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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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
30 results
Search Results
Item Auditory and visual hallucinations in an adolescent following orthotopic liver transplantation(Sri Lanka College of Psychiatrists, 2024-10) Chandradasa, M.; Abeyrathne, M.; Sithara, P.; Kodithuwakku, K.; Fernando, M.No abstract availableItem Diagnostic overlap between adolescent affective instability in borderline personality and juvenile bipolar disorder in Sri Lanka(Sri Lanka College of Psychiatrists, 2019) Chandradasa, M.; Fernando, W.K.T.R.; Kuruppuarachchi, K.A.L.A.Borderline personality disorder (BPD) and bipolar disorder (BD) could present a diagnostic challenge in the adolescent due to the presence of overlapping symptoms such as impulsivity, affective instability, and sexual arousal. Of these symptoms, affective instability is a central feature of BPD, and there is a rapid shift from the neutral affect to an intense affect, and this is associated with a dysfunctional modulation of emotions. We describe three Sri Lankan adolescents presenting with affective instability, treated with psychopharmacological agents as for BD. While BPD is characterized by transient mood shifts induced by interpersonal stressors, in BD, there are sustained mood changes. A longitudinal assessment of the symptomatic profile and collateral information clarified the diagnosis as being BPD. An examination of the nature of affective instability is vital for a proper diagnosis and provision of evidence-based treatment.Item Prediction equation for physical activity energy expenditure in 11-13-year-old Sri Lankan children(MDPI Publishing, 2023) Dabare, P.; Wickramasinghe, P.; Waidyatilaka, I.; Devi, S.; Kurpad, A.V.; Samaranayake, D.; de Lanerolle-Dias, M.; Wickremasinghe, R.; Hills, A.P.; Lanerolle, P.This study aimed to develop a regression equation to predict physical activity energy expenditure (PAEE) using accelerometry. Children aged 11-13 years were recruited and randomly assigned to validation (n = 54) and cross-validation (n = 25) groups. The doubly labelled water (DLW) technique was used to assess energy expenditure and accelerometers were worn by participants across the same period. A preliminary equation was developed using stepwise multiple regression analysis with sex, height, weight, body mass index, fat-free mass, fat mass and counts per minute (CPM) as independent variables. Goodness-of-fit statistics were used to select the best prediction variables. The PRESS (predicted residual error sum of squares) statistical method was used to validate the final prediction equation. The preliminary equation was cross-validated on an independent group and no significant (p > 0.05) difference was observed in the PAEE estimated from the two methods. Independent variables of the final prediction equation (PAEE = [0.001CPM] - 0.112) accounted for 70.6% of the variance. The new equation developed to predict PAEE from accelerometry was found to be valid for use in Sri Lankan children.Item Pyrexia of unknown origin (PUO) and the cost of care in a tertiary care institute in Sri Lanka(BioMed Central, 2023) Premathilaka, R.; Darshana, T.; Ekanayake, C.; Chathurangani, K.C.; Mendis, I.; Perinparajah, S.; Shashiprabha, M.; Nishshanka, S.; Tilakaratna, Y.; Premawardhena, A.BACKGROUND: Despite advancements in diagnostic technology, pyrexia of unknown origin (PUO) remains a clinical concern. Insufficient information is available regarding the cost of care for the management of PUO in the South Asian Region. METHODS: We retrospectively analyzed data of patients with PUO from a tertiary care hospital in Sri Lanka to determine the clinical course of PUO and the burden of the cost incurred in the treatment of PUO patients. Non-parametric tests were used for statistical calculations. RESULTS: A total of 100 patients with PUO were selected for the present study. The majority were males (n = 55; 55.0%). The mean ages of male and female patients were 49.65 (SD: 15.55) and 46.87 (SD: 16.19) years, respectively. In the majority, a final diagnosis had been made (n = 65; 65%). The mean number of days of hospital stay was 15.16 (SD; 7.81). The mean of the total number of fever days among PUO patients was 44.47 (SD: 37.66). Out of 65 patients