Conference Papers

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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine

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20 year follow up and survival analysis in a cohort of patients with Haemoglobin E beta Thalassaemia.
(Sri Lanka Medical Association., 2019) Olivieri, N.F.; Premawardhena, A.P.; Amir-Arsalan, S.; Ediriweera, D.; Mettananda, S.; Bandara, W.D.; Arambepola, M.; de Silva, S.; Refai, M.A.C.M.; Allen, A.
INTRODUCTION & OBJECTIVES: Haemoglobin E beta thalassaemia (EBT) is the commonest beta thalassaemia syndrome in the world and is extremely phenotypically variable. Unlike for transfusion dependent thalassaemia (TDT) there are no clear guidelines for the management of this disease. We have followed up a cohort of 109 patients with EBT for 20 years. Objective of the study was to study the 20-year survival and factors that affect survival. METHODS: Study was conducted at Kurunegala Thalassaemia centre. Transfusions were stopped in 1997 in all 109 patients. Since then they were assessed every three months by the clinical team for the next 20 years. Relevant haematological, biochemical, radiological assessments were done periodically. RESULTS: 32 (30%) of patients were dead at 20 years. Kaplan Meir survival curve identified the median survival to be 51 years. Splenectomy had been done in 73/109 (67%) patients. Splenectomy allowed 66% to be off transfusions even 9.7± 1.3 years post- surgery. However, 33% had to return to transfusions. The commonest cause of death in the cohort was infections (34.3%). Most (72%) infective deaths happened in those who were splenectomised. Transfusions needed to be restarted in 60%, of whom 33% went back to (>8 per year) regular transfusions at a mean 8.4 ±0.8 years after stopping transfusions. CONCLUSION: In this first ever long term follow up study of EBT, significantly shortened survival is observed. Though splenectomy allows prolonged transfusion free phases in many it increases risk of infective deaths. Overall the disease is far less benign than previously thought with a high prevalence of morbidity and mortality.
30-year cardiovascular risk prediction of medical undergraduates of university of Kelaniya, Sri Lanka
(Sri Lanka College of Internal Medicine, 2019) Mettananda, K.C.D.; Gunarathna, M.R.T.A.; Gunasekara, M.D.S.D.; Gunasekara, P.; Gunasekara, T.N.A.S.; Gunasekara, W.S.M.T.M.; Thampoe, R.S.
BACKGROUND: Medical students could be at high risk of cardiovascular diseases (CVDs) due to lack of exercises, increased mental stresses, unhealthy dietary practices. However, there are no reported data on this from Sri Lanka. OBJECTIVE: We aimed to predict 30-year CVD-risk of medical students of University of Kelaniya. METHODS: A cross-sectional study was conducted among medical students of Faculty of Medicine, University of Kelaniya during November 2018. 20 students from each batch were randomly selected. Data were collected using an interviewer administered questionnaire. 30-year risk of General-CVDs were calculated using Framingham 30- year CVD-risk calculator using sex, age, systolic blood pressure, use of antihypertensive medications, smoking, presence of diabetes mellitus and body mass index(BMI). Data was analysed using SPSSversion-22. RESULTS: 100 students (female 59(59%)) aged 21-29 years (mean 24.8 ± 1.8 years) were studied. Cardiovascular risk factor prevalences were; hypertension 1(I%), hyperlipidaemia 2(2%), diabetes mellitus I (I %), smoking 3(3%), overweight 37(37%) and obesity 2(2%). Mean 30-year hard-CVD risk was 2.13% (SD±l .63), mean 30-year general-CVD risk was 4.58% (SD±2.88). Majority (93%) were low-risk, and 7% were at moderate-risk and none were categorised high-risk. Of the moderate risk participants, 5(28.6%) were male (p=0.11), 6(87.7%) (p=0.043) were overweight but none were smokers nor had diabetes mellitus, hypertension or hyperlipidaemia. CONCLUSION: Majority of current medical students of University of Kelaniya e at low risk of future CVD events. The commonest risk factor seen among moderate risk students was being overweight. This emphasize the importance of adhering to healthy lifestyle.
6379 Pre-admission management of children presenting with febrile illness in a tertiary hospital of Sri Lanka
(BMJ, 2024) Arunath, V.; Mettananda, S.
