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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Item Lung function of fuel handlers exposed to volatile organic compounds(Journal of the Ceylon College of Physicians, 2020) Wadasinghe, D.; Warnakulasuriya, T.; Medagoda, K.; Kottahachchi, D.; Luke, D.; Ariyawansa, J.; Rathnayake, P.; Dissanayake, T.; de Silva, D.; Amarasiri, L.; Devanarayana, N.M.; Scheepers, P.INTRODUCTION AND OBJECTIVES: The respiratory system is a target for effects from air pollutants, including vehicle emissions composed of volatile organic compounds (VOC), particulate matter and other noxious gasses. Our objective was to study the association between selected VOCs and lung function in a cohort of fuel handlers. METHOD: Forty-four fuel handlers (men) from the Gampaha district of Sri Lanka aged 19-65 years were selected using consecutive sampling with a group of 38 males matched by age, without occupational exposure to fuel recruited as controls. Spirometry was performed using a Vitalograph Alpha Touch spirometer, according to ATS guidelines. Pre and post shift VOC levels were measured in end exhaled air samples. RESULTS: The spirometry parameters were not significantly different between the two groups but obstructive (47.72% vs.34.21%) and restrictive ventilatory patterns (31.81% vs. 21.05%) were higher among the fuel handlers. FVC and FEV1 negatively correlated with age (r=-0.672, p<0.001 and r=-6.888, p<0.001 respectively) and number of days of exposure (r=-0.329, p=0.033 and r=-0.306, p=0.049 respectively). Among the fuel handler's, benzene exposure negatively correlated with FVC (r=-0.552, p=0.012) and FEV1 (r=-0.476, p=0.034) and toluene exposure negatively correlated with PEF (r=-0.488, p=0.034). Although levels of all VOCs measured were significantly low among the controls, toluene exposure levels negatively correlated with all spirometry parameters (p<0.05). CONCLUSIONS: A decline in lung function is seen with more days of exposure as a fuel handler. The different vVOCs· affect the volume parameters and flow parameters uniquely and even non-occupational exposure causes an alteration of spirometry parameters among adult males.Item Autonomic functions among fuel handlers in the Gampaha District(Journal of the Ceylon College of Physicians, 2020) Medagoda, K.; Warnakulasuriya, T.; Kottahachchi, D.; Luke, D.; Wadasinghe, D.; Ariyawansha, J.; Rathnayaka, P.; Dissanayake, T.; de Silva, D.; Devanarayana, N.M.INTRODUCTION AND OBJECTIVES: Economic growth of Sri Lanka has increased the number of motor vehicles. Fuel stations employing more fuel handlers have been established to cope with the demand. The long working hours with exposure to hydrocarbon fuels result in adverse health effects and this study was done to assess the cardiovascular autonomic functions (ANF) including heart rate variations (HRV). METHOD: Fifty fuel handlers from the Gampaha district of Sri Lanka (19-65 years; all were males) from 7 fuel stations were recruited using consecutive sampling and compared with 46 age and gender matched individuals without occupational exposure to fuel (controls). Demographic data were collected after obtaining informed written consent and systematic examination was conducted. ANF assessment and HRV assessment were performed using validated protocols. RESULTS: There were no significant differences in age, weight, height or the BMI among the study and the control populations (p>0.05). Both systolic blood pressure (BP) (Mann Whitney U (MW)= 743.5, p=0.003), diastolic BP (MW= 686.5, p=0.001) and Valsalva ratio (MW= 874.00, p=0.043) were significantly higher among the fuel handlers compared to the controls. Rise in DBP in sustained handgrip, a sympathetic parameter was significantly higher among controls (MW= 863.00, p=0.049). Among HRV parameters, standard deviation of RR intervals was higher among the fuel handlers compared to controls (MW=842.QO, p=0.034). Parasympathetic parameters correlated with exposure hours per week (p<0.05). CONCLUSION: Altered sympathetic: parasympathetic balance was observed among the fuel handlers with a parasympathetic predominance suggesting that autonomic functions are affected on expo sure to air pollution and hydrocarbons.Item The Prevalence and clinical profile of abdominal pain predominant functional gastrointestinal disorders (AP-FGIDs) in 5-12 year olds in Sri Lanka(Japanese Society of