Medicine

Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12

This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

Browse

Now showing 1 - 20 of 4680

100 Years of Mass Deworming Programmes: A Policy Perspective From the World Bank's Disease Control Priorities Analyses
(London : Academic Press, 2018) Bundy, D.A.P.; Appleby, L.J.; Bradley, M.; Croke, K.; Hollingsworth, T.D.; Pullan, R.; Turner, H.C.; de Silva, N.
For more than 100 years, countries have used mass drug administration as a public health response to soil-transmitted helminth infection. The series of analyses published as Disease Control Priorities is the World Bank's vehicle for exploring the cost-effectiveness and value for money of public health interventions. The first edition was published in 1993 as a technical supplement to the World Bank's World Development Report Investing in Health where deworming was used as an illustrative example of value for money in treating diseases with relatively low morbidity but high prevalence. Over the second (2006) and now third (2017) editions deworming has been an increasingly persuasive example to use for this argument. The latest analyses recognize the negative impact of intestinal worm infection on human capital in poor communities and document a continuing decline in worm infection as a result of the combination of high levels of mass treatment and ongoing economic development trends in poor communities.
14 Topics in health professions education: A guide to practical wisdom.
(College of Medical Educations., 2020) Chandratilake, M.; Olupeliyawa, A.
A 16-year-old boy from Sri Lanka with fever, jaundice and renal failure: Leptospirosis
(Saunders Ltd, 2014) Premaratna, R.
No abstract available
17p11. 2 and Xq28 duplication detected in a girl diagnosed with Potocki-Lupski syndrome
(Biomed Central, 2015) Sumathipala, D.S.; Mandawala, E.N.; Samanmalee, P.S.; Vajira, H.W.D.
BACKGROUND: Potocki-Lupski syndrome is a microduplication syndrome associated with duplication at 17p11.2. Features include facial dysmorphism, moderate to mild cognitive impairment and behavioural abnormalities including autism spectrum disorders. CASE PRESENTATION: We describe a patient from Sri Lanka that was referred for genetic assessment at 4 years of age due to subtle facial dysmorphism and expressive language impairment. She was diagnosed with Potocki-Lupski syndrome through multiplex ligation probe amplification. She carried two duplications; one in 17p11.2 consistent with Potocki-Lupski, and one in Xq including the region for X-linked intellectual disability. CONCLUSION: Despite the absence of expected behavioural symptoms, many features of this patient are in accordance with Potocki-Lupskisyndrome. This is the first diagnosed patient in Sri Lanka.
2'-Deoxy-5-ethyl-beta-4'-thiouridine inhibits replication of murine gammaherpesvirus and delays the onset of virus latency
(International Medical Press, 1999) Barnes, A.; Dyson, H.; Sunil-Chandra, N.P.; Collins, P.; Nash, A. A.
The antiviral thionucleoside analogue 2'-deoxy-5-ethyl-beta-4'-thiouridine (4'-S-EtdU) was shown to be a more potent inhibitor of gammaherpesvirus infection than acyclovir. This compound inhibits replication of murine herpesvirus (MHV)-68 in the lungs of mice when given 3 days post-infection. However, as with other nucleoside analogues, it was unable to prevent the establishment of latency, despite delaying the onset of latent infection in the spleen. In contrast, virus persistence in the lung was inhibited following drug treatment, although persistence was re-established in mice when treatment was suspended after 12 days. These data suggest that 4'-S-EtdU is a highly effective inhibitor of murine gamma herpesvirus replication and as such provides a powerful tool to study the pathogenesis of this virus in vivo.
20 year follow up and survival analysis in a cohort of patients with Haemoglobin E beta Thalassaemia.
(Sri Lanka Medical Association., 2019) Olivieri, N.F.; Premawardhena, A.P.; Amir-Arsalan, S.; Ediriweera, D.; Mettananda, S.; Bandara, W.D.; Arambepola, M.; de Silva, S.; Refai, M.A.C.M.; Allen, A.
