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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Author: search.filters.author.de Silva, H.J.End date: 2009

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Now showing 1 - 10 of 87
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    Occurence of tick bits and serological evidence of exposure to rickettsioses among Sri Lankan military personnel
    (International Society for Infectious Diseases, 2009) Premaratna, R.; Chandrasena, T.G.A.N.; Nawasiwatte, B.M.T.P.; Kulasiry, K.I.R.; Rajeev, S.; Bandara, K.B.K.R.G.W.; Rajapakse, R.P.V.J.; Kularatna, S.A.M.; de Silva, H.J.
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    Predicted cost benifits of establishment of Ricckettsial didease diagnostics in Sri Lanka
    (American Society of Rickettsiology, 2008) Premaratna, R.; Dissanayake, I.; Chandrasena, T.G.A.N.; Attanayake, N.; de Silva, H.J.
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    Rickettsial infections and their clinical presentations in the Western Province of Sri Lanka: A hospital based study
    (American Society of Rickettsiology, 2007) Premaratna, R.; Loftis, A.D.; Chandrasena, T.G.A.N.; Dasch, G.A.; de Silva, H.J.
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    The role of antioxidants in filarial infection
    (Royal Society of tropical medicine and Higiene (RSTMH), American Society of tropical medicine and Higiene(ASTMH), British Society for Parasitology, 2000) Premaratna, R.; Chandrasena, T.G.A.N.; Senarath, S.; Chandrasena, L.G.; de Silva, N.R.; de Silva, H.J.
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    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, p
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    Hepatitis B virus markers in primary hepatocellular carcinoma
    (Faculty of Medicine, University of Peradeniya, Sri lanka, 1994) de Silva, H.J.; Ratnatunga, N.; Ramadasa, S.
    Based on serological studies, Sri Lanka has a relatively low Hepatitis B virus (HB V) [hepatitis B surface antigen (HBsAg)] carrier rate of 0.9% and a low prevalence of HBV (5-10%) among patients with primary hepatocellular carcinoma (PHC). To investigate this further we looked for HBV markers in PHC using more sensitive immunoliistochemical methods. Formalin fixed paraffin embedded tissue obtained from 18 PHCs were studied. Only 7 of the specimens contained non-tumour liver tis¬sue around the PHC, and evidence of cirrhosis was seen in 5 of them. Four micron thick sections of tissue were stained, with polyclonai antibod¬ies directed against HBsAg and hepatitis B core antigen (HBcAg) using a three stage immunoperoxidase technique (peroxidase-anti peroxidase). Positive control liver tissue was used in all experiments. HBsAg was detected in6(33.3%)of the 18 specimens (in the tumour tissue only in 3 speci¬mens, tumour tissue and surrounding cirrhotic liver tissue in 1. and surrounding cirrhotic liver tissue only and not in tumour tissue in 2 speci¬mens). The staining was cytoplasrnic. HBcAg was not detected in any of the tissue specimens tested. Nodatareg;irding serum alphafetoprotein levels were available from the patients medical records. From the preliminary results of this on going study, HBsAg markers appear to be more frequently associated with PHC than serological studies from Sri Lanka have indicated. HBV may, therefore, have arnore important aetiologi-cal role in PHC in this country than was previ¬ously believed.
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    Effect of music on blood pressure in healthy young men
    (Faculty of Medicine, University of Peradeniya, Sri lanka, 1994) de Silva, A.P.; de Silva, H.J.; Fonseka, C.
