Identification of aero-allergen sensitization in children seeking treatment for bronchial asthma at a tertiary care hospital for children in Sri Lanka.

OBJECTIVES: Despite a significant rise in asthma globally as well as in Sri Lanka, data regarding allergen sensitization patterns and other risk factors for asthma are not available. Therefore, we set out to determine the allergen sensitization patterns in children with asthma in Sri Lanka. METHODS: Skin prick testing for common indoor aeroallergens (cockroach, cat, dog, house dust mite, moulds) were carried out in 156 children with bronchial asthma at Lady Ridgeway Hospital for Children. RESULTS: 49.1% of the patients were sensitized to at least one allergen and 6.4% were sensitized to three or more allergens. Of the children 37.8% tested positive to house dust mite, 23.7% to cockroach, 5.8% to indoor moulds, 12.2% to cats and 8.9% to dogs. Allergen sensitization was significantly less in children aged four years or younger than in older children (p<0.0001). A family history of asthma or allergic rhinitis (AR) was a significant risk factor (p<0.0001) for allergen sensitization (OR 10.9, 95% CI 3.9 to 30.1). Frequency of symptoms was significantly higher in those who used firewood alone compared to those who used other fuels (OR 2.5, 95% CI 1.1 to 5.8). CONCLUSIONS: Sensitization to aero-allergens was seen in a majority of children with asthma. Sensitization was significantly more in children above 4 years of age. Patients with more frequent symptoms and with AR were more likely to be sensitized to allergens.

Adherence to preventive health care in children and young adults with Down syndrome (DS) in Sri Lanka.

OBJECTIVES: To assess adherence to preventive care and age-appropriate screening in different age categories of Down syndrome (DS) persons. METHODS: This community-based retrospective observational study on ambulatory persons with DS from different regions of Sri Lanka was carried out on 100 randomly selected individuals from a sample framework of approximately 300. Their screening behavior for cardiac, ophthalmic, hearing and thyroid status was evaluated. Age at first medical consultation for DS specific complications, whether undertaken when symptomatic or asymptomatic, and use of DS-specific growth charts were extracted from medical records. Screening was compared in three age groups (<10, 10-15, and >15 years). RESULTS: One hundred clinically diagnosed DS individuals (F: M 1:1.2) aged 2-28 years (mean 13.5 years) were from varied socio-economic backgrounds and rural (68%) suburban (20%) and urban (12%) settings. They all had had postnatal medical assessments. Initial eye, ENT, cardiac consultations was at significantly earlier ages in those below 10 years. Age-appropriate cardiac assessments occurred in 58%, 25% and 7.5% in each age group. Vision, hearing and newborn thyroid status were not routinely screened for. Only 7% had special growth charts. Area of residence had no effect on screening behavior. CONCLUSIONS: Screening for complications in DS was delayed and inconsistent but occurred at significantly earlier ages in younger children. Use of appropriate growth charts was very low. Screening behavior was unaffected by area of residence. We recommend incorporating DS-specific medical checklists as a preventive health routine for this unique group of children.

N-acetylcysteine in children with acute liver failure complicating dengue viral infection.

OBJECTIVES: To describe the outcome after administration of N-acetylcysteine (NAC) to seven children with nonparacetamol induced acute liver failure (ALF) complicating dengue infection. METHODS: Clinical records of children with non paracetamol induced acute liver failure complicating severe dengue viral infection, were retrospectively analysed for clinical and biochemical outcome following treatment with NAC. RESULTS: Seven patients between ages six months to twelve years with plasma leakage and circulatory compromise complicating dengue infection developed ALF. Three were exposed to prolonged shock prior to hospitalisation. NAC infusion (100 mg/kg) was administered as soon as ALF was diagnosed, based on low GCS scores, raised transaminases and prolonged prothrombin/INR. Full clinical and biochemical recovery occurred in all patients. CONCLUSIONS: A successful outcome followed early administration of NAC to children with ALF complicating severe dengue infection.

Spices as a source of lead exposure: a market-basket survey in Sri Lanka.

We performed a laboratory analysis of spices sold in Sri Lanka for lead content. Samples of curry powder, chili powder and turmeric powder from seven provinces, collected using the market basket survey method, underwent atomic absorption spectrometry. Blanks and standards were utilised for instrument calibration and measurement accuracy. The results were validated in two different laboratories. All samples were found to have lead levels below the US Food and Drug Administration's action level of 0.5 µg/g. Spices sold in Sri Lanka contain lead concentrations that are low and within the stipulated safety standards.