INTRODUCTION & OBJECTIVES: Haemoglobin E beta thalassaemia (EBT) is the commonest beta thalassaemia syndrome in the world and is extremely phenotypically variable. Unlike for transfusion dependent thalassaemia (TDT) there are no clear guidelines for the management of this disease. We have followed up a cohort of 109 patients with EBT for 20 years. Objective of the study was to study the 20-year survival and factors that affect survival. METHODS: Study was conducted at Kurunegala Thalassaemia centre. Transfusions were stopped in 1997 in all 109 patients. Since then they were assessed every three months by the clinical team for the next 20 years. Relevant haematological, biochemical, radiological assessments were done periodically. RESULTS: 32 (30%) of patients were dead at 20 years. Kaplan Meir survival curve identified the median survival to be 51 years. Splenectomy had been done in 73/109 (67%) patients. Splenectomy allowed 66% to be off transfusions even 9.7± 1.3 years post- surgery. However, 33% had to return to transfusions. The commonest cause of death in the cohort was infections (34.3%). Most (72%) infective deaths happened in those who were splenectomised. Transfusions needed to be restarted in 60%, of whom 33% went back to (>8 per year) regular transfusions at a mean 8.4 ±0.8 years after stopping transfusions. CONCLUSION: In this first ever long term follow up study of EBT, significantly shortened survival is observed. Though splenectomy allows prolonged transfusion free phases in many it increases risk of infective deaths. Overall the disease is far less benign than previously thought with a high prevalence of morbidity and mortality.
2021 Asia-Pacific Graves' Disease consortium survey of clinical practice patterns in the management of graves' disease
(Humana Press, 2023) Parameswaran, R.; de Jong, M.C.; Kit, J.L.W.; Sek, K.; Nam, T.Q.; Thang, T.V.; Khue, N.T.; Aye, T.T.; Tun, P.M.; Cole, T.; Miller, J.A.; Villa, M.; Khiewvan, B.; Sirinvaravong, S.; Sin, Y.L.; Muhammad, R.; Jap, T.S.; Agrawal, A.; Rajput, R.; Fernando, R.; Sumanatilleke, M.; Suastika, K.; Shong, Y.K.; Lang, B.; Bartalena, L.; Yang, S.P.; Asian Graves Consortium Study.
Aim: Although Graves' disease (GD) is common in endocrine practices worldwide, global differences in diagnosis and management remain. We sought to assess the current practices for GD in countries across Asia and the Pacific (APAC), and to compare these with previously published surveys from North America and Europe.Methods: A web-based survey on GD management was conducted on practicing clinicians. Responses from 542 clinicians were received and subsequently analysed and compared to outcomes from similar surveys from other regions. Results: A total of 542 respondents participated in the survey, 515 (95%) of whom completed all sections. Of these, 86% were medical specialists, 11% surgeons, and 3% nuclear medicine physicians. In addition to serum thyroid-stimulating hormone (TSH) and free thyroxine assays, most respondents would request TSH-receptor autoantibody (TRAb) measurement (68%) during initial work-up. Thyroid ultrasound is requested by about half of respondents (53%), while the use of nuclear medicine scans is limited. The preferred first-line treatment is anti-thyroid drug (ATD) therapy (79%) with methimazole (MMI) or carbimazole (CBZ), followed by radioiodine (RAI; 19%) and surgery (2%). In case of surgery, one-third of respondents would opt for a subtotal rather than a total thyroidectomy. In case of mild Graves orbitopathy (GO), ATDs (67%) remains the preferred treatment, but a larger proportion of clinicians prefer surgery (20%). For a patient with intention to conceive, the preferred treatment pattern remained unchanged, although propylthiouracil (PTU) became the preferred ATD-agent during the first trimester. In comparison to European and American practices, marked differences were noted in the relatively infrequent usage of nuclear medicine scans and the overall higher use of a ATDs and β-blockers and adjunctive ATD-treatment during RAI in the APAC-group.Conclusion: Although regional differences regarding the diagnosis and management of GD are apparent in this first pan-Asia-Pacific survey, this study reveals the overall approach to the management of this disease in Asia-Pacific generally tends to fall between the trends appreciated in the American and European cohorts.
24 h activity guidelines in children and adolescents: A prevalence survey in Asia-Pacific cities
(MDPI, 2023) Quah, P.L.; Loo, B.K.G.; Mettananda, S.; Dassanayake, S.; Chia, M.Y.H.; Chua, T.B.K.; Tan, T.S.Z.; Chan, P.C.; But, B.W.; Fu, A.C.; Wong, S.M.; Nagano, N.; Morioka, I.; Kumar, S.; Nair, M.K.C.; Tan, K.H.