OBJECTIVES To describe the symptoms and pre-admission management of children presenting with febrile illness to the Colombo North Teaching Hospital, Ragama, Sri Lanka.METHODS A retrospective descriptive study was conducted at University Paediatric Unit of Colombo North Teaching Hospital, Ragama, Sri Lanka. Data on pre-admission management of all children admitted with febrile illness from July to December 2019 were extracted from patient records. Children who were transferred from other units, children with chronic illnesses and children developed fever following vaccinations were excluded. Ethical approval was obtained from Ethics Review Committee of Sri Lanka College of Paediatricians and data was analysed using SPSS version 22.RESULTS A total of 366 children were admitted; 56% were males. Mean age was 53.5 ± 41.7 months and the majority were from Gampaha district. Mean duration of illness on admission was 3.6 ± 2.5 days. 236 (65.6%) patients had recorded fever spikes at home while 150 (60.7%) reported a contact history of fever. Common associated symptoms were cough (62.3%), cold (56%) and vomiting (39.6%). 199 (54.5%) underwent investigations prior to admission and full blood count was the commonest (47.5%) investigation. Although 357 (97.8%) had taken medication prior to admission, only 87.3% had consulted a doctor. 356 (97.3%) received paracetamol at home of which 24 (7.9%) and 123 (40.6%) received sub-therapeutic and supra-therapeutic doses respectively. Significantly higher proportion (44.9%) of children who consulted a doctor received appropriate dose of paracetamol compared to others (3.7%), (c2=11.9, p=0.003, p<001). Higher proportion children who had recorded fever spikes consulted a doctor (c2=3.99, p=0.046, p<0.05) and received therapeutic doses of paracetamol prior to admission (c2=4.94, p=0.026, p<0.05).CONCLUSION Use of sub- and supra-therapeutic doses of paracetamol was common before admission to the hospital. Recording temperature at home and medical consultation prior to admission were associated with appropriate dose paracetamol usage (p<005).
6460 Children’s perception of the health effects of climate change – a mixed-method study in urban Sri Lanka
(BMJ, 2024) Dayasiri, K.; Anand, G.
OBJECTIVES While children bear the least responsibility for global climate change, they suffer the most from its consequences, including a higher incidence of non-communicable diseases and exposure to natural disasters. The United Nations has emphasised that failing to act on climate change infringes upon children’s rights to live in a secure environment. Our study focuses on examining the perspectives of Sri Lankan adolescents on climate change, its effects, and their roles in addressing this issue.METHODS This mixed-method cross-sectional study involved 104 adolescents attending schools in Colombo, Sri Lanka. We randomly selected participants from both governmental and private schools and invited them to complete a self-administered questionnaire. The questionnaire covered their perceptions of climate change, their contributions to addressing climate change, and their views on the regional and global implications of climate change. Qualitative data analysis was conducted using a second-order descriptive analysis of themes.RESULTS 104 adolescents participated in the study and 75.8% were female children. Median age =17 years (range 13–19 years). Majority (93.1%) expressed concern about the potential future health impacts of climate change. While most adolescents correctly understood the concept of climate change, some revealed misconceptions about it. The major health impacts associated with climate change, as reported by the participants, included asthma, the rise of non-communicable diseases, skin conditions, cancer, and increased stress. Notably, 25% of the participants felt that they had not received education on climate change. Nearly 60% reported feeling anxious over the issue of climate change. Regarding their contributions to addressing climate change, 29.8% of the children admitted that they had not taken sufficient actions. However, those who had acted mentioned activities such as tree planting, increased use of public transportation, and educating others about climate change. Almost half of the cohort were unaware of useful resources for learning about climate change. A significant 76% of the adolescents believed that adults were not actively taking measures to address climate change.CONCLUSION This study showed that children are evidently anxious over the issue of climate change. There is an urgent need for improved awareness of information sources among children through public health measures. It is essential for adults including those in the medical profession to serve as role models in educating and guiding children on how to make a positive impact on global climate change.
6503 Using anthropometric data to investigate the nutritional status of children included on the Sri Lankan cerebral palsy register.
(BMJ Publishing Group Ltd, 2024) Sumanasena, S.; Fernando, R.; Kurukulaarachchi, S.; Heiyanthuduwage, T.M.; Sheedy, H.S.; Wijesekara, S.; Jagoda, J.; Muttiah, N.
OBJECTIVES The nutritional data from children with cerebral palsy (CP) in low and middle income countries (LMIC) is sparse. In high income countries (HICs) well established nutritional care plans, commercial products and good psycho-social support are available.1 A multitude of complications arise due to malnutrition leading to poor quality of life.2 Here we investigated the nutritional status of children included in the Sri Lankan Cerebral Palsy Register (SLCPR).METHODS The study included 768 children aged 0–18 years with CP, attending three teaching hospitals in the Western Province, from September 2018 to November 2021. Data included clinical profile and anthropometry [weight (Kg), height (cm), BMI, mid upper arm circumference (MUAC) (cm), and OFC (cm)] based on WHO. Average was calculated using three repeated measurements. Children who could not stand independently (GMFCS level 4/5) underwent height estimations with the knee height equation: height = (2.69 X Knee height) + 24.2.Indicators used to measure the nutritional status were: weight for age Z score (WAZ), height for age Z score (HAZ), weight for height Z score (WHZ), BMI for age Z score (BAZ), and MUAC for age Z score (MUACZ). WHO Anthro and WHO AnthroPlus software calculated all Z scores.4 HAZ and BAZ were calculated for children aged <18 years, WAZ was calculated for children aged <10.1 years, and WHZ and MUACZ were calculated for children aged <5.1 years. The z scores < -2.0 SD were categorized as underweight (WAZ), stunted (HAZ), wasted (WHZ or MUAC), thin (BAZ).RESULTS Total of 768 children (mean age 59.6 months, SD 44.9, 62.5% males) participated. There were (n=431) children under 61 months and (n=520) from 0–10 years. Of them, 51.3% (n = 267/520) were underweight, 59.8% (n = 258/431) were stunted and 27.3% (n = 210/768) were thin. Among children aged < 5 years, 26.7% (n = 115/431) had severe wasting and severe acute malnutrition (SAM) according to MUACZ < -3SD. Both underweight and stunting were significantly higher among children with spastic CP compared with others (p<0.05). In the 5–19 year group 16.9% (n= 57/337) were obese (BAZ > + 2SD).CONCLUSION Predominant stunting and underweight in this population calls for urgent action to minimize chronic malnutrition. It is imperative to further explore nutritional intake and feeding difficulties in this group and offer structured nutritional care plans. The trend observed in older children towards obesity possibly indicates the need for coordinated nutrition and exercise programmes. It is recommended to regularly monitor growth and nutritional status of all children with CP as there may be serious implications for their activity levels.