whose aetiology was determined, the majority were diagnosed with an infection (n = 47; 72.31%) followed by non-infectious inflammatory disease (n = 13; 20.0%) and malignancies (n = 5; 7.7%). Extrapulmonary tuberculosis was the most common infection detected (n = 15; 31.9%). Antibiotics had been prescribed for the majority of the PUO patients (n = 90; 90%). The mean direct cost of care per PUO patient was USD 467.79 (SD: 202.81). The mean costs of medications & equipment and, investigations per PUO patient were USD 45.33 (SD: 40.13) and USD 230.26 (SD: 114.68) respectively. The cost of investigations made up 49.31% of the direct cost of care per patient. CONCLUSION: Infections, mainly extrapulmonary tuberculosis was the most common cause of PUO while a third of patients remained undiagnosed despite a lengthy hospital stay. PUO leads to high antibiotic usage, indicating the need for proper guidelines for the management of PUO patients in Sri Lanka. The mean direct cost of care per PUO patient was USD 467.79. The cost of investigations contributed mostly to the direct cost of care for the management of PUO patients.Item Gender dysphoria and morbid sexual jealousy in an adolescent.(Kandy Society of Medicine, 2022) Rathnayake, L.C.; Kuruppuarachchi, C.; Abeyrathne, M.; de Silva Rajaratne, P.K.D.H.J.L.; Chandradasa, M.; Kuruppuarachchi, K.A.L.A.Gender dysphoria is the psychological distress that occurs when an individual’s biologically determined sex and gender identity do not align. Jealousy is likely to occur in any form of intimate partnership, irrespective of sexual orientation. Jealousy in a relationship is affected by sociocultural variables, an individual’s sense of masculinity, femininity, and other factors. We report an 18-year-old assigned female at birth with gender dysphoria presenting with jealous-type delusional disorder. We found no previous reporting of morbid jealousy in adolescents with gender dysphoria.Item Risk factors for deliberate self-harm in young people in rural Sri Lanka: a prospective cohort study of 22,000 individuals(Sri Lanka Medical Association, 2021) Fernando, K.; Jayamanna, S.; Weerasinghe, M.; Priyadarshana, C.; Ratnayake, R.; Pearson, M.; Gunnell, D.; Dawson, A.; Hawton, K.; Konradsen, F.; Eddleston, M.; Metcalfe, C.; Knipe, D.Background: Over 90% of youth suicide deaths occur in low- and middle-income countries. Despite this relatively little is known about risk factors in this context. Aims: Investigate risk factors for deliberate self-harm (non-fatal) in young people in rural Sri Lanka. Methods: A prospective cohort study of 22,401 individuals aged 12-18 years with complete data on sex, student status, household asset score, household access to pesticides and household problematic alcohol use. Deliberate self-harm was measured prospectively by reviewing hospital records. Poisson regression estimated incidence rate ratios (IRRs) for the association of risk factors with deliberate self-harm. Results: Females were at higher risk of deliberate self-harm compared to males (IRR 2.05; 95%CI 1.75 – 2.40). Lower asset scores (low compared to high: IRR 1.46, 95%CI 1.12 - 2.00) and having left education (IRR 1.61 95%CI 1.31 – 1.98) were associated with higher risks of deliberate self-harm, with evidence that the effect of not being in school was more pronounced in males (IRR 1.94; 95%CI 1.40 – 2.70) than females. There was no evidence of an association between household pesticide access and deliberate self-harm risk, but problematic household alcohol use was associated with increased risk (IRR 1.23; 95%CI 1.04 – 1.45), with evidence that this was more pronounced in females than males (IRR for females 1.42; 95%CI 1.17 – 1.72). There was no evidence of deliberate self-harm risk being higher at times of school exam stress. Conclusion: Indicators of lower socioeconomic status, not being in school, and problematic alcohol use in households, were associated with increased deliberate self-harm risk in young people.Item Translation, cultural adaptation and validity of the Adolescent Sedentary Activity Questionnaire among school children aged 14-15 years(College of Community Physicians of Sri Lanka, 2020) Godakanda, I.; Abeysena, C.; Lokubalasooriya, A.INTRODUCTION: Sedentary behaviour is a risk factor for several diseases. Validation of questionnaires on sedentary