Neurogastroenterology and Motility (JSNM), Asian Neurogastroenterology and Motility Association(ANMA), 2017) Karunanayake, A.; Rajindrajith, S.; Devanarayana, N.M.INTRODUCTION Abdominal pain predominant functional gastrointestinal disorders (AP-FGIDs) are common among Sri Lankan adolescents and teenagers and it is an important healthcare problem. However, studies are rarely conducted to determine the prevalence and clinical profile of AP-FGIDs in 5-12-year age group. METHODS A cross sectional survey was conducted in four randomly selected schools in Gamapaha district of Sri Lanka. All children aged 5-12 years were recruited after obtaining parental consent. Data was collected using a translated and validated parental questionnaire. AP-FGIDs were diagnosed using Rome III criteria. RESULTS A total of 1000 questionnaires were distributed and 709 (70.9%) returned. Properly filled 653 questionnaires were included in analysis [309 (47.3%) boys. mean age 8.8 years (SD 1.9 years)]. Eighty-two (12.6%) fulfilled criteria for the AP-FGIDs. Prevalence of AP-FGIDs was higher in females than male (7.9% vs. 4.5%, p=0.037, Chi-square test). Thirty-two (4.9%) had FAP, 26 (4.0%) had IBS, 21 (3.2%) had FD and 3 (0.4%) had AM. Prevalence in AP-FGIDs in girls has shown a positive correlation with age (r=0.718, p=0. 045, Pearson correlation). The majority of the children had moderate to very severe pain (83.1%), lasting less than one hour (73.1%). In 24.4%, the duration of abdominal pain was more than one year, which was significantly higher in girls (9.27 vs. 6.03, p=0.021 independent T test). Other symptoms were not significantly different between girls and boys (p<0.05). Epigastric (24.4%) and periumbilical (18.3%) were the commonest sites for abdominal pain. Extra-abdominal pain (56.2%), abdominal fullness (51.2%) and headache (46.3%) were the common associated symptoms. CONCLUSION The AP-GIDs is a common disorder with a prevalence of 12.6% in 5-12 year olds in Sri Lanka. It is more common in girls.Item Is a six hour fast after a rice meal sufficient before upper gastrointestinal endoscopy?(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2009) de Silva, A.P.; Niriella, M.A.; Perera, N.J.A.H.D.; Aryasingha, J.S.; Kalubowila, U.P.; Dassanayake, A.S.; Pathmeswaran, A.; Manchanayake, M.M.J.H.; Devanarayana, N.M.; de Silva, H.J.OBJECTIVE: Rice is the staple diet in many Asian countries. Current endoscopic guidelines advice a 6 h fast for solids and a 4 h fast for liquids before the procedure. However, these guidelines focus on a Western type diet. The aim of the study was to determine if a 6 h fast for rice is sufficient prior to upper gastrointestinal endoscopy (UGIE). PATIENTS AND METHODS: After informed consent, 212 patients referred for UGIE, who had no alarm symptoms, were randomized into two groups in preparation for UGIE. Fasting 6 h after a rice meal (R6) or fasting 10 h after a rice meal (R10). All meals contained lentils and an egg, and were isocaloric. Endoscopic vision was graded as poor, average, or good. RESULTS: In the R10 group (n = 107) vision was poor in 2 (1.9%), average in 7 (6.5%), and good in 98 (91.6%). While in the R6 group (n = 105) vision was poor in 30 (28.6%), average in 19 (18.1%), good in 56 (53.3%). The observed difference of percentages among the two groups for endoscopic vision was significant (M-H Chi-Square for trend = 25.67; df = 1; p < 0.001). CONCLUSIONS: Fasting for 6 h after a rice based meal seems inadequate for UGIE. Fasting for 10 h significantly improves endoscopic vision. Current guidelines need to be re-evaluated for populations where rice is the staple diet.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 Constipation and exposure to stressful Life events in 10 to 16 year olds: Sri Lankan experience(Sri Lanka College of Paediatricians, 2009) Rajindrajith, S.; Devanarayana, N.M.INTRODUCTION: Constipation is a common paediatric problem, but little is known regarding its aetiology. Emotional stress is considered to be associated with functional gastrointestinal diseases including constipation. OBJECTIVES: To assess the association between constipation and exposure to stressful life events in Sri Lankan school children and adolescents. DESIGN, SETTING AND METHOD: A validated, self-administered questionnaire was distributed to randomly selected children, aged 10-16 years, in 5 randomly selected schools, in 3 geographically and socio-economically