liver cell injury eventually leading to cirrhosis. Weight loss is the primary modality of treatment of NAFLD which can be difficult to achieve and maintain in a majority of patients. Bariatric surgery has been shown to reverse NAFLD but the type of bariatric surgery that is most effective, especially in South Asian patients is not clear. In this study we aimed to compare the effectiveness of laparoscopic sleeve gastrectomy (LSG) versus laparoscopic mini gastric bypass (LMGB) in reversing NAFLD in obese Sri Lankans. We did a retrospective analysis of medical records of 155 obese patients who underwent LSG and LMBG at Colombo South Teaching Hospital, Sri Lanka. Overall 114 (73.5%) and 41 (26.5%) patients underwent LSG and LMBG respectively. Among patients who underwent LSG and LMGB, there was no statistically significant difference in the baseline body weight (112.5 ± 19.5 vs 120.2 ± 29.4 kg), BMI (44.7 ± 6.1 vs 45.9 ± 8.0 kg/m2), waist circumference (WC) (female: 118.9 ± 11.2 cm vs 117.9 ± 9.0 cm, male: 125.5 ±14.7 cm vs 130.7 ±15.9 cm) and body fat percentage (BFP) (female: 45.9 ± 3.1% vs 43.1 ± 9.5%, male: 40.9 ± 6.8% vs 39.4 ± 1.6%). There was no significant difference between patients who underwent LSG and LMBG, in decrease in weight (24.7 ±7.1 kg vs 32.6 ±14.7 kg, p=0.12) and decrease in BMI (10.0 ±2.9 kg/m2 vs 12.0 ±4.2 kg/m2, p=0.08) at 6 months post-procedure as compared to baseline, although LMBG showed a trend towards greater benefit. There was no statistically significant difference in the decrease in WC (19.0 ±9.9 cm vs 20.8 ±5.8) and decrease in BFP (7.4% ±5.8 vs 10.8% ±5.6). Overall 88.4% of patients had NAFLD by ultrasound scan (USS) imaging criteria. Patients with LSG and LMBG did not show a significant difference in baseline AST (31.8 ±21.1 vs 26.8 ±11.6 U/L, p>0.05) and ALT (41.1 ±30.3 vs 35.8 ±25.7, p>0.05). At 6 months post procedure, AST (21.6 ±8.1 vs 25.0 ±13.9 U/L, p=0.32) and ALT (19.1 ±9.4 vs 26.9 ±11.0 U/L, p<0.05) levels were lower in patients with LSG than patients with LMBG, although only ALT values reached statistical significance. Thus LSG showed a greater degree of AST (32.1% vs 6.7%, p<0.05) and ALT (53.5% vs 24.9%, p=0.001) reduction compared to LMBG. At 6 months post-procedure, patients who underwent LSG had less patients with elevated AST (4.4% vs 11.1%) and ALT (4.4% vs 12.5%) as compared to LMBG. Overall LSG showed a higher rate of complete reversal of NAFLD (75.0% vs 44.4%) and improvement of the grade of NAFLD (91.7% vs 66.7%) on USS imaging when compared with LMBG. In conclusion, our study reveal that LSG has a more favorable effect on complete reversal and improvement of NAFLD when compared with LMBG. This effect seems to be independent of weight loss. Thus LSG should be considered ahead of LMBG when bariatric surgery is planned for obese patients with NAFLD.

A prospective study on aetiology and outcome of haemospermia from a urology unit in Sri Lanka

Introduction: Haemospermia is an alarming symptom for ordinary members of the public. The worry become greater as it has been described as a warning sign of a prostate cancer in the media. Objectives: The aim of the study was to identify the aetiological factors and outcome of haemospermia in a cohort of patients. Methods: All patients with newly diagnosed haemospermia treated at the urology unit of Colombo South Teaching Hospital over a period of 5 years (2013–2018) constituted the study sample. Data related to demographics, symptomatology, clinical findings, investigations, treatment given and outcome during follow-up were recorded prospectively. Results: There were 94 men with haemospermia who sought treatment during the study period. Mean age was 43.7 years (range: 23–67, median = 41). Twenty-seven (29%) patients had clinical evidence of prostatitis and/or a positive seminal fluid culture. One patient each had prostate carcinoma, prostatic cyst, severe hypertension, sclerotherapy for haemorrhoids, post-chemotherapy and post-epididymectomy. The patient who had high blood pressure (220/150 mmHg) was found to have mesangio-proliferative glomerulonephritis. In 61 (65%) patients, there was no identifiable cause. Conclusion: The majority of patients with haemospermia are aged &lt; 45 years and have a benign aetiology. As haemospermia is self-limiting in the majority of cases, extensive investigations are unnecessary. Advanced and invasive tests should be confined to those with abnormal clinical findings, and to those with persistent or recurrent haemospermia. Level of evidence: Level IV.

