ABSTRACT
Aim: The aim of this study was to investigate the proportion of common clarithromycin‑resistant mutation types present in the 23S ribosomal ribonucleic acid (rRNA) gene of H. pylori strains in Sri Lanka. Settings and Design: The study was a cross‑sectional, descriptive study where 76 dyspeptic patients who were required to undergo endoscopy examination were included. The study was carried out at a Teaching Hospital in Sri Lanka. Subjects and Methods: In‑house urease test and polymerase chain reaction (PCR) amplification of the glmM gene of H. pylori was performed to confirm the H. pylori infection. Analysis of point mutations in 23S rRNA gene strains were performed by PCR‑restriction fragment length polymorphism (RFLP). Results: Of the 16 urease‑positive biopsies, 94% (n = 15) were positive by PCR using the glmM primer. All H. pylori strains yeilded a point mutation at A2142G site of the 23S rRNA gene, while A2143G mutation was not detected. Conclusions: For the first time in Sri Lanka, we reported predominance of A2142G point mutation associated with claritromycin resistance of H. pylori in a Sri Lankan population.
ABSTRACT
Objectives: To prospectively study several aspects of ventilated neonates at the neonatal intensive care unit (NICU) of Sri Jayawardenepura General Hospital (SJGH) and compare this data to retrospective data from the same unit. Method: A descriptive observational, longitudinal hospital based prospective study was conducted on ventilated babies in NICU, SJGH from1st July 2009 to 1st July 2010. Data were obtained using a pre-tested recording form. NICU records were used to gather data of infants ventilated from 1st July 2000 to 1st July 2001. Data obtained from the current study were compared to data in 2000/2001. Data were analysed using SPSS version 16 for Windows. Results: During the study period 135 babies were ventilated. Four were excluded due to severe congenital defects. Seventy two percent were male and 53% had gestational periods of 32 weeks or less. There were 46% very low birth weight (VLBW) babies. In 72% the indication for ventilation was respiratory distress syndrome (RDS). Duration of ventilation was over one week in 34%. Continuous positive airway pressure (CPAP) was the sole mode of ventilation in 33%. Surfactant was used in 53% babies, 96% for RDS. Oxygen for over 2 weeks was required in 17% and 22% received theophylline as respiratory stimulants. Midazolam infusion was used for sedation in 56%. Total parenteral nutrition was started in 56%, 29% received blood transfusions and 65% received volume support or inotropes for hypotension. Complications included seizures (16%), persistent pulmonary hypertension of the newborn (9%), patent ductus arteriosus (8%), pulmonary haemorrhage (7%), retinopathy of prematurity (6%), nosocomial sepsis (6%), ventilator-associated pneumonia (5%), bronchopulmonary dysplasia (5%), necrotising enterocolitis (3%), intraventricular haemorrhage (2%) and pneumothorax (2%). Eighty eight percent babies were followed up till 2 years of age. Mortality in 2009/2010 was 18% compared to 39% in 2000/2001 (P<0.0001). Conclusions: Babies with 32 weeks or less gestation and VLBW babies were significantly more in 2009/2010 (P<0.05). Complications such as VAP, nosocomial sepsis and pneumothorax were significantly more common in babies ventilated in 2000/2001 but ROP was significantly more common in babies ventilated in 2009/ 2010 (P<0.05). HIE caused significantly more deaths in 2000/ 2001 whilst significantly more deaths occurred in ex-utero babies and babies with pulmonary haemorrhage in 2009/2010 (P<0.05). Overall mortality, mortality in babies with 32 weeks or less gestation and mortality in VLBW babies were significantly lower in 2009/2010 (P<0.0001). In 2009/2010, the outcome in babies receiving CPAP only was significantly better than those receiving IMV only (P<0.0001). There was no morbidity at 2 years of age in significantly more babies over 32 weeks gestation in 2009/2010 compared to babies with gestation 32 weeks or less (P<0.0001).
ABSTRACT
Objective To assess the outcome of surfactant therapy at a tertiary referral centre in Sri Lanka Design, setting and method All babies treated with surfactant at Sri Jayewardenepura General Hospital during 2007 were included in the study. Data on weight, maturity, age of ventilation, age of surfactant therapy, ventilator settings before and after surfactant, arterial blood gas results before and after surfactant, details regarding pneumothorax and pulmonary haemorrhage, duration of ventilation and chronic lung disease at 28 days, 3 months, and 6 months were collected. Data analysis was done according to maturity groups. Results Forty eight babies had surfactant therapy during the study period. The commonest indication was hyaline membrane disease (HMD) in prematures (45), followed by meconium aspiration syndrome (03). According to maturity, 22 (46%) were in 28- 33+ weeks, followed by 12 (25%) in < 28 weeks, 11 (23%) in 34-36+ weeks and 3 (6%) were >37 weeks (mature). Only 6 (12%) babies in 34-36+ weeks had transient hypoxia. None of them developed pneumothorax. Four (8%) had features suggestive of pulmonary haemorrhage 12-48 hours after surfactant replacement therapy. Four (8%) babies had chronic lung disease at 28 days of age and two of them were in babies < 28 weeks. The reduction in oxygen requirements was seen within 6 hours of therapy in 7/12, 18/22, 6/11 in < 28, 28-33+ and 34-36+ weeks babies respectively and in 12-24 hours in babies >37 weeks. There were 14 deaths comprising 5/12 of babies < 28 weeks, 5 /22 of 28-33+ weeks, 4/11 of 34- 36+ weeks. Duration of ventilation varied among the survivors; 5/7 babies of < 28 weeks needed >10 days of ventilation whereas 10/17 of 28-33+ weeks needed < 10 days of ventilation. Conclusions Reduction in oxygen requirement was seen within 6 hours of surfactant therapy in 65% of babies. Only 16% of babies who had surfactant therapy developed complications such as pulmonary haemorrhage and chronic lung disease. Duration of ventilation varied according to the maturity of the baby.