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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Exploring the impact of occupational exposure: A study on cardiovascular autonomic functions of male gas station attendants in Sri Lanka(Wiley periodicals LLC on behalf of the physiological society and the American physiological society, 2024-10) Warnakulasuriya, T.; Medagoda, K.; Kottahachchi, D.; Luke, D.; Wadasinghe, D.; Rathnayake, P.; Ariyawansa, J.; Dissanayake, T.; Sandeepani, P.; De Silva, D.C.; Devanarayana, N.M.Fuel dispensing at fuel stations is performed manually by unprotected male gas station attendants in Sri Lanka, who have long working hours. These workers are exposed to hydrocarbon fuels associated with multiple health effects by modulation of the autonomic nervous system. This study was performed to determine cardiovascular autonomic functions among fuel pump attendants in Sri Lanka. Fuel pump attendants (n = 50) aged between 19 and 65 years were identified for the study from seven fuel stations. They were compared with age- and gender-matched controls (n = 46) without occupational exposure to fuel. A physical examination was performed before the autonomic function and heart rate variability (HRV) assessment. There were no significant differences in weight, height, or BMI between the study and the control populations (p > 0.05). Both the systolic blood pressure (SBP) (Mann Whitney U (MWU) = 743.5, p = 0.003) and diastolic blood pressure (DBP) (MWU = 686.5, p = 0.001) were significantly higher among the gas station attendants compared to controls. Valsalva ratio was significantly higher among the study group (MW U = 874.00, p = 0.043) compared to controls. The HRV analysis showed significantly higher SDNN and SD2 (MWU = 842.00, p = 0.034, and MWU = 843.50, p = 0.035 respectively) among the gas station attendants compared to controls. The changes to the cardiovascular autonomic parameters among those exposed to fuel vapor as a gas station attendant indicate an increase in sympathetic outflow to the vessels. In the occupational setting as fuel pump attendants need periodic monitoring.Item Gastroesophageal reflux disease in Sri Lanka: An island-wide epidemiological survey assessing the prevalence and associated factors(Public Library of Science, 2024) Wickramasinghe, N.; Thuraisingham, A.; Jayalath, A.; Wickramasinghe, D.; Samarasekera, D.N.; Yazaki, E.; Devanarayana, N.M.Gastroesophageal reflux disease (GERD) is commonly encountered in clinical practice in Sri Lanka. However, its prevalence in Sri Lanka is unknown. Our objective was to study the island-wide prevalence of GERD symptoms in Sri Lanka and its associated factors. A total of 1200 individuals aged 18-70 years (male: female 1: 1.16, mean age 42.7 years [SD 14.4 years]). were recruited from all 25 districts of the country, using stratified random sampling. An interviewer-administered, country-validated questionnaire was used to assess the GERD symptom prevalence and associated factors. Weight, height, waist, and hip circumference were measured. Heartburn and/or regurgitation at least once a week, an internationally used criterion for probable GERD was used to diagnose GERD. In this study, GERD symptom prevalence was 25.3% (male 42.1% and female 57.9%). Factors independently associated with GERD were inadequate sleep, snacking at midnight, sleeping within two hours of consuming a meal, skipping breakfast, increased mental stress, and certain medications used such as statins, and antihypertensive medications (p<0.001, univariate and logistic regression analysis). 38.4% of the study population have been using medication for heartburn and regurgitation in the past 3 months and 19.8% were on proton pump inhibitors. To conclude, the prevalence of GERD symptoms in Sri Lanka (25.3%) is higher than its estimated global prevalence of 13.8%. Several meal-related lifestyle habits, mental stress, and the use of some medications are significantly associated with GERD, indicating the importance of lifestyle modification and stress reduction in its management.Item The association between symptoms of gastroesophageal reflux disease and perceived stress: A countrywide study of Sri Lanka(Public Library of Science, 2023) Wickramasinghe, N.; Thuraisingham, A.; Jayalath, A.; Wickramasinghe, D.; Samarasekara, N.; Yazaki, E.; Devanarayana, N.M.BACKGROUND/AIMS: Stress is a known associated factor for gastroesophageal reflux disease (GERD). However, the dynamics between stress and GERD are not fully studied, especially in Sri Lanka. Our objective was to assess it. METHODS: For this cross-sectional descriptive study, 1200 individuals (age ranged 18-70 years, mean 42.7 