Teaching Hospital Karapitiya Research Articles

Undetected falls among older adults attending medical clinics in four tertiary care centres in Sri Lanka; the need of a comprehensive geriatric assessment

ObjectiveFalls take a high priority among the prevalent medical conditions in old age. Despite this, a history of falls or the risk of future falls is not routinely assessed or properly managed in medical clinics in Sri Lanka. This study was done to evaluate the prevalence and factors associated with falls and recurrent falls among older adults attending medical clinics in four selected tertiary care centres in the country.MethodsA cross-sectional study was carried out at four centres (Teaching Hospital Karapitiya, Colombo South Teaching Hospital, Colombo North Teaching Hospital and University Hospital-Kotelawala Defence University) with 704 older adults, aged 65 years and above, attending medical clinics for more than six consecutive months. Information related to falls and possible associated factors (socio-demographic, behavioural, environmental and biological) were collected using an interviewer-administered questionnaire.ResultsThe Mean (SD) age of the participants was 72.5(5.5) years and 58.7% were females. Of the 704 total sample, 220 (31.3%, 95% CI 28–35%) participants experienced at least one fall after the age of 65, and 12.8% (95% CI 10–15%) (n = 90) experienced recurrent falls (two or more falls within the last 12 months). Falls were associated with gender, level of education, marital status, and physical dependence (p < 0.01). For those who had at least one fall, multiple logistic regression (MLR) revealed being single (p = 0.03, OR = 2.12, 95% CI; 1.052–4.304), being widowed/divorced/separated (p = 0.03, OR = 1.47, 95% CI; 1.039–2.093) compared to living with a spouse, presence of moderate (p = 0.007, OR = 1.72, 95% CI; 1.160–2.577) and severe (p = 0.001, OR = 2.98, 95% CI; 1.563–5.688) physical dependency compared to mild physical dependency as risk factors for falls. Having secondary education (p = 0.01, OR = 0.55, 0.350–0.876) was a protective factor for falls. For those with recurrent falls, MLR showed moderate physical dependency (p = 0.001, OR = 2.34, 95% CI; 1.442–3.821) compared to slight physical dependency as a risk factor.ConclusionsApproximately one-third of the older adults attending medical clinics had experienced at least a single fall, and one-eighth have had recurrent falls, which were mostly unrecorded and not clinically assessed. Physical dependency was the major contributing factor to falls and recurrent falls. Falls assessment should be included in the routine clinical assessment of older adults attending outdoor medical clinics. Health professionals should be educated to detect and assess those at risk of falling and take appropriate measures to prevent or minimize falls.

Correlation between salivary and serum biomarkers of kidney function in chronic kidney disease patients attending the nephrology clinics at Teaching Hospital Karapitiya, Sri Lanka

The present study was designed to determine the correlation between salivary and serum levels of creatinine and urea in patients with chronic kidney disease (CKD) and to propose the use of saliva as an alternative medium for the analysis of biochemical parameters of kidney function. Accordingly, an analytical cross-sectional study was carried out using 100 CKD patients attending the Nephrology Clinics at Teaching Hospital Karapitiya, Sri Lanka. Saliva and serum samples were collected from the patients for the estimation of creatinine and urea using spectrophotometric assay kits. Of the total, the majority of the patients were found within CKD stage 3 (82%). The salivary and serum concentrations of creatinine varied within the range of 0.20 - 2.10 mg/dL and 1.54 – 11.6 mg/dL, whereas the salivary and serum concentrations of urea varied within the range of 68.04 – 127.59 mg/dL and 60.14 – 168.25 mg/dL respectively within the study population. Significant positive correlations were observed between the salivary and serum concentrations of creatinine (r= 0.985, p=0.01), and urea (r= 0.942, p=0.01), and between salivary concentrations of creatinine and urea (r=0.887, p=0.01). A significant difference was observed in the salivary biomarkers between mild to moderate stages of CKD patients and severe to end-stage CKD patients. No significant association was observed in the salivary markers with the age and sex of the patients. The area under curve values in the receiver operating characteristic analysis was&gt;0.9 (95% CI). These findings revealed high levels of diagnostic accuracy in salivary biomarkers suggesting the potential use of saliva for the assessment of kidney function in CKD patients.

