Proceedings of Annual Scientific Sessions of Faculty of Medical Sciences
Faculty of Medical Sciences, University of Sri Jayewardenepura.
The difference of Quality of Life (QOL) between hospitalized male and female patients with Type 2 Diabetes Mellitus in a selected hospital in Sri Lanka
Background: The Assessment of Quality of Life (QOL), accounting gender is considered as an essential measure of outcome in Type 2 Diabetes Mellitus (T2DM). Reasons for such gender wise differences remain unclear, and guidelines for diabetes treatment is not differentiated between different gender. Objective: To determine the difference of QOL considering the demographic variables between hospitalized male and female patients with T2DM in a selected hospital in Sri Lanka. Methods: The descriptive cross-sectional study design was used among 122 patients with T2DM selected using convenient sampling technique in medical wards at Colombo South Teaching Hospital in Sri Lanka. The subjects were interviewed using the World Health Organization Quality of Life BREF Questionnaire (WHOQOL-BREF). The pretest was done with fourteen patients. The participants who were above 18 years old, having more than six months of duration of diabetes, were recruited and those with severe complications of diabetes, were excluded from the study. WHOQOL-BREF scale was used to calculate QOL. Student t-test was used to analyze data. Results: Among the study participants, 68 (55.73%) were male, and 54 (44.26%) were female. The mean age of females was 63.76 years ±10.52, and males were 59.59 years ±8.84. The mean score of QOL in physical, psychological, social, and environmental domains of females were 57.40±15.00, 52.08±12.26, 51.85±16.56, 58.91±13.83 respectively. Among males, it was 51.41±17.49, 48.28±14.86, 43.25±16.74, 56.89±17.35. However, there was a statistically significant difference only in physical and social domains (p<0.05). When considering demographic variables among the study participants, there was a significant difference between males and females in age, income and use of alcohol (p<0.05). Conclusion: Male patients with T2DM showed lower QOL score than female patients with T2DM. Health education interventions should target to improve QOL of male patients with T2DM.
Copyright (c) 2019 Proceedings of Annual Scientific Sessions of Faculty of Medical Sciences
Body mass Index, Markers of airway inflammation, and carboxy hemoglobin levels of Chronic Obstructive Pulmonary Disease patients, attending to a chest clinic at Colombo South Teaching Hospital in Sri Lanka
Background: Chronic Obstructive Pulmonary disease (COPD) is a chronic progressive disease with airway inflammation and frequent exacerbations. The main etiological factor for COPD amongst Sri Lankan males is smoking. Smoking elevates breath CO levels and airway inflammation elevates fraction of exhale nitric oxide (FeNO). However, the level of inflammation of airways and breath carboxy hemoglobin (bCO) levels of Sri Lankan COPD patients are unknown. Objectives: To determine the symptom severity, airway inflammation and levels of bCO among a sample of COPD patients attending a chest clinic in a selected teaching hospital. Method: A descriptive cross sectional study was conducted on 145 patients diagnosed with COPD. Through consecutive sampling baseline data, and symptoms severity were obtained by MRC Dyspnea scale and an interviewer administered questionnaire. Airway inflammation was determined bybreath FeNO (Bedford Inc. UK) and exhaled breath CO (Bedford Inc. UK). Results: 63.1% were males; low BMI was observed in 35.1% that which indicates poor nutritional status. Mean BMI of the subjects was 20.64 kg/m2. 53.1% were ex-smokers. Airway inflammation as determined by FeNO level was associated with smoking status (p<0.05). 51% had intermediate FeNO levels (25 – 50 ppb). Patients had high FeNO levels (more than 25 ppb) was taken as airway inflammation. Ninety three percent had low COHb levels (< 5 ppm), 6.1 % had intermediately high COHb levels (> 5 ppm). The mean exhaled CO level was significantly higher in smokers when compared to non-smokers (<0.001). Majority (64.6%) had severe dyspnea level (MRC of grade 4-5) that indicates majority had breathlessness according to the MRC dyspnea scale. Conclusion: The present study confirms that measurements of FeNO levels can detect airway inflammation and bCO levels can determine smoking status of COPD patients. Poor nutritional status of COPD patients to be addressed by proper dietary advice and supplementation
Determinants of quality of life in people with dementia in a Sri Lankan setting
Background: Dementia has become a public health priority along with population ageing worldwide. Owing to its chronic progressive nature in the absence of a cure, maintaining the best possible quality of life (QOL) have become the desired outcome for people with dementia. Objectives: To determine the factors associated with good QOL in people with dementia in Sri Lankan setting. Methods: An unmatched case-control study was conducted to identify the factors associated with ‘good’ QOL. Cases were patients with ‘good’ QOL and controls were those with ‘poor/average’ QOL, accompanied by informal primary caregivers of last six months. They were identified using the validated DEMQOL tool, adhering to strict eligibility criteria, from state hospital tertiary care psychiatric clinics in the Colombo district. There were 64 cases and 208 controls. An interviewer-administered questionnaire was used to assess the associated factors. Bivariate analysis followed by logistic regression modelling determined the associated factors adjusted for confounders using odds ratio (OR) and 95% confidence interval (CI). Results: After adjusting for confounders, the significant factors associated with ‘good QOL’ were; education up to GCE O/Level and above (OR=4.02; 95% CI=2.97, 12.0), ever employed (OR=3.21; 95% CI=1.59, 11.06), good social functioning (OR=4.14; 95% CI=3.39, 16.46), mild functional impairment (OR=1.77; 95% CI=1.13, 9.67), little or no caregiver burden (OR=2.96; 95% CI=1.86, 10.94), absence of apathy (OR=2.22; 95% CI=1.27, 12.48) and absence of irritability (OR=2.17; 95% CI=1.72, 10.34).60% of the variance of ‘good’ QOL among patients with dementia was explained by the factors in the final model. Conclusions: The identified associated factors indicate that QOL improvement programmes should primarily focus on patients’ activities of daily living, social functioning and caregiver burden.
