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Anuradhapura Medical Journal
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This is an Open Access Journal

Open Access journal
ISSN (Print) 2279-3771
Published by Sri Lanka Journals Online

[71 journals]

Mental health of children from a war affected border village: a cross
sectional comparative study
- Abstract: BackgroundSri Lankan government had a war against terrorism for thirty years in North and East of Sri Lanka. There were villages in the North-East border that the LTTE held territory and the community living in those villages faced frequent attacks during those three decades. The present study was conducted to compare the mental health of children in a war affected border village, with the mental health of same aged children from a village not directly affected by the war. MethodsGrade 8 and 9 students (n=148) from a government school were selected as subjects and a self-administered questionnaire and the validated Sinhalese version of the Strengths and Difficulties Questionnaire (SDQ) were completed. Age matched 138 students were selected as the comparison group, from an area which is socioeconomically similar but not affected by the war as a border village. Same questionnaires were completed by the comparison group. ResultsSubject group consisted of 76 (51%) males and 72 (49%) females. Age ranged from 12-16 years (median 14, IQR 13-14). Majority (n=85, 57.0%) of children living in the border village experienced some kind of an extremely terrifying incident related to the war. Nearly one fifth (n=26, 17.6%) living in the border village, had lost at least one immediate family member due to terrorist attacks. Majority of the border village children (n=94, 63.5%) believed that the war produced a significant negative impact on their lives. Children living in the border village showed 2.5 fold excess risk for a mental health problem (OR 2.5, 95% CI 1.4 to 4.5. Living in a border village carried 3 times excess risk for conduct problems (OR 3.1, 95% CI 1.6 to 6.0). Children living in the border village showed 2 fold excess risk for peer relationship problems (OR 1.9, 95% CI 1.1 to 3.2). Living in a border village carried 2 fold excess risk for hyperactivity/inattention problems (OR 2.3, 95% CI 1.2 to 4.2). ConclusionsMajority of the children living in border village reported different exposures related to the civil war that can cause considerable and long-lasting psychological impact. Children from the border village had a significantly higher risk of showing borderline abnormal values on the SDQ, compared to children not from a border village. It is probable that this is due to the effect of war and its impact on the mental health of the children of the border village. Published on 2018-12-27 00:00:00
Mutlicentric Castleman’s disease presenting in a young patient
- Abstract: Multicentric Castleman's disease (MCD) is a rare lymphoprofilerative disease and Its presentation in a young age population is unusual. Here, we report the case of a 28 year old Sri Lankan, male who was evaluated for lower limb edema and sensory type neuropathy along with skin thickening and pigmentation. He was found to have generalized lymphadenopathy and hepatosplenomegaly. His investigations revealed evidence of demyelinating type sensory- motor polyneuropathy, pulmonary hypertension, hypothyroidism. However studies conducted for HIV viruses and monoclonal gammopathy were negative. An excision biopsy of an Inguinal lymph node of his right side axila revealed changes supportive of a diagnosis of multicentric Castleman's disease. Despite being a rare disease and even rarer in a young population, diagnosis of MCD/POEMS syndrome should be suspected in patients' presenting with similar features described above. MCD is associated with many malignancies and has poor prognosis. Published on 2018-12-27 00:00:00
Prevalence of incidental thyroid carcinoma (ITC) among total
thyroidectomies performed by PSU-UOR on multinodular goiters; how accurate
is the diagnosis and how rational is the treatment'
- Abstract: BackgroundFNAC is regarded as a accurate, safe, and economical technique in identifying thyroid cancer in Mulitnodular goiter (MNG). The aim of our study was to detect the accuracy of FNAC in detecting thyroid cancer among patients undergoing total thyroidectomy at Professorial surgical unit, Teaching Hospital-Galle (PSU-THK). MethodsIndications for total thyroidectomy at PSU-THK include Thy 3-5 on FNAC, retrosternal goiters, those presenting with symptoms suggestive of obstruction or infiltration and cosmesis. However thy1-2 are also offered depending on the situation. Patients who had undergone total thyroidectomy for MNG with FNAC reporting Thy1-2, as well as those with Thy-3 FNAC, from 1st April 2014 to 31st march 2016 were analyzed. ResultsThree hundred and forty two patients completed selection criteria for the study and 299 of them were females. Forty five point six percent belonged to the 20-39 age