Frequency of depression and its correlation with sociodemographic and clinical characteristics among adult epilepsy patients in neurology clinics at a tertiary care hospital in Sri Lanka

Background: Depression is a common concern among epilepsy patients and affects individuals globally. This presents substantial clinical, social, and economic ramifications, impacting healthcare requirements, quality of life, and productivity. Despite this, comprehensive data on depression in epilepsy remain scarce for Asia, with no published studies from Sri Lanka.Objective: This study aimed to determine the frequency of depression, and its associated sociodemographic and clinical characteristics, among adult epilepsy patients in a tertiary care hospital in Sri Lanka.Method: A descriptive cross-sectional study was performed at teaching hospital Karapitiya, involving 413 epilepsy patients. Exclusion criteria included individuals under 18 years, presence of other neurological conditions, chronic severe medical ailments, additional psychiatric comorbidities, history of active cancer within the last five years, and current illicit drug use. Consecutive sampling was employed. Data collection utilized an interviewer-administered sociodemographic and clinical characteristics questionnaire, alongside the 9-item Patient Health Questionnaire (PHQ-9). Statistical analysis was performed using SPSS software.Results: The observed frequency of depression among epilepsy patients attending the clinic was 29.8%. Among those affected, 21.3% exhibited mild depression, 5.6% moderate depression, 2.2% moderately severe depression, and 0.7% reported severe depression. The statistically significant associations with depression among epilepsy patients included recent seizure occurrence (p=0.001), marital status (p=0.009), and parenthood status (p=0.011).Conclusions: The observed frequency of depression among the study population surpassed that in the general Sri Lankan populace (4.1%). Timely identification and management of psychiatric comorbidities linked to epilepsy hold promise for optimising healthcare resource allocation in Sri Lanka.

The Effect of Neurophysiological Modulation on Muscle Power and Pain Through Manual Therapy Over Electro- Physiotherapy for Athletes with Illio Tibial Band Syndrome (ITBS)

Introduction and Objectives: Iliotibial Band Syndrome (ITBS) is a common overuse injury in athletes, primarily impacting the knee and hip due to repetitive friction of the iliotibial band against the femur, resulting in pain and restricted hip abduction and knee extension. Muscle power and pain associated with ITBS can be measured using Hand-held Dynamometer (HHD) and Visual-Analog-Scale scores (VAS) respectively. This study aimed to compare the efficacy of two treatment groups, Manual-Therapy (MT) and Electro-Physiotherapy (EPT), in determining the most effective approach for managing ITBS. Materials and Methods: A RCT was conducted at the Sports Medicine Clinic of the Teaching Hospital Karapitiya, enrolling twenty athletes in each group as controls and experimental subjects. The control group received EPT, NSAIDS, and paracetamol for one week, while the experimental group received MT, NSAIDS, and paracetamol for the same duration. Muscle power and pain measurements were assessed using HHD &amp; VAS on D1 and D28. P-values for statistical significance were obtained using RM-ANOVA followed by Bonferroni test. Results: Mean ages for EPT and MT groups were 24.4±6.6 and 25.4±6.6years, respectively. Muscle power (N) for EPT group on D1, and D28 were 101.7±26.3 and 112.7±23 respectively. The same parameters for MT group were 98.1±26 and 186.8±25.3. The mean differences for muscle power of two groups on D1 and D28 were -3.600(P=0.666) and 74.050(P&lt;0.001). VAS scores for EPT group on D1, and D28 were 8.2±0.9 and 7±1 respectively. The same parameters for MT group were 7.9±0.8 and1.8±0.8. The mean differences for pain of two groups on D1 and D28 were 0.250(P=0.395) and -5.200(P&lt;0.001). Partial-Eta-Squared for the two groups were 0.355 and 0.758respectively. ManualTherapy group’s higher effectiveness was statistically significant (p&lt;0.001) and a 35.5% variance in muscle power and 75.8% variance in VAS score was attributable to it. Conclusion:Manual-therapy is superior to electro-physiotherapy in improving muscle power and decreasing in VAS scores of athletes with ITBS.