6542 Clinical profiles of children less than 5 years presenting with or high risk of cerebral palsy in the Western Province of Sri Lanka
(BMJ, 2024) Sumanasena, S.; Heiyanthuduwage, T.M.; Fernando, R.; Sheedy, H.S.; Jagoda, J.; Wijesekara, S.; Wanigasinghe, J.; Muttiah, N.; Rathnayake, P.; Kitnasamy, G.; Khandaker, G.
OBJECTIVES Cerebral palsy (CP) is the commonest physical disability in children globally.1 It is a clinical diagnosis based on clinical and neurological findings. International clinical practice guidelines recommend early diagnosis and CP specific interventions to invest in neural plasticity and achieve optimal functional levels.2 In the past diagnosis was confirmed at 12–24 months but now it is advanced to confirm or identify as high risk for CP before the age of six months.3 4 Sri Lanka is one of the few Asian countries that initiated a CP register and National Guidelines on management of CP.5 The objective of this paper is to describe the clinical profiles of children less than 5 years presenting to Western Province hospitals in Sri Lanka based on the data from the Sri Lanka Cerebral Palsy Register (SLCPR).METHODS A cross sectional hospital-based study was conducted in the Western Province from September 2018 – October 2021 in three teaching hospitals to collect a minimum data set for the Sri Lanka SLCPR. Data of children less than 60 months was extracted with a confirmed clinical diagnosis of CP or identified formally as ‘high risk’ of CP.Information on sociodemographic, pre/peri/neonatal, and post neonatal risk factors, and associated impairments were collected using hospital records and clinic notes. Clinical motor type, topography, and associated impairments were evaluated.RESULTS Data of 431 children were extracted, 254 (58.9%) were males. Mean age at diagnosis was 28.73 months (median 27, SD 14.98). Most children (n= 422, 97.9%) acquired CP in the pre/peri/neonatal period. The mean birth weight was 2304.4 g (median 37, SD 825.58g) and the mean POA was 35.82 months (median 37, SD 4.88). Main risk factors identified were prematurity (n=190, 44.1%), hypoxic ischaemic encephalopathy (HIE) (n= 234, 54.3%), jaundice (n=31, 7.2%) and sepsis (n= 13, 3.0%). While 183 children (42.5%) showed evidence of definitive spastic motor type, 184 (42.7%) showed predominant dyskinesia.CONCLUSION The age at diagnosis of this population from Sri Lanka is significantly lower than from other LMICs. HIE and prematurity, both preventable conditions remain the highest risk factors. Longitudinal follow up will ascertain the final motor outcomes as a higher proportion of children showed dyskinesia. The SLCPR is an important resource which will support new research towards investigating opportunities for prevention and service planning for children.
Abdominal bloating in children: association with functional gastrointestinal diseases and adverse life events.
(The Korean Society of Neurogastroenterology and Motility, 2013) Rajindrajith, S.; Devanarayana, N.M.
BACKGROUND/AIMS: Abdominal bloating is a common symptom among children with functional gastrointestinal diseases (FGDs). It can lead to significant distress among affected children. However, its epidemiology, risk factors and clinical characteristics have not been described in paediatric population. We aimed to study die epidemiology and risk factors of abdominal bloating, and associated FGDs in Sri Lankan children. METHODS: A cross-sectional, island-wide survey was conducted in Sri Lankan children aged 10-16 years. Four provinces (out of 9) of the country were randomly selected and 2 schools were randomly selected from each of the provinces. From each school, 12 classes from academic years (grades) 6 to 11 (2 from each academic year) were randomly selected and all children in these classes were included in the study. The Rome III questionnaire for paediatric FGDs (self-report form) was used for data collection. FGDs were diagnosed using Rome III criteria. Abdominal bloating was considered to be present if die child indicated as having abdominal bloating at least 25% of the time during the past 2 months. RESULTS: A total of 1972 children and adolescents (54.8% boys, mean age 13.4 years, SD 1.8 years) were included in the analysis. One hundred and ninety-four (9.8%) children had abdominal bloating. Of them, 52.6% had aerophagia, 15.4% had irritable bowel syndrome, 9.7% had constipation, 6-7% had rumination syndrome, and 5.6% had functional abdominal pain. Bloating was significantly common among children exposed to emotional stress and adverse life events (P < 0.0001). Intestinal related symptoms and extra intestinal symptoms that were significantly associated with bloating include abdominal pain, nausea, pallor, photophobia and headache (P < 0.05). CONCLUSIONS: Bloating is a common symptom of children and often associated with a range of FGDs. Children who faced adverse life events and stress, have a higher tendency to develop bloating. Bloating coexist with several other intestinal related and extra intestinal symptoms.