Pulmonary langerhans cell histiocytosis masquerading as tuberculosis in an infant.

A 4-month-old infant presented with continued fever, unresolving bronchopneumonia and household contact with sputum-smear-positive tuberculosis (TB) and showed marginal improvement on anti-TB chemotherapy. Recurrent pneumothorax prompted the clinical diagnosis of TB to be revised. High-resolution CT scan of the chest and open lung biopsy confirmed the diagnosis of pulmonary Langerhans cell histiocytosis. Treatment with prednisolone and vinblastin resulted in settling of fever and resolution of respiratory symptoms and signs. In communities where the prevalence of TB is high, unusual presentations should prompt consideration of alternative diagnoses.

Vertical transmission in chikungunya infection.

We report the pregnancy outcome and clinical and laboratory findings in infants born to women with chikungunya infection during pregnancy. There was evidence of vertical transmission and poor pregnancy outcome in some cases.

Standards medical students set for themselves when preparing for the final MBBS examination.

INTRODUCTION: Determining whether the standard of an examination is appropriate is a difficult task. It is important for examiners and examinees to be aware of the standard of the examination. We compared the examination standards perceived by medical students with that of the examiners. MATERIALS AND METHODS: A descriptive comparative study was carried out on a sample of final-year medical students from the Faculty of Medicine, University of Colombo. All final-year students of a given year of intake were requested to devise true/false type, negatively marked, 5-response multiple-choice questions at a standard they thought suitable for students sitting the final MBBS examination in Paediatrics. Ambiguous and wrongly worded questions were excluded. A "mock" multiple-choice question paper of randomly selected student generated multiple-choice questions was held a fortnight prior to the final paediatric examination. The students were unaware that the multiple-choice questions in the "mock" examination had been devised by their peers. Marks obtained at the "mock" and final examinations were compared and the difficulty index was calculated for both papers. RESULTS: Correlation between marks obtained at the 2 multiple-choice question papers was moderate (r = 0.67) and significant (P <0.01). The mean marks for the "mock" examination, 47.1% [standard deviation (SD) +/-9.2], and for the final examination, 58.9% (SD +/-8.7), showed a statistically significant difference (P <0.0001). CONCLUSION: This study showed that student-set multiple-choice questions correlated significantly with those of the university but were of a tougher standard.

Children of imprisoned mothers.

OBJECTIVES: To describe the problems faced by children during separation from their imprisoned mothers, and evaluate the health of children who accompanied their mothers into prison. DESIGN: A prospective observational study. SETTING: Welikada Prison, Colombo, Sri Lanka. METHODS: 200 randomly selected mothers who had left their children at home were interviewed using a questionnaire. During a period of 8 months 30 children living with their mothers in prison underwent physical and developmental examination and tuberculin testing. The living conditions within the prison were evaluated. RESULTS: During 18 months from January 1999, 4089 women were imprisoned. 88% were remanded, 20% awaited trial for more than one year in prison. 2416 were mothers. 1411 had at least one child under 12 years of age. The 200 mothers interviewed had 262 children under 12 years at home. Their care arrangements were: a relative (69%), father (16%), older sibling (4%), religious organisation (2.7%), neighbour (1.3%). None had received social services support. 70 children accompanied mothers into prison. In the 30 children followed up regularly 23% had scabies, 10% pediculosis, and 7% impetigo. No severe malnutrition was found and screening for tuberculosis was negative. 70% were breastfed. The child-friendly dormitory was inadequate to accommodate all children. CONCLUSION: Care arrangements and schooling were affected and no counselling services were provided during the imprisoned mothers' absence. The children within the prison enjoyed close bonds with the mothers and their physical needs were met. The child's best interest had not always been considered by court when deciding on custody during the mothers' imprisonment.

Cerebral thrombosis in beta-thalassaemia major.

Two patients with homozygous beta thalassaemia complicated by cerebral thrombosis are reported. An alteration in coagulability due to a sudden increase in haematocrit and platelets was the probable cause in one patient. Although the other patient had many complications of thalassaemia, the cause for cerebral thrombosis was not identifiable.