years [SD 14.4 years], 46.1% males), were recruited using stratified random cluster sampling from all 25 districts of Sri Lanka. An interviewer-administered questionnaire, which included a country-validated GERD symptom screening tool, and the Perceived Stress Scale (PSS), was used to assess GERD symptoms and stress. Probable GERD was defined as those having heartburn and/ or regurgitation at least once per week which is on par with globally accepted criteria. Those who did not fulfill these criteria were considered as controls. RESULTS: PSS score was higher in those with probable GERD (mean 13.75 [standard deviation (SD) 6.87]) than in controls (mean 10.93 [SD 6.80]), (p <0.001, Mann-Whitney U test). The adjusted odds ratio for GERD symptoms was 1.96 times higher (95% confidence interval 1.50-2.55) in the moderate to high-stress level compared to the low-stress level participants. PSS score correlated significantly with the GERD screening tool score (R 0.242, p <0.001). Heartburn, regurgitation, chest pain, cough, and burping were significantly frequent in those with moderate to high-stress levels (p <0.001). Those with higher stress scores were more likely to use acid-lowering drugs (p = 0.006). CONCLUSIONS: Individuals exposed to higher levels of stress are more likely to have GERD symptoms. Therefore, stress reduction should be an important part of GERD symptom management.Item Functional diarrhea in children(All India Institute Of Medical Sciences, 2024) Rajindrajith, S.; Hathagoda, W.; Devanarayana, N.M.Functional diarrhea in children is a disease that has been focused on by both general pediatricians as well as pediatric gastroenterologists across the world. Although it is seen across the pediatric age group from late infancy to adolescence, most still believe that functional diarrhea only occurs in younger children. Recent epidemiological studies have shown that functional diarrhea is prevalent in all subcontinents. The classic clinical features include chronic loose stools with undigested food particles without growth faltering. Although known for long years, pathophysiological mechanisms and therapeutic options are not well explored, and the existing literature is outdated. In this article, authors review the available literature on functional diarrhea, with a reminder that a fresh look is needed to broaden the horizons of understanding of this disease.Item Early life events in functional abdominal pain disorders in children(Public Library of Science,San Francisco, 2022) Karunanayake, A.; Devanarayana, N.M.; Rajindrajith, S.Objectives: Functional abdominal pain disorders (FAPDs) are common gastrointestinal problems in children, and the pathophysiology is thought to be multifactorial. Adverse early life events (ELE) induce alterations in the central nervous system, perhaps predisposing individuals to develop FAPDs. We aimed to study the potential adverse ELE that are associated with FAPDs. Methods: We steered a school-based survey involving 1000 children from 4 randomly selected schools. FAPDs were assessed using the translated Rome III questionnaire, and ELE were identified using a pre-tested, parental questionnaire. FAPDs were diagnosed using the Rome III criteria. Results: Hundred and eighty-two (182) children had FAPDs (62.1% girls, mean age 8.5, SD 2.1). ELE of them were compared with 571 children without FAPDs (51.1% girls, mean age 8.8, SD 1.9). According to the binary logistic regression analysis, family members with abdominal pain, family member with chronic pain other than abdominal pain, prenatal maternal complications and interventional deliveries, were recognized as potential risk factors for the development of FAPDs. Breast feeding over two years has shown to reduce the prevalence of FAPDs.a. Conclusions: Prenatal maternal medical problems are associated a with higher prevalence of FAPDs later in life. Prolonged breastfeeding and normal vaginal delivery could be considered as factors that reduce the vulnerability of developing FAPDs in children. Therefore, minimizing pregnancy-related complications, encouraging vaginal deliveries, and encouraging breastfeeding are potentially valuable measures to prevent FAPDs during childhood.Item Childhood constipation: Current status, challenges, and future perspectives(Baishideng Publishing Group, 2022) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.Constipation in children is a major health issue around the world, with a global prevalence of 9.5%. They present to clinicians with a myriad of clinical signs. The Rome IV symptom-based criteria are used to diagnose functional constipation. Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children. There are various risk factors identified globally, including centrally connected factors such as child abuse, emotional and behavioral issues, and psychological stress. Constipation is also precipitated by a low-fiber diet, physical inactivity, and an altered intestinal microbiome. The main pathophysiological mechanism is stool withholding, while altered rectal function, anal sphincter, pelvic floor, and colonic dysfunction also play important roles. Clinical evaluation is critical in making a diagnosis, and most investigations are only required in refractory patients. In the treatment of childhood constipation, both nonpharmacological (education and de-mystification, dietary changes, toilet training, behavioral interventions, biofeedback, and pelvic floor physiotherapy), and pharmacological (osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone) interventions are used. For children with refractory constipation, transanal irrigation, botulinum toxin, neuromodulation, and surgical treatments are reserved. While frequent use of probiotics is still in the experimental stage, healthy dietary habits, living a healthy lifestyle and limiting exposure to stressful events, are all beneficial preventive measures.Item Epidemiology of aerophagia in children and adolescents: A systematic review and meta-analysis(Public Library of Science, 2022) Rajindrajith, S.; Gunawardane, D.; Kuruppu, C.; Dharmaratne, S.D.; Gunawardena, N.K.; Devanarayana, N.M.Background: Aerophagia is a common functional gastrointestinal disorder among children. The disease leads to symptoms related to air in the intestine leading to burping, abdominal distension, and excessive flatus. We aimed to perform a systematic review and a meta-analysis to assess the epidemiology of aerophagia in children. Methods: We conducted a thorough electronic databases (MEDLINE, EMBASE, PsycINFO and Web of Science) search for all epidemiological surveys conducted in children on aerophagia. All selected studies were assessed for their scientific quality and the extracted data were pooled to create a pooled prevalence of aerophagia. Results: The initial search identified 76 titles. After screening and in depth reviewing, 19 studies representing data from 21 countries with 40129 children and adolescents were included in the meta-analysis. All studies have used standard Rome definitions to diagnose aerophagia. The pooled prevalence of aerophagia was 3.66% (95% Confidence interval 2.44-5.12). There was significant heterogeneity between studies [I2 98.06% with 95% Confidence interval 97.70-98.37). There was no gender difference in prevalence of aerophagia in children. The pooled prevalence of aerophagia was highest in Asia (5.13%) compared to other geographical regions. Conclusion: In this systematic review and meta-analysis, we found aerophagia has a significant prevalence across the world.Item Gastric motility and pulmonary function in children with functional abdominal pain disorders and asthma: A pathophysiological study(Public Library of Science,San Francisco, 2022) Kumari, M.V.; Amarasiri, L.; Rajindrajith, S.; Devanarayana, N.M.Background: An association has been shown between functional abdominal pain disorders (FAPDs) and asthma. However, the exact reason for this association is obscured. The main objective of this study is to identify the possible underlying pathophysiological mechanisms for the association between FAPDs and asthma using gastric motility and lung function tests. Methods: This was a cross-sectional comparative study that consisted of four study groups. Twenty-four children (age 7-12 years) each were recruited for four study groups; asthma only, FAPDs only, both asthma and FAPDs, and healthy controls. Asthma was diagnosed using the history and bronchodilator reversibility test. The diagnosis of FAPDs was made using Rome IV criteria. All subjects underwent ultrasound assessment of gastric motility and pulmonary function assessment by spirometry, using validated techniques. Results: All gastric motility parameters, gastric emptying rate, amplitude of antral contraction, and antral motility index, were significantly impaired in children with FAPDs only, children with asthma only, and children with both asthma & FAPDs, compared to controls (p<0.05). Pulmonary function parameters indicating airway obstruction (FEV1/FVC ratio, peak expiratory flow rate, FEF25-75%) were not impaired in children with FAPDs only compared to controls (p>0.05), but significantly impaired in children with asthma and children with both disorders. Antral motility index correlated with the FEV1/FVC ratio (r = 0.60, p = 0.002) and FEF25%-75% (r = 0.49, p = 0.01) in children with both asthma and