Physical and mental well-being and job satisfaction among male construction workers in selected urban construction sites in Sri Lanka
Background: Construction sites are mushrooming everywhere in the urbanized areas of Sri Lanka, keeping pace with the rapid economic development. As this industry is inseparably associated with numerous risks endangering the workers, it is important to assess and identify any potential overall health impairments. Objectives: Our aim was aimed to assess the physical and mental wellbeing and job satisfaction among male construction workers in selected urban construction sites. Methods: A cross sectional descriptive study was carried out in a sample of 120 male workers at three urban construction sites using an interviewer administered questionnaire that was specially designed. Socio-demographic factors, level of physical activity, nutrition and diet, alcohol and smoking, rest and sleep, energy and fatigue, pain and discomfort, level of mental wellbeing and level of job satisfaction of them were assessed. Rate of Perceived Exertion Scale (CR10), Fatigue Severity Scale, Warwick Edinburgh Mental Wellbeing Scale, Job Satisfaction Survey used in designing the tool for data collection and for the sections questionnaires which were validated through a content expert. Data was analysed using SPSS version 22. Results: A majority (N=88, 73.3%) of the workers monthly earned more than thirty thousand rupees. Most (N=51, 42.5%) were engaged in vigorous physical activities. Most (N=68, 56.7%) had normal BMI while 21(20.8%) were underweight. Current prevalence of alcohol use and smoking were 55.0% (N=66) and 44.2% (N=54) respectively whereas 24(36.9%) were consuming alcohol for more than 10 years and 5(9.4%) were smoking more than 10 pack years. Majority (N=69, 57.5%) had adequate sleep but most (N=70, 58.3%) were not involved in leisure activities. Majority (N=100, 83.3%) was not fatigued whereas 80(66.6%) had musculoskeletal pains, most common being the back pain. Most had good mental wellbeing (N=119, 99.2%) and good job satisfaction (N=115, 94.8%). Conclusions: In conclusion the monthly income of majority of the workers was high and the overall nutritional status was satisfactory whereas alcohol use and smoking were significantly prevalent in comparison to the general population. Many suffered from musculoskeletal pains but majority had good mental wellbeing and were satisfied about their job.
Preventive effect of Shemamruthaa - an indigenous herbal formulation against 7, 12-dimethylbenz (a) anthracene induced breast cancer in female Sprague Dawley rats
Background: Cancer is the leading cause of morbidity and mortality worldwide, with approximately 18.1 million new cases and 9.6 million deaths in 2018. The major type of cancer among females is breast cancer, accounting for 24.2% of the total cancer cases. In the last decades, phytochemicals have attracted a growing attention as anti-cancer agents and the study of herbal formulations from traditional medicine represents a challenging research field. Objectives: Shemamruthaa (SM), an indigenous herbal formulation constituting petals of Hibiscus rosa-sinensis and fruits of Emblica officinalis and honey was evaluated for anticancer property. Methods: Adult female Sprague-Dawley rats (8-week-old) were used for the study and were divided into 4 groups. Group I, normal control animals received a single oral dose of olive oil (1 ml) at the age of eight weeks (Control); Group II animals induced for mammary carcinoma with a single oral dose of 25 mg of 7, 12- dimethylbenz (a) anthracene DMBA dissolved in one ml of olive oil after overnight fasting. Group III mammary carcinoma was induced as in Group II, in addition, after three months; animals were treated with SM at the dose of 400 mg/ kg body weight/day by gastric intubation (DMBA+ SM treated). Group IV Animals received 400 mg/kg body weight of SM alone and served as SM control. The experimental design was performed in accordance with the current ethical norms approved by the Committee for the Purpose of Control and Supervision of Experiments on Animals (CPCSEA), and Institutional Animal Ethics Committee Guidelines (IAEC. No. 01/030/2011). The tumour markers and the mRNA expression of pro-apoptotic genes/anti-apoptotic genes were examined by RT-PCR analysis in mammary tissues of control and experimental animals. Results: Results of the study revealed that SM treatment significantly (p< 0.05) abridged the levels of tumour markers viz. carcinoembryonic antigen (CEA) and breast cancer specific marker (CA-15-3) when compared to DMBA-induced rats. SM treatment significantly induced mRNA levels of p53 and Bax. Meanwhile, the cell proliferative (PCNA) and anti-apoptotic gene, Bcl-2 were down-regulated by SM treatment. Conclusion: The expression pattern of breast cancer markers and apoptotic signaling molecules analyzed in the present study signifies the therapeutic efficacy of SM against breast cancer. Acknowledgments: Food Testing Laboratory, Indian Institute of Crop Processing Technology, Ministry of Food Processing Industries, Government of India, Tanjavur 613005, Tamil Nadu, India, for providing Gas Chromatography - Mass Spectrometry and HPLC facilities.
