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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 How do we define normal bowel frequency from newborn to teens?:A Bayesian meta-analysis(Wiley, 2024-12) Munasinghe, S.; Manathunga, S.; Hathagoda, W.; Kuruppu, C.; Ranasinghe, P.; Devanarayana, N. M.; Baaleman, D. F.; Benninga, M. A.; Rajindrajith, S.OBJECTIVES Defecation disorders are a common pediatric problem and bowel frequency is crucial in identifying them. The aim of this analysis is to define normal bowel frequencies in healthy children ranging from newborns to adolescents. METHODS A literature search was conducted using MEDLINE, SCOPUS, EMBASE, Cochrane Library, and Web of Science from their inception to February 2024, aiming to identify studies reporting bowel habits of healthy children (0–18 years). A Bayesian distribution modeling approach was adopted to pool the mean frequency of bowel opening using inverse-variance weighing. A subgroup analysis and a meta-regression were performed with Bayesian generalized additive mixed distributional models. The methodological quality of the articles was evaluated using the Newcastle–Ottawa Scale modified for cross-sectional studies. RESULTS Seventeen studies were included in the analysis, including 22,698 children aged from 0 to 18 years. The subgroup meta-analysis showed mean bowel frequencies for newborns, 1–6 months, 6–12 months, 1–2 years, 2–5 years, and over 5 years are 3.24 (95% credible interval [CrI]: 2.83–3.63), 1.99 (95% CrI: 1.77-2.19), 1.66 (95% CrI: 1.45–1.88), 1.53 (95% CrI: 1.37–1.7), 1.15 (95% CrI: 0.99–1.31), and 1.02 (95% CrI 0.88–1.18), respectively. Between studies, heterogeneity demonstrated a near-normal distribution with a mean of 0.16 and a 95% CrI of 0.04–0.28. The variance of the distribution of mean bowel frequency reduced with age. DISCUSSION In this Bayesian meta-analysis, we found that younger children have a higher bowel frequency. The reported bowel frequencies for each age group could serve as normal values in clinical practice to differentiate health and disease.Item Epidemiological patterns and trends of paediatric snakebites in Sri Lanka(Biomed Central, 2024-12) Dayasiri, K.; Caldera, D.; Suraweera, N.; Thadchanamoorthy, V.; Hettiarachchi , M.; Denipitiya, T.; Bandara, S.OBJECTIVES This study aimed to analyse the epidemiological patterns of paediatric snake bites in Sri Lanka over a 4-year period (2020-2024).METHODS A multi-centre, retrospective observational study was conducted from June 2020 to June 2024 across nine governmental hospitals in seven provinces of Sri Lanka. Data were collected based on 757 children presenting with snake bites. The snake bites were analysed based on age, gender, and seasonal variations. Data on the type of snake involved, geographic variations and the temporal trends in snake bite occurrences were also analysed.RESULTS The mean age of the 757 children recruited to the study was 10.3 years (SD-5.00, range-0.1-17 years). Males (57.7%) were significantly more affected than females (42.3%) (p < 0.05). Visual identification confirmed the snake species in 58.4% of cases. The hump-nosed viper (16.7%), Russell's viper (14.7%), and common krait (12.9%) were the most common medically important snakes identified in the study. Seasonal peaks in snake bites occurred in May-July and November-December. An increasing trend in snake bite incidence was noted over the first three years, with a slight decline in the final year.CONCLUSION Paediatric snake bites in Sri Lanka show significant age, gender, and seasonal patterns. Targeted public health interventions are needed to mitigate the impact on children.Item Knowledge, attitudes, and beliefs about liver transplantation among caregivers of children with liver diseases; a single centre experience from Sri Lanka(Sri Lanka Medical Association, 2023) Gunaratne, A.L.S.N.; Gunarathna, P.G.P.D.; Gunawardana, A.D.J.N.; Hansamali, U.V.S.; Heenkenda, H.M.A.N.; Ekanayaka, J.; Fernando, C.M.P.INTRODUCTION: Paediatric Liver transplantation (PLT) is evolving in Sri Lanka. There is no data documented related to caregivers' knowledge of PLT. OBJECTIVES: To determine the knowledge, attitudes, and beliefs about liver transplantation (LT) among caregivers of children with liver diseases. METHODS: A descriptive cross-sectional study was conducted among the caregivers attending the paediatric liver clinic at Ragama. The calculated sample size was 186. Data were collected using an interviewer-administered questionnaire. Descriptive statistics with SPSS 27.0 were used for analysis. Ethical approval was obtained from the Faculty of Medicine, Ragama. Since there were no previous similar studies, as the tool, we used a newly designed, pre-tested questionnaire which included the basic facts about the knowledge of LT. RESULTS: Of 186 caregivers, the majority were mothers (n=107, 57%). A mixed religious background was noted with Buddhists, Catholics, Islam and Hindus being 80%, 11%, 7% and 2% respectively. Most were educated up to or above the GCE ordinary level (n=180, 97%). The majority (n=124, 68%) were from low-income families with a monthly income of less than 50,000 LKR. Almost half of the participants, 89 (47.8%) knew someone who had undergone an LT. Knowledge of having PLT within the country, living donation, diseased donation, blood group matching and life-long medications were accurate in 171 (91.9%), 170 (91%, 75 (40%), 172 (92%), 116 (62%) respectively. Regarding the beliefs and attitudes towards LT, 170 (91%) were willing to donate and 144 (77%) indicated to support LT. There were 32 (17%) who believed that liver diseases can be cured with alternative medicine and 103 (55%) believed being religious would result in better outcomes. CONCLUSION: Knowledge of LT among caregivers is promising with a positive attitude. Some of their beliefs seem to be non-scientific.Item Fathers’ attitudes towards father-child interaction and how they interact with their children aged 2 - 2 ½ years in the home setting in the Puttalam District.