No abstract

Objective-To investigate the maternal comprehension of two diVerent growth charts and to identify the group of mothers with poor comprehension. Design-An experimental prospective study. Setting-A child welfare clinic at the De Soysa Hospital for Women, Colombo, Sri Lanka. Subjects-932 mothers were studied regarding their interpretation of the type of growth chart their infants had been allocated. A total of 413 mothers interpreted the 'road-to-health' chart and 519 mothers interpreted the revised chart. A validated scoring system was used to assess comprehension. The two groups of mothers were comparable. Results-62.4% (324) mothers who interpreted the revised chart had good comprehension. Only 20.6% (85) mothers had similar comprehension with the road-tohealth chart. Education up to or beyond grade 8 in school significantly improved comprehension. Conclusion-The design of the growth chart has a powerful eVect on maternal comprehension of growth patterns. Length of schooling rather than literacy alone is a marker of a comprehending mother. The policy implications of these findings are that governments and agencies may need to redesign parent held growth charts to achieve better comprehension by mothers.

Objectives To assess the clinical, biochemical and echocardiographic findings of infants born to diabetic mothers given human insulin and to compare the impact of pre-gestational and gestational diabetes. Design Prospective descriptive study. Method Fifty one infants born to diabetic mothers treated with human insulin were studied. 23 had pregestational and 28 had gestational diabetes. Mode of delivery, prematurity, birth weight, asphyxia, plethora, congenital malformations, hypoglycaemia and hyperbilirubinaemia were analysed. The data was also compared with the details of the total birth cohort group of the same unit. Results Caesarian section was performed in 55%. Birth weights of over 3.5 kg were seen in 15.6% while prematurity was present in 10%. Small-for-dates (14%), large-for dates (4%), symptomatic hypoglycaemia (2%) asymptomatic hypoglycaemia (12%), plethora (2%), hyperbilirubinaemia (12%), congenital malformations (13%) and cardiac septal hypertrophy (8%) were the main morbidity features. Prematurity, low birth weight and cardiomyopathy were significantly higher in pregestational diabetes. Caesarian sections, prematurity, high birth weight and congenital malformations were higher in the study group when compared to the general birth cohort. Conclusions Morbidity in this series was higher than in the general population despite strict control of diabetes with human insulin.

BackgroundAlthough genitourinary Tuberculosis (GUTB) is the second commonest source of extrapulmonary TB in most countries, the reported rate of GUTB in Sri Lanka remains very low. Furthermore, the characteristics of GUTB in Sri Lanka have not been published due to paucity of data. Therefore, we aimed to study the clinical and imaging characteristics, treatment modalities and outcomes of GUTB in Sri Lanka. MethodsA retrospective analysis was performed based on patients treated by a single urological surgeon in two consecutive centres over a period of 21 years. All patients (n=82, males = 45 (54.9%), median age: 51 years; range: 26 - 75) with a microbiological and/or histological diagnosis of GUTB were included. Median duration of follow-up was 24 months (range: 6- 96). Data were obtained from direct patient interview, hospital notes and clinic files. ResultsCommonest prominent symptoms at presentation included haematuria (n=13, 15.8%) and scrotal manifestations (n=12, 14.6%). Mantoux was either positive (>10mm) (n=62/70) or equivocal (>5mm) (n=8/70). Erythrocyte sedimentation rate (ESR) was available in 69 patients and was >30 in 54 (78.3%) patients. Chest x-ray and x-ray kidney-ureter-bladder (KUB) abnormalities were detected in 9 (11%) and 6 (7.3%) respectively. CT-urography was performed in 72 patients and abnormalities were detected in 57 (79%) patients. Forty-two patients underwent a cystoscopy and 73.8% (n=31) had abnormal findings. Microbiological diagnosis was feasible in 42 (51.2%) and rest were diagnosed histologically. Commonest organs involved were kidney (64.6%, n=53), ureters (51.2%, n=42), bladder (43.9%, n=36) and testis/epididymis (14.6%, n=12). One patient had prostate TB. All were treated primarily with anti-TB drugs however, 50 (61%) had indications for some form of therapeutic intervention. The majority of interventions were reconstruction surgeries (n=20, 24.4%) followed by excision surgeries (n=19, 23.2%) and drainage procedures (n=11, 13.4%).Seven patients developed serious adverse reactions to anti-TB drugs. Five patients developed a thimble bladder and 3 patients developed end-stage renal failure. Two patients had relapse of infection. ConclusionCT-Urography, cystoscopy and histopathology are essential adjuncts to diagnose GUTB. Most ureteric strictures, non-functioning kidneys and epididymal masses needed surgical treatment. Long-term follow up is essential to detect progressive renal dysfunction.

Nalidixic acid is a 4-quinolone antimicrobial agent used in the treatment of uncomplicated lower urinary tract infection and shigellosis. The recommended dose for a child is 50-55 mg/kg body weight daily in 4 divided doses. The drug is rapidly and almost completely absorbed from the gastrointestinal tract (GIT) and the plasma half-life is about 2.5 hours. Nalidixic acid and its metabolites are excreted rapidly in the urine. This drug should ideally be avoided in children younger than three months of age.