Journal/Magazine Articles
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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
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Item Association between child maltreatment and constipation: a school Based survey using Rome III Criteria(Lippincott Williams and Wilkins, 2014) Rajindrajith, S.; Devanarayana, N.M.; Lakmini, C.; Subasinghe, V.; de Silva, D.G.H.; Benninga, M.A.Child abuse leads to multiple physical and psychosomatic sequelae. The aim of the present study was to evaluate the association between child abuse and constipation among schoolchildren. METHODS: Children 13 to 18 years of age were selected from 4 semiurban schools in Gampaha District, Sri Lanka. A self-administered questionnaire was used for data collection. Information regarding socio demographic factors and gastrointestinal symptoms, child abuse, and somatisation were collected. Constipation was diagnosed using Rome III criteria. RESULTS: A total of 1792 children were included in the analysis (boys 975 [54.4%], mean age 14.4 years, standard deviation [SD] 1.3 years). One hundred thirty-eight (7.7%) fulfilled Rome III criteria for constipation. The number of children exposed to physical, emotional, and sexual abuse were, respectively, 438 (24.4%), 396 (22.1%), and 51 (2.8%). The prevalence of constipation was significantly higher in those exposed to sexual (5.8% vs 2.6% P = 0.03), emotional (40.9% vs 20.8%, P < 0.0001), and physical abuse (41.6% vs 23.2%, P < 0.0001). Mean somatisation score was higher in the total group of abused children with constipation (mean 18.6, SD 12.5) compared with those without (mean 13.9, SD 12.3; P = 0.027). Children with a history of abuse did not seek health care more often than children without this history. Patient-perceived severity of bowel symptoms was higher in children with physical abuse (23.7 vs 19.7 P = 0.001) and emotional abuse (25.4 vs 19.3 P < 0.0001). CONCLUSIONS: Childhood constipation shows a significant association with physical, sexual, and emotional abuse. Children with constipation complain of more somatic symptoms and bowel symptoms when they are exposed to abuse.Item The Use of child soldiers in war with special reference to Sri Lanka(Maney Publishing, 2013) de Silva, D.G.H.Throughout history, the involvement of children in military operations has been extensively documented. The issue of child conscription is multi-faceted, with very few medical but more sociological aspects, including terrorism, politics, economics, history, culture and religion amongst other factors. Many United Nations Instruments as well as the International Criminal Court have documented that child conscription is detrimental to a child's development, violates Child Rights, and is a war crime. Efforts by international bodies to address conscription as childabuse have failed since the process is undertaken by groups rather than individuals, and because the law has no access to the perpetrators. The background to a conflict in Sri Lanka and various ethno-religious and political factors are discussed. The role of the diaspora community, the internet and various fund-raising mechanisms for war are discussed. The history of child conscription and studies examining reasons and the tasks assigned to them as conscripts as well as abusive aspects, especially in relation to emotional abuse, neglect and physical harm, are discussed. Documentation of conscription as child abuse needing a definition including a new definition of 'suicide by proxy' is stressed. The importance of culture and history, and the manipulation of the idealistic mind are discussed in the context of 'setting the stage' for child conscription. The toy weapon industry and the real arms industry, especially small arms, are important in maintaining conflicts, especially in the developing world. The conflicts of interests of members of the UN Security Council and the 'peace-keepers' of the world is discussed.Item Recurrent Abdominal Pain Syndrome in a Cohort of Sri Lankan children and adolescents(Oxford University Press, 2008) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.Item Aetiology of recurrent abdominal pain in a cohort of Sri Lankan children(Wiley-Blackwell, 2008) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.AIMS: Recurrent abdominal pain (RAP) has a multifactorial aetiology with many affected children having no evidence of organic pathology. This study assessed the functional and organic causes for RAP in a cohort of Sri Lankan children. METHODS: Fifty-five Sri Lankan children (45.5% males, aged 5-15 years) having RAP were screened for organic diseases. RAP was defined using Apley criteria. Children without clinical or laboratory evidence of organic diseases were classified into functional gastrointestinal diseases (FGD) using Rome II and III criteria. Thirty-nine patients with functional RAP and 20 healthy children (50% males, age 5-15 years) from same area were tested for Helicobacter pylori using a stool antigen test. RESULTS: Thirteen (23.6%) children had organic RAP. According to Rome II, 33 (60%), and according to Rome III, 39 (71%) (functional abdominal pain 19, irritable bowel syndrome nine, functional dyspepsia nine, abdominal migraine one, aerophagia one) children had FGD. Two (5.1%) patients and one (5%) control tested were positive for Helicobacter pylori (P > 0.05). Except for constipation, pain characteristics and associated symptoms were not significantly different between organic and functional RAP. CONCLUSIONS: Organic pathology accounted for symptoms in less than a quarter of Sri Lankan children with RAP. The majority had functional bowel diseases, of which the commonest was functional abdominal pain. Rome III criteria were more effective than Rome II criteria in identifying FGD. Helicobacter pylori infection did not appear to be associated with RAP.Item Gastric myoelectrical and motor abnormalities in children and adolescents with functional recurrent abdominal pain(Wiley-Blackwell, 2008) Devanarayana, N.M.; de Silva, D.G.H.; de Silva, H.J.BACKGROUND AND AIMS: Recurrent abdominal pain is common among children and adolescents. The majority of the affected patients have no apparent cause for their symptoms. This study evaluated gastric myoelectrical activity and motility abnormalities in children and adolescents with functional recurrent abdominal pain. METHODS: Forty-two children with functional recurrent abdominal pain [19 (45.2%) males, mean 8 years, SD 3 years, 19 functional abdominal pain, 9 irritable bowel syndrome, 9 functional dyspepsia, 1 abdominal migraine, 1 aerophagia and 3 non-specific abdominal pain according to Rome III criteria] and 20 healthy children [10 (50%) males, mean 9 years, SD 2.7 years] from the same geographical area underwent electrogastrography (EGG), and ultrasonographic assessment of gastric emptying rate and antral motility. RESULTS: Average gastric emptying rate, amplitude of antral contractions and antral motility index were lower in patients (46.5%, 74.3% and 6.5 respectively) compared to controls (66.17%, 89% and 8.3 respectively) (P < 0.001). Gastric emptying rate had a negative correlation with scores obtained for severity of symptoms (r = -0.63, P < 0.0001). Postprandial dominant frequency instability co-efficient (post-DFIC) was higher in patients than in controls (27.83% vs 18.3%, P = 0.0087), and correlated with the symptom score (r = 0.26, P = 0.045). CONCLUSIONS: Gastric emptying and antral motility were significantly impaired in patients, indicating a possible role for gastric motility disturbances in the pathogenesis of childhood functional recurrent abdominal pain. Further studies, including therapeutic trials, are needed to confirm this association and for recommendation of prokinetic drugs in its management.Item Children needing protection: experience from South Asia(British Medical Association, 2007) de Silva, D.G.H.No Abstract AvailableItem An Intervention study to monitor weight gain in infants using a home based complementary food recipe and a hand blender(Sri Lanka Medical Association, 2007) de Silva, D.G.H.; Rajindrajith, S.; Pathmeswaran, A.; Karunasekera, W.OBJECTIVES: To assess the efficacy of a home made energy dense weaning food, containing 110-130 kcal (26-30kJ) per 100 ml on prevention of growth faltering during infancy. METHODOLOGY: Infants attending four child health welfare clinics in the Medical Officer of Health (Ragama) area were recruited at the age of 4 months. The intervention group received a specially designed hand blender, recipe and advice to prepare a weaning food. The control group received weaning foods without any intervention. They were followed up monthly up to the age of 12 months. RESULTS: 152 infants completed the study (83 from intervention group). The infants in the intervention group gained significantly more weight than the control group (intervention group 2.43 +/- 0.72 kg, control group 2.02 +/-0.62 kg, p = 0.0002). Both groups showed a drop in the Z score for meanweight for age during the study period but this was less marked in the intervention group. CONCLUSIONS: A high energy density home made complementary food was effective in improving the weight gain of infants during the weaning period.Item Iodine prophylaxis, goitre and thyroid autoimmunity in Sri Lanka(Sri Lanka Medical Association, 2005) Wijeyaratne, C.N.; Jayasinghe, A.; de Silva, D.G.H.; Parkes, A.B.; Lazarus, J.H.; Premawardena, L.D.K.E.No Abstract AvailableItem Sequential studies on thyroid antibodies during pregnancy(Mary Ann Liebert Publishers, 2005) Smyth, P.P.; Wijeyaratne, C.N.; Kaluarachi, W.N.; Smith, D.F.; Premawardena, L.D.K.E.; Parkes, A.B.; Jayasinghe, A.; de Silva, D.G.H.; Lazarus, J.H.Thyroid antibodies were measured sequentially in 25 pregnant women from a Sri Lankan population. A high prevalence of antithyroidantibodies, particularly antithyroglobulin antibodies (TgAb) had previously been demonstrated in female schoolchildren drawn from this population. In the present study TgAb were detected in 36.8% of nonpregnant controls while thyroid peroxidase antibody (TPOAb) positivity was present in 26.3%. The prevalence of both antibodies in the pregnancy study group showed a progressive decline compared to nonpregnant controls throughout gestation becoming undetectable in the third trimester. The results are consistent with an immunosuppressive effect of pregnancy in a population in whom high thyroid autoantibody titers may have resulted from a recent salt iodization program.Item Maternal and child health: is South Asia ready for change?(British Medical Association, 2004) Bhutta, Z.A.; Gupta, I.; de Silva, D.G.H.; Manandhar, D.; Awasthi, S.; Hossain, S.M.; Salam, M.A.No Abstract Available