group and 38.89% belonged to the 39-64 age group. Two hundred ad eighty-four had Thy1-2 FNAC while 58 had Thy-3. Of the Thy 1-2 group, 212 had colloid goiter on FNAC and 54 had thyroiditis. Histology revealed malignancy in 14 female patients, 9 papillary and 4 follicular. Among the 58 patients of Thy 3, 15 had confirmed malignancy with 10 papillary and 4 follicular. The policy practiced by PSU-UOR in offering total thyroidectomy to MNGs in Thy1- 2 group is justified as the study shows them to have 4.93% risk of ITC. A similarly policy of offering total thyroidectomy to all the cases with Thy3 MNGs is recommended as the requirement of a second operation is high. ConclusionFurther research need to be carried out to identify thyroid cancer in MNGs with Thy 1-3 cytology, allowing clinicians to offer total thyroidectomy for more solid indications. Published on 2018-12-27 00:00:00
Teaching life skills through arts; an option for adolescent health
promotion in resource poor settings
- Abstract: BackgroundLife skills prepare teenagers to face challenges in daily life. This study describes a novel art based life skills training programme that takes vulnerabilities and available opportunities for individual participant into account, to promote health of adolescents in resource poor settings. MethodsA 2 hour session with two drawing activities followed by facilitated discussion was conducted for 42 students aging 13 to 16 years at a rural school. Drawings of the students were observed and themes were identified. Observation memos were documented during discussions and drawing activities. Anonymous written Feedback obtained at the end was analyzed thematically and triangulated with observations. ResultsEnthusiastic participation across all age groups was observed. The programme was described as interesting, clear and motivating. Students getting an understanding on applicability of life skills to overcome their personal challenges were observed during discussion and through feedback. ConclutionThe programme requires minimum resources and can provide an individualized active life skill learning opportunity to adolescents in low resource settings. Long term outcomes need to be assessed objectively. Published on 2018-12-27 00:00:00
Thyrotoxicosis presenting with pancytopenia: a case report
- Abstract: Thyrotoxicosis can present with a wide array of clinical manifestations, among which pancytopenia is a rare entity. The disease itself, as well the treatment, can result in pancytopenia which makes the diagnosis more difficult and crucial. The mechanisms underlying are poorly understood currently. Antithyroid drugs which are well known to produce cytopenias as a side effect can safely be implemented in the management. Pancytopenia of thyrotoxicosis should completely reverse with the establishment of euthyroid state. We report a rare case of thyrotoxicosis presenting with pancytopenia which completely resolved with antithyroid treatment. Published on 2018-12-27 00:00:00
Analysis of gaps in the correct diagnosis of leishmaniasis at primary care
level; socio-demographic and environmental risk factors of leishmaniasis
transmission in Anuradhapura
- Abstract: BackgroundThe leishmaniasis is an emerging health problem in dry zone of Sri Lanka. The multiplicity of factors involved in the transmission of leishmaniasis constitutes a challenge to its control. Knowledge of such factors may contribute to identify the control strategies. Although Medical officers have been given training on leishmaniasis, still patients with leishmaniasis had been diagnosed incorrectly. Aim of the study was to analysis of the diagnosis pattern of leishmaniasis patients by the primary care medical officers and to identify potential socio demographic and environmental risk factors of leishmaniasis transmission. MethodsA descriptive cross sectional study conducted among the leishmaniasis patients attending to the Dermatology clinic, Teaching Hospital Anuradhapura during November 2015 to November 2016 using interviewer administered questionnaire. Results The study sample was 300 leishmaniasis patients .Male to female ratio was 2:1.The commonest affected age group was 20 to 40 years .Lesser number (33%) had heard about leishmaniasis. Nearly one forth (23%) of patients had been diagnosed incorrectly at the primary health care level. Nearly 50%of patients got leishmaniasis due to occupation related activities. Most (75%) of patients had paddy fields, large number of Banana bushes, Manna bushes and large wild area near their residence. Nearly 50% of patients had water channel near their residence. All most all (96%) patients use bed nets. ConclusionNearly one forth of patients missed diagnosis at the primary health care level. Paddy fields, Banana bushes, Manna bushes, large wild area and water channels close to residence may play role in leishmaniasis transmission. Published on 2018-12-27 00:00:00
Is Cancer Screening a Priority among Adult Females in Sri Lanka'