    It is widely believed that listening (.0 music quietly is relaxing and therefore tends to reduce blood pressure (BP). To test this hypothesis we performed a cress-over study in 30 healthy Sinhalese male volunteers (non-smokers) aged between 23 and 25 years. None ol" them, were on any medication and all were requested not to consume coffee or a similar beverage for at least two hours prior to the test. Each individual rested silting for five minutes before the ex¬periment, and then listened to light classical music of his choice while sitting quietly for 30 minutes. BP was measured before and after listening to music. He was then allowed to engage in normal activities for one hour and the experiment was repeated, this time without music, where the person just sat quietly for 30 minutes in the same room. The systolic and diastolic BP differences were recorded for each person. Subjects were not allowed to fall asleep during the experiment and all experiments were performed between 1 and 4 pm to reduce the possible effect, if any, of diurnal variation in BP. There was no difference in diastolic BP either with or without music. Systolic BP dropped by a mean of 8 rnm (range 4-10) when listening to music and by a mean of 7 mm (range4-10) when sitting quietly without music (P>0.5, Mann-Witney U test). We conclude that listening to light music by itself does not reduce BP signifi¬cantly in normal individuals. Any reduction that occurs is probably a result of the subject sitting quietly while listening to the music.
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    The Recto-Anal Inhibitory Reflex (RAIR): abnormal response in diabetics suggests an intrinsic neuro-enteropathy
    (BMJ Publishing, 1997) Deen, K.I.; Premaratna, R.; Fonseka, M.M.D.; de Silva, H.J.
    INTRODUCTION: The recto-anal inhibitory reflex (RAIR) is characterized by reflex relaxation of the anal canal in response to electrical stimulation of the rectal mucosa, and is mediated by nitrergic neural plexuses within the gut wall. Impairment of this reflex may lead to incontinence. AIM: To measure anal canal pressures, anal mucosal electrosensation and RAIR in diabetic patients and correlate these measurements with incontinence for gas or faeces. METHODS: Anal canal pressure, RAIR and continence was evaluated in 30 diabetic patients [Male:Female=13:17, median age 57 years (range 37- 70)], and these data were compared with similar data obatained from 22 age and sex matched 'healthy' controls [Male:Female= 9:13, median age 51 years (range 19 - 65 )]. Median duration of diabetes was 8 years (range 3 -30 ). 12 (40%) of the 30 diabetics had impaired continence for gas (n=12) and liquid faeces (n=3). None ofthe controls had incontinence. RESULTS: Maximum resting anal canal pressure (MRP) was [median (range)]: Patients 30mmHg (20-75) vs. Controls 40mmHg (20-105), P=0.61. Maximum squeeze pressure (MSP) [median (range)]: Patients 65mmHg (30- 150) vs. Controls 84mmHg (35-230), P=0.59. Threshold rectal mucosal eletrosensation (RMES-T) [median (range)]: Patients 27 mA (5-40) vs. Controls l3mA (5-28), P=0.03. Maximum tolerable rectal mucosal electrosensation [median (range)]: Patients 40 mA (20-60) vs. Controls 20 mA (10-30), P=0.042 (all comparisons using Wilcoxon rank test). RAIR was present in 8, abnormal in 5 (1 with incontinence), and absent in 17 (II with incontinence) diabetics while it was present in 18 and abnormal in 4 controls (test of proportion, P=0.03 I). CONCLUSIONS: RAIR was impaired in significantly more patients with diabetes than controls implying impairment of intrinsic neuronal function. All diabetic patients with incontinence had impaired or absent RAIR. Impairment of this reflex may be a useful predictor of incontinence in diabetics.
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    Etiology of fever of unknown origin in a selected group of Sri Lankan patients with prompt responses to Doxycycline
    (Centers for disease control and Prevention, 2008) Dasch, G.A.; Premaratna, R.; Rajapakse, R.P.; Chandrasena, T.G.A.N.; Eremeeva, M.E.; de Silva, H.J.