(University of Kelaniya, Sri Lanka, 2023) Perera, S.; Hamsa, S.OBJECTIVE/S: The general objectives of this study were to describe fathers’ educational level and socioeconomic status and their effect on their attitudes about father-child interaction, and the quality and the frequency of home-based language strategies used by them with their children aged 2 - 2 ½ years in home setting in Puttalam District. The specific objectives were; To determine whether fathers’ educational level affects their attitudes about father-child interaction and home-based language strategies used by them. To determine whether the fathers’ educational level affects the frequency of home-based language strategies used by them. To determine whether fathers’ socioeconomic status affects their attitudes about father- child interaction and home-based language strategies used by them. To determine whether the fathers’ socioeconomic status affects the frequency of home- based language strategies used by them. METHODS: A Quantitative Cross-sectional study design was conducted with 300 participants who were fathers of typically developing children aged 2 - 2 ½ years. Participants were recruited from MOH clinics in Puttalam District. Data collection of the study was done onsite through a self- administered questionnaire including 4 parts as family demographics, fathers’ educational and socioeconomic status (SES), fathers’ attitudes towards father-child interaction, and quality and frequency of father-child interaction. Data was analyzed using SPSS software. RESULTS: Most of the participants with good attitudes about father-child interaction are fathers aged 40-50 years and fathers whose educational level is from Advanced to graduate level. Most home-based language strategies are also used by fathers aged 40-50 but by fathers with educational levels below Advanced Level. A minority of the participants with good attitudes about father-child interaction are young fathers aged 20-40. Most participants in the self-employing sector have good attitudes about father-child interaction. Fathers who work less than 8 hours per day interact more with their children than fathers who work more than 8 hours per day. CONCLUSION/S: The findings of this study conclude that the educational level and the SES of the fathers affect their attitudes about father-child interaction and the quality and frequency of home-based language strategies used by them. The findings describe that attitudes are ‘good’ when the educational level and the SES are high. But, the quality and the frequency of home-based language strategies are ‘good’ when educational level and SES are low. The age level of fathers directly affects their attitudes and usage of 25 home-based language strategies. The findings confirm that mature fathers have ‘good’ attitudes and high quality and frequency of home-based language strategies than young fathers. Furthermore, the findings describe that fathers’ working hours per day affect their time of interaction with their children. It contributes to determining that the interaction time decreases when the working hours per day increase.Item Childhood constipation: Current status, challenges, and future perspectives(Baishideng Publishing Group, 2022) Rajindrajith, S.; Devanarayana, N.M.; Benninga, M.A.Constipation in children is a major health issue around the world, with a global prevalence of 9.5%. They present to clinicians with a myriad of clinical signs. The Rome IV symptom-based criteria are used to diagnose functional constipation. Functional constipation is also a huge financial burden for healthcare system and has a detrimental impact on health-related quality of life of children. There are various risk factors identified globally, including centrally connected factors such as child abuse, emotional and behavioral issues, and psychological stress. Constipation is also precipitated by a low-fiber diet, physical inactivity, and an altered intestinal microbiome. The main pathophysiological mechanism is stool withholding, while altered rectal function, anal sphincter, pelvic floor, and colonic dysfunction also play important roles. Clinical evaluation is critical in making a diagnosis, and most investigations are only required in refractory patients. In the treatment of childhood constipation, both nonpharmacological (education and de-mystification, dietary changes, toilet training, behavioral interventions, biofeedback, and pelvic floor physiotherapy), and pharmacological (osmotic and stimulant laxatives and novel drugs like prucalopride and lubiprostone) interventions are used. For children with refractory constipation, transanal irrigation, botulinum toxin, neuromodulation, and surgical treatments are reserved. While frequent use of probiotics is still in the experimental stage, healthy dietary habits, living a healthy lifestyle and limiting exposure to stressful events, are all beneficial preventive measures.Item Constipation in children: the Sri Lankan perspective(Sri Lanka Medical Association, 2021) Hathagoda, W.; Rajindrajith, S.; Devanarayana, N.No Abstract available