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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Re: Anaemia and iron deficiency in pregnant women attending an antenatal clinic in a Teaching Hospital in Southern Sri Lanka(Sri Lanka Medical Association, 2017) Mettananda, S.; de Silva, D.G.H.No Abstract AvailableItem Anaemia in children: are we using the correct prevention strategies?(Sri Lanka Medical Association, 2017) Mettananda, S.; de Silva, D.G.H.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 A study on adolescent sexual & violent behaviour, drugs & alcohol abuse and its relationship to the past experiences(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Mettananda, D.S.G.; de Silva, D.G.H.; Jayasinghe, Y.C.; Waduge, T.R.W.; Pathmeswaran, A.; Abeysinghe, A.P.S.D.Item Causes for recurrent abdominal pain in children and adolescents: a classification according to rome ii criteria(Sri Lanka College of Paediatricians, 2007) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.BACKGROUND: Recurrent abdominal pain (RAP) among children and adolescents is defined as "at least three bouts of abdominal pain, severe enough to affect activities, over a period of not less than 3 months". RAP has multifactorial aetiology with many affected children having no evidence of organic pathology. The ROME II criteria for 'childhood functional gastrointestinal disorders' classify non-organic RAP into five main categories: functional dyspepsia (FD), irritable bowel syndrome (IBS), abdominal migraine, aerophagia and functional abdominal pain. OBJECTIVES: To identify the causes of RAP in Sri Lankan children. To classify non-organic RAP using ROME II criteria. DESIGN, SETTING AND METHOD: The children identified as having RAP during a school survey were recruited and screened for organic diseases using history, examination, stool microscopy and culture, full blood count, erythrocyte sedimentation rate and abdominal radiograph. Other investigations, performed based on clinical evidence, included serum amylase, renal and liver function tests, abdominal ultrasound and gastrointestinal endoscopy. RAP was defined according to Apley criteria. Children without clinical or laboratory evidence of organic diseases were classified using ROME II criteria. RESULTS: Fifty five children with RAP were investigated [25(45.5%) males, aged 5-15 years {mean 8.1 years, SD3.1 years)]. Thirteen (23.6%) had organic RAP (constipation 7, urinary tract infection 2, urinary calculi 1, gastro-oesophageal reflux I, antral gastritis and duodenitis I, and intestinal amoebiasis 1) and 42 (76.4%) had no organic disease. Thirty three (60%) could be classified according to ROME II criteria [functional abdominal pain 13, IBS 9, FD 9, abdominal migraine l,aerophagia I]. Nine (16.4%) did not fall into any of the above categories. CONCLUSIONS: The majority (60%) of children with RAP had functional bowel disease, which can be classified using ROME II criteria. • Organic pathology accounted for symptoms in less than 25% of patients.Item Association between recurrent abdominal pain in sri lankan school children and exposure to stressful life events(Sri Lanka College of Paediatricians, 2007) Devanarayana, N.M.; de Silva, D.G.H.BACKGROUND: Approximately one tenth of school children around the world suffer from recurrent abdominal pain (RAP). It is found to be significantly higher among children exposed to emotional stress. Patients can sometimes date the onset of pain to a specific stressful event, such as change of school, birth of a sibling or separation of parents. OBJECTIVE: To study the association between RAP and exposure to stressful life events in Sri Lankan school children. DESIGN, SELLING AND METHOD: The study was across-sectional survey among a randomly selected group of school children in the Gampaha District of Sri Lanka. Information regarding demographic features and exposure to stressful events was obtained using a parental questionnaire. Diagnosis of RAP was done using Apley criteria: "at least three bouts of abdominal pain, severe enough to affect activities, over a period of not less than three months". RESULTS: Eight hundred and ten questionnaires were distributed and 734 (90.6%) were returned [342 (46.6%) males, age range 5-15 years (mean 10.5 years, SD 2.7 years)]. Seventy seven (10.5%) had RAP (9.6% in males, 11.2% in females) and 657 children without RAP served as controls. Fifty five (71.4%) with RAP were exposed to stressful events compared to 274 fe.7%) controls (P<0.0001). After univariate analysis following stressful events were significantly higher in children with RAP compared to controls: change of school, being bullied at school, change in address, severe illness in a close family member, frequent punishment by parents, divorce or separation of parents and domestic fights (p<0.01). Sibling rivalry, monthly income, father's alcoholism and maternal employment were not associated with the condition (p>0.05) CONCLUSIONS: RAP was significantly high among Sri Lankan school children who were exposed to stressful life events. Several family and school related stressful events were associated with the condition.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.