Clinico-demographic characterization of Cutaneous leishmaniasis in patients reporting to two hospitals in Matara and Hambantota districts, Sri Lanka
Background: Cutaneous leishmaniasis (CL) is an established disease in Sri Lanka. Objectives: This study aimed to characterize clinico-demographic pattern of CL, in patients reported to District General Hospital (DGH) Matara and Base Hospital (BH) Tangalle, which report about 100 new cases monthly. Methods: Clinico-demographic findings of 47 CL confirmed patients (>18 years; Slit skin smears (SSS) and/or PCR positive) from preliminary data of a cross sectional study carried out at DGH Matara and BH Tangalle from August/2018 to January /2019 were analysed. Interviewer administered questionnaire was used to gather the demographic data. Results: Median age was 43 years. Out of the 13 cases from DGH Matara, four reported from Urugamuwa and one each from other areas of the district. Of the 34 cases from BH Tangalle, 12 were from Beliaththa. Eight SSS negatives became PCR positive and one PCR negative was SSS positive. Majority of the lesions were single (n=40, 85.1%), non-tender (n=38, 80.8%), non-itchy (n=34, 72.3%) and small (< 2cm, n=36, 76.6%) ulcerated nodules (n=14, 29.8%) in upper limbs (n=25, 53.1%) with parasitic grading of 1+ (n=20, 42.5%). Nine patients reported persistent itching without any evidence of secondary pathology. Clinical evidence of secondary bacterial infection presented in four patients and out of them, two had painful lesions. Thirty two lesions were <4 months duration. In addition to ulcerated nodules and plaques, three out of nine papules were ulcerated within 4 months’ by history. Two patients had a family member with CL. Conclusions: Ulceration of papules is a novel observation. Urugamuwa is a possible emerging focus of CL in Matara where Dickwella is the known hot spot. Beliathta could be a main disease focus in Hambantota. This preliminary study based on a smaller sample size needs to be validated with a bigger sample size.
Evaluation of bactericidal activity of antiseptics and disinfectants commonly used in healthcare settings in Colombo District
Background: Increasing risk of healthcare associated infections especially polymicrobial wound infections is a major problem in healthcare settings in Sri Lanka. Proper use of antiseptics and disinfectants may be useful in reducing the magnitude of such infections. Objectives: To determine the efficacy of bactericidal activity in recommended concentrations and lower concentrations of selected antiseptics and disinfectants. Methods: Bactericidal activity of 40%, 50% and 60% isopropyl alcohol, 1%, 5% and 10% povidone iodine, 1%, 2% and 4% chlorhexidine gluconate, 1.22%, 1.42% and 1.62% peracetic acid, 1.9% and 2.9% hypertonic saline and 1.5%, 2% and 2.5% of the mixture of 2-aminoethanol, didecyldimethylammonium chloride, potassium carbonate and bis (3-Aminopropyl) dodecylamine was evaluated with 9 standard strains of American Type Culture Collection (ATCC) and 13 clinical isolates of bacteria. Reduction of growth of methicillin sensitive Staphylococcus aureus (MSSA), methicillin resistant Staphylococcus aureus (MRSA), Streptococcus pyogenes, Enterococcus faecalis, Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae (ESBL and carbapenem resistant), Pseudomonas aeruginosa was assessed with contact times of 1 minute, 15 minutes and 24 hours by counting colonies comparing with test control which contains same volume of distilled water instead of antiseptic or disinfectant solution. Results: All chemicals except hypertonic saline showed 100% bactericidal activity in all concentrations against all tested bacteria in stated contact times. Hypertonic saline in 1.9% and 2.9% showed significant reduction of Gram positive bacteria and Acinetobacter baumannii only after 24 hours. Acinetobacter baumannii was inhibited by1.9% and 2.9% of hypertonic saline in 67.48% and 68.20% of respectively; however, other Gram negative bacteria were not inhibited. Conclusion: Recommended concentrations of antiseptics and disinfectants have an accepted bactericidal activity against tested standard strains and clinical isolates. Hypertonic saline is only effective to inhibit Gram positive bacteria after 24 hours of contact time. Acknowledgement: Staff of Department of Microbiology, the University of Sri Jayewardenepura, Sri Jayewardenepura General Hospital and Colombo South Teaching Hospital.