Cost of patient and staff diet in Teaching Hospital Karapitiya, Galle

Background: Government hospitals in Sri Lanka offer all services free of charge including the patient diet. Currently patient care services are affected by increasing health care cost in state hospitals. Cost cutting measures are essential in health care management in public sector without sacrificing the standards of care provision. Analysing hospital diet costs is crucial to figuring out how to save indirect operating costs while maintaining service quality and standards.Objective: To determine the cost of diet for patients and staff in the Teaching Hospital, Karapitiya.Methods: A descriptive cross-sectional study was carried out retrospectively to determine the cost of patient and staff diet. The step-down costing method was used in this study, and secondary data was collected from kitchen records, the diet branch and the finance branch during the month of August 2023.Results: The total expenditure for the diet during the period was 9,864,157 LKR and per unit cost was 182.76 LKR to provide diet for patients and staff. The cost of breakfast, lunch and dinner was, 117 LKR, 225.39 LKR and 179.5 LKR respectively.Conclusion: The unit cost for diet was higher compared to previous Sri Lankan hospital study findings but lower than the present market price. Separate registers to record capital items and consumables are recommended to determine the diet cost in future and for the interventions to improve quality and reduce the cost.

Effectiveness of thera-band exercise program and electro- physiotherapy on abductor strength of the iliotibial band in athletes with iliotibial band syndrome

Objectives: The iliotibial band (ITB) is a thick fascial band formed near the hip by merging the fascia of the gluteus maximus, gluteus medius, and tensor fasciae latae muscles. Iliotibial band syndrome (ITBS) is a common overuse injury, manifests as pain on the outer side of the knee and hip due to ITB friction with the femur. Athletes may experience reduced hip and knee mobility, potentially impacting performance. This study aims to compare the efficacy of two ITBS treatments: Thera-Band Exercise Program (TBEP) as the experimental group and Electro-Physiotherapy (EPT) as the control group.Methods: A randomized controlled trial carried out at the Teaching Hospital Karapitiya, with thirty athletes in each group. The control group received EPT, and medications, for two weeks, the experimental group received TBEP and medications for the same duration. Abductor Muscle strength assessment was conducted on Day 01 and Day 28 using handheld dynamometer (HHD)Results: The mean ages in the control and experimental groups were 24.33±6.40 years and 24.97±6.87 years, respectively. Muscle strength (N) for the control group on Day 1 and Day 28 were 99.77± 24.81 and 108.83±22.36, respectively. In the experimental group, the corresponding values were 102.50±26.71 and 147.00±29.92, respectively. The mean differences for muscle strength of two groups in D1 and D28 were 2.733(P&gt;0.683) and 38.167(P&lt;0.001) (RM-ANOVA). TBEP had a statistically significant effect (p=0.000), and it explained 16.8% of the variance in muscle strength. The Partial Eta Squared was 0.168.Conclusions: The Thera band program works better in improving abductor muscle strength of the athletes with ITBS compared to electro- physiotherapy.

Prevalence, Characteristics and Factors Associated with Adverse Drug Reactions Among Hospitalized Patients.

