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 Feeding dilemma: gastro-oesophageal reflux disease and gastrostomy care(Sri Lanka College of Paediatricians, 2015) Rajindrajith, S.Feeding children with gastro-oesophageal reflux disease (GORD} is a complex process. The suggested thickened feeding although it slightly improves the number of episodes of regurgitation and weig gain, has no beneficial effects reducing number of acid refluxes and reflux index. In addition, the evidence for using variety of hydrolyzed formulae and added pre and probiotics has not improv the clinical care of children with GORD.Since 1980, the year that the first report of modern percutaneous endoscopic gastrostomy was started, the procedure has revolutionized feeding of children with complex feeding disorders. It has paved the way to address nutritional rehabilitation and prevent micro-aspiration and progressive loss of lung function especially in neurologically handicapped children. Furthermore, the procedure has also improved the quality of life of the caregivers. However, the care of the gastrostomy tube and feeding can be quite complicated. Most neurologically handicapped children have derailed gastrointestinal motility predisposing them to develop delayed gastric emptying which induces gastro-oesophageal reflux. Although iso-osmolar feeds can minimize this problem hyperosmolar feeds are often needed to address the nutritional issues of these children. Whether or not feeds may be delivered by bolus or need initiating by continuous feeds is largely determined by the previous feeding history. Continuous intra-gastric feeds are not physiological and may lead to slower gastric emptying and higher baseline pH values than bolus feeds. The latter promotes bacterial growth, which, particularly in children with significant dysmotility, may further exacerbate this clinical problem. Although excessive bolus feeds may lead to abdominal discomfort and distension blous feeds per se contribute to distal colonic motor suppression, and hence allow better water absorption in the ascending colon. If a feed is administered too rapidly via a PEG, this may, however lead to "dumping syndrome”.Item Do mothers have the correct perception of their obese/overweight children? A cross sectional study in a tertiary care hospital, Sri Lanka(Sri Lanka Medical Association, 2018) Jayasekera, P. S. C.; Fernando, C. M. P.; Rajindrajith, S.INTRODUCTION AND OBJECTIVES: Overweight and obesity in children is currently an epidemic across the globe. However, the perception of the problem is poor among care takers of children. Though many studies have been conducted on obesity, the literature on maternal perception and their determinants of their obese children is sparse. Objectives: 1. To study the accuracy of the maternal perception of their children who are overweight and obese. 2. To study the maternal demographic and social factors associated with the accuracy of the perception METHODS: Three hundred and ten (310) obese/overweight children admitted to Colombo North Teaching Hospital were recruited for the study. BMI was documented in all subjects. Perception of their child’s weight status were assessed among their mothers using a pre-tested, interviewer administered questionnaire. The data were analyzed using SPPS 20. RESULTS: Of 310, 63% (n=195) were obese and 37% (n=l 15) were overweight. One fourth (25%) of the mothers underestimated their children’s weight. Girls (32.3%) were underestimated more than boys (20.0%), (P <0.0001). Mothers who were more than 40 years underestimated the weight less compared to younger mothers p=0.005). Accuracy of maternal perception demonstrated an inverse relationship with the family income (P= 0.002/odd 0.063). Employed mothers underestimated the weight of their children (36.1 %) more than those who were unemployed (21.1%), (p < 0.0001/odd 7.420). CONCLUSION: The maternal perception of their children being overweight or obese was poor. Moreover, girls were more underestimated and maternal age, employment status and family income were main determinants of their perceptionItem Prevalence of obesity and its associations among adolescents: an urban community-based birth cohort study(Sri Lanka Medical Association, 2017) Niriella, M.A.; de Silva, S.T.; Ediriweera, D.S.; Kasturiratne, A.; Jayasinghe, C.; Rajindrajith, S.; de Silva, A.P.; Pathmeswaran, A.; de Silva, H.J.INTRODUCTION & OBJECTIVES: Community based data on childhood obesity is lacking. We