Microbiological analysis of skin and soft tissue infections in cancer patients at Apeksha Hospital, Sri Lanka
Background: Skin and soft tissue infections (SSTIs) in patients with malignancies are common and frequently have serious consequences. These infections are caused by a wide range of microorganisms with variable anti-microbial susceptibilities. Objectives: To analyse skin and soft tissue infections in cancer patients at Apeksha Hospital with regard to causative agents, antibiotic susceptibility and associated factors. Methods: A descriptive cross sectional study was carried out for 18-month period. Specimens from adult cancer patients admitted to Apeksha Hospital, Maharagama with SSTIs were analysed. Aerobic and anaerobic bacterial culture, fungal culture, species identification and antibiotic susceptibility testing were performed. Clinical data were obtained from patient records. Results: A total of 85 patients were included with a male: female ratio of 1:1.1.Majority (75%) were >50 years old. Out of the 80 aerobic bacterial isolates most (69%) were Gram negatives, majority being Enterobateriaceae (42/80) followed by Pseudomonas (11/80). Escherichia coli was the commonest bacterial species. Staphylococcus aureus was the commonestGram positive organism (22/80). No strict anaerobic bacteria were yielded however, 3 fungi (two Candida albicans, one Fusarium species) were isolated. Enterobacteria showed lowest resistance to amikacin (7%) and meropenem (10%). Pseudomonas species had highest resistance to ticarcillin-clavulanate (64%). Methicillin resistant Staphylococcus aureus (MRSA) rate was 61%. None had resistance to anti-MRSA agents. Gram-negative bacteria caused 74% of wound infections while 54% of the abscesses were caused by Gram positives. Gram negatives were prevalent (73%) in patients with solid organ cancers and Gram positives in haematological malignancies (83%). Gram-negative infections (69%) predominate in patients on radiotherapy while chemoptherapy had similar rates of infections by the two types of organisms. Conclusion: SSTIs in the cancer patients at Apeksha Hospital, Maharagama are mainly caused by Gram negative bacteria however, Gram positives predominate in haematological malignancies. Multi-drug resistance is prevalent in all commonly isolated pathogens. Acknowledgements: University of Sri Jayewardenepura research grant ASP/01/R/MED/2016/61 (Centre for Cancer Research)
Analysis of viral pathogens in children with community acquired pneumonia (CAP) at two selected teaching hospitals in Colombo, Sri Lanka
Background: Community acquired pneumonia is an important cause of morbidity and mortality in children. Infection is caused by many different organisms and rational treatment depends on the identification of causative agents. Objectives: To describe the viral pathogens in community acquired pneumonia in children at two selected teaching hospitals in Colombo. Methods: A descriptive cross sectional study was carried out including 123 children, 3 months to 14 years of age admitted to two teaching hospitals with a clinical diagnosis of CAP. A nasopharyngeal sample was collected from each child and analyzed using multiplex real time PCR assay. FBC and CRP were done. Chest X-rays were blindly reported by a radiologist and categorized into 3 groups according to the WHO classification 1) Primary end-point consolidation/pleural effusion 2) Other consolidation/infiltrate 3) No consolidation/infiltrate/effusion. Results: Female to male ratio of this group was 1.5:1 and mean age was 40 months. The mean values for CRP and WBC were 51.41mg/L and 14.97/μL respectively. Out of123 samples one was negative for any organism. At least one virus was detected in 111 samples (90.2%). A single virus was present in the majority (60.4%) of cases and multiple viruses in the rest (39.6%). The commonest was Respiratory Syncytial virus (43.2%). Rhino, Parainfluenza and Adeno viruses were more abundant than Influenza A, Corona, Influenza B, Boca, Metapneumo, Entero and Parecho viruses. Both bacteria and viruses were detected in 77 samples. Ninety CXRs were reported in the group positive for viruses and category 2 was the commonest (55.6%). Conclusions: Viruses are predominant in paediatric CAP and co-infections with multiple viruses are fairly common. Acknowledgement: University Grant- ASP/01/RE/MED/2017/32
Pathogenic microbial contamination status and antibiotic resistance of isolated Salmonella spp. in well water of Jaffna Peninsula
Background: The incidences of typhoid fever which is caused by Salmonella spp. has markedly increased in Sri Lanka in the recent past. Out of 12, 823 typhoid cases reported during 2005-2014, 2588 cases were reported from Jaffna Peninsula. Health ministry statistics also showed that, occurrence of significant intestinal diseases in Jaffna during 2005-2014. The only way of obtaining water for drinking and domestic consumption of people in Jaffna Peninsula is from dug wells therefore concern on quality of groundwater is important, as these diseases are water borne. Objectives: To evaluate the microbial contamination status with a special emphasis on Salmonella spp. and Shigella spp. and their antibiotic resistance. Methods: Forty sampling points were randomly selected covering the whole peninsula. Total coliform, and fecal coliform, Salmonella spp. and Shigella spp. were enumerated and identified according to the methods given by WHO. Antibiotic resistance of Salmonella sp. and Shigella sp. were carried out using antibiotic susceptibility tests according to CLSI guidelines. AST was carried out using Agar disk diffusion method using a commercially available susceptibility test disk. Results: The results of the study revealed that the 100% of the samples were contaminated with total and fecal coliform and they were not within the range given by the WHO and SLS drinking water quality standards. Further, it was found that 8% of sampling locations were contaminated with Salmonella spp. and all the positive wells are being used to extract water for drinking. However, no Shigella spp. was recorded during the time of sampling. Serovar identification revealed that the isolated Salmonella strains belong to Salmonella weltevreden, a human pathogen which causes water borne intestinal diseases. Further, the isolated Salmonella spp. were tested for their antibiotic susceptibility. Six different commonly used antibiotics for typhoid and intestinal diseases were used. Out of them one strain of Salmonella weltevreden showed resistance to Gentamicin and intermediate resistance to Amoxicillin. Conclusions: Thus, the results of the study is alarming, it relives that almost all the parts of Jaffna Peninsula are contaminated with coliforms. The contamination of ground water sources with Salmonella spp. is also posing a threat. The results also showed that there’s a development of resistance to commonly used antibiotics. Therefore, the importance of proper strategic plan to monitor microbial contamination of ground water along with proper disposal practices of antibiotics in order to avoid development of antibiotic resistance in the environment are much needed.