This study aimed to examine the prevalence of adherence to 24 h activity guidelines in children and adolescents from Asia-Pacific cities. In 1139 children aged 5-18 years, moderate-to-vigorous physical activity (MVPA), screen viewing time (SVT), sleep duration, child weight, height, sex, and age were parent-reported. Descriptive statistics were used to assess the number of guidelines met, and prevalence of adherence to activity guidelines by city and child sex. Prevalence of meeting all three 24 h activity guidelines was low across all countries (1.8-10.3%) (p < 0.05). Children from Thiruvananthapuram, India had the highest [10.3% (95% CI: 6.0-17.0)], while those from Tokyo, Japan had the lowest prevalence [1.8% (95% CI: 0.5-7.0)] of meeting all three guidelines. The highest prevalence of meeting individual MVPA, SVT and sleep guidelines was found in India [67.5% (95% CI: 58.8-75.1)], Kelaniya, Sri Lanka [63.2% (95% CI: 58.7-67.4)] and Kowloon, Hong Kong [59.4% (95% CI: 51.1-65.3)], respectively. Overall, a higher prevalence of boys met all three guidelines, compared to girls [5.9% (95% CI: 4.1-8.1) vs. 4.7% (3.1-6.6), p = 0.32]. The prevalence of adhering to all three activity guidelines was low in all five participating cities, with a higher proportion of boys meeting all guidelines.
30-year cardiovascular risk prediction of medical undergraduates of university of Kelaniya, Sri Lanka
(Sri Lanka College of Internal Medicine, 2019) Mettananda, K.C.D.; Gunarathna, M.R.T.A.; Gunasekara, M.D.S.D.; Gunasekara, P.; Gunasekara, T.N.A.S.; Gunasekara, W.S.M.T.M.; Thampoe, R.S.
BACKGROUND: Medical students could be at high risk of cardiovascular diseases (CVDs) due to lack of exercises, increased mental stresses, unhealthy dietary practices. However, there are no reported data on this from Sri Lanka. OBJECTIVE: We aimed to predict 30-year CVD-risk of medical students of University of Kelaniya. METHODS: A cross-sectional study was conducted among medical students of Faculty of Medicine, University of Kelaniya during November 2018. 20 students from each batch were randomly selected. Data were collected using an interviewer administered questionnaire. 30-year risk of General-CVDs were calculated using Framingham 30- year CVD-risk calculator using sex, age, systolic blood pressure, use of antihypertensive medications, smoking, presence of diabetes mellitus and body mass index(BMI). Data was analysed using SPSSversion-22. RESULTS: 100 students (female 59(59%)) aged 21-29 years (mean 24.8 ± 1.8 years) were studied. Cardiovascular risk factor prevalences were; hypertension 1(I%), hyperlipidaemia 2(2%), diabetes mellitus I (I %), smoking 3(3%), overweight 37(37%) and obesity 2(2%). Mean 30-year hard-CVD risk was 2.13% (SD±l .63), mean 30-year general-CVD risk was 4.58% (SD±2.88). Majority (93%) were low-risk, and 7% were at moderate-risk and none were categorised high-risk. Of the moderate risk participants, 5(28.6%) were male (p=0.11), 6(87.7%) (p=0.043) were overweight but none were smokers nor had diabetes mellitus, hypertension or hyperlipidaemia. CONCLUSION: Majority of current medical students of University of Kelaniya e at low risk of future CVD events. The commonest risk factor seen among moderate risk students was being overweight. This emphasize the importance of adhering to healthy lifestyle.
A 45-year-old man from Sri Lanka with fever and right hypochondrial pain: amoebic liver abscess
(Saunders Ltd, 2014) Premaratna, R.
No abstract avaialble
A 58-year-old woman from Sri Lanka with fever, deafness and confusion: scrub typhus
(Saunders Ltd, 2014) Premaratna, R.
No abstract available
6379 Pre-admission management of children presenting with febrile illness in a tertiary hospital of Sri Lanka
(BMJ, 2024) Arunath, V.; Mettananda, S.
