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 Heart rate variability among gas station attendants exposed to benzene, toluene, and xylenes (BTX) in Sri Lanka(Springer Nature., 2021) Warnakulasuriya, T.; Medagoda, K.; Kottahachchi, D.; Luke, D.; Wadasinghe, D.; de Silva, D.; Ariyawansha, J.; Rathnayaka, P.; Dissanayaka, T.; Fernando, S.; Devanarayana, N.M.; Scheepers, P.T.J.Introduction: Benzene, toluene, and xylenes (BTX) exposure among gas station attendants in Sri Lanka is high. Cardiovascular morbidity and mortality are reported to be higher among those exposed to BTX. A hypothesis is based on alterations in the autonomic nervous system, especially disruption of autonomic regulation of the heart. Autonomic regulation of cardiac functions can be assessed by short-term heart rate variability (HRV), which measures the fluctuations in the interval between sequential sinus heartbeats. Objective: To determine whether BTX exposure affects the heart rate variability (HRV) among gas station attendants. Methods: Forty-nine gas station attendants from the Gampaha district of Sri Lanka, aged between 19 and 65 years, were recruited for the study. Age and gender-matched controls (n = 46) without occupational exposure to fuel were used as controls. Ethical approval for the study was granted by the Ethics Review Committee of the Faculty of Medicine, University of Kelaniya, Sri Lanka. Informed written consent was obtained from each participant. Demographic data were collected, and a physical examination was performed before the HRV assessment. We measured SDNN, RMSSD, pNN50, HF, LF, and LF: HF ratio as HRV indices. Pre- and post-shift samples of end-exhaled air were collected and analyzed for BTX using a thermal desorption gas chromatography–mass spectrometry system (TD-GC-MS) among 24 gas station attendants and 14 controls. As a proxy of shift exposure, we calculated the increase from pre-shift (as a baseline) to postshift and reported this as ‘delta’. Results and discussion: For gas station attendants (n = 24) median pre-/post-shift exhaled air concentrations (ng/L) were: benzene 10.47/ 19.00; toluene 10.41/21.86; m/p-xylene 1.63/2.14; o-xylene 0.93/1.42. For controls (n = 14) these values were 9.40/11.05, 3.19/3.91, 1.23/ 1.43 and 0.47/0.47. The heart rate variability (HRV) analysis showed significantly higher SDNN and SD2 among the gas station attendants (n = 49) than controls (n = 46) (Mann Whitney U = 842.00, p = 0.034 and Mann Whitney U = 843.50, p = 0.035, respectively). RMSSD, pNN50, Total power, HF, and SD1 among gas station attendants negatively correlated at a significant level with the mean increment in exposure to BTX (p\0.05).Conclusions: Exposure to BTX alters the HRV indices, indicating an effect on autonomic cardiac regulation. Funding: University of Kelaniya research grant: RP/03/04/03/01/ 2017, Foreign Award 2017 of the Dutch Occupational Hygiene Society (NVvA).Item Cardiovascular autonomic functions of gas station attendants in Sri Lanka(Springer Nature., 2021) Warnakulasuriya, T.; Medagoda, K.; Kottahachchi, D.; Luke, D.; Wadasinghe, D.; de Silva, D.; Ariyawansha, J.; Rathnayaka, P.; Dissanayaka, T.; Fernando, S.; Devanarayana, N.M.Introduction: Sri Lanka, a middle-income country in South Asia, has seen a rapid expansion in motor vehicles and, associated with this, an increase in demand for fuel. The dispensing of fuel at fuel stations is performed manually by male fuel handlers, who have long working hours. Such workers are exposed to hydrocarbon fuels which are associated with multiple health effects. This study was performed to determine cardiovascular autonomic functions among fuel handlers in a densely populated district of Sri Lanka. Methods: Fuel handlers (n = 50) from the Gampaha district of Sri Lanka, aged between 19 and 65 years, were identified for the study from seven selected fuel stations. Age and gender-matched controls (n = 46) without occupational exposure to fuel were used as controls. All participants were male (females were not employed as fuel handlers). After obtaining written informed consent, demographic data were collected, and general physical examination performed before autonomic function assessment. Non-parametric methods were used for data analysis. Ethical approval was granted by the ethics review committee of the Faculty of Medicine, University of Kelaniya, Sri Lanka. Results: There were no significant differences in weight, height or BMI among the study and the control populations (p[0.05). Both the systolic (SBP) and diastolic (DBP) blood pressures were significantly higher among the fuel handlers compared to controls (SBP, Mann Whitney U = 743.5, p = 0.003) and (DBP, Mann Whitney U = 686.5, p = 0.001). Valsalva ratio was significantly higher among the fuel handlers (Mann Whitney U—874.00, p = 0.043). The rise in DBP during sustained handgrip, a sympathetic parameter, was significantly higher among the controls (Mann Whitney U = 863.00, p = 0.049). Conclusions: Altered sympathetic:parasympathetic balance was observed among the fuel handlers. Monitoring of the health, using personal protective equipment, and curtailing hours of employment per week is recommended for those employed at fuel stations.