activity is a great challenge. OBJECTIVES: To translate, culturally adapt and validate the Adolescent Sedentary Activity Questionnaire (ASAQ) among school children. METHODS: Back translation method was used to translate ASAQ into Sinhala language (ASAQ-S). Cultural adaptation and judgmental validity were ensured using a panel of experts. Criterion validity was assessed by comparing ASAQ-S data with the reference standard, which was the ActiGraph GT1M accelerometer worn on the waist. The study population consisted of 42 school children aged 14-15 years. Sedentary activity time was taken from the accelerometer recorded data as total hours per day. The ASAQ-S has 14 items and then total sedentary time was calculated by summing up the activities of all seven days. Intra-class correlation coefficient (ICC) and 95% confidence interval (CI) were calculated. RESULTS: The average sedentary time was 11.7 (SD=3.4) hours per day recorded by an accelerometer and from the ASAQ-S 9.0 (SD=2.3) hours per day. An ICC for total sedentary activity time between the accelerometer and ASAQ-S was 0.52 (95% CI=0.08, 0.78) and Pearson correlation coefficient was 0.55 (p<0.01). CONCLUSIONS: The validity of ASAQ-S was satisfactory and can be used as a tool to assess adolescent sedentary behaviour. KEYWORDS: Adolescence, Cultural, Questionnaire, Reliability, Sedentary, ValidityItem Epidemiological and pathophysiological aspects of abdominal pain predominant functional gastrointestinal disorders in children and adolescents: a Sri Lankan perspective(Author Publication, 2015) Devanarayana, N.M.SUMMARY Abdominal pain is the second common painful health problem in children, only second to headache. Abdominal pain can be acute or recurrent in origin. Chronic abdominal pain is a misnomer since episodes of abdominal pain in children are distinct and separated by periods of well being. Numerous organic disorders lead to recurrent abdominal pain (RAP). However, in Sri Lanka, and also in developed countries, common causes for RAP are functional gastrointestinal disorders (FGIDs) such as irritable bowel syndrome (IBS), functional abdominal pain (FAP), functional dyspepsia (FD), and constipation. John Apley, the British pediatrician is the first person to study abdominal pain among children. He gave the initial definition for RAP. Apley’s criteria has been used frequently to diagnose non-organic RAP in children until Rome criteria for abdominal pain predominant functional gastrointestinal disorders (AP-FGIDs) are released. Main AP-FGIDs recognized by Rome III definition are IBS, FD, abdominal migraine (AM) and FAP. Childhood FGIDs are a worldwide health problem. With growing population trends and increasing predisposing factors such as psychological stress and obesity, it can be predictable that the incidence of FGIDs will increase further and become a significant healthcare problem. Although FGIDs are not life threatening, research shows that children suffering from FGIDs tend to have a lower quality of life than their healthy peers and frequently miss school. In addition many FGIDs such as constipation and IBS has high healthcare expenditure and are becoming a major challenge on already overstretched healthcare budgets. Chapter 1 of this thesis introduces these key aspects of FGIDs in children including definitions, global epidemiology and burden of the disease. Chapter 2 of this thesis gives a detailed account on possible underlying pathophysiological mechanisms for AP-FGIDs and available treatment modalities. In the currently accepted biopsychosocial model, the interplay of genetic, physiological, psychological and immunological factors are considered to give rise to FGIDs in children. The prevailing viewpoint is that the pathogenesis of func¬tional pain syndromes involves the inter-relationship between changes in visceral sensation, so-called visceral hyperalgesia or hypersensitivity, and altered gastrointestinal motility. Potential targets for pharmacological and nonpharma¬cological therapy are arising from this model. To date, high-quality efficacy studies of treatment in pediatric AP FGIDs are scarce. Available evidence indicates benefi¬cial effects of hypnotherapy and combined behavior therapy. Evidence for diets low in fermentable oligosaccharides, disaccharides, monosaccharaides and polyols (FODMAP) and probiotics