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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Role of antral motility in gastric emptying of liquids: A paediatric study(The Physiological Society of Sri Lanka, 2006) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.INTRODUCTION: Emptying of liquids from the stomach was thought to be primarily a function of the pressure gradient between the stomach and the duodenum. Sustained contractions of the proximal stomach were thought to be responsible for the basal intragastric pressure. The distal stomach (mainly the antrum) was considered to be mainly responsible for solid gastric emptying. But recent studies have shown that antral contractions also play an important role in emptying of liquids. OBJECTIVE: To study the correlation between liquid gastric emptying and antral motility. METHODS: Sixty-two children (age 5-15years) were recruited. After overnight fasting, all subjects consumed a standard liquid test meal (2GOmL of chicken broth, 54.8kJ) within 2 min. Gastric emptying and antral motility were recorded simultaneously using real-time ultrasound scanner with.3.5MHz and 5MHz curve-linear transducers using a previously reported method. The percentage emptying at ISmin was correlated with frequency and amplitude of antral contractions, and antral motility index. RESULTS: Twenty healthy children and 42 children with recurrent abdominal pain [29 (46.8%) males, mean age S.Tyears, SD Syears] were investigated. Liquid gastric emptying had significant positive correlation with the amplitude of antral contractions (r=0.44, pItem Knowledge and attitudes regarding child abuse and child rights among Sri Lankan school children(Sri Lanka Medical Association, 2012) Mettananda, S.; de Silva, D.G.H.; Perera, T.; Pathmeswaran, A.AIMS: To describe knowledge and attitudes regarding child abuse and child rights among school children in 3 districts in Sri Lanka. METHODS: A descriptive study was conducted in Anuradapura, Monaragala and Kandy districts in 2011. Five schools were randomly selected from each district. Three classes of grades 9-11 were randomly selected and all students in selected classes were recruited into the study after obtaining informed consent. A self-administered questionnaire given under examination conditions was used to gather data. The questionnaire contained questions to assess knowledge/attitudes regarding child abuse and rights. Subjects were assigned a mark (range 0-5) on their answers to questions in different aspects of child abuse and higher marks signify better knowledge. RESULTS: The study population comprised 1091 adolescents (Anuradapura-30%, Moneragala-35%, Kandy-34%). Mean age was 14.2 (SD±1.23) years and 48% were males. The majority of boys (85%) and girls (78%) were unaware of the child rights convention. A higher percentage of girls (10.1%) than boys (5.2%) answered the question on child rights satisfactorily [p=0.003]. Corporal punishment in schools was recommended by 38%, whereas 42% suggested positive disciplinary methods. On other's request, 29% boys and 6% girls would do life-endangering tasks. Marks for the question regarding ability to handle/avoid sexual abuse were- 0 in 7%, 1-3 in 51% and 4-5 in 42%. Girls scored significantly higher than boys [p<0.001]. CONCLUSIONS: Knowledge regarding child rights among Sri Lankan children was unsatisfactory. A high proportion acknowledged corporal punishment as a disciplinary method. Girls had a better knowledge regarding child rights and are better aware of how to handle situations of sexual abuse.Item Experience of abuse among Sri Lankan school children(Sri Lanka Medical Association, 2012) Mettananda, S.; de Silva, D.G.H.; Perera, T.; Pathmeswaran, A.AIMS: To describe the experiences of abuse and maltreatment among children and adolescents in 3 districts in Sri Lanka. METHODS: A descriptive study was conducted in Anuradapura, Monaragala and Kandy districts in January-March 2011. Five schools were randomly selected from each district. Two primary classes [grade 4-5 [children)] and 3 senior classes [grades 9-11 [adolescents]] were randomly selected and all students in selected classes were recruited into the study after obtaining informed consent from students and staff. A self administered questionnaire given under examination conditions was used to gather data. The questionnaire contained questions regarding experiences of physical, emotional and sexual abuse. Results: The study population comprised 739 children [Anuradapura-279, Moneragala-207, Kandy-253) and 1091 adolescents [Anuradapura-327, Moneragala-387, Kandy-377). Male; female ratio was 49:51. 75% children and 91% adolescents claimed that they are physically punished when they misbehave in school, whereas 79% and 97% respectively, agreed that they are shouted at. 28% adolescents [MaIe-49%, Female-10%) had performed life endangering tasks, and in 43% the caretaker/adult had requested it of them. Part-time child labour was reported by 2.7% children and 1.6% adolescents. 2.6% children [Male-3.6%, Female-1.7%) and 1.7% adolescents [Male-2%, Female-1.4%) had experienced incidents of sexual abuse. 14% children and 7% adolescents were staying alone at home whereas 37% children and 49% adolescents travelled alone. CONCLUSIONS: Corporal punishment, although banned, is still being widely used as a disciplinary method. About 2% of school children had experienced sexual abuse. Significant proportions of school children were either living alone or going out alone, and are therefore at risk of abuse.Item Child abuse and abdominal pain - Is there an association?