investigated the community prevalence and associations for adolescent obesity. METHODS: Fourteen-year-olds (Year-2000 birth-cohort), from Ragama MOH area were included. Demographic and life style data was collected. Standard blood biochemistry was performed. Physical activity (PA) and sedentary time (ST) were assessed using the short version of the International Physical Activity Questionnaire (IPAQ). Body mass index (BMI), waist circumference (WC) and blood pressure were measured. Total body fat (TBF%) was measured using impedance method. Multiple logistic regression was used to assess relationships between demography, life style habits, anthropometry, TBF% and biochemistry with obesity. RESULTS: A total of 508 [261 (51.6%)-girls, median birth weight-2.9 (IQR: 2.6-3.2) kg, 9 (1.78%) had maternal gestational diabetes (GDM), with median age of menarche-12 [IQR: 11-13] years] participated in the study. 61 (12.0%) had general obesity (GO) (BMI>age-sex equivalent of 23kg/m2) [33 (11.4%)-girls, 28 (12.7%)-boys; p=0.76]. 136 (27.0%) had central obesity (CO) (WC>cut-off for age and sex) [97 (37.3%)-girls, 39 (16.0%)-boys; p<0.01]. Median TBF% was 19.4 (IQR: 14.2-23.5). 10 (2.0%) had abnormal TBF% [3 (1.1%)-girls, 7 (2.9%)-boys; p=0.21]. Those engaging in some-PA [below recommendation (duration<150 min/week) and recommended-PA [at or above recommendation (duration≥150 min/week)] among girls were 129 (49.4%) and 132 (50.6%) while among boys were 116 (48.1%) and 125 (51.9%) respectively. Those with ST≥4 hour, <4 hours for girls and boys were 63 (24.4%), 195 (75.6%) and 31 (12.7%), 213 (87.3%) respectively. HOMA-IR median was 120.3 (IQR: 86.2-173.8). On multiple logistic regression, birth weight (OR-1.01; p<0.01), age at menarche (OR-1.48; p<0.05), TBF% (OR-2.27; p<0.001) and HOMA-IR (OR-1.01; p<0.001) were significantly associated with CO while PA or ST were not. CONCLUSION: Central obesity among adolescent girls was significantly more than boys. Adolescent central obesity was associated with birth weight, age at menarche, adverse TBF% and insulin resistance.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 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.Item Neonatal deaths in a tertiary care hospital in sri lanka(The Sri Lanka College of Paediatricians, 2008) Pannala, W.S.; Adikari, A.M.C.; Mettananda, D.S.G.; Rajindrajith, S.; Devanarayana, N.M.BACKGROUND: Neonatal mortality rate reliably assesses the level of perinatal care in a country. Lethal congenital malformations and extreme prematurity are the main causes of neonatal mortality in developed countries. Developing countries continue to lose neonates due to infections, malnutrition and birth asphyxia. OBJECTIVE: To describe the clinical characteristics, timing and causes of neonatal deaths Jn a tertiary care hospital in Sri Lanka, DESIGN, SETTING AND METHOD: A descriptive study was conducted at the Special Care Baby Unit of the University Paediatric Unit of North Colombo Teaching Hospital, Ragama. Data on all neonatal deaths which occurred from January 2006 to June 2007 were extracted from hospital records using a data collection form. RESULTS: Fifty-nine neonatal deaths were studied. All babies were born at hospitals and there were no home deliveries. Thirty (51%) were males and 42% were first born. Sixty six percent were deliveredpreterm including 13% delivered before 28 weeks. Mean birth weight was 1.81 (SD^O.87) kg. Twenty eight (47%) were delivered following an' uncomplicated antenatal period while 9 (15%) mothers had pre-labour rupture of membranes, 8 (14%) had pregnancy induced hypertension and 6 (10%) had antepartum haemorrhages. Fifty four percent were delivered vaginally and 41% by emergency caesarean section. Forty five (76%) needed resuscitation at birth. Eight (14%) newborns did not survive more than an hour and a further 16 (27%) died within the first 24 hours. Forty four (75%) died within one week. Twenty six (44%) died of complications of prematurity of which half had surfactant deficient lung disease. Other causes of death were sepsis (20%), congenital abnormalities (14%), meconium aspiration syndrome (12%) and birth asphyxia (10%). Pathological postmortems were done on 17 (29%). CONCLUSIONS: Seventy five percent of deaths occurred in the first week of life, 41% occurring within the first 24 hours. Forty four percent died of complications of prematurity. Birth asphyxia accounted for only 10% of deaths.Item Fate of premature neonates born before 34 Weeks