Abdominal pain predominant functional gastrointestinal diseases in children and adolescents: prevalence, symptomatology and association with emotional stress
(Sri Lanka Medical Association, 2011) Devanarayana, N.M.; Mettananda, S.; Rajindrajith, S.
INTRODUCTION AND OBJECTIVES: To assess the prevalence of abdominal pain predominant functional gastrointestinal diseases (FGD) in Sri Lankan children, their symptomatology, and predisposing factors. METHODS: A cross sectional survey was conducted among a randomly selected group of 10-16 year olds, in 8 randomly selected schools, in 4 provinces in Sri Lanka. A validated, self-administered questionnaire was distributed in an examination setting. Research assistants were present while filling the questionnaire and explanations were given. FGD Were Diagnosed using Rome III criteria. RESULTS: A total of 2180 questionnaires were distributed and 2163 (99.2%) were included in the analysis [1189 (55%) males, mean age 13.4 years, SD 1.8 years]. Seventeen incompletely filled questionnaires were excluded. Two hundred and seventy (12.5%) had at least one abdominal pain predominant FGD. Irritable bowel syndrome (IBS) was seen in 107 (4.9%), functional dyspepsia (FD) in 54 (2.5%), functional abdominal pain in 96 (4.4%) and abdominal migraine (AM) in 21 (1.0%) (2 had AM and FD, 6 had AM and IBS). Extraintestinal somatic symptoms (headache, limb pain, sleeping difficulty) were more common among affected children (p<0.05). Abdominal pain predominant FGD were significantly higher in girls and those exposed to stressful events (p<0.05). Prevalence negatively correlated with age. CONCLUSION: Abdominal pain predominant FGD were a significant health problem in Sri Lankan children affecting 12.5%. IBS was the commonest FGD diagnosed. Abdominal pain predominant FGD were higher in girls and those exposed to emotional stress. Prevalence of FGD decreased with age. Somatic symptoms were more frequent in affected children.
Abdominal pain predominant functional gastrointestinal diseases: association with child abuse, traumatic life events and quality of life
(Wiley Blackwell Scientific Publications, 2012) Devanarayana, N.M.; Rajindrajith, S.; Karunanayake, A.; Nishanthini, S.; Perera, M.S.; Benninga, M.A.
BACKGROUND/AIMS: Abdominal pain predominant functional gastrointestinal diseases (AP-FGD) have significant repercussions on affected individuals. Aims of this study were to assess its association with traumatic life events and child abuse, and its impact on quality of life. METHODS: Children aged 13–18 years were randomly selected from 3 schools in Western province of Sri Lanka. A previously validated, self administered questionnaire was used to collect information on gastrointestinal symptoms, traumatic life events, exposure to abuse, healthcare consultation and quality of life (QOL). AP-FGD were diagnosed using Rome III criteria. RESULTS AND DISCUSSION: A total of 1365 children were recruited [males 749 (54.9%), mean age 14.2 years and SD 1.22 years]. AP-FGD were found in 243 (17.8%) children [Irritable bowel syndrome in 70 (5.1%), functional dyspepsia in 11 (0.8%), abdominal migraine in 26 (1.9%) and functional abdominal pain in 146 (10.7%)]. Prevalence of AP-FGDs were significantly higher in those exposed to traumatic life events (37.9% vs. 3.1%, p = 0.03), sexual abuse (35.3% vs. 17.3%, p = 0.01), physical abuse (19.7% vs. 12.6%, p = 0.0003), and emotional abuse (27.4% vs. 16.9%, p < 0.0001). Health care consultation was significantly higher in children exposed to physical abuse (26.4% vs. 0.0%, p = 0.03). QOL scores for physical (85.7 vs. 89.6), emotional (71.7 vs. 79.4), social (85.9 vs. 92.3) and school (74.3 vs. 81.1) function domains were significantly lower in children with AP-FGD who were exposed to emotional abuse (p < 0.05). QOL scores for school function domain was lower in children exposed to physical abuse (77.8 vs. 83.6, p = 0.03). CONCLUSIONS: Traumatic life events and child abuse in any form are significantly associated with higher prevalence of AP-FGD. Children exposed to physical abuse are more likely to seek healthcare for abdominal pain. Children with AP-FGD, exposed to emotional abuse, have significantly poor quality of life in all four domains.
Abdominal suture rectopexy without large bowel resection for rectal prolapse does not result in constipation: data from prospective bowel function evaluation, anorectal physiology and transit studies
(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Sabaratnam, V. Y.; Rathnayake, G.; Deen, K.I.