- Abstract: We assessed the use of well women clinics (WWC) screening services for cervical and breast cancer prevention in a sample of females attending the largest religious festival in Sri Lanka. Of the 3,116 women studied, 2, 874(92.2%) were aware on breast cancer and 2, 609(83.7%) on cervical carcinoma. Of them only 1,895 (60.8%) were aware of the WWC services, but only 578 (18.5%) had ever used the services. Of the 217 professionals or associate professionals in the study sample, 190 (87.6%) were aware of the WWC compared to only 58.8% among the 2,899 women falling under the categories of other occupations and housewives. Clinic attendance was also significantly higher amongst professionals and associate professionals compared to women in other occupational categories and housewives (40.1% versus 16.9%). Use of cancer screening services are low and new strategies needed to improve the secondary prevention of these cancers in Sri Lanka. Published on 2018-09-18 22:11:53
A rare presentation of Guillain -Barre syndrome:
Pharyngeal-cervical-brachial variant
- Abstract: Guillain-Barre syndrome is characterized by acute onset symmetrical , generalized, ascending weakness with areflexia. It has wide variety of subtypes according to the involvement of muscle and nerve groups. We describe a case of 70 year old lady developing a rare form of GBS, the pharyngeal-cervical-brachial variant of the disease. Published on 2018-09-17 00:40:26
Lung function assessment in preschool children; a review of the utility of
basic spirometry, interrupter technique and forced oscillation technique
- Abstract: Objective lung function assessment in preschool children is a challenge; the mechanics of the lungs are changing rapidly with advancing age and maturation, the population is too old to ethically justify routine sedation prior to lung function assessment, as in infants, and also, they are too young to be able to focus sufficiently and perform elaborate respiratory manoeuvers required by commonly used lung function tests in older children and adults. But, clinically, a clear evidence based demarcation between isolated non-significant episodes of respiratory symptoms and pathognomonic symptoms is vital for the management. Even though many different lung function techniques are commonly used in the assessment of preschool children, the purpose of this review is to evaluate three commonly used pulmonary function tests, viz. basic spirometry, interrupter technique and forced oscillation technique in order to assess their usefulness in preschool children. We conclude that contrary to common misbelief, ample evidence exists that preschool children are capable of performing lung function tests. Basic spirometry, which stood the test of time, remains one of the most commonly used lung function tests. The interrupter technique and the forced oscillation techniques are quickly gathering reputation as reliable alternatives for lung function assessment in preschool children, especially due to the minimal co-operation required from the subject and the versatility of the test. These techniques will enable definitive diagnosis, assessment of severity and the therapeutic response of multiple, complex and often challenging clinical respiratory conditions to enable efficient management Published on 2018-09-06 00:40:52
Factors affecting respiratory function of rice millers in Anuradhapura
district
- Abstract: IntroductionRice is the most important crop cultivated in Sri Lanka and rice milling is the largest agro-based industry in the country.ObjectivesTo compare lung functions of rice millers and controls with predicted normal values for Sinhalese and to determine the effects of rice husk dust on lung functions of rice millers in relation to length (years) of exposure.MethodsRice millers (male: 84, female: 84) and controls (male: 84, female: 84) were selected and matched for determinants of lung functions. Data were collected via a validated questionnaire and spirometry. Observed mean lung functions were compared with lung function norms published for non-smoking Sinhalese.ResultsMost of the male millers and controls were smokers while none of the females were. All mean lung functions tested FVC, FEV1, PEFR and FEF25-75%, were significantly lower than the predicted values among male millers. While some lung functions were significantly reduced in female millers and male controls, all were comparable with predicted values in female controls. Duration of employment in rice mills was significantly and inversely related to FVC and FEV1 of millers.ConclusionsObserved deficiencies in lung functions of rice millers were probably caused by occupational exposure to rice husk dust and tobacco smoke. The cumulative effect of the two were found to be more harmful than each alone. Wearing face masks, worker education and adequate ventilation in mills are recommended. Advantages of cessation of smoking should be further stressed to communities of lower socioeconomic and educational backgrounds. Published on 2018-09-04 15:58:33