Objectives: This study aimed to describe the prevalence and characteristics of ADRs and to identify the factors associated with ADRs among hospitalized patients. Methodology: A descriptive cross-sectional study was conducted over a 6 month period at Teaching Hospital Karapitiya (THK), Sri Lanka. A total of 2000 patients, who were admitted consecutively for any type of treatment during the study period were enrolled. The factors associated with ADRs were evaluated using logistic regression models, using ADR occurrence as the outcome. Results: A total of 123 ADRs were found from the sample. The prevalence of ADRs among hospitalized patients was 6.2%. (95% CI 5.1-7.2). ADRs were reported in 62 males (50.4%). The median (IQR) age of ADR occurrence was 52 (35-67) years. The most prevalent type of ADR was Type A (n = 62, 50.4%) and out of the total ADRs, 74 were moderately severe reactions (60.2%). Antibiotics (n = 29, 23.5%) were the most common causative agent for ADRs, followed by anticoagulants (n = 10, 8.1%). The multivariate logistic regression model showed that the number of prescribed drugs (P = .011), ADR history (P = 0 0.01) and diabetes mellitus (P = .003) were significantly associated with the occurrence of ADRs. Age (P = .21), gender (P = .31), ethnicity (P = .14), and other concomitant illnesses (Hypertension P = .66, Ischemic Heart Disease P = .25, etc.) did not associated with the occurrence of ADRs. Conclusion: According to this study the prevalence of ADRs was significant among inward patients in the Teaching Hospital, Karapitiya. The number of prescribed drugs, ADR history and diabetes mellitus were significantly correlated with the occurrence of ADRs. The results of the study can be used to guide healthcare professionals to revise the medication list frequently and monitor the patients who are at risk for developing ADRs.

Correlation of eGFR values estimated by different equations based on creatinine and cystatin-C in patients on hemodialysis treatment at Teaching Hospital Karapitiya, Galle, Sri Lanka

The present study was to compare eGFR values estimated from different equations based on creatinine and cystatin-C in patients on hemodialysis treatment. eGFR values were calculated using Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology equations based on Creatinine (CKD-EPICr) and cystatin-C values alone (CKDEPI Cys C) and by their combination (CKD-EPICr-Cys C), using 40 pre-dialysis samples. No significant differences in renal function parameters and eGFR were observed, either between male (55%) and female (45%) patients or within different age groups (p&gt;0.05). Certain levels of agreement (p&gt;0.05) were observed between the equations, except for the values derived from CKD-EPICys C and CKD-EPICr-Cys C (p = 0.022). Significant positive correlations were observed between all selected equations. The highest correlation was observed between CKD-EPICr and MDRD (r = 0.998, p = 0.000), whereas the lowest correlation was found between MDRD and CKD-EPICys C (r = 0.552, p = 0.000). The present findings revealed that MDRD and CKD-EPICr equations are suitable for the calculation of eGFR in routine local clinical settings for the assessment of progression of kidney impairment in patients with CKD on hemodialysis treatment. However, the use of CKD-EPICr-Cys C rather than the CKD-EPICys C is recommended as a confirmatory tool where necessary.

Knowledge on anaphylaxis, its associated factors and self-perceived confidence on its management among medical officers attached to the Teaching Hospital Karapitiya

Introduction: Knowledge on anaphylaxis management is paramount in saving lives. The main objective of this study was to assess the knowledge on anaphylaxis, its associated factors and self-perceived confidence on its management among medical officers practising at Teaching Hospital, Karapitiya. Methods: This cross-sectional study included all medical officers (n=531) working in Teaching Hospital Karapitiya. The data were collected within three months via a self-administered questionnaire. The questionnaire consisted of 3 main parts. Part A for demographic data, part B on knowledge on diagnosis and management of anaphylaxis generated from case scenarios and part C on self-perceived confidence on diagnosis and management of anaphylaxis.Results: The response rate was 79% (n=395). Of the respondents, only 9.36% doctors diagnosed all case scenarios correctly. Nearly a quarter (25.8%) identified all anaphylaxis triggers and 25% identified all the amplifying factors. Majority (91.9%) of doctors identified adrenaline as the first line treatment. More than 80% correctly mentioned the second line treatment with more than 90% scored for correct initial management. The score of knowledge on treatment doses of adrenaline in the paediatric age group was poor (60%). Importance of adrenaline auto-injector was identified by 69.1% but knowledge on further follow up of anaphylaxis was sub-optimal. Self-perceived confidence in diagnosis of anaphylaxis 87.6% and the self-perceived confidence in management of anaphylaxis was 83.9%. Conclusions &amp; recommendations: Even though the self-perceived confidence in diagnosis and management of anaphylaxis was satisfactory among the doctors, the knowledge on triggers and amplifying factors were sub-optimal. Novel educational and training strategies must be implemented to overcome the identified deficiencies.