Synthesis, Characterization and Antimicrobial Activity of Garcinol Coated Titanium Dioxide Nanoparticles
Background: Garcinol is a secondary metabolite derived from the plants of Clusiaceae Family. It has shown a broad range of bioactivities such as antimicrobial, antioxidant, anticancer and anti-inflammatory. Titanium dioxide nanoparticles (TiO2NPs) are known to have a significant photocatalytic activity and are widely used in medicine. In this study, garcinol was used to modify the surface of TiO2NPs to enhance the antibacterial activity. Objectives: To synthesize, characterize and determine antimicrobial activity of garcinol coated titanium dioxide nanoparticles G-TiO2NPs. Methods: Garcinol was isolated from the dried fruit rinds of Garcinia quaesita. TiO2NPs were coated by garcinol and characterized by using Scanning Electron Microscopy (SEM), Powder X-Ray Diffraction (XRD), and Diffused Reflectance Spectroscopy. Minimum Inhibition Concentration (MIC) was tested against five microbial species including Staphylococcus aureus (ATCC 25623), Pseudomonas aeruginosa (ATCC 27853), Escherichia coli (ATCC 25922), Candida albicans (ATCC 10231) and clinical isolates of Methicillin Resistant Staphylococcus aureus (MRSA), using broth micro-dilution assay. Time-kill kinetic study was performed to determine the inhibition percentage of Staphylococcus aureus over time. Results: SEM images confirmed the spherical shape of G-TiO2NPs, diameter ranging from 20 - 200 nm. XRD data revealed the anatase phase and rutile phase of TiO2NPs. Formation of G-TiO2NPs caused a red shift of the absorption wavelength. G-TiO2NPs and TiO2NPs showed a MIC range of 250-500 μg/ml and 500-1000 μg/ml against the tested microbial species, respectively. In the time-kill kinetic studies, inhibition percentage (IP) of microbial growth was determined at 60 minute time intervals. TiO2NPs and G-TiO2NPs demonstrated inhibition over 50% at 3 hours. Conclusions: G-TiO2NPs presented a significant enhancement in antimicrobial activity against S. aureus compared to TiO2NPs. Surface modification of TiO2NPs with garcinol has created a synergistic antimicrobial effect against S. aureus. Acknowledgement: University Grant ASP/01/RE/SCI/2017/19
Spectrum of sputum culture isolates and their antibiotic susceptibility pattern in adult cancer patients receiving empirical antibiotics at Apeksha Hospital, Maharagama, Sri Lanka
Background: Infections are the second commonest cause of non-cancer deaths among patients with malignancies. Both lower respiratory tract infections (LRTI) and blood stream infections have shown near equal prevalence in these populations. Objective: To determine the spectrum and the antibiotic susceptibility pattern of the bacteria isolated from sputum of cancer patients receiving empirical antibiotics for LRTI at the time of the specimen collection. Methods: Fifty five patients who were diagnosed clinically and/or radiologically to have LRTIs were included in the study from May, 2018 to January, 2019 at Apeksha Hospital, Maharagama. Sputum culture was done and ABST was performed for isolated pathogens. Results: Klebsiella pneumoniae was the commonest pathogen (49.1%, 27/55) isolated followed by multi-drug resistant Acinetobacter spp. (16.4%, 9/55). Overall proportion of coliforms was found to be 63.6% (35/55). All the isolated Staphylococcus aureus (12.7%, 7/55) were methicillin-resistant (MRSA) and inducible clindamycin resistant was detected among three of those. Coliforms showed the highest sensitivity to amikacin (71.4%, 25/35) and gentamicin (68.6%, 24/35). Colistin was the only antibiotic detected sensitive against eight Acinetobacter baumannii /A. calcoaceticus isolates. One A. iwoffii isolate was resistant to all the tested antibiotics including colistin. Extended spectrum beta lactamase (ESBL) production was detected in 22.8% (8/35) and carbapenem resistance in 54.3% (19/35). Meropenem was the empirical antibiotic of choice in this patient population which had been given to 34.5% (19/55). The isolated pathogen in 54.5% (30/55) of the patients was resistant to the selected empirical antibiotic. Conclusion: Sputum culture isolates show a very high resistance to multiple antibiotics which results in limitations of appropriate empirical antibiotic selection. Acknowledgement: University of Sri Jayewardenepura, research grant No. ASP/MED/2017/36.
Can we move forward to Digital Healthcare in Sri Lanka? Developing an Electronic record keeping system to a local Paediatric clinic
Background: Paediatric multi-disciplinary team (MDT) clinic at Colombo-south teaching hospital is designed for patient-centered management of paediatric neurological disorders. This clinic lacks an electronic database management system (E-DBMS). Open source technology through Google and AppSheet® provides tools to create E-DBMS. Objectives: To design a user-friendly, secured electronic DBMS for record keeping, audit, data analysis and research purposes. Methods: New google account was created for the MDT clinic. Google spreadsheets® were used to design the data tables and linked to AppSheet® software to generate graphical user interface of the mobile app of the database. Appearance and features of the App were designed through options provided by the AppSheet® without writing codes using computer language. Once the app is ready, email address and password are shared among the authorized team members and mobile app was installed into their phones. Results: This app enabled the team members to add, edit and view data of MDT patients. Telephone calls could be taken and patients’ locations could be accessed through the app. Since database is accessible through phones, patients’ past records could be reviewed and new records can be entered while conducting the clinic. Success of the therapies given to patients can be quantified by motor skills score and AIMS centile analysis. These spreadsheets could be linked to SPSS software to analyze data for research purposes. Even though this provides adequate confidentiality and security to data, all the authorized team members who share the app have an unrestricted access to add, edit or remove data. Conclusion: Electronic DBMS could be designed practically via AppSheet®, which is an effective tool to maintain and to retrieve patients’ record sand for research purposes.