FAPDs. Conclusions: Gastric motor functions were significantly impaired in children with asthma, children with FAPDs, and children with both disorders. Motility index, measuring overall gastric motor activity, showed a significant positive correlation with lung function parameters that measure airflow limitation. Therefore, these diseases might arise as a result of primary disturbance of smooth muscle activity in the airways and gastrointestinal wall, which could be a possible pathophysiological mechanism for this association between asthma and FAPDs.Item Lung function of fuel handlers exposed to volatile organic compounds(Journal of the Ceylon College of Physicians, 2020) Wadasinghe, D.; Warnakulasuriya, T.; Medagoda, K.; Kottahachchi, D.; Luke, D.; Ariyawansa, J.; Rathnayake, P.; Dissanayake, T.; de Silva, D.; Amarasiri, L.; Devanarayana, N.M.; Scheepers, P.INTRODUCTION AND OBJECTIVES: The respiratory system is a target for effects from air pollutants, including vehicle emissions composed of volatile organic compounds (VOC), particulate matter and other noxious gasses. Our objective was to study the association between selected VOCs and lung function in a cohort of fuel handlers. METHOD: Forty-four fuel handlers (men) from the Gampaha district of Sri Lanka aged 19-65 years were selected using consecutive sampling with a group of 38 males matched by age, without occupational exposure to fuel recruited as controls. Spirometry was performed using a Vitalograph Alpha Touch spirometer, according to ATS guidelines. Pre and post shift VOC levels were measured in end exhaled air samples. RESULTS: The spirometry parameters were not significantly different between the two groups but obstructive (47.72% vs.34.21%) and restrictive ventilatory patterns (31.81% vs. 21.05%) were higher among the fuel handlers. FVC and FEV1 negatively correlated with age (r=-0.672, p<0.001 and r=-6.888, p<0.001 respectively) and number of days of exposure (r=-0.329, p=0.033 and r=-0.306, p=0.049 respectively). Among the fuel handler's, benzene exposure negatively correlated with FVC (r=-0.552, p=0.012) and FEV1 (r=-0.476, p=0.034) and toluene exposure negatively correlated with PEF (r=-0.488, p=0.034). Although levels of all VOCs measured were significantly low among the controls, toluene exposure levels negatively correlated with all spirometry parameters (p<0.05). CONCLUSIONS: A decline in lung function is seen with more days of exposure as a fuel handler. The different vVOCs· affect the volume parameters and flow parameters uniquely and even non-occupational exposure causes an alteration of spirometry parameters among adult males.Item Autonomic functions among fuel handlers in the Gampaha District(Journal of the Ceylon College of Physicians, 2020) Medagoda, K.; Warnakulasuriya, T.; Kottahachchi, D.; Luke, D.; Wadasinghe, D.; Ariyawansha, J.; Rathnayaka, P.; Dissanayake, T.; de Silva, D.; Devanarayana, N.M.INTRODUCTION AND OBJECTIVES: Economic growth of Sri Lanka has increased the number of motor vehicles. Fuel stations employing more fuel handlers have been established to cope with the demand. The long working hours with exposure to hydrocarbon fuels result in adverse health effects and this study was done to assess the cardiovascular autonomic functions (ANF) including heart rate variations (HRV). METHOD: Fifty fuel handlers from the Gampaha district of Sri Lanka (19-65 years; all were males) from 7 fuel stations were recruited using consecutive sampling and compared with 46 age and gender matched individuals without occupational exposure to fuel (controls). Demographic data were collected after obtaining informed written consent and systematic examination was conducted. ANF assessment and HRV assessment were performed using validated protocols. RESULTS: There were no significant differences in age, weight, height or the BMI among the study and the control populations (p>0.05). Both systolic blood pressure (BP) (Mann Whitney U (MW)= 743.5, p=0.003), diastolic BP (MW= 686.5, p=0.001) and Valsalva ratio (MW= 874.00, p=0.043) were significantly higher among the fuel handlers compared to the controls. Rise in DBP in sustained handgrip, a sympathetic parameter was significantly higher among controls (MW= 863.00, p=0.049). Among HRV parameters, standard deviation of RR intervals was higher among the fuel handlers compared to controls (MW=842.QO, p=0.034). Parasympathetic parameters correlated with exposure hours per week (p<0.05). CONCLUSION: Altered sympathetic: parasympathetic balance was observed among the fuel handlers with a parasympathetic predominance suggesting that autonomic functions are affected on expo sure to air pollution and hydrocarbons.