Browsing by Author "de Silva, D.G.H."

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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.
Albendazole in the treatment of goehelminth infections in children
(Sri Lanka Medical Association, 1989) de Silva, D.G.H.; Hettiarachchi, S.P.; Fonseka, P.H.
Children with mixed helminthic infections between the ages of 2 and 14 years, from a slum area, were treated with two regimes of albendazole. A majority of children had moderate to heavy infections with Trichuris trichiura (greater than 70%) and Ascaris lumbricoides (greater than 84%). Children treated with a single 400 mg dose of albendazole showed a very good response in ascariasis with 100% cure rate irrespective of the severity of infection. In Trichuriasis (n = 40), a cure rate of 50% was observed in mild infections, but only a reduction in the egg counts of 60% and 57% respectively were observed in moderate and heavy infections. Only 10 patients with Necator americanus infections were treated with the single dose, and the cure rate in mild infections was satisfactory (86%), with an overall egg reduction rate of 95%. In 47 children included in the multiple dose regime (200 mg daily x 3 days), the cure rates in trichuriasis were, 82%, 66%, and 37% respectively in mild, moderate, and heavy infections. The egg reduction rate was 98% in all degrees of infection in trichuriasis. The cure rate in ascariasis, with the multiple dose regime was similar to that of the single dose, with 100% egg reduction, irrespective of the severity of infection.
Anaemia in children: are we using the correct prevention strategies?
(Sri Lanka Medical Association, 2017) Mettananda, S.; de Silva, D.G.H.
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.
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.
Attitudes towards genetic counselling and testing among medical students and newly qualified doctors
(Sri Lanka Medical Association, 1997) de Silva, D.; Jayasekera, K.M.; Rubasinghe, N.K.; de Silva, D.G.H.
OBJECTIVES: To determine knowledge about four genetic disorders (Down's syndrome (DS), haemophilia (haem), spinal muscular atrophy type 1 (SMA1) and Huntington's disease (HD)), attitudes towards counselling, acceptability of prenatal diagnosis and termination of pregnancies affected with these conditions. DESIGN: Questionnaire survey of a cohort of medical students and newly qualified doctors. SETTING: Faculty of Medicine, University of Ruhuna. RESULTS: 227 completed questionnaires (111 fourth year and 86 final year students, and 30 demonstrators) were analysed. Awareness of DS and haem, was higher than of SMA1 and HD, and was highest among the demonstrators. Over 80 percent of the cohort would not counsel directively about future pregnancies and would discuss the diseases with the family or at risk individuals. Prenatal diagnosis was found acceptable for DS, haem and SMA1 by a majority of the cohort. Attitudes to termination of affected pregnancies varied, 88 percent, 77 percent, 55 percent and 36 percent finding it acceptable for DS, SMA1, haem, and HD respectively, provided legal terminations were available and termination was requested by parents. CONCLUSIONS: This cohort of students and doctors appear to accept the principles of clinical genetics involving non-directive counselling, prenatal diagnosis and in some disorders, termination of pregnancy
Bilateral pneumothorax following rupture of pneumatocoeles in kerosene aspiration
(Sri Lanka Medical Association, 1979) de Silva, D.G.H.; Arulanandham, P.; Talwatte, S.N.
No abstract available
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.
"CHARGE" association
(Sri Lanka Medical Association, 1993) Jayantha, U.K.; Devasiri, I.V.; de Silva, D.G.H.
No Abstract Available
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.
Child abuse in Sri Lanka
(Sri Lanka College of Paediatricians, 1997) de Silva, D.G.H.
Child abuse:time for action
(Sri Lanka Medical Association, 1996) Fernando, A.D.; de Silva, D.G.H.
No Abstract Available
A Child with myocardial infarction--Kawasaki disease
(Sri Lanka Medical Association, 1993) de Silva, D.G.H.; Fernando, A.J.L.; Ekanayake, R.
No Abstract Available
Children needing protection: experience from South Asia
(British Medical Association, 2007) de Silva, D.G.H.
No Abstract Available
Chronic brucellosis in a farmer
(Sri Lanka Medical Association, 1981) de Silva, D.G.H.; Wijeratne, U.
No Abstract Available
Concentrations of interleukin 6 and tumour necrosis factor in serum and stools of children with Shigella dysenteriae 1 infection
(British Medical Assosiation, 1993) de Silva, D.G.H.; Mendis, L.N.; Sheron, N.; Alexander, G.J.; Candy, D.C.; Chart, H.; Rowe, B.