OBJECTIVES To describe the symptoms and pre-admission management of children presenting with febrile illness to the Colombo North Teaching Hospital, Ragama, Sri Lanka.METHODS A retrospective descriptive study was conducted at University Paediatric Unit of Colombo North Teaching Hospital, Ragama, Sri Lanka. Data on pre-admission management of all children admitted with febrile illness from July to December 2019 were extracted from patient records. Children who were transferred from other units, children with chronic illnesses and children developed fever following vaccinations were excluded. Ethical approval was obtained from Ethics Review Committee of Sri Lanka College of Paediatricians and data was analysed using SPSS version 22.RESULTS A total of 366 children were admitted; 56% were males. Mean age was 53.5 ± 41.7 months and the majority were from Gampaha district. Mean duration of illness on admission was 3.6 ± 2.5 days. 236 (65.6%) patients had recorded fever spikes at home while 150 (60.7%) reported a contact history of fever. Common associated symptoms were cough (62.3%), cold (56%) and vomiting (39.6%). 199 (54.5%) underwent investigations prior to admission and full blood count was the commonest (47.5%) investigation. Although 357 (97.8%) had taken medication prior to admission, only 87.3% had consulted a doctor. 356 (97.3%) received paracetamol at home of which 24 (7.9%) and 123 (40.6%) received sub-therapeutic and supra-therapeutic doses respectively. Significantly higher proportion (44.9%) of children who consulted a doctor received appropriate dose of paracetamol compared to others (3.7%), (c2=11.9, p=0.003, p<001). Higher proportion children who had recorded fever spikes consulted a doctor (c2=3.99, p=0.046, p<0.05) and received therapeutic doses of paracetamol prior to admission (c2=4.94, p=0.026, p<0.05).CONCLUSION Use of sub- and supra-therapeutic doses of paracetamol was common before admission to the hospital. Recording temperature at home and medical consultation prior to admission were associated with appropriate dose paracetamol usage (p<005).
6460 Children’s perception of the health effects of climate change – a mixed-method study in urban Sri Lanka
(BMJ, 2024) Dayasiri, K.; Anand, G.
OBJECTIVES While children bear the least responsibility for global climate change, they suffer the most from its consequences, including a higher incidence of non-communicable diseases and exposure to natural disasters. The United Nations has emphasised that failing to act on climate change infringes upon children’s rights to live in a secure environment. Our study focuses on examining the perspectives of Sri Lankan adolescents on climate change, its effects, and their roles in addressing this issue.METHODS This mixed-method cross-sectional study involved 104 adolescents attending schools in Colombo, Sri Lanka. We randomly selected participants from both governmental and private schools and invited them to complete a self-administered questionnaire. The questionnaire covered their perceptions of climate change, their contributions to addressing climate change, and their views on the regional and global implications of climate change. Qualitative data analysis was conducted using a second-order descriptive analysis of themes.RESULTS 104 adolescents participated in the study and 75.8% were female children. Median age =17 years (range 13–19 years). Majority (93.1%) expressed concern about the potential future health impacts of climate change. While most adolescents correctly understood the concept of climate change, some revealed misconceptions about it. The major health impacts associated with climate change, as reported by the participants, included asthma, the rise of non-communicable diseases, skin conditions, cancer, and increased stress. Notably, 25% of the participants felt that they had not received education on climate change. Nearly 60% reported feeling anxious over the issue of climate change. Regarding their contributions to addressing climate change, 29.8% of the children admitted that they had not taken sufficient actions. However, those who had acted mentioned activities such as tree planting, increased use of public transportation, and educating others about climate change. Almost half of the cohort were unaware of useful resources for learning about climate change. A significant 76% of the adolescents believed that adults were not actively taking measures to address climate change.CONCLUSION This study showed that children are evidently anxious over the issue of climate change. There is an urgent need for improved awareness of information sources among children through public health measures. It is essential for adults including those in the medical profession to serve as role models in educating and guiding children on how to make a positive impact on global climate change.
6503 Using anthropometric data to investigate the nutritional status of children included on the Sri Lankan cerebral palsy register.
(BMJ Publishing Group Ltd, 2024) Sumanasena, S.; Fernando, R.; Kurukulaarachchi, S.; Heiyanthuduwage, T.M.; Sheedy, H.S.; Wijesekara, S.; Jagoda, J.; Muttiah, N.