Phenotypic and molecular characterisation of outbreak strain of Enterobacter clocae in a special care baby unit (SCBU), Colombo South Teaching Hospital (CSTH), Sri lanka

Introduction: Increased frequency of clinical isolates of Enterobacter species raised a concern about emerging outbreak in SCBU of CSTH. During June–July 2018, six neonates became septic with four fatalities. SCBU was closed while outbreak investigations were undertaken.

A descriptive cross sectional study on mental health outcome and perceived care needs following miscarriage in a tertiary care hospital in Sri Lanka

Introduction Miscarriage increases women's risk for psychiatric disorders such as depression, anxiety and stress and can also lead to a threat to life. Hospital environment and provision of appropriate clinical information to the client is an important determinant in prevention of psychological distress. The aim of our study was to describe the psychosocial consequences of miscarriages, its correlates and perceived needs in the care provided by the hospital. Method A descriptive cross sectional study was carried out in the Colombo South Teaching Hospital in 405 consecutive women admitted with first trimester miscarriages to the Gynaecology wards. An intervieweradministered study specific questionnaire was used to collect information on demographic details and Depression Anxiety Stress Scale (DASS) was used to assess psychosocial consequences. Results Out of the 405 women studied, 55.7% met the cut-off scores for depression, 66.6% for anxiety and 50.2% for stress. The symptoms of depression, anxiety and stress were severe in 14%, 40% and 18% respectively. Women who have taken treatment for subfertility had significantly higher depressive (p=0.01) and anxiety symptoms (p=0.02). The attending doctors not listening to concerns, not explaining the condition and not explaining the treatment methods were significantly associated with symptoms of depression, anxiety and stress. (p=0.02). Discussion Anxiety was the most common psychological condition detected following miscarriage followed by depression and inadequacies of service provision at the hospital have contributed significantly to the experience of emotional distress. Provision of correct information, validation of distress and psychological debriefing, may be useful in enabling women to adjust emotionally following miscarriage.

Shifting the paradigm of peri-oprative care in colorectal surgery in a Sri Lankan tertiary care unit

Enhanced recovery after colorectal surgery (ERAS) protocol is a multimodal perioperative care pathway aiming to reduce stress response to surgery. It helps to return to normal physiology at earliest with minimum complications compared to traditional care pathway in colorectal surgery. In order to have intended benefits of ERAS, accurate staging of the patients with colorectal cancer is invaluable. Pretreatment pelvic MRI scan is the gold standard in rectal cancer staging due to its proven benefits. While preoperative MRI scan in rectal cancer patients with internationally recognized reporting protocol has been encouraged, ERAS with some modifications (mERAS) has been introduced at the university surgical unit of the Colombo south teaching hospital to overcome the resource limitations at local setting. Modified ERAS protocol was well tolerated by our cohort of patients and the favourable outcomes of ERAS protocol in our centre are comparable with published data. Therefore mERAS would be a safe alternative to the traditional practice of colorectal surgery in Sri Lanka. This article describes the methods of mERAS implementation and the strategies adhered in shifting the paradigm of perioperative care in colorectal surgery at our centre.

Patient characteristics and drug prescribing pattern in Parkinson disease: A hospital based study in Sri Lanka

Purpose of the study: To describe the demographic factors, pattern of anti-Parkinsonism drugs used and to identify factors influencing treatment in PD patients attending Colombo South Teaching Hospital (CSTH) in Sri Lanka.Methods: A descriptive cross sectional study was conducted at CSTH during March 2012 - September 2012, recruiting patients with PD (according to diagnostic criteria of the United Kingdom Parkinson’s Disease Society Brain Bank) attending neurology and medical clinics.Results: There were 103 PD patients, with a mean age of 64 yrs (SD 9.6, range 43-86) and 58 (56.3%) were males. Duration of illness ranged from 1 month to 15 yrs (median 2 yrs) and average age of onset was 61yrs (SD 9.6, range 41 - 82). 13 patients (12.6%) had onset of PD before 50yrs. Majority (n=57, 55.3%) had at least one co-morbidity. Levodopa alone was the treatment in 100 (97.1%) patients, Ropinirole alone in one, and 10 (9.7%) on Levodopa and Ropinirole combination with 2 (2%) drug-naïve patients. Benzhexol was used in 82 (79.6%) patients. Sex, disease severity, duration of illness, education level or employment status did not differ between treatment groups.Conclusion: PD is a commonly seen neurodegenerative disorder in hospital outpatient clinics and majority had other co-morbidities. Levodopa and Benzhexol are the commonly used drugs in Sri Lanka. Use of dopa agonists are much less common when compared to other countries. Age, the age of onset of PD, cost, and availability are major determinants of treatment.