INTRODUCTION: Traditionally, suture rectopexy has been combined with sigmoid resection for rectal prolapse to prevent postoperative constipation. Furthermore, preservation of lateral ligaments will not result in constipation. Suture rectopexy alone without resection, is being popularised. OBJECTIVE: To study the influence of suture rectopexy without resection on colonic transit and postoperative constipation. PATIENTS AND METHODS: Forty-six patients (median (range) age 32(19-82) years) with rectal prolapse underwent suture rectopexy alone without division of lateral ligaments from March 1999. Prospectively, bowel function and anorectal physiology (ARP) were evaluated before and after surgery in a subset of 15 patients. Follow up (median, range) has been 12 (1-42) months. RESULTS: Follow up was complete in 36 patients. Recurrent prolapse was seen in 5 (full thickness 3 (8.3%); mucosa! prolapse 2 (5.5%)). Physiological data in a subset of 15 patients revealed no significant difference in anorectal physiology before and 3 months after the operation (table). Similarly there was no significant difference in the rate of evacuation of transit markers on day 3 and 5. Maximum resting pressure (median and range) was 25(7-50) mmHg and 33.2(7- 80, P value 0.026) before and after surgery. The median (range) maximum squeeze pressure were 67.5(19-i30) and 90(28 - 157, P 0.!64) before and after surgery. The maximum tolerable volume (ml) was 230 ( ! 80 -340) before surgery and 200 (50-290) after surgery (P. 0.139). Transit (as an excretion percentage) was 100% before and after surgery (P = 0. 197). CONCLUSION: Abdominal suture rectopexy without resection for rectal prolapse improves constipation and does not result in significant change in colonic transit. We recommend this procedure either by open operation or by laparoscopy.
Abnormal personality traits in children with aerophagia
(Lippincott Williams & Wilkins, 2015) Devanarayana, N.M.; Jayawickrama, N.; Gulegoda, I.C.; Rajindrajith, S.
OBJECTIVE: The main objective of this study is to study the personality types in children with aerophagia. METHODS: A cross sectional survey was conducted in 8 randomly selected schools in 4 randomly selected provinces Sri Lanka. From each school, all children aged 13-18 years were selected after obtaining written consent from parents, school administration and provincial education office. Assent was obtained from all children recruited. Date were collected using a self-administered questionnaire administered under examination setting to ensure confidentiality and privacy. Questionnaire contained previously translated and validated Rome III questionnaire for functional gastrointestinal diseases (self-administered form for children above 10 years) and childhood personality assessment questionnaire. Trained research assistants were present during filling the questionnaire to provide assistance and to verify doubts. Aerophagia was defined using the Rome III criteria. Severities of individual symptoms were recorded in 100 mm visual analogue scale. RESULTS: A total of 1069 questionnaires were distributed and all of them were returned and included in analysis [males 508 (47.5%), mean age 15.3 years, SD 1.8 years years]. One hundred and thirty six (12.7%) fulfilled Rome III criteria for aerophagia and 933 children without aerophagia were considered as controls. Nineteen (13.8%) children with aerophagia and 71 (7.6%) controls had personality scores above the international cut-off value (105) for abnormal personality (p = 0.01). Children with aerophagia had significantly higher scores for different personality traits than controls; including hostility and aggression (13.2 vs. 12.2 in controls, p = 0.006), negative self-esteem (11.0 vs. 9.9, p < 0.0001), negative self-adequacy (10.6 vs. 9.6, p = 0.001), emotional unresponsiveness (10.5 vs. 9.6, p < 0.0001), emotional instability (16.9 vs. 15.7, p < 0.001), negative world view (10.9 vs. 10.1, p = 0.02) and total personality score (92.1 vs. 87.7, p = 001). In children with aerophagia, scores obtained for severity of bloating correlated with scores obtained for hostility and aggression (r = 0.22, p = 0.02). CONCLUSIONS: Children with aerophagia has abnormal personality traits and this fact may at least partly responsible for development and perpetuation of symptoms in them.
Accidental scrotal burns due to paraquat while handling a patient with deliberate self-harm
(Sri Lanka Medical Association, 2007) Premaratna, R.; Rathnasena, B.G.N.; de Silva, H.J.
INTRODUCTION: The main risk of paraquat poisoning is from deliberate ingestion. Serious accidental or occupational poisoning is comparatively rare. We report two patients who had accidental exposure to paraquat resulting in scrotal burns in both, and systemic poisoning in one, while attending to a patient who had ingested paraquat for deliberate self harm. CASE REPORT: Two days after death of a patient who had ingested paraquat for deliberate self harm, his brother and a friend who had accompanied him to hospital presented with painful swelling of the scrotum. The brother had severe burns in the scrotal skin sparing the penile skin, and the friend had milder burns in the scrotum. The patient had vomited several times onto the laps of these two men while being brought to hospital in a vehicle. The brother developed mild derangements in hepatic and renal functions suggesting significant systemic absorption. His biochemical and clinical parameters returned to normal over the next 2 weeks on conservative management. In both these patients, the scrotal skin healed without scarring over the next 4 weeks after treatment with silver sulphadiazine local application and amoxicillin given orally. CONCLUSIONS: Precautions should be taken by persons attending to those who have ingested poison. This is especially applicable to patients who have ingested corrosive substances
Accumulation of toxic metals in ectopic endometrial tissue
(Sri Lanka Medical Association, 2011) Silva, N.; Senanayaka, H.; Peiris-John, R.; Wickremasinghe, R.; Waduge, V.