    BACKGROUND: Most patients with long duration of fever go undiagnosed in settings where diagnostic facilities are inadequate. Untreated rickettsial infections cause extended fevers; while both scrub typhus and tick typhus are re-emerging diseases in Sri Lanka, laboratory facilities to specifically diagnose rickettsial infections in Sri Lanka are not available. METHODS: We collected 2 ml venous blood from febrile patients who had no etiological diagnosis after 7 days of hospital admission, but who showed rapid clinical response to doxycycline, to verify whether they had experienced a rickettsial infection. Acute serum samples were analysed using IFA for rickettsial infections caused by Orientia tsutsugamushi, Rickettsia conorii and Rickettsia typhi. A positive IgG IFA titer >1:128 was used to define a probable case of rickettsial infection. RESULTS: 28 patients [15 males, mean age 32.5 (SD 9.2 yrs)] were studied. Mean duration of fever at admission was 6.1 days (SD 3.1). Two patients had features suggestive of encephalitis and two had erythema nodosum. Others had no specific clinical features. Routine investigations were inconclusive and blood cultures were negative. IgG-IFA titer of >128 was found in 10 for R. conorii, 6 for O. tsutsugamushi and 6 for both R. conorii and O. tsutsugamushi. None were positive for R. typhi. Six were negative for all tests. One patient with encephalitis and one with erythema nodosum had high titers for R. conorii. CONCLUSIONS: The majority of Sri Lankan patients with undiagnosed fever responding promptly to doxycycline had a rickettsial etiology. Patients with rickettsioses exhibit varied clinical presentations so greater use of doxycycline for patients with extended fevers in rickettsial-endemic settings with inadequate diagnostic facilities appears warranted. The high proportion of patients with tick typhus and antibodies against both spotted fever and scrub typhus rickettsiae was unexpected based on previous studies of patients from the same region who were confirmed to have scrub typhus by serology and by the presence of the classic eschar. It is unknown whether the etiology of tick typhus and vector(s) transmitting this agent on the Western lowland region of Sri Lanka are the same as those responsible for spotted fevers in the central hill country of Sri Lanka.
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    One hour fast for liquids prior to endoscopy is safe, effective and results in minimum patient discomfort
    (American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2006) de Silva, A.P.; Amarasiri, L.; Kottahachchi, D.C.; Sabhapathige, R.D.; Dassanayake, A.S.; de Silva, H.J.
    INTRODUCTION: Current guidelines for endoscopy advice at least 6-8 hours fasting for solids and at least 4 hours for liquids. This is claimed to ensure safety and a clear endoscopic view. However, prolonged fasting may result in patient discomfort. Also due to practical delays the fasting period for endoscopy may be much longer, thus causing even more discomfort to patients. Several anaesthesia societies now recommend a 2-h pre-operative fast for clear fluids and a 6-h fast for solids in most elective patients. A pilot study done by us showed the time for a clear liquid (tea) or water to empty from the stomach using real-time ultrasonography was one hour. AIMS: To determine whether a one-hour fast prior to endoscopy was safe, effective and resulted in less patient discomfort. METHODS: 63 patients referred for endoscopy, without alarm symptoms or clinically obvious motility problems, were recruited. Patients were given a standard meal 6 hours before endoscopy. They were then randomized to either nil by mouth for 6 hours (group A, n = 31) or allowed to take clear fluids up to one hour prior to endoscopy (group B, n = 32). Just prior to endoscopy patients indicated discomfort due to fasting on a visual analog scale (0-no discomfort to 10-severe discomfort). Investigators were blinded to the period of fasting. Presence of fluid in the gastric fundus was noted, and endoscopic vision was graded as good, average or poor. Patients were followed one week after the procedure for the presence of any late complications. RESULTS: Discomfort was significantly lower in group B than group A (median visual analog score 0.3 vs. 5.1; p < 0.0001, Wilcoxon two-sample test). Endoscopic vision was good in all 31 patients in group A and 30 in group B, and average in 2 patients in group B. None were graded as poor. Fluid in the gastric fundus was noted in 7 patients in group A and 10 in group B. There were no complications in either group. CONCLUSIONS: A one-hour fast for clear liquids seems safe and effective and has minimum discomfort for the patient. However, a larger study should be done before the current endoscopic guidelines are revised.