The ‘Allergy alert’ campaign; Use of a Red wristband as an indicator of allergy in all surgical patients of Colombo South Teaching Hospital - A quality improvement project

The Sri Lankan Journal of Anaesthesiology is the official journal of the College of Anaesthesiologists of Sri Lanka. It publishes clinical investigations, research articles, audits, case reports, review articles and CME articles relating to anaesthesiology, critical care and pain. It is published bi annually in January and June. Sri Lankan Journal of Anaesthesiology is included on DOAJ and Scopus.

Why do mothers fail to breastfeed successfully? A descriptive study done at selected lactation management centres in Sri Lanka

Background: Exclusive breastfeeding (BF) up to six months is recommended in Sri Lanka because it is known to be the best food for the infants and it provides vast benefits to the mother as well. Since exclusive BF rates decline with the advancing age of the baby, it is quite obvious that mothers face difficulties in BF. Objective: To describe the factors associated with difficulties in BF in mothers with neonates attending selected lactation management centres in the Colombo district. Method: A hospital based cross sectional study was conducted at lactation management centres in De Soysa Maternity Hospital and Colombo South Teaching Hospital from August to September 2015. Mothers who paid their first visit with the corresponding neonates were selected. Sample size was 288. They were selected by systematic random sampling method, proportionate to their monthly admissions excluding neonates with congenital hypothyroidism. Study instruments used were a structured interviewer administered questionnaire, Breast Feeding Observation Form and a checklist of the neonate. Chi squared test and Fisher’s exact test where relevant were used for statistical analysis. Results: One hundred and sixty three (56.6%) had difficulty in BF. Among the sociodemographic factors studied, being in extended family ( p = 0.012) was significantly associated. Among the maternal factors, not receiving antenatal health education after getting admitted to the ward ( p = 0.03), having pain ( p = 0.016) and discomfort ( p = 0.01) during BF, not having previous experience in BF ( p = 0.006) and being discharged within 24 hours after delivery ( p =0.03) were significantly associated after controlling for confounding factors. Conclusions: Being in an extended family, not receiving antenatal health education, having pain and discomfort during BF, not having previous experience in BF and being discharged within 24 hours after delivery were significantly associated with BF difficulties in mothers with neonates attending selected lactation management centres in the Colombo district Sri Lanka Journal of Child Health , 2017; 46 (4): 337-342

Does continuing medical education improve general practitioners’ knowledge and practice on management of fever without a focus and dengue fever in children?

Introduction: Fever is a common symptom in children and is a cause of great anxiety for parents and caregivers. The improvement in patient comfort appears to be a key therapeutic objective in busy general practices. However, nonsteroidal anti-inflammatory drugs (NSAIDs) in any form and steroids are best avoided especially in patients with fever without a focus. Sri Lanka has been witnessing an increase in dengue fever incidence over the years. Disease manifestations of dengue fever are complex and management is comparatively simple. However, lack of knowledge and erroneous practice at primary care level in managing these children could lead to increase morbidity and mortality. Objective: To assess the current practice of a group of GPs management of children with fever without a focus and dengue fever, to determine whether this practice is in accordance with available guidelines and to assess the value of educational programmes on strengthening knowledge and practice. Method This was an experimental, pre-test and post-test design study carried out at the Colombo South Teaching Hospital (CSTH). General Practitioners (GPs) from health divisions in close proximity to CSTH were invited for the study. The enrolled GPs were given a pre-piloted questionnaire. A seminar was conducted on management of fever without a focus and dengue fever for all who took part in the study and information, education, communication (IEC) material were given to all participants. Participant GPs were assessed by a post-test questionnaire. All the data were entered into an electronic format (spreadsheet) and analysed using SPSS version16. Results: A total of 93 GPs participated in the study. Response rate for the pre-test and post-test questionnaires were 93% and 78% respectively. Before intervention overall median score was 75.68 (IQR-16.22) and after intervention overall median score was 85.14 (IQR-13.51), p value Conclusions: This study has clearly shown improvement of knowledge and perception on febrile phase management of dengue fever. Sri Lanka Journal of Child Health , 2017; 46 (4): 353-356

Weight gain of mother, birth weight of infant and maternal knowledge regarding nutrition in Sri Lanka

Birth weight of an infant is an indicator to a healthy future generation. This study was designed to find out the association between weight gain and level of knowledge about nutrition of pregnant mothers and the association between weight gain of mother to the birth weight of the child.Healthy mothers (n=201) were selected from the antenatal wards of Colombo South Teaching Hospital, Sri Lanka. Those who fulfilled the inclusion criteria were given a self-administrated questionnaire and their weight at initial registration was noted and weight before delivery was measured. After delivery, birth weights of infants were taken.Weight gain during the course of the pregnancy (mean 12.78 ±4.09 kg) had a significant association with birth weight of infants (Mean 2963.18 ±421.41 g). More than 70% of the study participants were found to have satisfactory or good knowledge on nutrition. Furthermore, majority of pregnant mothers avoid certain foods during pregnancy due to myths associated with pregnancy outcome and the food type. Thus further health education regarding nutrition should be conducted in antenatal clinics for the benefit of pregnant mothers.