INTRODUCTION AND OBJECTIVES: Aim of this study was to determine the association between heavy metals and endometriosis. METHODS: A case-control study was conducted in a tertiary care hospital comparing 50 cases of endometriosis with 50 age matched controls confirmed by laparoscopy or laparotomy. Blood samples and ectopic endometrial tissue samples were obtained and digested with supra pure 65% HNO3. Samples were analysed for cadmium by graphite furnace atomic absorption spectroscopy (GFASS). In a subset of cases (n=30) and controls (n=40) samples were analyzed for nickel, lead and zinc by Total Reflection X-ray Fluorescence (TXRF) technique. T-tests and Spearman's correlation coefficient were used for analysis. RESULTS: Cases had significantly higher (p=0.011) mean (+SD) blood nickel levels (1.69+1.18 ug/1) as compared to controls (0.96+0.94 ug/1). Blood levels of cadmium (0.75±0.46 ug/I vs 0.77 ±0.37 ug/1) lead (5.8S±1.25 ug/1 vs 3.45±1.25 ug/1) and zinc (123.02±2.49 ug/1 vs151.35 ±2.46 ug/1) were similar in the two groups (p=0.289, p=0.123s and p=0.339, respectively). Tissue samples had significantly higher (p=0.001, p<0.001, p=0.049 respectively) mean (+SD) levels of cadmium (2.86±0.61 ug/1 vs 0.8±0.48 ug/1) nickel (8.64±0.4.12 ug/Lvsl.58±1.21ug/l) and lead (11.22±4.67 ug/1 vs 5.86±3.38 ug/1) compared to blood levels. Mean (+SD) blood levels of zinc (117.48 ±2.64 ug/1) was higher (p<0.001) than that in tissues (27.54±6.65 ug/1). There was a positive correlation between blood zinc levels and tissue zinc levels (r=0.417;p= 0.034) but there was no correlation between blood and tissue levels of cadmium, nickel and lead (r=0.237,p=0.085; r=0.372,^=0.113; r=0.70,/?=0.067, respectively). CONCLUSIONS: Cadmium, nickel and lead but not zinc accumulate in ectopic endometrial tissue.
Accuracy of histopathology reporting in colorectalcancer (crc): we need a proforma
(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Siriwardana, P.N.; Rathnayaka, G.; Deen, K.I.
INTRODUCTION: The quality of a histopathology report in CRC will determine prognosis and the need for adjuvant therapy. OBJECTIVE: To evaluate the completeness of pathology reports in colorectal cancer.METHODS: In 82 consecutive patients (rectal cancer 47, colon cancer 35) based on the minimum data set by the Royal College of Pathologists, UK. Pathology reports were reviewed by a single person who looked for 17 pathology data sets for colon cancer and 15 for rectal cancer. Completeness of reporting(%) was classified as 40 - 50%, 60 - 70% or 80 - I 00%. RESULTS: 47 of rectal cancer group, 5 (11%) reports were 40-59% complete and 23 (49%) and 19 (40%) were 60-79% and 80-100% complete respectively. In the colon cancer group 04 ( 11.5%), 13.(37%) and 18 (51.5%) were in the categories of 40-59%, 60-79% and 80-100% respectively. The presence or absence of tumour at the resection margin was reported in 91.5%. Information on the distance of tumour to distal resection margin was present in 68% of reports. Apical node involvement was commented in 33%. CONCLUSION: There is a wide variation in the quality of pathology reports in colorectal cancer. We have found a lack of vital data in up to two thirds of the reports.
Achieving millennium development goal 4 in 2015: are we really on track?
(Sri Lanka College of Paediatricians, 2011) Mettananda, S.; Rajindrajith, S.; Warnakulasuriya, T.; Fernando, M.; Devanarayana, N.M.; Gunawardena, N.K.