Outcomes of anastomosis of mechanically prepared bowel vs. mechanically unprepared bowel in laparoscopic anterior resection in adult patients with rectal cancer

Introduction: The limited literature supporting the utilization of mechanical bowel preparation (MBP) for patients undergoing laparoscopic anterior resection of rectum (LAR) remains a notable issue. This study was conducted to examine the clinical consequences of anastomosis in rectal surgery with MBP compared to cases where MBP is not utilized (no-MBP) in the context of LAR.Methods: This is a retrospective comparative study conducted in the professorial surgical wards of Teaching Hospital Karapitiya (THK). Rectal cancer patients (n=306) participated in the study, including 151 MBP patients and 155 no-MBP patients where the postoperative complications and mortality rates were compared.Results: The anastomotic leakage rate was 2.6% (n=4) in the no-MBP group and 6.0% (n=9) in the MBP group, (p=0.143). Postoperative paralytic ileus rate was 18.5% (n=28) and 5.8% (n=9) in the MBP group and no-MBP group respectively displaying a statistically significant difference (p=0.001). Wound infection, pneumonia, urinary tract infection, and cardiac complication rates also were higher in the MBP group. Overall mortality rate was 1.3% (n=3) in no-MBP group and 2.0% (n=2) in MBP group. Conclusions: The evidence concludes that MBP increases post-operative complications. Therefore, prophylactic MBP in LAR has not been proven to benefit patients. However, further research is necessary to understand the comparative effects of MBP versus no preparation comprehensively.

Knowledge, Attitudes, and Practices of Adverse Drug Reaction Reporting Among Healthcare Professionals in Sri Lanka- A Cross Sectional Study.

Objectives: The objectives of this study were to describe the knowledge, attitudes and practices of Adverse Drug Reactions (ADR) reporting among healthcare professionals at Teaching Hospital Karapitiya (THK), a tertiary care hospital in Sri Lanka. Methodology: A descriptive cross-sectional study was conducted at THK. The healthcare professionals working in THK who were available during the study period were invited to the study. A self-administered pre-tested questionnaire was administered to the participants. Respondents were evaluated for their knowledge, attitudes and practices related to ADR reporting. The data were analyzed using SPSS statistical software. Results: Of the total 444 respondents, 31% were doctors and 69% were nurses. The majority of respondents, 90% (n = 400) were aware of the term ADR, while 64.8% (n = 288) could correctly define it. Among the respondents, 30.8% (n = 137) knew about the types of ADR and only 15.5% (n = 70) were able to mention a drug that is banned due to ADR correctly. Among the respondents, only 38.7% (n = 172) were aware of a formal process of reporting ADR and, only 35.3% (n = 157) stated that they had seen the ADR reporting form. Further, only 33.7% (n = 150) respondents have recognized ADR during their clinical practice and only a small proportion 18.2% (n = 81) have ever reported an ADR during their practice. Regarding attitudes toward ADR reporting, overall 84.1 (n = 373) had positive attitudes toward ADR reporting, while 13.54% (n = 60) of them stayed neutral and 2.25% (n = 10) had negative attitudes toward ADR reporting. Conclusions: Although the majority were aware of ADR , the knowledge and practices regarding spontaneous reporting of ADR are inadequate. However, most respondents have shown a positive attitude toward ADR reporting. A sincere and sustained effort should be made by concerned bodies to enhance the healthcare professionals' knowledge, attitudes, and practices regarding ADR reporting.