Physical activity levels of patients prior to acute coronary syndrome – Experience at a tertiary care hospital in Sri Lanka

ObjectivesPhysical inactivity is associated with high cardiovascular risk. The purpose of this study was to study physical activity levels of patients with acute coronary syndrome (ACS). MethodologyA total of 504 patients, from the Professorial Unit of the Colombo South Teaching Hospital completed the International Physical Activity Questionnaire (IPAQ). IPAQ is a validated questionnaire used internationally to objectively measure physical activity. Both the total volume and the number of sessions of activity are included in the IPAQ. Populations are divided into three levels based on physical activity levels: low, moderate and high activity. ResultsOut of 504 patients, 128 (25.1%) were highly active, 87 (17.1%) were minimally active and 289 (56.7%) were found be inactive. When considering mets per week 134 (26.3%) spent less than 1000mets/week. Physical activity levels of men and women were similar (p=0.06). There was a no significant association between body mass index (BMI) with total IPAQ score (p=0.11). There was no difference in the physical activity levels of patients presenting with different types of ACS: ST-Elevation Myocardial Infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) or unstable angina (UA) (p=0.36). The activity levels did not affect the severity of ACS assessed by Thrombolysis In Myocardial Infarction (TIMI) scores. (NSTEMI/UA p=0.24, STEMI p=0.10). ConclusionIn Sri Lanka, a majority of patients with ACS were physically inactive. Physical inactivity is one of the remediable major risk factors of ACS and an active life style should be promoted.

Knowledge about diagnostic features and comorbidities of childhood autism among doctors in a tertiary care hospital

Introduction: Epidemiological surveys indicate that the prevalence of autism is rising worldwide. A study in Sri Lanka has shown 1 in 93 children to be affected. Early diagnosis is vital as early intensive behavioural interventions improve outcome in autism. It has been shown that the level of physicians’ knowledge of autism influences the average age of diagnosis and provision of further information to caregivers. Objectives: To assess the knowledge of diagnostic features and comorbidities of childhood autism among doctors in a tertiary care hospital and to identify the factors affecting it. Method: A descriptive study was conducted on 176 doctors at Colombo South Teaching Hospital, using the Knowledge about Childhood Autism among Health Workers Questionnaire. Data was collected by authors and analyzed using SPSS version 21. Ethical approval was obtained from the ethical review committee of the Lady Ridgeway Hospital. Results: Majority (61.9%) considered themselves incompetent in identifying autism. Knowledge was highest regarding symptoms of impaired social interactions (75.81%) and lowest for restricted repetitive interests/behaviours (60.79%), with a significant difference between medical officers and postgraduate trainees (p=0.045). Conclusions: Knowledge regarding childhood autism is poor among doctors in the tertiary hospital studied. Sri Lanka Journal of Child Health, 2017; 46(1): 29-32

Abortion and its legalization: an overview of the opinion of doctors in Colombo South Teaching Hospital, Sri Lanka

Introduction : According to Sri Lankan law, the only indication for abortion is when the life of the mother is in danger. Abortion is the third commonest cause for maternal mortality in Sri Lanka. Therefore, to make a change in current legal situation of abortion in Sri Lanka, it is important to assess the opinion on abortion especially from doctors, because they deal directly with maternal and child health. Method: According to random sampling method, a self-administered questionnaire was given to 207 doctors at the Teaching Hospital Colombo South, Sri Lanka. Results: Almost all (97%) agreed to perform abortion when mothers’ life is in danger and 76% agreed when mother’s health in danger. As overall opinion 57% agreed in special medical conditions such as Anencephaly, Down syndrome, Thalassemia major and hemophilia. Further, 68% agreed with abortion when ‘Rape’ and ‘Incest’, however, when rape presents as the condition disagreement of Muslims was statistically significant (p Conclusion: In addition to, when mother’s life is in danger, majority agreed to include medical conditions such as when mother’s health is in danger and four other special medical conditions, and legal situations such as rape and incest. However, majority disagreed on social conditions.