Serum interleukin 6 (IL-6) and tumour necrosis factor (TNF) were measured in children with dysentery during an epidemic caused by Shigella dysenteriae 1. IL-6 and TNF were also measured in fresh stool filtrates from children with acute gastroenteritis. The median serum IL-6 concentration was raised significantly in the children with complications (haemolytic uraemic syndrome, leukemoid reaction, thrombocytopenia, thrombocytosis, and severe colitis lasting more than one week) during the first week (n = 18, 9-7728 pg/ml; median 107) and in the second week (n = 13, 5-312 pg/ml; median 77), compared with convalescent sera (n = 10, < 3-85 pg/ml; median 39; p < 0.02 and < 0.05 respectively). The median IL-6 concentration during the first week was significantly higher in the group with complicated disease than in those with no complications (n = 8, < 3-37 pg/ml; median 5; p < 0.001). Although serum TNF concentrations were significantly raised in the complicated group during the first and second weeks of the illness and in the uncomplicated group compared with convalescence, there was no significant difference in the TNF concentrations between the complicated and uncomplicated groups. IL-6 was detectable in stool filtrates from eight of 13 children with S dysenteriae 1 infection and four of eight children with S flexneri infection. It was not detectable in Cryptosporidia, rotavirus, or adenovirus infections, those with pathogen-negative acute diarrhoea or controls. Seven of 13 children with S dysenteriae 1 and three of nine children with S flexneri infections had TNF detectable in stools. None of the children with Salmonella, Cryptosporidia, rotavirus of children with pathogen-negative diarrhoea and controls had detectable TNF in stool filtrates. It is postulated that the local and generalised vasculitis observed in shigellosis may be related to a direct effect of Shiga toxin on endothelial cells or caused by cytokine production stimulated by endotoxin, or both.
Congenital lipodystrophy (Seip syndrome) in Sri Lanka
(Sri Lanka Medical Association, 1984) de Silva, D.G.H.
No abstract available
Congenital nephrotic syndrome
(Sri Lanka Medical Association, 1995) de Silva, D.G.H.; Devasiri, I.V.; Dharmasiri, H.; Pathirana, C.
A six week old baby girl from a closed Malay community in Hambantota presented with gradually increasing oedema since two weeks of age. She was oedematous, with gross non selective proteinuria, hypoproteinaemia and hypercholesterolaemaia. Congenital nephrotic syndrome is extremely rare and has not been reported previously in Sri Lanka
Conscription of children in armed conflict
(British Medical Association, 2001) de Silva, D.G.H.; Hobbs, C.J.
No Abstract Available
Conscription of children in armed conflict - a form of child abuse: a sudy of 19 former child soldiers
(Wiley, 2001) de Silva, D.G.H.; Hobbs, C.J.; Hanks, H.
Armed combat in childhood is a form of child abuse. It may lead to serious consequences, including post-traumatic stress disorder. The inherent emotional abuse and acts or omissions by caregivers may cause behavioural, cognitive, emotional or mental disorder in the child. Nineteen former child soldiers were interviewed in a rehabilitation centre using a standard questionnaire. Reasons for recruitment included: volunteered (18), hatred of enemy (revenge) (5), virtue of being a freedom fighter (martyrdom) (9), as a means of supporting their family (economic) (3). One child was abducted, 7 joined for fear of the ‘enemy’ abducting them, and in 5 a family member was killed by ‘enemy’ or own group. The children were involved in manual labour (15), guard duty (15), front-line fighting (7), bomb manufacture (5), setting sea/land mines (5) and radio and communication (2). Fifteen were trained in firearms and 14 in self-destruction. Twelve children attempted to or did run away and 11 refused to obey orders or argued. This led to various punishments, including kitchen duty, beatings, imprisonment, blackmail or death threats. A majority of the children felt sad and emotionally upset when they remembered their mother and family. Children's involvement in war, whatever the ‘justifications’ may be, should always be considered as forced, as they cannot truly comprehend their action in war. The responsibility must be taken by the adult caregivers. The following definition of the abuse of children in armed conflict is proposed: ‘The involvement of dependent, developmentally immature children and adolescents in armed conflict they do not truly comprehend, to which they are unable to give informed consent, and which adversely affects the child's right to unhindered growth and identity as a child’. Firm international agreement on guidelines for the lower age limit of recruitment of children into armed forces is required.