OBJECTIVES The nutritional data from children with cerebral palsy (CP) in low and middle income countries (LMIC) is sparse. In high income countries (HICs) well established nutritional care plans, commercial products and good psycho-social support are available.1 A multitude of complications arise due to malnutrition leading to poor quality of life.2 Here we investigated the nutritional status of children included in the Sri Lankan Cerebral Palsy Register (SLCPR).METHODS The study included 768 children aged 0–18 years with CP, attending three teaching hospitals in the Western Province, from September 2018 to November 2021. Data included clinical profile and anthropometry [weight (Kg), height (cm), BMI, mid upper arm circumference (MUAC) (cm), and OFC (cm)] based on WHO. Average was calculated using three repeated measurements. Children who could not stand independently (GMFCS level 4/5) underwent height estimations with the knee height equation: height = (2.69 X Knee height) + 24.2.Indicators used to measure the nutritional status were: weight for age Z score (WAZ), height for age Z score (HAZ), weight for height Z score (WHZ), BMI for age Z score (BAZ), and MUAC for age Z score (MUACZ). WHO Anthro and WHO AnthroPlus software calculated all Z scores.4 HAZ and BAZ were calculated for children aged <18 years, WAZ was calculated for children aged <10.1 years, and WHZ and MUACZ were calculated for children aged <5.1 years. The z scores < -2.0 SD were categorized as underweight (WAZ), stunted (HAZ), wasted (WHZ or MUAC), thin (BAZ).RESULTS Total of 768 children (mean age 59.6 months, SD 44.9, 62.5% males) participated. There were (n=431) children under 61 months and (n=520) from 0–10 years. Of them, 51.3% (n = 267/520) were underweight, 59.8% (n = 258/431) were stunted and 27.3% (n = 210/768) were thin. Among children aged < 5 years, 26.7% (n = 115/431) had severe wasting and severe acute malnutrition (SAM) according to MUACZ < -3SD. Both underweight and stunting were significantly higher among children with spastic CP compared with others (p<0.05). In the 5–19 year group 16.9% (n= 57/337) were obese (BAZ > + 2SD).CONCLUSION Predominant stunting and underweight in this population calls for urgent action to minimize chronic malnutrition. It is imperative to further explore nutritional intake and feeding difficulties in this group and offer structured nutritional care plans. The trend observed in older children towards obesity possibly indicates the need for coordinated nutrition and exercise programmes. It is recommended to regularly monitor growth and nutritional status of all children with CP as there may be serious implications for their activity levels.
6542 Clinical profiles of children less than 5 years presenting with or high risk of cerebral palsy in the Western Province of Sri Lanka
(BMJ, 2024) Sumanasena, S.; Heiyanthuduwage, T.M.; Fernando, R.; Sheedy, H.S.; Jagoda, J.; Wijesekara, S.; Wanigasinghe, J.; Muttiah, N.; Rathnayake, P.; Kitnasamy, G.; Khandaker, G.
OBJECTIVES Cerebral palsy (CP) is the commonest physical disability in children globally.1 It is a clinical diagnosis based on clinical and neurological findings. International clinical practice guidelines recommend early diagnosis and CP specific interventions to invest in neural plasticity and achieve optimal functional levels.2 In the past diagnosis was confirmed at 12–24 months but now it is advanced to confirm or identify as high risk for CP before the age of six months.3 4 Sri Lanka is one of the few Asian countries that initiated a CP register and National Guidelines on management of CP.5 The objective of this paper is to describe the clinical profiles of children less than 5 years presenting to Western Province hospitals in Sri Lanka based on the data from the Sri Lanka Cerebral Palsy Register (SLCPR).METHODS A cross sectional hospital-based study was conducted in the Western Province from September 2018 – October 2021 in three teaching hospitals to collect a minimum data set for the Sri Lanka SLCPR. Data of children less than 60 months was extracted with a confirmed clinical diagnosis of CP or identified formally as ‘high risk’ of CP.Information on sociodemographic, pre/peri/neonatal, and post neonatal risk factors, and associated impairments were collected using hospital records and clinic notes. Clinical motor type, topography, and associated impairments were evaluated.RESULTS Data of 431 children were extracted, 254 (58.9%) were males. Mean age at diagnosis was 28.73 months (median 27, SD 14.98). Most children (n= 422, 97.9%) acquired CP in the pre/peri/neonatal period. The mean birth weight was 2304.4 g (median 37, SD 825.58g) and the mean POA was 35.82 months (median 37, SD 4.88). Main risk factors identified were prematurity (n=190, 44.1%), hypoxic ischaemic encephalopathy (HIE) (n= 234, 54.3%), jaundice (n=31, 7.2%) and sepsis (n= 13, 3.0%). While 183 children (42.5%) showed evidence of definitive spastic motor type, 184 (42.7%) showed predominant dyskinesia.CONCLUSION The age at diagnosis of this population from Sri Lanka is significantly lower than from other LMICs. HIE and prematurity, both preventable conditions remain the highest risk factors. Longitudinal follow up will ascertain the final motor outcomes as a higher proportion of children showed dyskinesia. The SLCPR is an important resource which will support new research towards investigating opportunities for prevention and service planning for children.