is promising, as well as for drug treatment such as peppermint oil, cyprohep¬tadine or famotidine, but well-designed trials with long-term follow-up are needed to confirm these preliminary results. Chapter 3 describes the prevalence and risk factors for development of AP-FGIDs in Sri Lanka. AP-FGIDs are seen in 12.5% of Sri Lankan children ages 10 to 16 years. IBS is the most common AP-FGID diagnosed, followed by FAP and FD. AP-FGIDs are significantly higher in girls compared with boys. There is a negative correlation between the age and prevalence of AP-FGIDs, with highest prevalence observed in children aged 10 years. Intestinal-related symptoms and extraintestinal symptoms are more frequent in affected children, compared with controls. Exposure to home- and school-related stressful life events are significantly associated with AP-FGIDs. The distribution of IBS subtypes in 10-16 year olds, their symptom characteristics, and bowel habits are described in details in chapter 4 of this thesis. Constipation predominant IBS (IBS-C), diarrhea predominant IBS (IBS-D) and mixed IBS (IBS-M) have almost equal distribution while untyped IBS (IBS-U) has a relatively lower prevalence. IBS is more frequent in girls than in boys. Several intestinal-related and extraintestinal symptoms are significantly associated with all four subtypes of IBS, indicating higher occurrence of somatization among affected children. Asia is the home for over 50% of the world’s childhood population. In addition, most of Asian countries are going through a rapid change in socio-economic status and their cultural foundations are constantly being challenged by globalization. In that light, we believed that studying epidemiological patterns of IBS in Asian children in a systematic way will provide a greater perspective for understanding the burden of IBS, its epidemiological distribution, and patterns of subtypes in this continent. Chapter 5 is a systematic review and meta-analysis which has demonstrated that a sizeable population of young Asians have IBS. The prevalence of IBS varies widely depending on the country, diagnostic criteria, and age of the participants. It is more common among girls compared to boys. There is a significant difference in the prevalence of sub-types in different studies. This systematic review concluded that further studies using pediatric criteria for IBS are needed to understand the true prevalence, especially in other parts of the Asia with large populations. It is believed that exposure to abuse as a child may subsequently result in abdominal pain. However, only a handful of studies have evaluated the impact of abuse on AP-FGIDs in children and none in teenagers. Results of a study conducted to assess this association between exposure to child abuse and AP-FGIDs in teenagers is presented as Chapter 6. The prevalence of AP-FGIDs is significantly higher in teenagers who have been exposed to physical, sexual, and emotional abuse. In addition, scores obtained for severity of bowel symptoms were significantly higher in teenagers with AP-FGIDs exposed to abuse than those not exposed to such events. Chapter 7 describes the health related quality of life (HRQoL) and healthcare consultation in Sri Lankan teenagers aged 13 to 18 years with AP-FGIDs. Children with AP-FGIDs have significantly lower HRQoL scores for physical, emotional, social and school functioning. Approximately 28% of affected children have sought medical advice for their symptoms during previous 3 months. The main symptoms associated with healthcare consultation were abdominal bloating and vomiting. The HRQoL was an important determinant of healthcare consultation, more than the severity of individual symptoms. Chapter 8, chapter 9, chapter 10 and chapter 11, using a simple, safe and non-invasive ultrasound method, we have shown a significant delay in gastric emptying and impairment in antral motility in children who fulfil Rome III criteria for all 4 main types of AP-FGIDs, namely FAP, IBS, FD and AM. Furthermore, there is a significant negative relationship between delayed gastric emptying and severity of symptoms in children with FAP, FD and AM. Furthermore, children with IBS who were exposed to recent stressful life events had a significantly lower gastric emptying rate compared to those not exposed to such events, suggesting