Annual Research Symposium (ARS)
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Item Validation of a Gastro-oesophageal Reflux Disease (GERD) Specific Screening Instrument for Epidemiological Purposes(University of Kelaniya, 2007) Amarasiri, W.A.D.L.; Pathmeswaran, A.; Ranasinha, C.; de Silva, H.J.Introduction: The prevalence of GERD is increasing worldwide: the community prevalence in Sri Lanka is not known. Objectives : To develop a practical clinical score to screen for GERD in the community and assess whether a score using both symptom frequency and severity correlates better to an objective measure of GERD than one using only symptom frequency. Methodology : 100 patients (endoscopy positive - which included patients with all grades of oesophagitis) and 150 controls (comparable in age and gender) faced a GERDspecific interviewer-administered questionnaire assessing seven upper gastro-intestinal symptoms. Each symptom was graded using Likert scales for frequency (4-items) and severity (5-items) and two scores were generated. Score 1 being the sum of frequency of symptoms while score 2 was the sum of products of frequency and severity of each. All patients then underwent 24-h ambulatory pHmetry. Both symptom scores were compared against 24-h pHmetry parameters as it is considered the gold standard to diagnose GERD. Cut-off values were determined by receiver-operating characteristic curves. Results : For both scores, mean scores of cases were significantly higher than controls (p=O.OOO). The cut-off score for score 1 was 2': 10.50 (sensitivity 92.0 %; specificity 78.7 %; area under the curve- 0.937). The cut-off score for score 2 was 2': 12.50 (sensitivity 90.0%; specificity 78.0%; area under the curve - 0.929). Both showed high reproducibility (Intra class correlation coefficient score1: 0.94 and score2: 0.82). There was good correlation between both symptom scores and 24-h pHmetry parameters (Spearman rank correlation, p=0.01), but score 2 showed a significantly better correlation. Conclusion: Our GERD questionnaire is valid, reproducible and showed better correlation with an objective test when both severity and frequency of symptoms were scored than frequency alone.Item Recurrent Abdominal Pain Syndrome in Children is a Significant Burden on Health Care System of Sri Lanka(University of Kelaniya, 2006) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.Background and objectives – Recurrent abdominal pain (RAP) is a common problem in Sri Lanka affecting more than 10% of children and adolescents. There have been relatively few studies on health care utilization in RAP and they have shown health care consultation of 8-48% in affected children. Methods- RAP patients identified during a school survey were recruited. RAP was defined according to Apley’s criteria; ‘at least three episodes of abdominal pain, severe enough to affect activities, over a period of not less than three months’. Information regarding health care consultations were obtained using parental questionnaire and confirmed during a clinical interview. A child taken to see a doctor due to abdominal pain at least once during the year 2001 was considered as a health care consulter. Results- Seventy seven with RAP were recruited in the study. Fifty five (70.1%) were health care consulters. Of them 6 (9.1%) were given in-patient care and 49 (90.9%) were managed by hospital out patient clinics or general practitioners. Average number of consultation was 2.0 visits per year (SD 2.5). Twenty three (29.1%) had not taken treatment even though they suffer from recurrent attacks of pain. Health care consultation was significantly high when the child with RAP was the eldest (p=0.0470), a good academic achiever (p=0.0210) and had pain associated with vomiting (p=0.00741). Conclusions- The health care consultation among Sri Lankan children with RAP is higher than reported from other countries. RAP is a significant burden on health care system of the country.Item The association between respiratory symptoms and gastro-oesophageal reflux events(Research Symposium 2009 - Faculty of Graduate Studies, University of Kelaniya, 2009) Amarasiri, W.A.D.L.; de Silva, H.J.; Ranasinha, C.Introduction: The oesophagus and the airways have a common origin. Abnormal gastroooesophageal reflux (GOR) may predispose to genesis of respiratory symptoms. This association has not been reported previously in Sri Lanka. Aims: To describe the association between reflux events and respiratory symptoms in a cohort of adult asthmatics in Sri Lanka. Methods: 30 stable, mild asthmatics (American Thoracic Society criteria) underwent dual-sensor oesophageal pH monitoring. Respiratory symptoms (cough, wheeze, difficulty in breathing, chest tightness) experienced during monitoring were recorded. Respiratory symptoms were correlated with reflux events by reviewing diary events and oesophageal pH tracings. A reflux episode was defined as a drop in pH to values <4 lasting> 4 seconds. A respiratory symptom was considered as associated with a reflux episode if it occurred 2 minutes prior to or after a reflux episode. Results: 50% of the asthmatics complained of one or more respiratory symptoms during the 24- hour recording period. Of 102 respiratory symptoms recorded, 73 were cough, 23 were wheezing and 5 were episodes of chest tightness. None experienced difficulty in breathing. 