different provinces in Sri Lanka. Constipation was defined using Rome III criteria. RESULTS: A total of 2770 questionnaires was distributed and 2699 (97.4%) which were returned were included in the analysis [1368 (50.6%) males, mean age 13.17 years, SD 1.72 years]. According to Rome III criteria 416 (15.4%) had constipation and they were compared with 2278 children without constipation. Prevalence of constipation was higher in those who were exposed to at least one stressful life event during the previous 3 months [Odd's ratio (OR) 0.38,p<0.0001]. During univariate analysis the stressful life events associated with constipation were: change in school or address, corporal punishment in school, separation from their best friend, preparation for government exams, exam failure, being bullied at school, sibling birth, severe illness or death in a family member, loss of job by a parent, separation or divorce of parents, parent remarriage to a step parent, hospitalization of the child himself/herself for other illness, frequent punishment by parents, father's alcoholism, domestic fights and living in an area affected by on-going separatist war (p<0.005). During multiple logistic regression analysis, separation from the best friend (adjusted OR 0.737, p<0.05), severe illness in a family member (adjusted OR 0.588, p<0.005); loss of job by a parent (adjusted OR 0.55 p<0.05), frequent punishment by parents (adjusted OR 0.581, p<0.01) and living in a war affected area (adjusted OR 0.666, p<0.001) remained to be significantly associated with constipation. CONCLUSIONS: Childhood constipation was significantly higher in those exposed to family and school related stressful life events and in those living in a war affected area.Item Functional abdominal pain in children and adolescents: association with impaired gastric motility(Sri Lanka College of Paediatricians, 2009) Devanarayana, N.M.; Dharmawansa, R.; Rajindrajith, S.INTRODUCTION: Chronic abdominal pain is a common paediatric problem affecting nearly 10% of school aged children. The majority of them have functional gastrointestinal diseases including functional abdominal pain (FAP). In them, the exact mechanism of pain remains unclear. Periumbilical pain, characteristic of this condition, appears to be of visceral origin, probably originating in the gastrointestinal tract. Gastrointestinal motility disturbances are reported in children with irritable bowel syndrome and functional dyspepsia, but are not properly studied in those with FAP. OBJECTIVES: To evaluate gastric emptying and antral motility in children and adolescents with FAP, DESIGN, SETTING AND METHOD: Sixty six children with FAP [24 (36.4%) males, 4-14 years, mean 8.2 years, SD 2.7 years] referred to the Gastroenterology Research Laboratory for gastric motility studies and 20 healthy children without evidence of gastrointestinal diseases [8 (40%) males, 4-15 years, mean 8.9 years, SD 2.7 years] were evaluated. FAP was diagnosed using Rome III criteria. None had clinical or laboratory evidence of organic diseases except for one control who was positive for Helicobacter pylori stool antigen test. All subjects underwent ultrasonographic assessment of liquid gastric emptying rate (GE) and antral motility, using a previously reported method. RESULTS: Average gastric emptying rate (42.7% vs. 66.2%), amplitude of antral contractions (60.6% vs. 89%), frequency of contractions per 3 minutes (8.5 vs. 9.3) and antral motility index (5.2 vs. 8.3) were significantly lower in patients with FAP compared to controls (p<0.01). Fasting antral area was higher in patients (1.2 vs. 0.6, p<0.01). The gastric emptying rate had a significant negative correlation with the scores obtained for severity of abdominal pain (r=-0.42, p<0.005). CONCLUSIONS: Gastric emptying rate and antral motility parameters are significantly impaired in patients with functional abdominal pain. Gastric emptying rate had negative correlation with the severity of abdominal pain.Item Prevalence of functional gastrointestinal diseases among a cohort of Sri Lankan school children aged 12 to 16 years(Sri Lanka College of Paediatricians, 2009) Devanarayana, N.M.; Adikari, C.; Pannala, W.; Rajindrajith, S.INTRODUCTION: Even though functional gastrointestinal disorders (FGID). such as irritable bowel syndrome and functional constipation, are common among children and adolescents around the world, little is