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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Challenges faced in establishing a pediatric liver transplant program in a lower‐middle‐income country with free healthcare service(Wiley, 2024) Fernando, M.; Tillakaratne, S.; Gunetilleke, B.; Liyanage, C.; Appuhamy, C.; Weerasuriya, A.; Uragoda, B.; Welikala, N.; Ranaweera, L.; Ganewatte, E.; Dissanayake, J.; Mudalige, A.; Siriwardana, R.ABSTRACT: BACKGROUND: Liver transplant is the cure for children with liver failure. Sri Lanka is a lower-middle-income country with a predominant free, state health system. Pediatric liver transplant program in Sri Lanka is still in the budding state where the initial experience of the program is yet to be documented. METHODS: A retrospective review was performed including the clinical characteristics of all pediatric liver transplant recipients of Colombo North Centre for Liver Diseases since the inception of the program from June 2020 to May 2023. RESULTS: There were 14 PLT performed in 3 years. The median recipient age and weight were 8 years (6 months–15 years) and 23.3 kg (6.4–49.2), respectively. The majority were boys (64%). All were from low-income backgrounds. Indications for LT were acute liver failure (5/14), decompensated chronic liver disease (5/14), and acute on chronic liver failure (4/14). Underlying liver diseases were Wilson disease (6/14), autoimmune liver disease (3/14), biliary atresia (2/14) and progressive familial intrahepatic cholestasis type 3 (1/14), and unknown etiology (2/14). The majority were living donor liver transplants (86%). Of the living donors, 42% (5/12) were Buddhist priests. There were three immediate deaths and two late deaths. The 3-month survival was 78%, and overall survival was 64%. Living donor transplants carried a higher success rate (92%) compared to diseased donor transplants (0%; 2/2). CONCLUSIONS: Initial experience of pediatric liver transplant program of Sri Lanka is promising despite being established in a free healthcare system amidst the crisis circumstances.Item Screen addiction among children and adolescents and the self-efficacy of mothers in screen use management during the COVID-19 lockdown in Sri Lanka(Sri Lanka College of Psychiatrists, 2023) Baminiwatta, A.; Nanayakkara, T.D.; Fernando, A.; Wijethunga, S.BACKGROUND: The prevalence of problematic screen use (PSU) or “screen addiction” among children and adolescents may have escalated during the COVID-19 pandemic. The self-efficacy of the mothers in managing screen use in their children may play an important preventive role in children developing PSU. AIMS: This study aimed to assess PSU among children aged 4-18 years during the lockdown period imposed during the COVID-19 pandemic and to explore the association between PSU and self-efficacy of mothers in managing screen use. METHODS: An online survey was conducted using social media groups among mothers of children aged 4-18 years. The PSU in their children was measured using the Problematic Media Use Measure (PMUM), and maternal self-efficacy in managing screen use was assessed using the Parental Screen Use Management Scale (PSUMS). The two questionnaires were translated and validated into Sinhala prior to this study. RESULTS: A total of 320 mothers responded to the survey. Based on the PMUM cut-off score, 25.3% of the children were found to have PSU. PSU was inversely correlated with maternal self-efficacy in managing screen use (r=-0.63, p<0.001). All three subscales of the PSUMS; reactive management (r=-0.56, p<0.001), proactive management (r=-52, p<0.001), and monitoring (r =-45, p<0.001), were significantly correlated with PSU. Younger age at screen use onset showed a marginal correlation (rho=-0.11, p=0.05) with PSU. The child’s age, gender and the educational level of the mother were not associated with PSU. CONCLUSION: Maternal self-efficacy in managing screen use among children was associated with lower PSU in children.Item 24 h activity guidelines in children and adolescents: A prevalence survey in Asia-Pacific cities(MDPI, 2023) Quah, P.L.; Loo, B.K.G.; Mettananda, S.; Dassanayake, S.; Chia, M.Y.H.; Chua, T.B.K.; Tan, T.S.Z.; Chan, P.C.; But, B.W.; Fu, A.C.; Wong, S.M.; Nagano, N.; Morioka, I.; Kumar, S.; Nair, M.K.C.; Tan, K.H.This study aimed to examine the prevalence of adherence to 24 h activity guidelines in children and adolescents from Asia-Pacific cities. In 1139 children aged 5-18 years, moderate-to-vigorous physical activity (MVPA), screen viewing time (SVT), sleep duration, child weight, height, sex, and age were parent-reported. Descriptive statistics were used to assess the number of guidelines met, and prevalence of adherence to activity guidelines by city and child sex. Prevalence of meeting all three 24 h activity guidelines was low across all countries (1.8-10.3%) (p < 0.05). Children from Thiruvananthapuram, India had the highest [10.3% (95% CI: 6.0-17.0)], while those from Tokyo, Japan had the lowest prevalence [1.8% (95% CI: 0.5-7.0)] of meeting all three guidelines. The highest prevalence of meeting individual MVPA, SVT and sleep guidelines was found in India [67.5% (95% CI: 58.8-75.1)], Kelaniya, Sri Lanka [63.2% (95% CI: 58.7-67.4)] and Kowloon, Hong Kong [59.4% (95% CI: 51.1-65.3)], respectively. Overall, a higher prevalence of boys met all three guidelines, compared to girls [5.9% (95% CI: 4.1-8.1) vs. 4.7% (3.1-6.6), p = 0.32]. The prevalence of adhering to all three activity guidelines was low in all five participating cities, with a higher proportion of boys meeting all guidelines.Item Thinness negatively affects lung function among Sri Lankan children(Public