INTRODUCTION: Millennium development goal (MDG) 4 aims to reduce under 5 mortality by two thirds from 1990 (22.2 per 1000 live births) to 2015 (7.4 per 1000 live births). In achieving this, proper and accurate description of the causes of deaths is crucial. OBJECTIVES: To describe the timing, causes and distribution of under 5 child deaths in Sri Lanka and to predict the likelihood of achieving MDG 4. DESIGN, SETTING AND METHOD: Information regarding all under 5 child deaths between 2002-2006 was obtained from the Registrar Generals' Department. Place, sex and age at death were retrieved. Causes of deaths documented accordingly to the ICD-10 classification were reclassified into clinically relevant and user-friendly categories. Mortality rates and predictions for 2015 were calculated using Microsoft Excel. RESULTS: A total of 26,273 deaths have occurred during 2002-2006 [55% neonatal, 21% post-neonatal infant and 24% child (l-5year)]. Tsunami wave in 2004 had caused 2,868 (11%) deaths and they were excluded from further analysis. Prematurity had caused 4,603 (31.8%) neonatal deaths; 2389 (16.5%) were due to infections and 1149 (7.9%) were due to birth asphyxia. Congenital anomalies have contributed to 1830 (12.6%) neonatal deaths, of which, the majority [1389 (9.6%)] were heart diseases. Leading causes for post-neonatal infant deaths include congenital anomalies [1772 (35%)], infections [1516 (29.9%)] and trauma [393 (7.7%)]. in children, 910 (23.4%) deaths were due to infections (10.2% respiratory, 2.0% gastroenteritis and 0.9% dengue). One fifth of deaths were due to congenital anomalies of which half were due to heart defects. Trauma/ accidents and malignancies had contributed to 731 (18.8%) and 279 (7.1%) deaths respectively. Colombo district reported the highest number of deaths (24%). More males (54.7%) have died compared to females. Reduction in mortality rates were observed from 2002-2006; neonatal mortality from 8.3 to 7.6, infant mortality from 11.4 to 10.4 and under 5 mortality from 13.7 to 12.3. Projections of data showed that the neonatal, infant and under 5 mortality rates in 2015 would be 4.6, 6.7 and 7.7 per 1000 live births respectively. CONCLUSIONS: Prematurity was the leading cause of neonatal mortality. Congenital heart diseases are an important cause of death throughout childhood. Trauma and accidents contribute to a significant proportion of child deaths. Predictions from data suggest that Sri Lanka may fall marginally short of achieving MDG 4.
Acute febrile illness: Epidemiology versus clinical judgement
(Elsevier, 2012) Premaratna, R.
Both epidemiology and clinical judgment are teachings by the father of medicine, the Greek physician. Hippocrates The term Epidemiology derives from the Greek: epi “upon/among” demos “people/district”, logos “study/disclosure”, so literally it means “the study of what is upon the people”. Hippocrates coined the terms endemic for diseases usually found in some places but not in others and epidemic for diseases that are seen at some times but not others. Clinical judgment is the application of information based on actual observation of a patient combined with subjective and objective data that lead to a conclusion; process by which the doctor decides on data to be collected, makes an interpretation of the data, arrives at a clinical diagnosis, and identifies appropriate management actions; this involves critical thinking, problem solving, and decision making. The knowledge of epidemiology is important to narrow down a differential diagnosis in a given situation. However, it should not result in tunnel vision. Furthermore, today epidemiological data together with the advancement of science seem to have shadowed or replaced the most valued history taking and examination taught by Hippocrates. For example, some infections have been overlooked in the middle of a known disease outbreak leading to extended morbidity by the former illness simply due to poor history taking and or examination. Similarly increasingly introduced epidemiology based sophisticated rapid diagnostic tools such as multi-test strips are likely to be misused, misinterpreted or wasted ignoring the value of systematic clinical approach in arriving at a diagnosis. At the same time, today infectious disease aetiologies are fast changing due to globalization, expansion of human travel, travel of bugs and hosts, expanding animal industry, and re-emergence of old bugs. Therefore in addition to having a good knowledge on local, regional and global epidemiology, an infectious disease physician today, should ensure a good clinical sense, broader thinking and an open mind in order to tackle an individual patient. This is the greatest challenge faced by an infectious disease physician compared to a physician attending to a well streamlined management plan of a non-communicable disease. This talk will be supported by case scenarios. © 2012 Elsevier Inc.
Acute hearing loss in febrile patients: a predictor of scrub typhus
(Sri Lanka Medical Association, 2005) Premaratna, R.; Chandrasena, T.G.A.N.; Dassanayake, A.S.; Loftis, A.; Dasch, G.A.; de Silva, H.J.
INTRODUCTION: Rickettsial infections are re-emerging in Sri Lanka. Complications such as pneumonitis, myocarditis and encephalitis can occur late in the disease, and result in a high mortality. Early diagnosis reduces morbidity and mortality, but as laboratory facilities for definitive diagnosis are lacking, early diagnosis depends on clinical suspicion. Acute hearing loss which occurs in about 30% of patients has been recognised as a predictor of scrub typhus. METHODS: Six patients admitted to hospital with high fever and hearing impairment were further investigated. RESULTS: All were females with a mean age of 65 years (SD 2). The mean duration of fever at presentation was 12 days (SD 1), Hearing impairment was observe
Acute poisoning in the paediatric age group in North-Central province of Sri Lanka
(Sri Lanka Medical Association, 2013) Dayasiri, M.B.K.C.; Jayamanne, S.F.; Jayasinghe, Y.C.
