Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Prevalence of asthma and its symptoms in Sri Lankan adults.(BioMed Central, London, 2022) Gunasekera, K.D.; Amarasiri, W.A.D.L.; Undugodage, U.C.M.; Silva, H.K.M.S.; Sadikeen, A.; Gunasinghe, W.; Fernando, A.; Perera, B.P.R.; Wickremasinghe, A.R.BACKGROUND: Data on adult asthma is scarce in Sri Lanka. The objective of this study was to estimate the prevalence of asthma and its symptoms in adult Sri Lankans. METHODS: A cross-sectional study using a translated version of the European Community Respiratory Health Survey screening questionnaire on subjects ≥ 18 years from 7 provinces in Sri Lanka was conducted. The asthma was defined as "wheezing in the past 12 months (current wheeze)", self-reported asthma attack in the past 12 months or on current asthma medication use. RESULTS: Among 1872 subjects (45.1% males, 48.8% between 18-44 years of age), the prevalence of current wheeze was 23.9% (95%CI: 22.0%-25.9%), self-reported asthma was 11.8% (95%CI: 10.3%-13.2%) and current asthma medication use was 11.1% (95% CI: 9.6%-12.5%). The prevalences were higher in adults > 44 years, 31.4% positively responded to any of the above questions (95%CI: 29.3%-33.4%) and 60.9% of current wheezers did not report having asthma whilst 38.2% used asthma medication. Among current wheezers, 80.1% had at least one other symptom, cough being the commonest. Those with no current wheeze, self-reported asthma and on current asthma medication use, 30%, 35.9% and 36.6%, respectively, reported at least one other symptom. Smokers comprises 22% current wheezers, 20.6% of self-reported asthmatics and 18.7% of current asthma medication users. CONCLUSIONS: The prevalence of asthma in Sri Lankan adults is higher than the other South Asian countries and higher in the older age group. A significant percentage of symptomatic individuals did not report having asthma or being on medication.Item Hypersensitivity pneumonitis associated with Red-Vented Bulbul: a new encounter of bird related hypersensitivity pneumonitis.(Hindawi Pub. Corp., 2019) Amarasinghe, W.D.N.L.; Jayasekara, R.; Jayamanne, B.D.W.; Nalaka, T.D.K.; Amarasiri, W.A.D.L.; Punchihewa, R.; Fernando, A.Bird related hypersensitivity pneumonitis (HP) is becoming more common than other forms of HP around the world. We present two cases of HP, associated with exposure to visiting birds which had nested within their homes in semi urban areas of Colombo, Sri Lanka. A 65-year-old female (case 1) and a 61-year-old male (case 2) presented to the chest clinic complaining of gradually progressive and persistent chronic dry cough and dyspnoea during the year 2018. Both were found to have close contact with red-vented bulbuls (Konda kurulla) in their homes for more than 6 months prior to onset of symptoms and denied any other risk exposures in detail history taking. In both patients, high-resolution computed tomography chest (HRCT) showed centrilobular nodules of ground glass density with significant lobular air trapping. Video-assisted thoracoscopic (VATs) lung biopsy of case 1 showed patchy and focal interstitial thickening with lymphocytic infiltrate, minimal fibrosis, and few noncaseating granulomata within the interstitium. Transbronchial lung biopsy of case 2 showed thickened alveolar septae with lympho-histiocytic infiltrate and occasional neutrophils and eosinopils. Both showed severe reduction in forced vital capacity (FVC) at presentation. Multidisciplinary diagnosis of HP associated with red-vented bulbuls was made. Both achieved good improvement in clinical, lung function, and radiological assessment following removal of offending antigen exposure and treatment with oral corticosteroids.Item Spirometry reference norms for 13-14 year old Sri Lankan children(Sri lanka Medical Association, 2015) Gunasekera, K.D.; Amarasiri, W.A.D.L.; Fernando, E.A.C.; Warnakulesuriya, D.T.D.; Undugodage, U.C.M.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: Reference norms have only been reported for Peak Expiratory Flow Rate (PEFR) in Sri Lankan children. The aim of this study was to construct prediction equations for spirometry in Sri Lankan children aged 13-14 years. METHOD: Spirometry was performed in 2078 Sri Lankan healthy children (1023 boys (49.2%) and 1055 (50.8%) girls) of 13-14 years of age according to American Thoracic Society guidelines. Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEVi), PEFR and Forced Mid-Expiratory Flow Rates (FEF25-75%) were measured. Correlation coefficients were established between each parameter and standing height, weight, and age. The functions were regressed over all possible combinations of variables separately for boys and girls. RESULTS: There were significant correlations between spirometry parameters and height and weight in both genders. There were significant correlations between age and PEFR, FEF25 and FEF50 in males and age and FEVi, PEF and FEF25-75% in females. The prediction equations in males for FVC: 0.047 height + 0.0007 age - 4.66; for FEVi: 0.041 height + 0.016 age - 4.22; for PEFR: 0.074 height + 0.123 age - 7.59 and FEF25-75%: 0.042 height -i-0.066 age-4.36. The equations in females for FVC: 0.028 height + 0.031 age - 2.36; for FEVi: 0.027 height + 0.047 age - 2.57; for PEFR: 0.038 height + 0.159 age - 2.93 and FEF25-75%: 0.029 height + 0.136 age-3.18. CONCLUSION: Height, weight and age influence ventilatory parameters and could be used to formulate prediction equations for spirometry in Sri Lankan children.Item Validation of a gastro-oesophageal reflux disease (GERD) specific screening instrument for epidemiological purposes(Sri Lanka Medical Association, 2006) Amarasiri, W.A.D.L.; Ranasinghe, C.; Pathmeswaran, A.; de Silva, H.J.INTRODUCTION: The prevalence of GERD is increasing worldwide; its community prevalence in Sri Lanka is unknown. AIMS: To develop a clinical score to screen for GERD in the community and assess whether a score using both symptom frequency and severity correlates better to an objective measure of GERD than one using only symptom frequency. METHODOLOGY: 58 GERD patients (endoscopy positive) and 60 controls (matched for age and gender) were given a GERD-specific interviewer-administered questionnaire assessing seven upper gastrointestinal symptoms. Each symptom was graded using Likert scales for frequency (4-items) and severity (5-items), and two scores were generated. Score 1 was the sum of frequency of symptoms while score 2 was the sum of products of frequency and severity of each symptom. The patients then underwent oesophageal manometry and 24h pHmetry. Cut-off values were determined by constructing receiver-operating characteristic curves. RESULTS: For both scoring systems, mean scores of cases were significantly higher than controls (p=0.000). The cut-off for score 1 was > 11.50 (sensitivity 91.4%, specificity 85%, positive and negative predictive values 83.29% and 92.34%). The cut-off for score 2 was > 12.50 (sensitivity 96.6%, specificity 80%, positive and negative predictive values 81.06% and 92.32%). Both scores showed high reproducibility (intra class correlation coefficient scorel=0.94 and score 2=0.82). There was good correlation between both scores and 24-h pH parameters (Spearman rank correlation, p=0.01), but score 2 was significantly better. CONCLUSION: Our GERD questionnaire is valid, reproducible and showed better correlation with an objective test when both severity and frequency of symptoms were scored rather than frequency alone.Item Oesophageal dysfunction in asthmatics(Sri Lanka Medical Association, 2010) Amarasiri, W.A.D.L.; Pathmeswaran, A.; Ranasinha, C.D.; de Silva, H.J.INTRODUCTION: Gastro-oesophageal reflux (GOR) predisposes to respiratory symptoms through reflex vagal activity. Asthmatics have oesophageal hypomotility and vagal hyperactivity. Whether this oesophageal hypomotility is primary or secondary to damage from GOR is unclear. METHODS: 30 mild, stable asthmatics (ATS criteria) and 30 healthy volunteers underwent 24-hour ambulatory oesophageal pH monitoring, manometry, autonomic function testing and GORD symptom assessment and gastroscopy. A vagal score using 3 tests (valsalva manouvre, heart rate response to deep breathing and to standing from supine position) was correlated with oesophageal function parameters. Respiratory symptoms during pH monitoring were correlated with reflux events. RESULTS: Asthmatics (mean age 34,8y; 60% female) had more frequent GORD symptoms than controls (mean age 30.9y; 50% female). 10/27 asthmatics had oesophageal mucosal damage, 22/30 showed hypervagal response, none had a hyperadrenergic response. 