(Sri Lanka Medical Assosiation, 2012) Devanarayana, N.M.; Rajindrajith, S.; Mettananda, S.; Weerasooriya, W.A.L.K.; Hathagoda, K.L.W.; Lakmini, B.C.; Subasinghe, S.M.V.; de Silva, D.G.H.INTRODUCTION AND AIMS: It is believed that there is an association between abdominal pain and child abuse. The main objective of this study was to assess this association in Sri Lankan school children. METHODS: Children aged 13-18 years were randomly selected from a semi-urban school in Gampaha district. A previously validated, self administered questionnaire was used to collect socio-demographic data and information on gastrointestinal symptoms, child abuse and exposure to other stressful events. Severity of symptoms was recorded using a validated, visual analogue scale. Children with abdominal pain were categorized into abdominal pain predominant functional gastrointestinal disorders (AP-FGD) using Rome III criteria. RESULTS: A total of 490 children were recruited [males 254 (51.8%), mean age 15.2 years and SD 1.64 years]. Forty eight (9.8%) fulfilled Rome lit criteria for AP- FGD (functional dyspepsia=3, functional abdominal pain=25, irritable bowel syndrome=15 and abdominal migraine=5). The number of children exposed to physical, emotional and sexual abuse, were respectively 119 (24.3%), 109 (22.2%) and 18 (3.8%). Prevalence of AP-FGD was significantly higher in those exposed to sexual (26.7% vs. 9.3% in controls, p=0.42) and emotional (16.5% vs. 8.3%, p=0.046) abuse, but not physical abuse (11.8% vs. 9.2%, p=0.69). AP-FGD type associated with sexual abuse was irritable bowel syndrome (15.4% vs. 2.7%, p=0.02). Mean scores obtained severity of abdominal pain were higher in children exposed to sexual (27.9 vs. 13.2, p=0.002) and emotional abuse (22.1 vs. 11.4, p<0.001). CONCLUSIONS: Chronic abdominal pain prevalence and severity were significantly higher in children exposed to sexual and emotional abuse.Item Oro-caecal transit in Sri Lankan children and adolescents with functional recurrent abdominal pain(Wiley Blackwell Scientific Publications, 2008) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.INTRODUCTION: Recurrent abdominal pain (RAP) is a common paediatric problem. The majority of the affected have no organic pathology. Gastrointestinal motility abnormalities are considered as a possible cause for their symptoms. This study evaluated oro-caecal transit in children and adolescents with functional RAP. METHODS: Thirty one children with functional RAP and 20 healthy children from the same geographical area underwent oro-caecal transit time measurement by lactulose (0.25 g/kg in 10% solution) breath hydrogen test. None had evidence of organic disease, except for one control who had a positive Helicobacter pylori stool antigen test. RESULTS: Oro-caecal transit times could be calculated in 30 patients [10 (33.3%) males, mean age 7.2 years, SD 2.4 years, 12 functional abdominal pain, 8 irritable bowel syndrome, 8 functional dyspepsia, 1 abdominal migraine, 1 non-specific abdominal pain according to Rome III criteria] and 19 controls [10 (52.6%) males, mean age 9 years, SD 2.7 years]. One patient (3%) and 1 control (5%) were non-responders. Oro-caecal transit time was significantly prolonged in patients (median 90 min, range 45–150 min) compared to controls (median 75 min, range 30–105 min) (p = 0.0045). Oro-caecal transit time did not correlate with scores obtained for severity of abdominal pain (r = 0.176, p = 0.354) and had no association with exposure to recent stressful life events (p > 0.05). CONCLUSIONS: Oro-caecal transit time was delayed in children and adolescents with functional RAP. The future studies are needed to confirm the role of delayed oro-caecal transit in generation of symptoms, and to evaluate the therapeutic value of drugs that normalize small intestinal transit.Item Recurrent abdominal pain syndrome among school children in the Gampaha district in Sri Lanka(Sri Lanka Medical Association, 2005) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.OBJECTIVES: Recurrent abdominal pain (RAP) syndrome is defined as "at least three bouts of abdominal pain, severe enough to affect activities, over a period of not less than three months". The prevalence of RAP syndrome among Sri Lankan children was unknown and the main objective of this study was to detect it. Methods: Questionnaires were distributed to a randomly selected sample of school children, aged between 5 to 15 years, from 4 randomly selected schools in the Gampaha district. RAP was defined according to Apley's criteria, a percentage of children fulfilling these criteria were interviewed and prevalence was adjusted accordingly. RESULTS: A total of 810 questionnaires were distributed and 734 (90.6%) were returned. There were 432 (46.6%) males and 392 (53.4%) females. The prevalence of RAP was 10.5% (9.6% in males and 11.2% in females). The highest prevalence was seen in children aged between 10 and 11 years and the mean age was 10.6years (SD 2.6years). RAP was significantly higher among children who were exposed to at least one stressful life event during past 6 months (p<0.0001) and who had a family history of RAP (p<0.000l). There were no associations between RAP and total family income, family size, father's alcohol consumption and having a working mother. CONCLUSIONS: Recurrent abdominal pain syndrome of childhood is a common problem in Sri Lanka affecting 10.5% of school children. RAP was higher in children who were exposed to emotional stress and who had a family history suggestive of the condition.Item Association between child maltreatment and constipation: a school Based