93% of coughs, 81 % of wheezes and all episodes of chest tightness were reflux-associated. In most cases reflux episodes preceded respiratory symptoms. There was no statistically significant difference in any oesophageal monitoring parameter between asthmatics with and without respiratory symptoms. Conclusion: Asthmatics experience respira~ory symptoms during reflux events. The deve:lopment of respiratory symptoms during an episode of acid reflux or within 2 minutes thereafter suggests that it is probably GOR that triggers asthma.Item Low fat diet and childhood functional recurrent abdominal pain syndrome: a preliminary study(Research Symposium 2009 - Faculty of Graduate Studies, University of Kelaniya, 2009) Devanarayana, N.M.; Rajindrajith, S.; de Silva, D.G.H.; de Silva, H.J.Background: There is a lack of high quality evidence on the effectiveness of dietary interventions on childhood recurrent abdominal pain (RAP). Fat is well known to affect gastrointestinal motility, but to date no studies have evaluated the value of low fat diets in RAP. Methods: Forty two children with functional RAP [19 (45.2%) males, 5-15 years] were recruited after electrogastrography (EGG), gastric emptying (GE), antral motility and oro-caecal transit (OCT) studies. Subjects were randomly allocated to low fat diet (group 1) and normal diet (group 2). Dietary instructions were provided in a diary and during an interview and energy and fat intake were recorded. Patients consumed allocated diet for 4 weeks. They were assessed before intervention and at 4 weeks using global seven-point scales for severity of symptoms and changing symptoms. Results: At one month, 12 (57.1%) patients in group 1 and 13 (61.9%) in group 2 had improvement of symptoms (P=0.759). The average scores obtained for pain severity, change in symptoms and frequency of episodes were not different between two groups (P=0.62). More patients with delayed GE had improvement in symptoms [9 (82%)] following a low fat diet compared to those with normal GE and OCT [3 (30%)] (P=0.024, power of the study 86%, at significant level of 0.05). Conclusions: Low fat diet seems to be beneficial for the subgroup of functional RAP children with delayed gastric emptying and intestinal transit while it has no significant therapeutic effect on patients with normal gastrointestinal motility.Item Aedes albopictus the “underrated” Asian Tiger(University of Kelaniya, 2010) Jayasooriya, D.H.S.W.; Gunawardene, Y.I.N.S.; Manamperi, A.; de Silva, H.J.; Abeyewickreme, W.Introduction The mosquito Aedes aegypti was thought to be the main vector responsible for virtually all dengue epidemics; while Aedes albopictus was considered a vector in which the virus is maintained but does not cause epidemics. Objective The study was conducted covering three endemic districts in Sri Lanka to determine the role of genus Aedes during dengue transmission. Methods and Material Mosquitoes were collected within a 350m radius from the location of the positive patients. Heads and abdomens of 63 pools were tested for DENV RNA with and RT-PCR-LH-(P32) assays Results Discussion Ae. albopictus was present in majority of the locations in all districts surveyed. Ae. albopictus was found in 13/17 (76.47%), 24/25 (96%)and 19/22 (86.36%) sites in Colombo, Gampaha and Kurunegala respectively. The RT-PCR-LH-(P32) assays indicated that 5/25 (20%) sites in Gampaha, 2/17 (11.76%) in Colombo and 6/22 (27.27%) in Kurunegala were positive for DENV. In Gampaha and Colombo there were 3 and 1 of DEN-2 positive pools respectively, while there were 2 and 1 of DEN-3 positive pools respectively. A higher number of positive pools (4/1or 21.05%) for DEN-1 and 1/1(5.26 %) for DEN-4 were found in Kurunegala. In Kurunegala one pool was positive for both DEN-2 and DEN-4 indicating the circulation of multiple serotypes within close proximity. Moreover one of the three DEN-2 positive pools in Gampaha consisting of only male Ae. albopictus mosquitoes is supportive of the belief of vertical transmission of DENV. In a DEN-4 positive location in Kurunegala HI was found to be10%, BI= 1and CI= 5.88 %while anotherDEN-2 positive site in Wattala showed HI of 5.55%and a BI of 5.55 suggesting active transmission. The abundance of Ae. albopictus in all districts and the findings indicating that100% of the positive pools were made of Ae. albopictus in this study highlights the importance of Ae. albopictus in the transmission dynamics dengue. The ability of Ae. albopictus to be infected with low viremia and the degree to which it permits replication within the mosquito itself could have an impact on the transmission and these verity of the disease. Co-circulation of two or more serotypes in a single pool or in different pools of mosquitoes within the same district is suggestive of hyper endemic transmission dengue in the three districts. The greater susceptibility of Ae. albopictus to infection by DENV is said to lead to greater virus adaptation. Sri Lanka as a whole would be at serious risks for multiple outbreaks in future. Our results indicate that Ae. albopictus is more efficient in dengue transmission than previously thought. The results shed light on the efficiency of Ae. albopictus as a vector in transmitting DENV in the absence or low abundance of Ae. aegypti in Sri Lanka. The present study suggests that Ae. albopictus sp is underrated in terms of transmission potential during peak transmission periods of dengue in Sri Lanka. Key words: RT-PCR-LH-(P32) RT-PCR-Liquid Hybridization with P32 radio isotope, HI-House hold Index, BI- Breteau Index, CI-Container Index,DENV-Dengue Virus Authors wish to acknowledge the financial assistance rendered by the NSF Sri Lanka (GrantNo:SIDA/2006/BT/02)and the IAEA (Grant NoTC SRL 6/028).