Conference Papers
Permanent URI for this collectionhttp://repository.kln.ac.lk/handle/123456789/6561
This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
Browse
12 results
Search Results
Item Prevalence of asthma and atopy among primary school children(Sri Lanka Medical Association, 2001) Karunasekera, K.A.W.; Perera, K.P.J.INTRODUCTION : Prevalence of asthma and atopy among school children in Sri Lanka is not known. Objectives : To estimate prevalence of asthma and atopy in children between 5-11 years and to determine the influence of sex and age on the prevalence of asthma. METHODS: A total of 2043 children between 5-11 years of 3 mixed schools in Gampaha district were screened for symptoms of asthma and atopy using a questionnaire in August 1998. Diagnosis of asthma was based on the presence of 3 symptoms of the following 5 in the preceding 12 months; cough at night, breathlessness, wheezing, persistent cough more than a week after common cold and cough and/or chest tightness during or after playing. Chi squared test and Chi squared test for trend were used for analysis. RESULTS: Prevalence of asthma symptoms were cough at night 22.1%, breathiessness 17.2%, wheezing 22.6%, persistent cough after common cold 29.9% and cough or chest tightness with playing 11%. Prevalence of asthma based on questionnaire was 17.1 %, allergic rhinitis 10% and eczema 2.5%. The prevalence of asthma in males was not significantly different from that of females (p=0.4). There was a decreasing trend of the prevalence of asthma with increasing age. This trend was significant in girls (p= 0.01) but not in boys. CONCLUSIONS: Nearly one fifth of primary school children suffer from asthma and 10% have allergic rhinitis. There was no significant gender difference in Jhe prevalence of asthma in primary school children. There was a decreasing trend of the prevalence of asthma with increasing age in girls but not in boys.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.Item Constipation and exposure to stressful life events in 10–16 year olds: a Sri Lankan experience(BMJ Publishing, 2009) Rajindrajith, S.; Devanarayana, N.M.INTRODUCTION: Constipation is a common paediatric problem, but little is known regarding its aetiology. The majority have functional constipation. Emotional stress is considered to be associated with functional gastrointestinal diseases including constipation. AIMS AND METHODS: The aim of this study was to assess the association between constipation and exposure to stressful life events in Sri Lankan school children and adolescents. A validated, self-administered questionnaire was distributed to randomly selected children, aged 10–16 years, in five randomly selected schools, in three geographically and socioeconomically different provinces in Sri Lanka. Constipation was defined using Rome III criteria. RESULTS: A total of 2770 questionnaires was distributed and 2699 (97.4%) 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 defaecation disorders (eg, constipation, diarrhoea, functional faecal retention, non-retentive faecal soiling, etc). The prevalence of constipation was higher in those who were exposed to at least one stressful life event during the previous 3 months (odds 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, hospitalisation of the child himself/herself for other illness, frequent punishment by parents, father’s alcoholism, domestic fights and living in an area affected by ongoing separatist war (p,0.005). During multiple logistic regression analysis, separation from the best friend (adjusted OR 0.737, p = 0.016), severe illness in a family member (adjusted OR 0.588, p = 0.001), loss of job by a parent (adjusted OR 0.55, p = 0.017), frequent punishment by parents (adjusted OR 0.581, p = 0.005) and living in a war-affected area (adjusted OR 0.666, p = 0.0001) remained to be significantly associated with constipation. CONCLUSION: Childhood constipation was significantly higher in those exposed to stressful life events. Modulation of gut motility through the brain–gut axis probably delays colonic transit causing constipationItem Constipation and functional faecal retention in Sri Lankan school children and adolescents(Wiley Blackwell Scientific Publications, 2008) Rajindrajith, S.; Adikari, C.; Pannala, W.; Devanarayana, N.M.INTRODUCTION: Constipation is a common paediatric problem, but little is known regarding it’s prevalence in Asia. AIMS : To assess prevalence of constipation and functional faecal retention among Sri Lankan school children and adolescents. MATERIALS: This is a cross sectional survey. A validated, self-administered questionnaire was distributed to randomly selected children, aged 10–16 years, in 4 randomly selected schools, in 3 geographically and socioeconomically different Provinces in Sri Lanka. Constipation was defined using Rome III criteria and Paris Consensus on Childhood Constipation Terminology (PACCT). Functional faecal retention was diagnosed using Rome II criteria. RESULTS: A total of 2770 questionnaires were distributed and 2699 (97.4%) were included in the analysis [1368 (50.6%) males, mean age 13.17 years, SD 1.72 years]. According to Rome III criteria and PACCT, 416 (15.4%) and 353 (13.1%) had constipation respectively [the agreement Cohen’s kappa (k) = 0.895, p < 0.0001]. Prevalence of constipation was higher in males than in females according to both PACCT (15.1% vs. 11%, p = 0.002) and Rome III criteria (16.8% vs. 14%, p = 0.047). The majority had family history of constipation (p < 0.0001). Straining, bleeding per rectum, abdominal pain, nausea, vomiting, anorexia and weight loss were significantly higher in the affected children (p < 0.001). Hundred and ten (4.1%) had functional faecal retention, of them 104 (94.5%) also fulfilled Rome III criteria for constipation (k = 0.402, p < 0.0001). CONCLUSIONS: Chronic constipation is a significant