survey using Rome III Criteria(Lippincott Williams and Wilkins, 2014) Rajindrajith, S.; Devanarayana, N.M.; Lakmini, C.; Subasinghe, V.; de Silva, D.G.H.; Benninga, M.A.Child abuse leads to multiple physical and psychosomatic sequelae. The aim of the present study was to evaluate the association between child abuse and constipation among schoolchildren. METHODS: Children 13 to 18 years of age were selected from 4 semiurban schools in Gampaha District, Sri Lanka. A self-administered questionnaire was used for data collection. Information regarding socio demographic factors and gastrointestinal symptoms, child abuse, and somatisation were collected. Constipation was diagnosed using Rome III criteria. RESULTS: A total of 1792 children were included in the analysis (boys 975 [54.4%], mean age 14.4 years, standard deviation [SD] 1.3 years). One hundred thirty-eight (7.7%) fulfilled Rome III criteria for constipation. The number of children exposed to physical, emotional, and sexual abuse were, respectively, 438 (24.4%), 396 (22.1%), and 51 (2.8%). The prevalence of constipation was significantly higher in those exposed to sexual (5.8% vs 2.6% P = 0.03), emotional (40.9% vs 20.8%, P < 0.0001), and physical abuse (41.6% vs 23.2%, P < 0.0001). Mean somatisation score was higher in the total group of abused children with constipation (mean 18.6, SD 12.5) compared with those without (mean 13.9, SD 12.3; P = 0.027). Children with a history of abuse did not seek health care more often than children without this history. Patient-perceived severity of bowel symptoms was higher in children with physical abuse (23.7 vs 19.7 P = 0.001) and emotional abuse (25.4 vs 19.3 P < 0.0001). CONCLUSIONS: Childhood constipation shows a significant association with physical, sexual, and emotional abuse. Children with constipation complain of more somatic symptoms and bowel symptoms when they are exposed to abuse.Item The Use of child soldiers in war with special reference to Sri Lanka(Maney Publishing, 2013) de Silva, D.G.H.Throughout history, the involvement of children in military operations has been extensively documented. The issue of child conscription is multi-faceted, with very few medical but more sociological aspects, including terrorism, politics, economics, history, culture and religion amongst other factors. Many United Nations Instruments as well as the International Criminal Court have documented that child conscription is detrimental to a child's development, violates Child Rights, and is a war crime. Efforts by international bodies to address conscription as childabuse have failed since the process is undertaken by groups rather than individuals, and because the law has no access to the perpetrators. The background to a conflict in Sri Lanka and various ethno-religious and political factors are discussed. The role of the diaspora community, the internet and various fund-raising mechanisms for war are discussed. The history of child conscription and studies examining reasons and the tasks assigned to them as conscripts as well as abusive aspects, especially in relation to emotional abuse, neglect and physical harm, are discussed. Documentation of conscription as child abuse needing a definition including a new definition of 'suicide by proxy' is stressed. The importance of culture and history, and the manipulation of the idealistic mind are discussed in the context of 'setting the stage' for child conscription. The toy weapon industry and the real arms industry, especially small arms, are important in maintaining conflicts, especially in the developing world. The conflicts of interests of members of the UN Security Council and the 'peace-keepers' of the world is discussed.Item Recurrent Abdominal Pain Syndrome in a Cohort of Sri Lankan children and adolescents(Oxford University Press, 2008) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.Item Aetiology of recurrent abdominal pain in a cohort of Sri Lankan children(Wiley-Blackwell, 2008) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.AIMS: Recurrent abdominal pain (RAP) has a multifactorial aetiology with many affected children having no evidence of organic pathology. This study assessed the functional and organic causes for RAP in a cohort of Sri Lankan children. METHODS: Fifty-five Sri Lankan children (45.5% males, aged 5-15 years) having RAP were screened for organic diseases. RAP was defined using Apley criteria. Children without clinical or laboratory evidence of organic diseases were classified into functional gastrointestinal diseases (FGD) using Rome II and III criteria. Thirty-nine patients with functional RAP and 20 healthy children (50% males, age 5-15 years) from same area were tested for Helicobacter pylori using a stool antigen test. RESULTS: Thirteen (23.6%) children had organic RAP. According to Rome II, 33 (60%), and according to Rome III, 39 (71%) (functional abdominal pain 19, irritable bowel syndrome nine, functional dyspepsia nine, abdominal migraine one, aerophagia one) children had FGD. Two (5.1%) patients and one (5%) control tested were positive for Helicobacter pylori (P > 0.05). Except for constipation, pain characteristics and associated symptoms were not significantly different between organic and functional RAP. CONCLUSIONS: Organic pathology accounted for symptoms in less than a quarter of Sri Lankan children with RAP. The majority had functional bowel diseases, of which the commonest was functional abdominal pain. Rome III criteria were more effective than Rome II criteria in identifying FGD. Helicobacter pylori infection did not appear to be associated with RAP.