Staphylococcus aureus bacteraemia Audit - UK experience
Background: Staphylococcus aureus bacteraemia (SAB) causes high morbidity, mortality and healthcare costs. There are national recommendations for minimal 14 days of IV antibiotics, repeat blood cultures and screen for endocarditis. Study was conducted in University Hospital Coventry (UHC). It is a most modern healthcare facility in Europe with 1,005 beds, 26 operating theatres and specialize in cardiology, neurosurgery, stroke, joint replacements, in vitro fertilization and maternal health, diabetes and kidney transplants. Management of SAB is continuously audited in UHC since 2007. The standard treatment pathway for the trust is underway. Objectives: This is to assess the standard of care in management of SAB comparing the results of past 3-years and looking forward for further development. Methods: Retrospective study conducted between June 2016 to December 2018. Electronic patient records were used. Results: Total 153 patients were identified with SAB. Majority were >60 years. There were 25 intravenous drug users in the group and 6 presented with recurrence. There were only 2% MRSAs. In majority (28%), the source of infection was skin and soft tissue infections. Surveillance blood cultures were done in 76% patients. It is improved form 67% in last audit which was conducted between June 2016 and May2018. Fifty one percent had undergone echocardiogram and 8% patients died before blood culture results are available. In 89% of patients appropriate treatment was started. More than 14 days of treatment was completed in 81% patients. Flucloxacillin, meropenem, ertapenem, daptomycin and other antibiotics were used for the completion of 14 days course. From total patients, 16% had complications and endocarditis was the commonest. The 60 days mortality rate was 21%. Conclusions: The mortality rate and complications of SAB is high disregard of the effective antibiotics and further improvement of the clinical management is essential.
Do we achieve LDL-cholesterol targets in routine clinical practice? Evidence from a tertiary care hospital in Sri Lanka
Background: Statins are widely used for primary and secondary prevention of cardiovascular disease (CVD). European Society of Cardiology / European Atherosclerosis Society (ESC/EAS) guidelines recommend LDL-cholesterol targets based on CVD risk. Objectives: This study aimed to determine whether LDL-cholesterol targets recommended by2016 ESC/EASare achieved in routine clinical practice. Methods: This paper is based on baseline data of patients recruited to a controlled clinical trial conducted at a tertiary care hospital. Participants have been on atorvastatin for >2 months. Demographic and clinical data were obtained using clinic records and interviewer administered questionnaires. LDL-cholesterol was assessed using Friedewald equation (when triglyceride was <400mg/dL) or by direct measurement (when triglyceride was ≥400mg/dL). Each participant’s CVD risk level and appropriate LDL-cholesterol target (very-high CVD risk:<70mg/dL; high CVD risk:<100mg/dL; low to moderate CVD risk:<115mg/dL) was determined according to 2016 ESC/EAS Guideline. Results: 101 patients were studied. (Women: 76.2%; mean-age: 61.2:±9.3years). Prevalence of coronary heart disease, ischaemic stroke, diabetes, hypertension and smoking was 30.7%, 4%, 77.2%, 80.2% and 4%, respectively. According to CVD risk level 80.2%, 15.8% and 4% were in very-high, high and moderate risk categories, respectively. Most were on atorvastatin 10mg (45.5%) followed by 20mg (43.6%), 40mg (8.9%), 30mg (1%) and 5mg (1%). Median duration of treatment was 41-months. Overall, only 12.9% had achieved target LDL-cholesterol (very-high risk: 7.4%; high risk: 37.5%, moderate risk: 25%; p=0.003). Men did better than women in achieving target LDL-cholesterol (men: 29.2%, women: 7.8%; p=006). There was no difference based on age, comorbidities or atorvastatin dose. Conclusions: In the study population majority has failed to achieve LDL-cholesterol targets recommended by 2016 ESC/EAS. Failure to achieve targets was more common among women and those having very-high CVD risk. Reason for suboptimal target achievement has to be studied further. Acknowledgement: Funded by University of Sri Jayewardenepura Research Grant (ASP/01/RE/MED/2015/54) and Ceylon College of Physicians Research Grant (2014).
Improving balance with wobble board exercises in stroke patients: single blind, randomized clinical trial
Background: Postural balance is often affected by stroke. A primary objective in stroke rehabilitation is to restore functional balance, which is a combination of dynamic and static balance. Objectives: To identify the efficacy and safety of wobble board exercises when combined with conventional physiotherapy, in improving balance in hemiplegic patients following ischemic strokes. Methods: A block-randomized, controlled, observer blinded, superiority trial was conducted in Stroke Rehabilitation Unit of the National Hospital of Sri Lanka. Participants were ambulatory hemiplegic patients following ischemic strokes of middle cerebral artery territory. Subjects in the control group received a conventional physiotherapy regime. Subjects in the intervention group received training on a wobble board combined with conventional physiotherapy. Main outcome measures were improvement of dynamic balance [Four-Square Step Test score (FSST)] and functional balance [Berg Balance Scale (BBS)] at the end of six weeks. The study was approved by the institutional Ethics Review Committees (UCP/LE/13/187; AA/ETH/COM/2018). Results: During recruitment, 30 patients were randomly assigned for intervention (n=15) and control (n=15) groups. One patient dropped out from the study, leaving 29 eligible for the analysis. Intervention and control groups were comparable in sociodemographic characteristics and pre-test scores of balance. A repeated-measures MANOVA showed a statistically significant difference in improvement of balance between the two study groups after six weeks [F (1,28)=32.6,p=.000; Wilk’s lambda=.46]. The improvement of mean scores of balances in interventional group were greater than in the control group (BBS: 9.5>5.5; FSST: 3.9>1.7). There were no injuries or accidents in both groups. Conclusions: Wobble board exercises, when combined with the conventional physiotherapy, are safe and effective in restoring dynamic and functional balance in patients with hemiplegia following ischemic strokes.