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 Impact of early life events (ELE) and family dynamics for developments of abdominal pain predominate functional gastrointestinal disorders (AP-FGIDs) in 5-12 age group(Japanese Society of Neurogastroenterology and Motility (JSNM), Asian Neurogastroenterology and Motility Association(ANMA), 2017) Karunanayake, A.; Rajindrajith, S.; Devanarayana, N.M.INTRODUCTION The pathophysiology of AP-FGIDs in children are poorly understood. Animal and human studies have suggested that adverse ELE such as pain or stress can induce long-term changes in the neurons. Apart from the abuse other aspects in early life have not been well investigated. METHODS ELE were evaluated in 182 school children with AP-FGIDs (62.1% girls, mean age 8.5, SD 2.1) and 571 children without AP-FGIDs recruited as controls (51.1% girls, mean age 8.8 SD 1.9 ) using a translated and pretested parental questionnaire. AP- FGIDs were diagnosed by Rome III criteria. RESULTS Compared to controls AP-FGIDs patients were low in birth order (1.7 vs. 1.9 p=0.01). Birth order of the parents, maternal and paternal age of marriage and number of members in the house were not associated with AP-FGIDs (p >0.05, Independent sample T test.). Prenatal complications (14.8% vs. 7.4% p= 0.002) and post-natal complications and receiving PBU care (7.7% vs. 3.1% p=0.008) were significantly higher in AP-FGIDs. Gestational period, mode of delivery, duration of hospital stay, period of exclusive breast feeding and duration of breast feeding were not significantly different (p>0.05). Presence of a family member with abdominal pain lasting more than 2 months and the presence of a family member with chronic pain (other than abdominal pain) in the family is also significantly higher in AP-FGIDs families (p<0.0001, Chi-square test). CONCLUSION ELEs occurring during pre and post-natal periods, which is a vulnerable period for developing neurons may be an important contributory factor for the development of AP-FGIDs. Familial predisposition for development of AP-FGIDs highlight the possible genetic basis for pathogenesis of AP-FGIDs. Breast feeding does not protective against the development of AP-FGIDs.Item Health related quality of life (HRQOL), family impact and disturbances to child activity in children with abdominal pain predominate functional gastrointestinal disorders(AP-FGIDs); School based, cross sectional study(Japanese Society of Neurogastroenterology and Motility (JSNM), Asian Neurogastroenterology and Motility Association(ANMA), 2017) Karunanayake, A.; Devanarayana, N.M.; Rajindrajith, S.INTRODUCTION This study assessed the impact of AP-FGIDs on life of 5-12-year olds and their families. METHODS A cross sectional survey was conducted in four randomly selected schools in Gampaha District of Sri Lanka. Data was collected using a translated and validated parental PedsQL TM4.0 Generic Core Scales and PedsQL TM2.0 family impact module. AP-FGIDs were diagnosed using Rome III criteria. RESULTS Eighty two AP-FGIDs children (63.4% girls, mean 9.2years, SD 1.9years) and 571 healthy controls (51.1% girls, mean 8.8years, SD1.9 years) were included in the analysis. Scores obtained for HRQOL were lower in those with AP-FGIDs in all domains (total 81.8 vs. 87.3 in controls, physical 85.3 vs. 91.8, emotional 72.5 vs. 81.8, school 73.7 vs. 80.7, p<0.01), except social functioning (89.7 vs. 92.8, p=0.83). The severity of pain negatively correlated with emotional (r=-0.31) and school (r=-0.359) functioning (p<0.01). The total HRQOL score negatively correlated with the number of healthcare consultations (r=-0.25, p=0.008). Scores obtained for family impact were lower in children with AP-FGIDs in all domains (total 79.0 vs. 86.9, physical 76.6 vs. 86.0, emotional 74.7 vs. 83.7, cognitive 81.6 vs. 88.2, communication 87.9 vs. 92.8, worry 83.1 vs. 90.7, family relationship 76.6 vs. 86.0) (p<0.01), except social (86.6 vs. 89.3) and daily activity (74.6 vs. 75.7) domains (p>0.05). The total score in family impact negatively correlated with scores obtained for pain frequency (r = -0.21) and severity (r = -0.267), anorexia (r= -0.20), school interruption (r = -0.19) and disturbances to daily activities (r= -0.32) and child's hobbies (r = -0.27) (p<0.05). CONCLUSION AP-FGIDs are severe enough to reduce HRQOL in affected children and has a significant impact on the families.Item Aerophagia in teenagers: association with child abuse, adverse life events, somatisation and quality of life(Japanese Society of Neurogastroenterology and Motility (JSNM), Asian Neurogastroenterology and Motility Association(ANMA), 2017) Devanarayana, N.M.BACKGROUND: Aerophagia (AP) is characterized by air swallowing, abdominal distension, excessive flatus and belching. Psychological factors are considered as a possible pathophysiological mechanism for AP. We aimed to assess association between aerophagia and exposure to abuse and adverse life events (ALEs), and its effects on somatisation and health related quality