A 9-year-old male with fever, proptosis and hemodynamic instability
(Baltimore, Md, 2021) Gunaratna, G.P.S.; Howard-Jones, A.R.; Khatami, A.; Huynh, J.; Kesson, A.M.
No abstract available
A novel mutation in the SLCO2A1 gene presenting as persistent hypoproteinaemia and refractory iron deficiency anaemia due to chronic enteropathy: A case report
(BioMed Central, 2024-11) Mettananda, S.; Bandara, P.; Rajeindran, M.; Padeniya, P.
BACKGROUND The SLCO2A1 gene encodes a prostaglandin transporter and we report a novel mutation causing hypoproteinaemia and refractory anaemia due to chronic enteropathy.Case PRESENTATION An 18-year-old boy of consanguineous parents was investigated for hypoproteinaemia and anaemia. He was short, pale and had generalised oedema. Investigations revealed haemoglobin 5.8 g/dL; hypochromic microcytic anaemia; low serum protein, albumin, globulin, ferritin and iron. Bone marrow aspiration revealed low iron stores. Upper and lower gastrointestinal endoscopies showed moderate gastritis, duodenitis, and non-specific patchy inflammation in the rectum. The whole exome sequencing revealed a homozygous missense mutation in SCLO2A1 gene (NP_005621.2:p.Arg97Cys; rs761212094). Sanger sequencing of the sibling with milder phenotype revealed same homozygous mutation, and carrier father was heterozygous.CONCLUSION We report a novel mutation of SLCO2A1 gene causing severe persistent hypoproteinaemia and refractory iron deficiency anaemia due to chronic enteropathy helping to delineate genotype-phenotype correlation of SLCO2A1 variants.
AARC score determines outcomes in patients with alcohol-associated hepatitis: a multinational study
(Springer, 2023) Maiwall, R.; Pasupuleti, S.S.R.; Choudhury, A.; Kim, D.J.; Sood, A.; Goyal, O.; Midha, V.; Devarbhavi, H.; Arora, A.; Kumar, A.; Sahu, M.K.; Maharshi, S.; Duseja, A.K.; Singh, V.; Taneja, S.; Rao, P.N.; Kulkarni, A.; Ghazinian, H.; Hamid, S.; Eapen, C.E.; Goel, A.; Shreshtha, A.; Shah, S.; Hu, J.; Prasad, V.G.M.; Yuemin, N.; Shaojie, X.; Dhiman, R.K.; Chen, T.; Ning, Q.; Panackel, C.; Niriella, M.A.; Lama, T.K.; Tan, S.S.; Dokmeci, A.K.; Shukla, A.; Sharma, M.K.; Sarin, S.K.
BACKGROUND AND AIM: Acute-on-chronic liver failure (ACLF) is a severe form of alcoholic hepatitis (SAH). We aimed to study the natural course, response to corticosteroids (CS), and the role of the Asian Pacific Association for the Study of Liver (APASL) research consortium (AARC) score in determining clinical outcomes in AH patients. METHODS: Prospectively collected data from the AARC database were analyzed. RESULTS: Of the 1249 AH patients, (aged 43.8 ± 10.6 years, 96.9% male, AARC score 9.2 ± 1.9), 38.8% died on a 90 day follow-up. Of these, 150 (12.0%) had mild-moderate AH (MAH), 65 (5.2%) had SAH and 1034 (82.8%) had ACLF. Two hundred and eleven (16.9%) patients received CS, of which 101 (47.87%) were steroid responders by day 7 of Lille's model, which was associated with improved survival [Hazard ratio (HR) 0.15, 95% CI 0.12-0.19]. AARC-ACLF grade 3 [OR 0.28, 0.14-0.55] was an independent predictor of steroid non-response and mortality [HR 3.29, 2.63-4.11]. Complications increased with degree of liver failure [AARC grade III vs. II vs I], bacterial infections [48.6% vs. 37% vs. 34.7%; p < 0.001); extrahepatic organ failure [66.9% vs. 41.8% vs. 35.4%; p < 0.001] respectively. The AARC score better discriminated 90-day mortality. Harrell's C-index was 0.72 compared to other scores. CONCLUSION: Nearly 4 of 5 patients with AH present with ACLF. Such patients have a higher risk of infections, organ failures, lower response to CS, and higher mortality. Patients with AH and ACLF with AARC grade 3 should be considered for an early liver transplant.