14/30 asthmatics had ineffective oesophageal motility. Higher GOR-score asthmatics had significantly fewer peristaltic contractions and more simultaneous contractions than controls, and higher oesophageal.acid contact times than those with lower scores. All reflux parameters were significantly higher and acid clearance time prolonged in asthmatics than controls. There was no correlation of vagal function with oesophageal function parameters. 50% of the asthmatics complained of respiratory symptoms during pH monitoring, and reflux episodes usually preceded respiratory symptoms. CONCLUSION: Asthmatics have abnormal oesophageal motility and pathological GOR which usually precede respiratory symptoms. There was no vagal dysfunction, and the vagal function score did not correlate with oesophageal motility parameters. Peristaltic dysfunction may be secondary to damage due to gastro-oesophageal reflux.Item Gastric motility following ingestion of a solid meal in a cohort of adult asthmatics(The Korean Society of Neurogastroenterology and Motility, 2013) Amarasiri, W.A.D.L.; Pathmeswaran, A.; de Silva, A.P.; Dassanayake, A.S.; Ranasinha, C.D.; de Silva, H.J.BACKGROUND/AIMS: Asthmatics have abnormal esophageal motility and increased prevalence of gastroesophageal reflux disease (GERD). The contribution of gastric motility is less studied. We studied gastric myoelectrical activity, gastric emptying (GE) and their association with GERD symptoms and vagal function in adult asthmatics. METHODS: Thirty mild, stable asthmatics and 30 healthy controls underwent real-time ultrasonography and 1 hour pre- and post-prandial cutaneous electrogastrography, following a test meal (480 kcal, 60% carbohydrate, 20% protein, 20% fat and 200 mL water). The percentage of normal slow waves and arrhythmias, dominant frequency and power, frequency of antral contractions, gastric emptying rate (GER) and antralmotility index (MI) was calculated. Twenty-seven asthmatics underwent gastroscopy and in all subjects GERD symptoms were assessed by a validated questionnaire. Vagal function parameters were correlated with gastric motility parameters. RESULTS: The asthmatics (37% male; 34.8 ± 8.4 years) and controls (50% male; 30.9 ± 7.7 years) were comparable. None had endoscopicgastric pathological changes. Twenty asthmatics described GERD symptoms. Twenty-two (73.3%) asthmatics showed a hypervagal response. Compared to controls, asthmatics had delayed GER and lower MI, lower percentage of normal gastric slow waves, more gastric dysrythmias and failed to increase the post-prandial dominant power. There was no correlation of GE and cutaneous electrogastrography parameters with presence of GERD symptoms or with vagal function. CONCLUSIONS: Asthmatics showed abnormal gastric myoelectrical activity, delayed GE and antral hypomotility in response to a solid mealcompared to controls. There was no association with vagal function or GERD symptom statusItem Coconut fats(Sri Lanka Medical Association, 2006) Amarasiri, W.A.D.L.; Dissanayake, A.S.In many areas of Sri Lanka the coconut tree and its products have for centuries been an integral part of life, and it has come to be called the "Tree of life". However, in the last few decades, the relationship between coconut fats and health has been the subject of much debate and misinformation. Coconut fats account for 80% of the fat intake among Sri Lankans. Around 92% of these fats are saturated fats. This has lead to the belief that coconut fats are 'bad for health', particularly in relation to ischaemic heart disease. Yet most of the saturated fats in coconut are medium chain fatty acids whose properties and metabolism are different to those of animal origin. Medium chain fatty acids do not undergo degradation and re-esterification processes and are directly used in the body to produce energy. They are not as 'bad for health' as saturated fats. There is the need to clarify issues relating to intake of coconut fats and health, more particularly for populations that still depend on coconut fats for much of their fat intake. This paper describes the metabolism of coconut fats and its potential benefits, and attempts to highlight its benefits to remove certain misconceptions regarding its use.