known regarding their prevalence in developing countries including Sri Lanka. The current symptom based criteria (Rome III criteria) were released in 2006 and are still not widely used fay paediatricians for positive diagnosis of FGID. OBJECTIVES: To assess prevalence of FGID among a group of Sri Lankan adolescents using Rome III criteria. DESIGN, SETTING AND METHOD: This is a cross sectional survey conducted in a randomly selected group of 12-16 year olds in a semi-urban school in Gampaha district. A validated, self-administered questionnaire (developed on Rome III criteria for FGID in children) was distributed after obtaining consent from the school administration and the parents. It was administered in an examination setting, to ensure confidentiality and privacy. The questionnaire was in Sinhala, the first language of the cohort. The questions were simple and easy to understand. Research assistants were present during the whole time with students while they were filling the questionnaires and explanations were given whenever the need arose. FGID were diagnosed using Rome III criteria. RESULTS: A total of 464 questionnaires was distributed and 427 (92%) were included in the analysis [214 (50.1%) males, mean age 14.42 years, SD 1.27 years]. Thirty seven incompletely filled questionnaires were excluded from the analysis. According to Rome III criteria, 123 (28.8%) had at least one FGID. Of them, 58 (13.6%) had abdominal pain related FGID [irritable bowel syndrome 30 (7%), functional dyspepsia 14 (3.3%), functional abdominal pain 12 (2.8%) and abdominal migraine 2 (0.46%). Prevalence of functional constipation was 4.2% (18). Aerophagia was seen in 27 (6.3%), while adolescent rumination syndrome was seen in 17 (3.9%). Nonretentive faecal incontinence [1 (0.23%)] and cyclical vomiting syndrome [2 (0.46%)] were rare in our group of school children. There was no age or sex difference in the prevalence of any of the above FGID (p>0.05). CONCLUSIONS: Functional gastrointestinal disorders are a significant problem in our group of school children, affecting more than a quarter of them. Irritable bowel syndrome is the commonest FGID diagnosed.Item Faecal incontinence in Sri Lankan children and adolescents: an epidemiological survey(Sri Lanka College of Paediatricians, 2009) Rajindrajith, S.; Devanarayana, N.M.INTRODUCTION: Faecal incontinence is seen in 1-4% of children and has a significant impact on their quality of life. Community based studies on this important problem are scare. There is no data regarding prevalence of faecal incontinence from developing countries. OBJECTIVES: To detect the prevalence of faecal incontinence in Sri Lankan school children 10-16 years and factors associated with this condition. DESIGN, SETTING AND METHOD: This was a school based, island-wide, cross sectional survey. A validated, self-administered questionnaire was distributed to randomly selected children, aged 10-16 years, in 5 randomly selected schools, from 3 geographically and socio-economically different provinces in Sri Lanka. The questionnaire was filled under guidance of research assistants. Faecal incontinence was defined as defaecation into places inappropriate to the social context, at least once per month, for a minimum period of 2 months. Constipation was defined using Rome III criteria. RESULTS: A total of 2770 questionnaires was distributed and 2686 (96%) were included in the analysis. Of them 55 (2%) had faecal incontinence [male 43 (78%), mean age 11.96 years, SD 1.59 years]. Forty five (82%) had constipation associated faecal incontinence and 10 (18%) had non-retentive faecal incontinence. The highest prevalence was seen in children aged 10 years (5.4%). A significant negative correlation was observed between age and the prevalence of faecal incontinence (r=-0.893, p<0.01). Faecal incontinence was significantly higher in males (male 3.2%, females 0.9%), those exposed to recent school and family related stressful life events and those from lower social classes (p<0.05). Other symptoms associated with this condition were abdominal pain, nausea and vomiting (p<0.05). CONCLUSIONS: Faecal incontinence was seen in 2% of Sri Lankan children and adolescents aged 10-16 years. The majority had constipation associated faecal incontinence. It was more commonly seen in males, younger age, those from a lower social background and children who were exposed to stressful events.