of gestation: experience at a tertiary Care centre in sri lanka(The Sri Lanka College of Paediatricians, 2008) Mettananda, D.S.G.; Rajindrajith, S.; Adhihetty, D.; Goonewardena, A.R.; Adikari, A.M.C.; Pannala, W.S.; Devanarayana, N.M.; Mettananda, K.C.D.BACKGROUND: Neonates bom before 34 weeks of gestation are at risk of numerous complications and their management is technologically demanding. Despite advancements in other areas of medicine, neonatal intensive care facilities are still at a primitive stage even in tertiary care hospitals in Sri y Lanka, OBJECTIVE: To describe the clinical characteristics, problems and outcome of premature neonates born before 34 weeks of gestation. DESIGN, SETTING AND METHOD:A descriptive study was conducted in the Special Care Baby Unit (SCBU) of the North Colombo Teaching Hospital. All babies born before 34 weeks of gestation during me year 2006 were recruited, after obtaining maternal consent. Data was collected by interviewing mothers and using patient's records. RESULTS: Seventy neonates were recruited (male 57%). Of them 42 (60%) were delivered vaginally and 10 (14%) were born before 28 weeks of gestation. Mean birth weight was 1.44 (SD = 0.46) kg. All were admitted to the SCBU and were kept in incubators. The stay in SCBU ranged from 1 to 110 days (mean 15 days) and they were kept in incubators for an average of 5,8 days. Thirty seven (53%) had jaundice of whom 25 (36%) needed phototherapy but only one required exchange transfusion. Sepsis, surfactant deficient lung disease and apnoea were seen in 45.7%, 28.6% and 24.3% respectively. Four neonates each developed hypoglycaerma, anaemia and retinopathy of prematurity. Sixty seven (96%) neoaates needed oxygen, 13% were ventilated and 80% were given antibiotics. In 63% blood was taken for investigations more than 5 times. Twelve (17%) died while the rest (83%) were discharged. CONCLUSIONS: Jaundice, sepsis, surfactant deficient lung disease and apnoea were the commonest problems in babies born before 34 weeks of gestation. Nearly one fifth of them died during the neonatal period.Item Socio-demograpfflc and clinical Characteristics of neonates born before 34 Weeks of gestation: a case control study(The Sri Lanka College of Paediatricians, 2008) Mettananda, D.S.G.; Rajindrajith, S.; Adhihetty, D.; Goonewardena, A.R.; Adikari, A.M.C.; Pannala, W.S.; Devanarayana, N.M.; Mettananda, K.C.D.BACKGROUND: Management of neonates born before 34 weeks of gestation demands special resources and'' facilities which are limited in Sri Lanka. Identification of pregnancies at risk of preterm deliveries will enhance the optimal use of these neonatal facilities by appropriate and timely referrals. Objective: To compare th'e socio-demographic and clinical characteristics of neonates born before 34 weeks of gestation with those of term neonates. DESIGN, SETTING AND METHOD: A case-control study was conducted at the university obstetric unit of the North Colombo Teaching Hospital in the year 2006. All neonates born before 34-weeks of gestation were recruited as cases and a randomly selected group of term neonates was recruited as controls into the study after obtaining maternal consent. Data was collected by interviewing mothers and using patient records. RESULTS: Seventy cases and an equal number of controls were recruited. Forty (57%) cases and 30 (43%) controls were males. Mean birth weight was 1.44 (SD=0.46) kg for cases and 2.94 (SD=0.35) kg for controls. Previous history of preterm deliveries was found in 06 (8.6%) cases and. 01 (1.4%) control. Multiple pregnancy [OR=14.3,95% 01=1.8-113] and monthly family income less than Rs.lO,000/= [OR=2.6, 95% Cr^Ll-5.8] carried a significantly higher risk of_deliveries before 34 weeks. Increased risk was also detected in subjects with obstetric [OR=4.2, 95% CI=2.0-8.8)] and fetal [OR=11.0, 95% CI=3.6-33.6] complications. Maternal blood group, maternal education level and social class assessed by father's occupation did not have any association with deliveries before 34 weeks. Mean 1-minute APGAR was significantly lower in neonates born before 34 weeks [7.2 (SD=2.9)] than controls [9.7 (SD=0.5)], (pO.OOl) and the same was true for the score at 5 minutes. CONCLUSIONS: Multiple pregnancies, presence of maternal or fetal complications and low family income were associated with increased risk of deliveries before 34 weeks of gestation. Apgar scores at 1 and 5 minute were lower in neonates born before 34 weeks of gestation.