the possibility of altered brain-gut interactions. In this light, our findings suggest that delayed gastric emptying and impaired antral motility play a role in the pathogenesis of AP-FGIDs. CONCLUSIONS This thesis clearly shows that AP-FGIDs are common among Sri Lankan children, especially those exposed to psychological factors such as school and home related stressful events and abuse. The commonest AP-FGID type is IBS of which IBS-D, IBS-C and IBS-M have almost equal prevalence. Affected children have a poor HRQoL in physical, emotional, social and school functioning domains. Only approximately a quarter of children with this troublesome symptom have received healthcare. Affected children have significant abnormalities in their gastric motility functions, and in some, the abnormal motility correlates with the severity of symptoms.Item Pattern of physical activity among school children aged 14-15 years in the district of Kalutara(College of Community Physicians of Sri Lanka, 2018) Godakanda, I.; Abeysena, C.; Lokubalasooriya, A.BACKGROUND: Physical inactivity is a major risk factor for NCD related global mortality. Sri Lanka is on the verge of an epidemic of NCDs. It is imperative that the pattern of physical activity is assessed among adolescents.OBJECTIVE: To describe the pattern of physical activity among school children aged 14-15 years in the district of KalutaraMETHODS: A cross-sectional survey was carried out in a sample of 1795 children in government schools in the district of Kalutara. The sample was selected using a multistage cluster sampling method with probability proportionate- to the size. A total of 90 class rooms (clusters) were included and the average cluster size was 20. The pattern of physical activity was assessed using the validated Physical Activity Questionnaire-S. Moderate to vigorous physical activities for at least 60 minutes per day for ≥5 days per week were categorized as ‘sufficiently active’. Chi-squared test was applied to compare the physical activity level with selected factors.RESULTS: Only 33.1% (n=595) of the adolescents were sufficiently active. Of them, 30.6% (246/805) females and 35.1% (349/990) males were sufficiently active (p=0.04). Of the overweight adolescents, 26.7% (48/176) were sufficiently active, which was significantly different from the normal (35.1%, 412/1175) and underweight (30.4%, 135/144) groups (p=0.04). Only 13.9% (n=249) adolescents participated on three or more days a week in sport clubs, aerobics, dancing or martial art during out-of-school hours; and 66.4% (n=1195) in one or more sport clubs during the previous year. Only 4.8% (n=86) adolescents were active on three or more days during school physical exercise period and 46.8% (n=842) traveling by bicycle to school and back during the previous week. Almost 80% (n=1407) of the adolescents learnt about benefits of physical exercise; 66.2% (n=1187) to develop a plan of physical exercise to improve it; and 80% (n=1434) on injury prevention of physical exercise during the previous year from the schools.CONCLUSIONS: Only 33.1% of the adolescents were sufficiently active. Males were more active than females. Participation of physical exercise activities within school and out-of-school hours was low.Item Social media use of adolescents as a component of the comprehensive mental health assessment(Science Forecast Publications LLC, 2018) Chandradasa, M.; Rathnayake, L. C.The mental health assessment of an adolescent involves exploring the interactions with their family, teachers, peers and important others. The modern-day adolescent socially communicates through the social media frequently. Therefore, the mental health assessment needs to be modified to include information about their social media use. The western world has established specialized mental health services targeting unique patient populations. However, many settings in the developing world lack well-distributed subspecialist services including child and adolescent mental health expertise. Due to the unavailability of subspecialists, mental health assessments of adolescents would be done by general specialists and primary-care physicians. This article provides simple instructions on how to assess the online media use of adolescents that could have a major impact on their mental health.
- «
- 1 (current)
- 2
- 3
- »