problem affecting 13–15% of Sri Lankan school children and adolescents. Constipation is commoner among males. Both Rome III criteria and PACCT are effective in diagnosing childhood constipation in epidemiological studiesItem Oro-caecal transit in Sri Lankan children and adolescents with functional recurrent abdominal pain(Wiley Blackwell Scientific Publications, 2008) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.INTRODUCTION: Recurrent abdominal pain (RAP) is a common paediatric problem. The majority of the affected have no organic pathology. Gastrointestinal motility abnormalities are considered as a possible cause for their symptoms. This study evaluated oro-caecal transit in children and adolescents with functional RAP. METHODS: Thirty one children with functional RAP and 20 healthy children from the same geographical area underwent oro-caecal transit time measurement by lactulose (0.25 g/kg in 10% solution) breath hydrogen test. None had evidence of organic disease, except for one control who had a positive Helicobacter pylori stool antigen test. RESULTS: Oro-caecal transit times could be calculated in 30 patients [10 (33.3%) males, mean age 7.2 years, SD 2.4 years, 12 functional abdominal pain, 8 irritable bowel syndrome, 8 functional dyspepsia, 1 abdominal migraine, 1 non-specific abdominal pain according to Rome III criteria] and 19 controls [10 (52.6%) males, mean age 9 years, SD 2.7 years]. One patient (3%) and 1 control (5%) were non-responders. Oro-caecal transit time was significantly prolonged in patients (median 90 min, range 45–150 min) compared to controls (median 75 min, range 30–105 min) (p = 0.0045). Oro-caecal transit time did not correlate with scores obtained for severity of abdominal pain (r = 0.176, p = 0.354) and had no association with exposure to recent stressful life events (p > 0.05). CONCLUSIONS: Oro-caecal transit time was delayed in children and adolescents with functional RAP. The future studies are needed to confirm the role of delayed oro-caecal transit in generation of symptoms, and to evaluate the therapeutic value of drugs that normalize small intestinal transit.Item Gastrointestinal disorders in children admitted to a tertiary care paediatric unit in Sri Lanka(Wiley Blackwell Scientific Publications, 2008) Devanarayana, N.M.; Adikari, A.M.D.B.; Sanjeewa, P.A.B.; Rajindrajith, S.OBJECTIVES : Gastrointestinal diseases, including diarrhoea and abdominal pain, are common presenting complains in children admitted to hospitals. In those with abdominal pain, non-specific abdominal pain is the commonest diagnosis at discharge. This study evaluated the gastrointestinal disorders in children admitted to a tertiary care general paediatric unit in Sri Lanka. METHODS: Records of all neonates, infants and children admitted to University paediatric unit in North Colombo Teaching Hospital, Ragama, Sri Lanka, during 12 month period from 01/10/2006 to 30/09/2007, were evaluated. Demographic information, details regarding the symptoms, exam nation findings, investigations, treatments and diagnosis at discharge were analysed retrospectively. RESULTS: Of the 5202 patients admitted during the study period, 167 (3.2%) had gastrointestinal disorders [90 (54.9%) were males, mean age 6.3 years, SD 2.5 years, range 2–13 years]. Common presenting complains were diarrhoea [79 (47.3%)], abdominal pain [62 (37.1%)], constipation [10 (6%)] and vomiting [8 (4.8%)]. Most common discharge diagnosis was acute gastroenteritis (AGE) [57 (45.5%)]. Of 62 children presented with abdominal pain, only 23 (36.1%) had exact diagnosis at the discharge (AGE 13, gastritis 3, constipation 4, gastro-oesophageal reflux 1, typhoid fever 1, functional abdominal pain 1). CONCLUSIONS: Diarrhoea and abdominal pain accounted for more than 80% of hospital admissions due to gastrointestinal disorders. Nearly two third of patients admitted due to abdominal pain had no diagnosis at discharge. Even though, Rome III criteria are widely available, only one patient was diagnosed as having functional gastrointestinal disorder.Item Bowel habits of Sri Lankan children and adolescents(Wiley Blackwell Scientific Publications, 2008) Rajindrajith, S.; Adikari, C.; Pannala, W.; Devanarayana, N.M.INTRODUCTION: Bowel habits vary greatly around the world, depending on food consumption and genetic factors. Thorough understanding of normal bowel habits is essential for correct diagnosis of defecation disorders which are common in paediatric age group. Main objective of this study was to evaluate normal bowel habits of Sri Lankan school children. METHOD: Normal children aged 10–16 years, without defecation disorders (e.g. diarrhoea, constipation, irritable bowel syndrome and non-retentive faecal soiling), were randomly selected from 5 schools in 4 districts in Sri Lanka. Details regarding their bowel habits of previous two months were collected using a pre-tested, self administered questionnaire. RESULTS: A total of 2273 children were recruited (male 50%, mean age 13.25 years, SD 1.7 years). Of them 1710 (75%) opened bowels once daily, while 153 (6.7%) and 11 (0.5%) had bowel motions less than 3 per week and more than 3 per day respectively. Stool consistency was normal in 1925 (84.6%), hard in 86 (3.7%), and 163 (7%) had changing consistency. Straining was present in 641 (28%), painful defecation in 273 (10.5%) and bleeding in 49 (2%). One hundred and four (4.6%) children reported stool withholding behaviour. Bulky stool was present in 156 (7%), while faecal soiling was seen in 15 (0.6%). Hard stools, bulky stools, faecal soiling and straining were commoner in males, whereas, painful defecation and withholding behaviour were common among females (p < 0.05). CONCLUSION: Hard stools, bulky stools, faecal soiling and straining were commoner in males, whereas, painful defecation and withholding behaviour were common among females (p < 0.05).