Medicine

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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

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Comparing two different presentations of Takayasu arteritis
(Sri Lanka College of Internal Medicine, 2024) Kurukulasuriya, S.A.F.; Munidasa, D.
Reported here are two Asian patients with Takayasu arteritis (TA) with contrasting presentations and responses to treatment. The first patient was a 53-year-old man who presented with disabling abdominal pain. Imaging revealed thickening of the coeliac axis extending to common hepatic and splenic arteries causing external compression with luminal narrowing. There was uniform thickening of the aortic arch and the wall of the descending aorta along with retroperitoneal fibrosis. Early treatment resulted in almost complete remission in eight weeks. The second patient was a 48-year-old woman with pain down the left upper limb with eventual ischaemia of the fourth finger. Imaging revealed circumferential wall thickening at the origin of the left subclavian artery. Treatment started after 3 weeks of the initial presentation, and took up to 14 months for clinical improvement. The relative rarity of this disease and the heterogeneous nature of its clinical manifestations predispose to late diagnosis and delayed treatment. Clinical suspicion and relevant imaging are crucial for the early and accurate diagnosis and management of patients with TA.
Functional abdominal pain disorders in children
(Taylor & Francis, 2018) Rajindrajith, S.; Zeevenhooven, J.; Devanarayana, N.M.; Perera, B.J.C.; Benninga, M.A.
Chronic abdominal pain is a common problem in pediatric practice. The majority of cases fulfill the Rome IV criteria for functional abdominal pain disorders (FAPDs). At times, these disorders may lead to rather serious repercussions. Area covered: We have attempted to cover current knowledge on epidemiology, pathophysiology, risk factors related to pathophysiology, clinical evaluation and management of children with FAPDs. Expert commentary: FAPDs are a worldwide problem with a pooled prevalence of 13.5%. There are a number of predisposing factors and pathophysiological mechanisms including stressful events, child maltreatment, visceral hypersensitivity, altered gastrointestinal motility and change in intestinal microbiota. It is possible that the environmental risk factors intricately interact with genes through epigenetic mechanisms to contribute to the pathophysiology. The diagnosis mainly depends on clinical evaluation. Commonly used pharmacological interventions do not play a major role in relieving symptoms. Centrally directed, nonpharmacological interventions such as hypnotherapy and cognitive behavioral therapy have shown both short and long term efficacy in relieving pain in children with FAPDs. However, these interventions are time consuming and need specially trained staff and therefore, not currently available at grass root level. Clinicians and researchers should join hands in searching for more pragmatic and effective therapeutic modalities to improve overall care of children with FAPDs.
Functional gastrointestinal diseases and psychological maladjustment, personality traits and quality of life
(BioMed Central, 2018) Ranasinghe, N.; Devanarayana, N.M.; Rajindrajith, S.; Perera, M.S.; Nishanthinie, S.; Warnakulasuriya, T.; de Zoysa, P.T.
BACKGROUND: Chronic abdominal pain is a common worldwide problem and known to be associated with psychological problems. This study evaluated the association between abdominal pain-predominant functional gastrointestinal disorders (AP-FGIDs), psychological maladjustment and personality traits in adolescents. METHODS: Adolescents aged 13-18 years were recruited from 5 randomly selected schools in Ampara district of Sri Lanka. AP-FGIDs were diagnosed using Rome III criteria. Translated and validated Rome III questionnaire (Child report form), personality questionnaire (PAQ) and PedsQL (Pediatric Quality of Life) inventory were used in data collection. Written consent was obtained from a parent and assent was obtained from every child recruited. The questionnaire was distributed in an examination setting to ensure confidentiality and privacy. Research assistants were present during data collection to assist on any necessary clarifications. RESULTS: A total of 1697 subjects were recruited [males 779 (45.9%), mean age 15.1 years, SD 1.6 years]. AP-FGIDs were present in 202 (11.9%). Those with AP-FGIDs had significantly higher mean scores for all personality traits (hostility and aggression, negative self-esteem, emotional unresponsiveness, emotional instability and negative world view), except dependency. Affected children had lower scores for all 4 domains of HRQoL (physical, emotional, social and school functioning), compared to controls (p < 0.05). When the cut off value for Sri Lankan children (89) was used, 66.3% with AP-FGIDs and 48.2% controls had PAQ scores within that of psychological maladjustment (p < 0.001). When the international normative value of 105 was used, these percentages were 27.2% and 14.2% respectively (p < 0.0001). The scores obtained for PAQ negatively correlated with scores obtained for HRQoL (r = - 0.52, p < 0.0001). One hundred and seventeen adolescents with AP-FGIDs (57.9%) had sought healthcare for their symptoms. Healthcare consulters had higher PAQ and lower HRQoL scores (p < 0.05). CONCLUSIONS: Adolescents with AP-FGIDs have more psychological maladjustment and abnormal personality traits than healthy controls. Affected adolescents with higher psychological maladjustments have lower HRQoL. Greater psychological maladjustment and lower HRQoL are associated with healthcare seeking behaviour in adolescents with AP-FGIDs.
Irritable Bowel Syndrome in children: Current knowledge, challenges and opportunities
(Baishideng Publishing Group, 2018) Devanarayana, N.M.; Rajindrajith, S.
Irritable bowel syndrome (IBS) is a common and troublesome disorder in children with an increasing prevalence noted during the past two decades. It has a significant effect on the lives of affected children and their families and poses a significant burden on healthcare systems. Standard symptom-based criteria for diagnosis of pediatric IBS have changed several times during the past two decades and there are some differences in interpreting symptoms between different cultures. This has posed a problem when using them to diagnose IBS in clinical practice. A number of potential patho-physiological mechanisms have been described, but so far the exact underlying etiology of IBS is unclear. A few potential therapeutic modalities have been tested in children and only a small number of them have shown some benefit. In addition, most of the described patho-physiological mechanisms and treatment options are based on adult studies. These have surfaced as challenges when dealing with pediatric IBS and they need to be overcome for effective management of children with IBS. Recently suggested top-down and bottom-up models help integrating reported patho-physiological mechanisms and will provide an opportunity for better understanding of the diseases process. Treatment trials targeting single treatment modalities are unlikely to have clinically meaningful therapeutic effects on IBS with multiple integrating patho-physiologies. Trials focusing on multiple combined pharmacological and non-pharmacological therapies are likely to yield more benefit. In addition to treatment, in the future, attention should be paid for possible prevention strategies for IBS.