of life (HRQoL) in teenagers. METHODS: A cross sectional survey was conducted in 13 to 18 year-olds in 8 randomly selected schools in 4 provinces of Sri Lanka. Translated and validated, self-administered questionnaires were used in data collection. Written parental consent and assent was obtained from all participants. AP was diagnosed using the Rome III criteria. RESULTS: A total of 2453 questionnaires was included in the final analysis (males 1200 [48.9%], mean age 14.8 years, SD 1.6years). Of them, 371 teenagers had AP (15.1%). AP is associated with exposure to physical abuse (20.4% vs. 12.7% in controls), emotional abuse (20.3% vs. 8.2%) and ALEs (22% vs. 10.2%) (p<0,001). ALEs that were associated with AP include, a parent living away from home (20.6% vs. 14.4%), child staying in a hostel (27.1% vs. 14.7%), father’s alcoholism (24.3% vs. 13.4%), and substance abuse (21.8% vs. 14.6%), and quarrels with neighbours (27.7% vs. 13.5%) (p<0.001). Teenagers with AP had higher somatization (16.4 vs 8.9) and lower overall HRQoL (77.0 vs. 85.1) scores than controls (p<0.0001). HRQoL scores were lower in all four domains, namely, physical (80.6 vs. 86.9), emotional (69.1 vs. 80.3), social (83.8 vs 90.5) and school (72.6 vs. 82.5) functioning (p<0.0001). CONCLUSIONS: AP in teenagers is associated with exposure to physical abuse, emotional abuse and ALEs. Affected teenagers have significantly more somatic symptoms. Although considered as benign, AP leads to significant impairment of HRQoL in teenagersItem Role of antral motility in gastric emptying of liquids: A paediatric study(The Physiological Society of Sri Lanka, 2006) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.INTRODUCTION: Emptying of liquids from the stomach was thought to be primarily a function of the pressure gradient between the stomach and the duodenum. Sustained contractions of the proximal stomach were thought to be responsible for the basal intragastric pressure. The distal stomach (mainly the antrum) was considered to be mainly responsible for solid gastric emptying. But recent studies have shown that antral contractions also play an important role in emptying of liquids. OBJECTIVE: To study the correlation between liquid gastric emptying and antral motility. METHODS: Sixty-two children (age 5-15years) were recruited. After overnight fasting, all subjects consumed a standard liquid test meal (2GOmL of chicken broth, 54.8kJ) within 2 min. Gastric emptying and antral motility were recorded simultaneously using real-time ultrasound scanner with.3.5MHz and 5MHz curve-linear transducers using a previously reported method. The percentage emptying at ISmin was correlated with frequency and amplitude of antral contractions, and antral motility index. RESULTS: Twenty healthy children and 42 children with recurrent abdominal pain [29 (46.8%) males, mean age S.Tyears, SD Syears] were investigated. Liquid gastric emptying had significant positive correlation with the amplitude of antral contractions (r=0.44, pItem Neonatal mortality in sri lanka: timing, causes And distribution(The Sri Lanka College of Paediatricians, 2008) Rajindrajith, S.; Mettananda, S.; Adihetti, D.; Goonawardana, R.; Devanarayana, N.M.BACKGROUND: Millennium Development Goals (MDG) state that all countries should commit to reduce under 5 mortality in children by two thirds between 1990 and 2015. However, the reduction of neonatal mortality rate (NMR) in Sri Lanka during past decade had been slow (12.6 to 10.6). Having a NMR far better than most of the neighbours and developing countries, had given a false reassurance to Sri Lankan policy makers, reducing their attempts on farther reduction of NMR to reach MDG. There is a paramount need for accurate epidemiological data about the causes and distribution of neonatal deaths for meaningful policy making and efficient resource distribution. OBJECTIVE: To analyse the neonatal mortality data in Sri Lanka to shed light on neonatal deaths. DESIGN, SETTING AND METHOD: This study evaluated the neonatal deaths in Sri Lanka from year 1997 to 2001. Data related to neonatal mortality was obtained from the civil registration system maintained by the Registrar-General Office of Sri Lanka and analyzed according to 25 districts of the country. RESULTS: A total of 17,946 neonatal deaths had occurred during the period 1997 to 2001 in Sri Lanka, on average 3589 per year. Of them, 90.5% had occurred during the first week of life. The main causes for neonatal deaths were preterm deliveries (33%), infections (20%, including 15 deaths from neonatal tetanus), cardiac anomalies (17.4%), birth asphyxia (6.5%), meconium aspiration (5%), non cardiac anomalies (3%) and maternal cornplications (1%). The other causes accounted for 13.6%. The NMR was higher in Kandy (19), Anuradhapura (18.9), Badulla (18.4), Colombo (13.4) and Nuwara Eliya (13). CONCLUSION: Approximately 3600 neonates die in Sri Lanka annually. The number of deaths reported was higher in some of the major cities and in the estate sector. The majority of deaths were due to complications of preterm birth, neonatal sepsis and cardiac anomalies.