Library of Science, 2022) Senevirathna, N.; Amarasiri, L.; Jayamanne, D.; Manel, K.; Liyanage, G.Background: There have been conflicting findings on the effect of body mass index (BMI) on lung functions in children. Therefore, we studied the relationship between spirometry parameters and BMI among healthy Sri Lankan school children aged 5-7 years. Methods: A cross-sectional study was conducted among 296 school children (5-7-year-old) without apparent lung disease. Recruitment was done with stratified random sampling. Spirometry parameters, FEV1, FVC, PEFR, and FEV1/FVC ratio were determined. The acceptable and reproducible spirometry recordings were included in the analysis. Simple and multivariate linear regression analysis examined possible associations of lung function parameters with BMI, socio-demographic variables and indoor risk factors. Also, the mediator effect of gender on lung function through BMI was explored. Results: The participants' mean age (SD) was 6.4 (0.65) years. One-third were thin/severely thin (37%). A statistically significant difference in FVC (p = 0.001) and FEV1 (p = 0.001) was observed between BMI groups (obesity/overweight, normal, and thinness). Yet, PEFR or FEV1/FVC did not significantly differ among BMI groups (p = 0.23 and p = 0.84). Multivariate regression analysis showed that FEV1 and FVC were significantly associated with BMI, child's age, gender, family income, father's education, having a pet, and exposure to mosquito coil smoke. Interaction between gender and BMI for lung functions was not significant. The thin children had significantly lower FVC (OR: -0.04, 95%CI: -0.077, -0.012, p = 0.008) and FEV1 (OR: -0.04, 95%CI: -0.075, -0.014, p = 0.004) than normal/overweight/obese children. Family income demonstrated the greatest effect on lung functions; FVC and FEV1 were 0.25L and 0.23L smaller in low-income than the high-income families. Conclusion: Lower lung function parameters (FVC and FEV1) are associated with thinness than normal/overweight/obese dimensions among children without apparent lung disease. It informs that appropriate nutritional intervention may play a role in improving respiratory health.Item Auditory brainstem response for Sri Lankan children under 5 years of age: Normativedata(College of Otorhinolaryngologists and Head and Neck Surgeons of Sri Lanka, 2021) Ileperuma, L.D.; Weerasinghe, V.S.; Wickremasinghe, A.R.Abstract For years Sri Lankan Audiologists resorted to western norms in the interpretation of Auditory Brainstem Response (ABR) in the absence of national standards. The study focused on establishing normative data on ABR for Sri Lankan children below 5 years. ABR was performed on 258 healthy children between 6 weeks and 5 years of age to gather data on absolute latencies and inter-peak latencies.All inter-aural differences were within 0.2-0.4ms. The mean inter-aural difference for the study sample was significantly small (-0.0204ms to 0.0286ms). Mean values of absolute latencies for waves I, III, V for the 6-week age group at 30dBnHL were 3.33 ms, 5.91 ms and 8.27 ms respectively. Mean values of inter-peak latencies of wave I-III, III-V, I-V were 2.08 ms, 2.36 ms and 4.76 ms respectively for the 6-week age group at 30 dBnHL. The normative ABR data obtained in this study may be used across audiology clinics in Sri Lanka as a baseline measurement to diagnose hearing loss among children from infancy to 5 years of age when children are tested in their natural sleep and insert earphones are used. The mean value plus 2 standard deviations for each ABR measure may be used as the upper limit cutoff values. Hence this study helps eliminate misdiagnosis and under-diagnosis of hearing loss in children.Item Use of electronic devices and screen time of pre-school children in Homagama Medical Officer of Health area(Sri Lanka Medical Association, 2021) Rathnasiri, G.B.A.M.; Rathnayaka, H.; Yasara ,N.; Mettananda ,S.Introduction and objectives Electronic device use and screen time are increasing health problems in children. Here, we aim to describe the use of electronic devices and screen time in preschool children in the Homagama Medical Officer of Health area. Methods A cross-sectional study was conducted in the Homagama Medical Officer of Health area from January to March 2020 before the COVID-19 travel restrictions. All children aged between 3-5 years attending ten randomly selected pre-schools were recruited into the study. Data were collected using a parent-administered questionnaire and analysed using logistic regression in SPSS. Ethical approval was obtained from Sri Lanka College of Paediatricians. Results A total of 320 children (Male-48.1%; mean age-50.1±6.9 months) were recruited. Electronic devices were used by 95.6% of children. The use of different devices were; television-86.8%, smartphone- 62.9%, laptop- 15.9%, tablet- 8.2% and desktop-5.6%. Of these children, 20.9% used devices for more than 2 hours, and 18.7% commenced using devices before one year. Higher education level of father was independently associated with use of smartphones [OR-3.3(1.8-6.3); p<0.001] and laptops [OR-6.6(1.7-25.3); p<0.01] and screen time >2 hours [OR-3.1(1.3-7.2); p<0.01]. Male sex [OR-1.7(1.02- 2.8); p<0.05] and being the only child [OR-2.1(1.2-3.6); p<0.01] was associated with use of smartphones whereas maternal employment was associated with use of laptops [OR-2.2(1.07-4.5); p<0.05]. Conclusion Electronic devices were used by over 95% of preschoolers, and over one-fifth used them for more than the recommended upper limit of 2 hours. Higher paternal education, maternal employment and being the only child were significantly associated with electronic device use.