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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

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Author: search.filters.author.de Silva, M.

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    Is being barefoot, wearing shoes and physical activity associated with knee osteoarthritis pain flares? Data from a usually barefoot Sri Lankan cohort
    (Oxford, 2021) Atukorala, I.; Pathmeswaran, A.; Batuwita, N.; Rajapaksha, N.; Ratnasiri, V.; Wijayaratne, L.; de Silva, M.; Chang, T.; Zhang, Y.; Hunter, D.J.
    AIM: To identify the association between hours of being barefoot/wearing footwear, physical activity (PA) and knee osteoarthritis pain flares (KOAF). METHODS: Persons with a diagnosis of knee osteoarthritis, who reported previous KOAF, were followed up in a 3 months long telephone-based case-crossover study. Exposures to risk factors were assessed every 10 days and whenever the participants experienced a KOAF. Conditional logistic regression examined associations of KOAF with following: hours of being barefoot/using footwear and PA performed (P < .05). RESULTS: There were 260 persons recruited, of whom 183 continued longitudinal follow up. Of them, 120 persons had at least one valid KOAF and control period. Participants were female (90%) with mean (SD) age and body mass index of 59.9 (7.0) years, 28.0 (5.0) kg/m2 respectively. Participants were barefoot for a mean duration of 12.7 hours (SD 4.6) and used footwear for 5.1 (SD 4.7) hours daily; 99% wore heel heights <2.5 cm. Duration of being barefoot, 1 and 2 days before, demonstrated reduced multivariate odds of KOAF (odds ratio [OR] = 0.85; 95% CI 0.80-0.90). Moderate PA performed 1, 2 days prior was associated with a significantly increased risk of KOAF (multivariate OR 4.29; 2.52-7.30 and OR 3.36; 2.01-5.61). Similarly, hours of using footwear 1 and 2 days before flare demonstrated increased odds of KOAF (OR 1.15; 1.07-1.23 and 1.10; 1.03-1.18). CONCLUSIONS: Increased duration of being barefoot 1 to 2 days before is associated with reduced risk of KOAF. Performing moderate PA 1 to 2 days before was associated with an increased risk of KOAF. KEYWORDS: knee osteoarthritis pain.
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    A comparative study of patients with pancreatic calcification in Sri Lanka
    (The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) de Silva, M.; Selliah, S.; Thabrew, I.
    INTRODUCTION: Although alcohol abuse is a common cause of pancreatic calcification in the west, a non-alcoholic form called Tropical caicific Pancreatitis (TCP) is recognized in Asian countries.OBJECTIVE: To compare the clinical, biochemical, radiological and endoscopic profiles and success of endotherapy of TCP with Alcoholic Calcific Pancreatitis (ACP). METHODS:Biochemical assay. and ERCPs were performed on 50 patients with pancreatic calcification.There were 28 TCP and 22 ACP in the sample. Mean age of ACP (43.7y SD 8.9) was higher than TCP (37.7 SD 10 p<0/05). ACP was exclusively seen among males.Mean age of onset of pain was lower in the TCP. Nearly 80% of TCP had pain scores more or equal to 7 compared to 54.5% in ACP. Onset of diabetes mellitus in TCP occurred earlier than ACP (34y Vs 40y). Mean serum insulin and duodenal trypsin levels were higher in the TCP patients. On x-ray 85% of TCP had coarse calcium plaques and 71.4% of ACP had speckled plaques. ERCP was successful in nearly 70% of the total sample and 50% underwent stenting. Adequate pain relief was observed in 50% in TCP and 54% in ACP. CONCLUSION:Onset of pain and diabetes mellitus occurred at a younger age in TCP. Although more intraductal plaques were seen in TCP, no difference was observed in the response to endotherapy.
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    Is cassava consumption related to tropical calcific pancreatitis in Sri Lanka
    (The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Siva, S.; de Silva, M.; Thabrew, I.
    INTRODUCTION: Presence of calcification in the pancreas confirms the diagnosis of Chronic Pancreatitis. In the developing countries, a non alcoholic form referred to as Tropical Calcific Pancreatitis (TCP) is been increasingly recognized. An association has been suggested to malnutrition and cassava consumption. OBJECTIVES: To assess the aetiological factors and BMI of TCP patients. METHODS: On 28 TCP patients a detailed questionnaire was administered to collect the aetiological factors. Height and weight measurements were taken. The results were compared with 50 healthy controls and 22 Alcoholic Calcific Pancreatitis (ACP). RESULTS: The mean age of TCP patients and ACP was 34. 7 (SD 10) yrs and 43.7 (SD 8.9) yrs respectively. The percentage with monthly income less than Rs: 5000.00 was high in ACP (70%) compared to TCP (60%) which was similar to control group (58%). TI1e proportion of severe malnutrition {BM! <20) was comparable in TCP and ACP (72%) and was significantly higher (p<0.05) than control group (35%). Regularity of consumption of cassava for last 5 years was significantly (p<0.05) higher in ACP (35%) compared to 19% in TCP, and 4% in the control group. There was no difference in the consumption of red, green chilli, pepper, tea and coffee in the 3 groups. CONCLUSION: The above data indicate higher consumption of manioc by ACP than TCP. A long term study will assist in establishing the association of cassava consumption and malnutrition in Chronic Calcific Pancreatitis.
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    Complete pancreatic transection in a child treated by drainage and sphincterotomy
    (Lippincott Williams & Wilkins, 2010) Siriwardana, R.C.; Wijesuriya, S.R.E.; Marasinghe, A.; de Silva, M.; Deen, K.I.
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    Descriptive study of chronic calcific pancreatitis in Sri Lanka
    (Sri Lanka Medical Association, 2005) de Silva, M.; Selliah, S.; Thabrew, I.
    OBJECTIVES: To describe the potential risk factors, clinical features, biochemical and radiological features, and management of chronic calcific pancreatitis. DESIGN: Cross-sectional descriptive study. SETTING: Tertiary care general hospital. PATIENTS: Fifty patients with pancreatic calcification referred to the Colombo South Teaching Hospital, and 50 age-matched controls from healthy relatives or friends of the patients. MEASUREMENT: Height and weight measurements, immunoreactive insulin levels and trypsin levels of duodenal aspirates were estimated. Plain abdominal xray and ultrasonography were performed. INTERVENTION: Endoscopic retrograde cholangiopancreaticography (ERCP) was attempted on all patients during which duodenal aspirates were collected. Success rates of ERCP and response to endotherapeutic procedures were recorded. RESULTS: Twenty two of the 50 chronic calcific pancreatitis (CP) patients were diagnosed to have chronic alcoholic calcific pancreatitis(CACP). Mean age of the CACP patients was significantly higher than that of the chronic calcific pancreatitis of the tropics (CCPT) patients. Severe malnutrition (BMI < 20), frequent consumption of Manihot esculenta (manioc, cassava) and a high consumption of chilli or pepper were identified as possible risk factors for both alcoholic and non-alcoholic CP. Onset of diabetes occurred at a much younger age in the CCPT group than in the CACP group. Mean serum insulin was significantly higher in the CCPT group than in the CACP group and duodenal trypsin level was significantly lower in the CCPT than in CACP group. CONCLUSIONS: Our results confirm the existence of both alcoholic (CACP) and non-alcoholic (CCPT) types of chronic calcific pancreatitis in Sri Lanka. A larger study is required to confirm the associated risk factors such as Manihot esculenta and foods with a high content of chilli or pepper
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