INTRODUCTION AND OBJECTIVES: There is little data on poisoning in the paediatric age group in the North Central Province (NCP) of Sri Lanka. Objective of this study was to identify characteristics, risk factors and outcome of poisoning in the paediatric age group in the NCP. METHODS: All children presenting with either accidental or deliberate poisoning, to all paediatric casualty units at the Anuradhapura and Polonnaruwa Teaching Hospitals, over a period of 8 months from March 2012 were studied. Information was obtained from clinical interviews, focus group discussions, clinical observation and clinical records. RESULTS: Of the 167 children, 53% were male and 91% were below six years of age. Parents were agricultural workers in 25% and 51% had been educated up to GCE O' Level. Poisoning was mainly accidental (97%). Commonest poison was kerosene oil (24.9%). Reasons for delay in seeking medical help included lack of transport (14%), poor knowledge (12%), lack of awareness regarding urgency (12%) and financial constraints (8%). Complications included acute liver injury (4.2%), chemical pneumonitis (3.6%), and convulsions (1.8%). There were no deaths. Inadequate supervision by parents 87.5%, improper storage of household chemicals 52% and medicines 40% were common risk factors. CONCLUSIONS: Acute poisoning in children mostly occurred due to inadequate supervision by parents and improper storage of chemicals and medicines. Community education and safe storage of chemicals and medicines will reduce the incidence of poisoning in the paediatric age group.
The Adaptation and Validation of Stroke and Aphasia Quality of Life (SAQOL-39) Scale for the Sinhala Language in the Sri Lankan Context.
(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Karunathilake, K.M.M.G.S.L.; Rathnayake, S.; Ranawaka, U.K.
Stroke and aphasia rehabilitation aims to improve the quality of life of the individuals affected. Aphasia is a disturbance of the language. Most of scales for measuring health-related quality of life in stroke exclude people with aphasia due to inability to communicate during the questionnaires. However, it is vital to identify the effect on quality of life among individuals with aphasia to provide proper rehabilitation. No reliable measure was developed in Sri Lankan context to analyze this, which became the research question of the present study. The Stroke and Aphasia Quality of Life Scale-39 which is the commonest, valid and reliable measures was used in assessing quality of life among aphasia and it was analyzed applying to the Sri Lankan context. The following were the aims of the study, translate and adapt the (SAQOL-39) Scale for the Sinhala Language in the Sri Lankan context, identify its reliability and validity, identify the relationship between the severity level of communication and the quality of life level and analyze the most affected domain among aphasia population. The original (English) version of the SAQOL-39 has been adapted and translated using Delphi method. The sociocultural and linguistically adapted Sinhala version was administered on a group of 35 patients with aphasia to examine the test-retest reliability, inter rater reliability internal consistency reliability as well as the concurrent validity of the instrument. The inclusion criteria of the study population were as following, Aphasia resulting from a stroke at least after 6 months from the onset and not with the evidence of psychiatric illnesses and cognitive difficulty. 10 patients were used for the test retest assessment. And for the inter rater reliability assessment 2 raters were used. The Sinhala version of SAQOL-39 exhibited high test-retest reliability (ICC =0.83) as well as the inter rater reliability (ICC=0.99). This instrument exhibited high internal consistency (Chronbach's∝ =0.845) and also the concurrent validity was examined with the WHOQOL BREF and found a significant correlation between SAQOL-39 and WHOQOL-BREF (r=0.75, p=0.000). The most affected domain of the aphasia patients as the communication domain was identified through this study and it was also identified that there is a significant positive correlation (r=0.685, p=0.000) between the severity level of aphasia and quality of life. Despite the small sample size, the Sinhala version of the SAQOL-39 showed good internal consistency, inter rater reliability, test-retest reliability and concurrent validity. The importance of communication ability in perceiving the quality of life in patients with aphasia has also been highlighted.
Adaptation of "Medical Interview Satisfaction Scale" (MISS-21) for Sri Lankan general practice
(Sri Lanka Medical Association, 2019) de Silva, A.H.W.; Kasturiratne, K.T.A.A.; Seneviratne, A.L.P.; Wickremasinghe, A.R.
INTRODUCTION & OBJECTIVES: Patient satisfaction is an important clinical outcome and a validated Sinhalese tool to measure it is essential. MISS 21 is a tool validated in the British general practice. Objective was to translate, cross-culturally adapt and validate the MISS 21 to for the Sri Lankan Sinhala speaking general practice setting. METHODS: The suitability and relevance of items in MISS-21 were assessed and unacceptable items revised. Translation process involved back translations and synthesis. Conceptual and linguistic equivalence was considered. Accuracy in rephrasing-and semantic adjustments was made following pretest. Operational equivalence was evaluated. A sample size of 300 was estimated and 480 recruited to account for non-respondents. Tool was self-administered amongst literate Sinhala patients of ≥18 years from six general practices. Exploratory factor analysis (EFA) extracted potential components associated with satisfaction. Internal consistency was assessed using Cronbach's alpha. RESULTS: Sixteen items fulfilled 80% acceptance. Four items were retained unchanged on consensus while one item was changed. Operational equivalence was accepted. Only 381 were complete enabling EFA. EFA extracted two components. This model explained 56% of the variability of total patient satisfaction scores. Items exploring communication and distress releasing aspects loaded on component 1 ("communication and comfort"). Items related to unmet expectations of patients and the doctor's regard loaded on component 2 ("regard and clarity"). All items in components 1 and 2 (Cronbach's alpha >0.9 and >0.7) demonstrated good internal consistency. CONCLUSION: The Sinhala version of MISS 21 exhibited high content validity, satisfactory construct validity with an acceptable factor structure, internal consistency and high response rates.