Knowledge, attitude and practices on insulin therapy among patients with type 1 diabetes

Introduction: The incidence of type 1 diabetes mellitus (T1DM) is increasing worldwide. Daily administration of multi-dose or single-dose Insulin therapy is the cornerstone in the treatment of T1DM. The recent studies highlighted the gap in knowledge, attitude, and practice (KAP) towards insulin therapy for the optimal control of hyperglycemia T1DM. The study aimed to assess knowledge, attitudes, and practices regarding insulin therapy among T1DM patients attending the diabetic clinic, Teaching Hospital Karapitiya (THK).Methods: A cross-sectional descriptive study was conducted using an interviewer-administered questionnaire to elicit socio-demographic information and KAP towards insulin therapy. A total of 62 attending the diabetic clinic at THK were recruited.Results: The study population consisted of 91.9% early young adults (ages 18-25 years) while the remainder represented late young adults (ages 26 - 30 years). A good knowledge, attitude and practice were seen in 61.3%, 62.9% and 38.1% of the patients respectively. Age, level of education, duration of DM, regular clinic visits and favourable attitudes were associated with good knowledge whereas level of education, duration of DM, regular clinic visits and good knowledge were associated with favourable attitudes. Duration of DM and regular clinic visits were the only factors associated with good practices. Higher level of knowledge or higher level of education were not associated with good practices towards insulin therapy (p&gt;0.05).Conclusions &amp; recommendations: Though majority had good knowledge and attitudes, practices were unsatisfactory in the majority of them. Self-management education and training giving special attention to psychosocial aspects of living to improve self-care behaviour are recommended to address the gap between knowledge and practices.

Cross-cultural adaptation and psychometric evaluation of a Sinhalese version of the &lt;em&gt;Multidimensional Scale of Perceived Social Support (MSPSS)&lt;/em&gt; in patients with cancer

Introduction: The Multidimensional Scale of Perceived Social Support (MSPSS) is a tool widely used in health surveys to assess social support (SS) perceived by individuals. The lack of an appropriate tool to measure SS perceived by patients with cancer has hindered our understanding of how SS is associated with the management and recovery process of Sri Lankan patients with cancer. The study aimed to examine the reliability and validity of the Sinhalese version of the MSPSS.Methods: Cross-cultural adaptation of the MSPSS was done following the standard guidelines of the process of translation and adaptation set by the World Health Organization. The study sample consisted of 40 patients with cancer at the Teaching Hospital Karapitiya, Galle, Sri Lanka. Data analysis was done using SPSS 25.0. Internal consistency of the overall MSPSS was calculated using Cronbach’s alpha. Test-retest reliability of the tool was also assessed using the intra-class correlation coefficient (ICC). The convergent and divergent validity of the tool was assessed using the Centre for Epidemiological Studies-Depression (CES-D) and the World Health Organization-Quality of Life-Brief Scale (WHOQoL-BREF). Construct validity was assessed using Exploratory Factor Analysis (EFA).Results: The Sinhalese version of MSPSS showed high reliability (Cronbach’s alpha-0.911). The tool showed favourable test-retest reliability (ICC=0.91). The overall MSPSS score was correlated negatively with depressive symptoms (r= -0.459, p&lt;0.001) and positively with dimensions of quality-of-life scores; overall (r=0.674, p&lt;0.001), physical (r=0.426, p&lt;0.001), psychological (r=0.540, p&lt;0.001), social (r=0.674, p&lt;0.001) and environmental quality of life (r=0.767, p&lt;0.001) ensuring strong discriminant/divergent and convergent validity of the Sinhalese version of the MSPSS. Factor analysis extracted three factors (e.g., family, friends, and significant others) explaining 96.65% of the variance.Conclusion: The Sinhalese version of MSPSS is a reliable and valid tool to assess the perceived SS from family, friends, or significant others among patients with cancer.

Comprehensive diagnostic testing identifies diverse aetiologies of acute febrile illness among hospitalised children and adults in Sri Lanka: a prospective cohort study

IntroductionAcute febrile illness (AFI) is a common cause of hospital admissions in tropical settings. Identifying AFI aetiology is essential for guiding clinicians’ diagnoses and developing diagnostic and management guidelines. We...