Developing a theory of change model to re-orient malaria screening programme during the prevention of re-introduction phase in Sri Lanka
Background: Sri Lanka is the first major tropical country certified by WHO as malaria free during the past three decades. High malariogenic potential within the country makes this achievement extremely fragile. WHO recommends to re-orient the malaria programme following elimination. Theory of Change (ToC) is effective in developing, Implementing and evaluating complex public health interventions. This paper represents a part of a broad study to evaluate the effectiveness of an intervention package designed to achieve desired programme changes of re-orientation and describes framework developed based on ToC. Methods: The impact and the long-term outcomes expected to see in a re-oriented malaria programme were identified in consultation with two experts in the field of malaria and ToC, and review of relevant literature. Two consultative meetings held with stakeholders to develop the ToC, including six regional malaria officers, five experts from the national malaria programme and technical support group of the programme. The desired long-term outcomes, interventions and the target groups and the content of the interventions were decided. Available resources and feasibility of implementation were discussed, and major assumptionswere recorded. The indicators to evaluate the processes and outcomes were decided. Results: A ToC model was developed to achieve re-orientation of malaria screening. This was used to identify areas that need changes in order to achieve expected programme change, to develop specific interventions targeting relevant groups to bring about the desired programme change, and to identify indicators to evaluate the same. Conclusions and recommendations: This model was successfully used as the basis of designing, implementing and evaluating an intervention package to achieve re-orientation of malaria screening. Acknowledgement: National Science Foundation, National Health Research Council.
Application of Failure Mode Effect Analysis (FMEA) to analyze the safety of medication dispensing in a tertiary care hospital
Background: Failure Mode Effect Analysis (FMEA) is a prospective, team based, structured process used to identify system failures of high risk processes before they occur. Medicines dispensing is a high risk process that should be analyzed for its inherent risks. Objectives: To identify possible failures, their effects and causes of the dispensing process of the study setting using Failure Mode Effect Analysis. Methods: This prospective, cross sectional study was carried out for two months in the Pharmacy Department of a selected teaching hospital, Colombo, Sri Lanka. Thirteen pharmacists had discussions in two independent groups (Group A, n=06; Group B, n=07) to conduct a FMEA. Each group had one in-charge pharmacist, at least one senior pharmacist (>ten years of working experience), and one graduate pharmacist. Each group had five meetings of two hours each, where the dispensing process and sub processes were mapped, and possible failure-modes, their effects, and causes, were identified. A score for potential severity (S), frequency (F) and detectability (D) was assigned for each failure-mode according to specified guidelines. Risk Priority Numbers (RPNs) were calculated (RPN = SxFxD) to prioritize identified failure-modes. Feedbackwas obtained from participants about the usefulness of FMEA. Results: Group A identified 48 failure-modes while Group B identified 43. Among all 91 failure modes, 69 failure-modes were common to both groups. The 22 that were not in-common scored low RPNs. Considering the RPN, Group A prioritized one failure-mode, while Group B prioritized three failure-modes (having identical RPNs). Both groups identified overcrowded dispensing counters as a cause for 57 identified failure-modes. All participants accepted FMEA as an effective method to analyze the safety of the dispensing process. Conclusions: FMEA was successfully utilized to identify and prioritize possible failure-modes of the dispensing process through active involvement of pharmacists. This prospective approach is useful to prevent dispensing errors before they occur. Acknowledgement: This study was funded by the University Research Grant ASP/01/RE/MED/2017/37, University of Sri Jayewardenepura.
Drug dependency and drug use behaviour among male illicit drug users in selected rehabilitation centres in Sri Lanka
Background: Illicit drug use has become a growing public health phenomenon in Sri Lanka. Many illicit drug users end up with drug dependency, becoming a burden to the country. Objectives: To describe drug dependency and drug use behaviour among male illicit drug users in selected rehabilitation centres in Sri Lanka. Methods: A cross-sectional study was conducted among 431 male illicit drug users in five selected rehabilitation centres in Galle, Colombo, Gampaha and Kandy districts, Sri Lanka. An interviewer-administered questionnaire was used for data collection. Drug dependency was identified using ICD symptom checklist for substance use disorder. Results: Majority of the sample were Sinhala (82.4%) and Buddhists (70.5%). Mean age (SD) was 32 (10.3) years. The highest percentage of the drug users were from Western province (75.6%). Of all illicit drug users, 97% were drug dependents according to ICD 10 symptom checklist. Heroin was most commonly addicted illicit drug (86.5%). Cannabis addiction was identified among 4.3% and all of them were from rural areas. Approximately 4% were addicted to multiple drugs. Injecting drug practices were reported among 23.4%. Mobile transfer of funds (eZ cash) was a popular method used to purchase drugs by drug users (21.8%) outside the Western province. In a shortage of the regular drug, 32.9% of drug users used alternative illicit drug, 3.2% used alcohol and 16.9% had a period of abstinence. Interestingly, 46.9% never experienced a shortage of drugs. Drug overdose was experienced by 25.1% of drug users. Conclusions: Drug dependency is a significant problem among illicit drug users. A proper system for early identification of drug dependents at community level is required to deliver better preventive care.