Abdominal bloating in children: association with functional gastrointestinal diseases and adverse life events.
(The Korean Society of Neurogastroenterology and Motility, 2013) Rajindrajith, S.; Devanarayana, N.M.
BACKGROUND/AIMS: Abdominal bloating is a common symptom among children with functional gastrointestinal diseases (FGDs). It can lead to significant distress among affected children. However, its epidemiology, risk factors and clinical characteristics have not been described in paediatric population. We aimed to study die epidemiology and risk factors of abdominal bloating, and associated FGDs in Sri Lankan children. METHODS: A cross-sectional, island-wide survey was conducted in Sri Lankan children aged 10-16 years. Four provinces (out of 9) of the country were randomly selected and 2 schools were randomly selected from each of the provinces. From each school, 12 classes from academic years (grades) 6 to 11 (2 from each academic year) were randomly selected and all children in these classes were included in the study. The Rome III questionnaire for paediatric FGDs (self-report form) was used for data collection. FGDs were diagnosed using Rome III criteria. Abdominal bloating was considered to be present if die child indicated as having abdominal bloating at least 25% of the time during the past 2 months. RESULTS: A total of 1972 children and adolescents (54.8% boys, mean age 13.4 years, SD 1.8 years) were included in the analysis. One hundred and ninety-four (9.8%) children had abdominal bloating. Of them, 52.6% had aerophagia, 15.4% had irritable bowel syndrome, 9.7% had constipation, 6-7% had rumination syndrome, and 5.6% had functional abdominal pain. Bloating was significantly common among children exposed to emotional stress and adverse life events (P < 0.0001). Intestinal related symptoms and extra intestinal symptoms that were significantly associated with bloating include abdominal pain, nausea, pallor, photophobia and headache (P < 0.05). CONCLUSIONS: Bloating is a common symptom of children and often associated with a range of FGDs. Children who faced adverse life events and stress, have a higher tendency to develop bloating. Bloating coexist with several other intestinal related and extra intestinal symptoms.
Abdominal migraine in children: association between gastric motility parameters and clinical characteristics
(BioMed Central, 2016) Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A.
BACKGROUND: Approximately 0.2-1 % of children suffers from abdominal migraine (AM). Pathophysiology of AM has not been adequately studied. This study evaluated gastric motility in children with AM. METHODS: Seventeen children (6 boys), within an age range of 4-15 years, referred to a tertiary care paediatric unit, North Colombo Teaching Hospital Ragama, Sri Lanka, from 2007 to 2012, were screened. Those fulfilling Rome III criteria for AM were recruited after obtaining parental consent. None had clinical or laboratory evidence of organic disorders. Twenty healthy children (8 boys), with an age range of 4-14 years, were recruited as controls. Liquid gastric emptying rate (GE) and antral motility parameters were assessed using an ultrasound method. RESULTS: Average GE (41.6 % vs. 66.2 %, in controls), amplitude of antral contractions (A) (57.9 % vs. 89.0 %) and antral motility index (MI) (5.0 vs. 8.3) were lower and fasting antral area (1.8 cm(2) vs. 0.6 cm(2)) was higher in children with AM (p < 0.01). No significant difference in the frequency of antral contractions (F) (8.8/3 min vs. 9.3/3 min, p = 0.08) was found between the two groups. Scores obtained for severity of abdominal pain had a negative correlation with A (r = -0.55, p = 0.03). Average duration of abdominal pain episodes correlated with GE (r = -0.58, p = 0.02). Negative correlations were observed between duration of AM and A (r = -0.55), F (r = -0.52), and MI (r = -0.57) (p < 0.05). CONCLUSIONS: GE and antral motility parameters were significantly lower in children with AM. A significant correlation was found between symptoms and gastric motility. These findings suggest a possible role of abnormal gastric motility in the pathogenesis of AM.