Trends and Patterns of Long Bone Fractures in Relation to The Road Traffic Accidents, Assaults, and Falls Among Patients Admitted to Emergency Treatment Unit in Teaching Hospital Karapitiya

Trends and Patterns of Long Bone Fractures in Relation to The Road Traffic Accidents, Assaults, and Falls Among Patients Admitted to Emergency Treatment Unit in Teaching Hospital Karapitiya

CHARACTERISTICS AND ASSOCIATED RISK FACTORS AMONG CHILDREN DIAGNOSED WITH RICKETS PRESENTING TO A TERTIARY CARE HOSPITAL IN SRI LANKA

Objective: This study aimed to identify characteristics and associated risk factors among children diagnosed with rickets in a tertiary care hospital.Methodology: A descriptive cross-sectional study was conducted, in children diagnosed with rickets who attended the University Pediatric clinic at Teaching Hospital Karapitiya, Sri Lanka. Data was collected on sociodemographic factors, pregnancy-related factors, birth-related factors, breastfeeding, complementary feeding practices, playing environment, exposure to sunlight, clinical signs, and laboratory investigations. Known risk factors were identified through literature and assessed in the study.Results: A total of 36 patients diagnosed with rickets were included in the study. Majority (58.3%) were males, and from rural areas (77.8%). It was observed that 72.2% of children were vitamin D deficient and 25% had insufficient level, while serum calcium and phosphate levels were normal in the majority 72.2% (n=26) and 47.2% (n=17) respectively. Indoor physical activities and inadequate sun exposure (75%), prolonged breastfeeding (69.4%) and low socio-economic status (61.1%) were identified as the most common risk factors for rickets.Conclusion: This study concludes that all rickets patients in the study sample were Vitamin D deficiency rickets and is a significant health problem particularly in rural areas. Inadequate sun exposure, prolonged breastfeeding, and low socio-economic status are the most significant risk factors associated with Vitamin D deficiency rickets. Early diagnosis and management of rickets are crucial to prevent complications and to improve outcomes.

Inferences from COVID-19 post-exposure risk assessment of health care workers in the pre-vaccination era at a major COVID sentinel center, Sri Lanka.

Despite the hospital triage system trying to prevent COVID-19 patients from getting admitted to wards other than isolation/quarantine units, COVID-19 patients were accidentally being discovered time to time from non-COVID-19 wards due to atypical or asymptomatic presentations. Consequently, post-exposure risk assessment was carried out for the relevant health care workers (HCW) and the other patients to assess their risk level of acquiring COVID-19, and to quarantine them if concluded as high risk. Hence, the objective of the study was to assess the outcome and the adequacy of COVID-19 post-exposure risk assessment of health care workers which would be useful in future outbreaks. We studied all events of accidental detection of COVID-19 patients happened in non-COVID-19 wards which were leading to subsequent risk assessment using the 5-questions based tool adapted from the WHO recommendations. The 5 questions discussed the protective measures during face to face meetings or in physical contacts, protective measures during aerosol generating procedures, splashes onto the face, and hand hygiene measures. A retrospective cross-sectional study carried out in the Teaching Hospital Karapitiya, Galle, Sri Lanka, for 4 months covering the second wave of the pandemic. Hospital data base of risk assessments was accessed anonymously and the "yes" or "no" responses to the 5-questions assessment tool were analysed. There were 62 events involving 891 health care workers who underwent post-exposure risk assessment. From the responses the highest score of "yes" was recorded against question 3 (25.7% of total "yes" answers for all questions and 5.8% of total answers for the question number 3) revealing inadequate precautions taken by HCWs in aerosol generating procedures. Hundred and sixty two (18.2%) HCWs were quarantined as high risk and only one became positive for COVID-19 during the quarantine period. Though the 5-question based risk assessment tool effectively helps to identify breaches in infection control during an exposure to a positive COVID-19 patient, it may not be adequate at times as the only tool in deciding the assessee's risk level.