Health and psycho-social outcomes of playing video games among undergraduates at University of Sri Jayewardenepura, Sri Lanka
Background: With the increase in the technological advances, the use of media devices has contributed to increase the screen time of users. Especially playing video games has a major contribution to excessive screen time and also that leads to make changes in daily routines, social behaviors, emancipative values, family relations and social interactions. Therefore, excessive time spending on video games holds the potential to be harmful to one’s health. Though there are no local evidence of screen time related to video games, higher levels of playing video games have shown associations with some health and psycho-social problems in previous studies in other countries. Objectives: The objective of this study was to estimate the time spend on playing video games, associated health and psycho-social problems among undergraduates at University of Sri Jayewardenepura. Methods: This descriptive cross-sectional study was conducted among 430 participants selected by convenient sampling in four faculties including Faculty of Medical Sciences, Humanities & Social Sciences, Management Studies and Commerce and Faculty of Applied Sciences of University of Sri Jayewardenepura. A pre-tested, self-administered questionnaire was used to ascertain data related to video game usage. Hyperactivity and conduct problems were measured based on Strengths and Difficulties Questionnaire (SDQ). Data were analyzed using SPSS statistical software (Version 20). Associations were determined with chi-square test. Ethical approval for the study was obtained from ethics review committee of the Faculty of Medical Sciences. Results: The mean time spent on playing video games in a week day was 27.76 minutes (SD=80.57) followed by 40.90 minutes (SD=103.17) weekend-day. Excessive video game playing in week days was significantly associated with frequent hand pain (OR=2.13, 95%CI=1.04-4.38) followed by obesity and overweight (OR=1.81, 95%CI=1.05-3.10). Playing video games excessively in week days was significantly associated (p<0.05) with delaying main meals very often (OR=1.86, 95%CI=1.20-2.87) followed by hyperactivity (OR= 1.88, 95%CI=1.00-3.57) and conduct problems (OR= 2.72, 95%CI=1.45-5.08) respectively. Playing video games excessively in weekends also associated with hyperactivity (OR= 1.88, 95%CI=1.00-3.53) and conduct problems (OR= 3.01, 95%CI=1.61-5.62). Conclusions: Excessive video games playing has impacts on physical and psychological well-being as well as normal behavior of the university students. Students should be made aware regarding the harmful effects of involving in video games excessively in order to minimize the harmful effects.
The knowledge and attitude of graphical warning signs on tobacco among males working in the Sri Lanka Railway Department.
Background: Cigarette smoking has now become a major health burden in Sri Lanka. Government introduced graphical warning signs displaying eight pictures in 2012. Regardless of global studies done on this issue, none have been conducted in the local context. Hence, this study was done with the intention of furnishing this discontinuity. Objectives: To determine the knowledge and attitude of graphical warning signs on tobacco among males working in the Sri Lanka Railway Department. Methods: A descriptive cross-sectional study with a cluster sampling method was carried out among 110 male workers aged between 20-60 years. A self-administered questionnaire was used. The significance was tested using the Chi-Square test at a 5% significance level. Results were analyzed using SPSS software. Results: The overall response rate was 100%. Participants were aware of the diseases depicted in the graphical warning signs (67.9%, n=72) than the ones that were not (29.2%, n=31), and there was a significance difference in this observation (p<0.0001). Out of the displayed diseases, lung cancer was the most widely known disease (89.6%, n=95) and conversely diseases in children were the least known (26.4%, n=28). The people who hadn’t appreciated the warning signs (n=16)stated the pictures being unpleasant to look at (68.8%, n=11) and letters being too small (31%,n=9) as the reasons. From the smokers, 84% (n=42) believed cigarette packets should carry graphical warnings and it should cover 50-100% of the package. The pictures with oral cancer had the best response when the effectiveness and health message was considered while the pictures containing children were rated low in conveying the relevant message. Conclusions: Graphical warnings have captured the attention of the majority and, both smokers and non-smokers had positive attitudes regarding them. From the eight pictures that are currently been used, five had conveyed the health message to the public more effectively than the other three.
Family level dementia care assessment tool’: a tool to assess Quality of care received by dementia patients in Sri Lankan setting
Background: Dementia has become a public health priority along with population ageing worldwide. In the absence of a cure, maintaining the best possible quality of care (QOC) has become the desired outcome for people with dementia. Objectives: To develop a multi-source tool to describe QOC received by patients at family level Methods: The tool development process was consisted of five steps; item generation, item reduction, formulating the draft tool, translation and finalization. A qualitative study was conducted. Interpretative phenomenological approach was applied to identify items for the tool based on current quality care recommendations, using triangulation of techniques [in-depth and key informant interviews (KI) and focus group discussion (FGD)]. KI were consultant psychiatrists, neurologists, psychiatric social workers and consultant community physicians. In-depth interviews were conducted with patients and FGDs with the caregivers. Purposive sampling was done. Number of interviews was decided on data saturation. Item reduction was done through modified Delphi technique. The tool was translated to Sinhala language and finalized after assessing judgmental validity (face, content and consensual validity). Results: The newly developed ‘Family level dementia care assessment tool’ comprised of 56 items under 7 themes to be used as a multisource tool (observations on home environment, interviews with patient and caregiver). The main themes in the tool are home environment, primary caregiver, availability of a care plan, types of activities in practice, interpersonal relationships, availability of social network and patient’s appearance and behaviour. The tool has demonstrated acceptable level of face, content and consensual validity. Conclusions: ‘Family level dementia care assessment tool’ can be used as an observational checklist even by a grass root level health care worker, to assess the family level care received by dementia patients. This preliminary data on family level dementia care can be used to sensitize policy makers and also to plan interventions towards improving QOC among dementia patients.