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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

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    Quantitative video-fluoroscopic analysis of swallowing in infants
    (Elsevier/North-Holland., 2020) Dharmarathna, I.; Miles, A.; Fuller, L.; Allen, J.
    OBJECTIVES: To utilize objective, quantitative videofluoroscopic swallow measures to profile swallowing in infants and to determine the likelihood of objective swallow measures to predict risk of swallow impairments such as airway violation, reflux and post swallow residue. STUDY DESIGN: Our single center retrospective observational study used a cohort of 146 bottle-fed infants (0-9 months) referred for VFSS with any kind of feeding related concern. Frame-by-frame analysis of 20-s video loops of mid-feed sucking was completed to obtain quantitative timing, displacement and coordination measures as well as presence of other findings including aspiration, residue and naso-pharyngeal reflux (NPR) and esophago-pharyngeal reflux (EPR). Spearman correlation, Mann-Whitney U test and binomial logistic regression were conducted to determine statistical associations between swallow measures and binary reporting of swallow impairments. RESULTS: Videofluoroscopic data of 146 infants were reviewed and analyzed. 49% of infants demonstrated at least one penetration or aspiration event. Total pharyngeal transit time (TPT) and suck-swallow ratio were associated with aspiration (p < .05). Infants with >3 sucks per swallow had significantly longer TPT and their risk of aspiration was greater than those with <3 sucks per swallow (RR 1.23, 95% CI 0.43-8.507, p = .03). Pharyngeal constriction ratio (PCR) and bolus clearance ratio (BCR) were associated with residue, NPR and EPR (p < .05). CONCLUSION: Objective measures provide clinicians with reliable timing and displacement data even in the very young. These measures correlate with swallowing safety and may help to identify enhanced risk in some infants, which may influence management recommendations. KEYWORDS: Deglutition; Deglutition disorders; Dysphagia; Fluoroscopy; Infants; Swallowing disorders.
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    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.
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    Prevalence of functional constipation in infants and toddlers in Sri Lanka.
    (Lippincott Williams & Wilkins, 2015) Walter, H.A.; Hovenkamp, A.; Rajindrajith, S.; Devanarayana, N.M.; Rajapakshe, N.N.; Benninga, M.A.
    OBJECTIVE: To determine the prevalence of functional constipation (FC) in toddlers in Sri Lanka and to identify risk factors associated with the development of FC, such as demographic features, social and economic factors. METHODS: Children between 7 months and 5 years of age were selected from 14 well baby and vaccination clinics in the Gampaha District, Sri Lanka. Data were collected using a self-administered questionnaire. The questionnaire contained questions regarding the child's bowel habits, socio-demographic characteristics as well as physical and verbal violence against mother and/or child. Functional constipation was diagnosed according to ROMEIII criteria. RESULTS: A total of 1151 toddlers were included in the analysis, (female n = 588 [50,8%], mean age 21,7 months, standard deviation [SD] 12,5 months). A total of, 92 children (8,0%) fulfilled the Rome III criteria for FC. The prevalence of constipation was significantly and independently associated with first birth order (9,6% vs. 6,5% p = 0,026), underweight [<2SD] (15,0% vs. 7,1%, p = 0,004) and living in an urban residence (9,5% vs. 5,8%, p = 0,023). Odds ratios [OR] and 95% confidence intervals [CI] are were respectively 1,61 (CI; 1,02-2,53), 2,53 (CI; 1,45-4,41), 1,70 (CI; 1,08-2,69). Toddlers being overweight, being subject to violence or with mothers subject to violence illustrated higher prevalence of FC, but p-values were >0,05. No association was found with gender, age, parental age, parental education level, shortage in income and quality of relationship between parents. CONCLUSIONS: Functional constipation is a significant health problem in toddlers in Sri Lanka, concerning 8 percent of its population between 7 months and 5 years old. Toddlers being first born, underweight and living in an urban area show a significant higher risk for FC.
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    Infant dyschezia in Sri lankan children: epidemiology and risk factors
    (Lippincott Williams & Wilkins, 2015) Hovenkamp, A.; Walter, H. A.; Devanarayana, N.M.; Rajindrajith, S.; Benninga, M.A.
    OBJECTIVES: Little is known regarding functional gastrointestinal diseases in infants, especially in developing countries. Our aim was to assess the prevalence of infant dyschezia in relation to bowel habits and sociodemographic factors in a representative community sample in Sri Lanka. METHODS: A multicenter cross-sectional study was conducted among mothers of 0 -7-month-old infants, attending 14 growth monitoring and immunization clinics in Gampaha District, Sri Lanka. A self-administered questionnaire was used to determine gastrointestinal symptoms, the infant's bowel habits and sociodemographic characteristics for a total of 1004 infants. The questionnaire was translated to the native language (Sinhala) and pretested. Infant colic and infant dyschezia were diagnosed according to the Rome III criteria. RESULTS: The prevalence of infant dyschezia in Sri Lanka was 4.3%. An infant was more likely to suffer from infant dyschezia if he or she was formula-fed (9.6% vs. 7.8% in breast fed and 4.2% in those on additional foods, P = 0.025) or had a highly educated father (mean years of education 13.5 [SD 4.0] vs. 12.3 [SD 2.6] in unaffected children, P = 0.005). No significant association was found between infant dyschezia and age, sex, gestational age, birth order, birth weight, current weight, and presence of domestic violence (P > 0.05). CONCLUSIONS: Infant dyschezia is a significant health problem in Sri Lanka affecting approximately 4.3% of healthy infants. Infants with infant dyschezia are more likely to be formula-fed and have a highly educated father.
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    Bowel habits in Sri Lankan infants and toddlers, a population based study.
    (Lippincott Williams & Wilkins, 2015) Walter, H.A.; Hovenkamp, A.; Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.
    OBJECTIVE: To obtain knowledge about bowel habits in healthy population of infants and toddlers in Sri Lanka. METHODS: We selected healthy children between 7 months and 5 years of age who visited vaccination and weighing clinics. To achieve data we used a self-administered questionnaire about the child's bowel habits during the previous two months. All subjects were selected in Gampaha district, Sri Lanka. Only those without defecation disorders were used for analysis. RESULTS: A total of 879 toddlers were eligible for analysis, (female n = 442 [50,3%], mean age 21,7 months, standard deviation [SD] 12,5 months). Of them, 595 (69,6%) defecated once a day, 20 (2,3%) had defecation >3/week and 6 (0,7%) <3/week. Stool consistency was hard or very hard in 30 (3,4%), 665 (78,9%) had smooth and soft stool and 107 (12,2%) had varying consistency. Straining and painful stool were reported in 560 (64,7%) respectively 194 (23%) of the sample, stool holding was present in 93 (10,8%) and 44 (4,9%) passed blood with the stool. No children reported fecal incontinence. CONCLUSIONS: This study provides data on normal bowel habits of Sri Lankan toddlers and infants. Bowel habits and disorders related to defecation in Sri Lankan toddlers and children differ from those living in the West probably due to dietary, genetic and environmental variations
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    Infantile glaucoma associated with neonatal rubella
    (Sri Lanka Medical Association, 1976) de Silva, D.G.H.; Soysa, P.E.; Rajasimman, S.; Vitarana, U.T.; de Silva, D.D.
    No abstract available
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