Study of Unit Costs of Selected Dental Treatments Provided in Teaching Hospital Karapitiya

Study of Unit Costs of Selected Dental Treatments Provided in Teaching Hospital Karapitiya

Analysis of injury patterns and contributory factors among three-wheeler occupants admitted to Teaching Hospital Karapitiya following road traffic accidents

<strong><em>Introduction:</em></strong><em> </em>Increasing morbidity and mortality following road traffic accidents (RTA) is a major health and economic burden in developing countries. Among the increased number of registered vehicles in Sri Lanka 15% are three-wheelers and they are responsible for 11% of the road fatalities in the year 2021 with high impact incidence. The objectives in this study were to determine different patterns, nature, and mechanisms of the injuries, contributory factors, safety measures, and crash characteristics among the occupants of three-wheelers who are admitted following road traffic accidents to a tertiary care hospital in Southern Sri Lanka. <strong><em>Methodology:</em></strong> Data on socio-demographic profile, mechanisms of causation of injuries, affected region and severity of injuries, and contributory factors for the collision were retrieved from Medico-Legal Examination Forms of the patients admitted following three-wheeler accidents to the teaching hospital Karapitiya from 2019 to 2021. The data were analyzed using the SPSS IBM Version 22. <strong><em>Results:</em></strong> Rear-seat passengers (64%) were mostly injured than drivers. A bi-fold pattern of prevalence was observed at the time of incidents. The commonest incident was impacts with moving vehicles (41%) and most injuries were sustained by impacts of objects inside the vehicle (48%). The commonest injury seen was abrasion (69%) and the majority were seen over upper limbs (51%). There was no significant difference in the injury pattern between drivers and rear passengers. (11%) of the three-wheel drivers in this study did not possess a driving license and (24%) of them were drunk at the time of the accidents. <strong><em>Conclusion:</em></strong> High vehicular instability, lack of safety measures, reckless driving, and unnecessary vehicular modifications increase the number of three-wheel accidents. Replacing more crash-worthy four-wheel light vehicles and enforcement of legal limits are recommended.

Impact of COVID-19 related lockdown on hospital admissions, hospital burden and deaths due to non- COVID illnesses in a tertiary care centre in Southern Sri Lanka

Background: Sri Lanka imposed an aggressive curfew to prevent the spread of COVID-19, which led to major changes in population behaviour. It was presumed that these measures could affect the morbidity patterns and management of other medical conditions. We aimed to study the impact of the pandemic on hospital admissions, morbidity patterns and mortality from non-COVID illnesses during the period of lockdown.Methods: A retrospective study was conducted to gather data related to all non- COVID medical admissions from four medical wards and emergency treatment unit (ETU) of the Teaching Hospital Karapitiya for a six-week period during the lockdown. Data on the total number of admissions, reasons for admission, diagnoses, duration of hospital stay and outcome including deaths were obtained. Corresponding data from the same period of the previous year (pre COVID period) were compared.Results: The total number of admissions during the pre- COVID period was 2939 and that reduced to 1491 during the lockdown period. There was a significant reduction of admissions due to infectious illnesses including respiratory tract infections (p &lt;0.001), dengue (p= 0.01) and leptospirosis (p=0.02) during the lockdown period. There was a significant increase in requested admissions (p=0.002) including admissions for procedures, investigations, referrals and transfers. The mortality during the two periods did not change significantly (pre-covid period 5.1 %, lockdown period 4.2%, p=0.16).Conclusions: The results of the study showed that social distancing and travel restriction had a significant impact on health seeking behaviour, disease patterns and outcome. Reduction in hospital admissions and changes in disease patterns, especially reduction in respiratory tract infections could be a positive effect of preventive measures: physical distancing, wearing masks and travel restriction. Total lockdown of the country had no significant effect on total deaths as well as deaths related to NCDs.