Sanath P. Lamabadusuriya

The Sri Lankan Cleft Lip and Palate Project: The Unoperated Cleft Lip and Palate:

Since 1984, the Sri Lankan Cleft Lip and Palate Project has developed a large surgical and research program collecting records on over 500 subjects with unrepaired cleft lip and palate. In addition, 410 operations were performed by Project and will be followed by individual reports on facial growth and morphology, speech, surgical and anesthetic aspects, and the otologic significance of cleft palate in this issue and subsequent ones.

Defining anthropometric cut-off levels related to metabolic risk in a group of Sri Lankan children

Background: Body mass index (BMI) is widely used as a measure of adiposity. However, currently used cut-off values are not sensitive in diagnosing obesity in South Asian populations. Aim: To define BMI and waist circumference (WC), cut-off values representing percentage fat mass (%FM) associated with adverse health outcomes. Subjects and methods: A cross-sectional descriptive study of 285 5–14 year old Sri Lankan children (56% boys) was carried out. Fat mass (FM) was assessed using the isotope (D2O) dilution technique based on 2C body composition model. BMI and WC cut-off values were defined based on %FM associated with adverse health outcomes. Results: Sri Lankan children had a low fat free mass index (FFMI) and a high fat mass index (FMI). Individuals with the same BMI had %FM distributed over a wide range. Lean body tissue grew very little with advancing age and weight gain was mainly due to increases in body fat. BMI corresponding to 25% in males and 35% in females at 18 years was 19.2 kg/m2 and 19.7 kg/m2, respectively. WC cut-off values for males and females were 68.4 cm and 70.4 cm, respectively. Conclusion: This chart analysis clearly confirms that Sri Lankan children have a high %FM from a young age. With age, more changes occur in FM than in fat free mass (FFM). Although the newly defined BMI and WC cut-off values appear to be quite low, they are comparable to some recent data obtained in similar populations.

A study of the serum carotenoids of eight cases of hypercarotenemia in Sri Lanka

Over-consumption of absorbable carotenoids causes hypercarotenemia. Although hypercarotenemia is detected in Sri Lanka, a detailed study on this condition has not been carried out previously. Two millilitres of venous blood was drawn from hypercarotenemic patients (n=8) and examined by high-performance liquid chromatography for carotenoids and vitamin A. A common high-performance liquid chromatographic pattern in serum was shown by six of the cases with β-carotene (9.9–35.7 µg/dl), β-cryptoxanthin and monohydroxy metabolites collectively (5.3–48.5 µg/dl), and six to eight metabolites of dihydroxy, trihydroxy and polyhydroxy metabolites (22.5–282.1 µg/dl). Vitamin A levels were within the normal range (32–61 µg/dl). However, two cases identified were abnormal. The first of these showed low β-carotene (3.5 µg/dl) and no β-cryptoxanthin and monohydroxy metabolites, but normal dihydroxy, trihydroxy and polyhydroxy metabolites (128.2 µg/dl). However, the vitamin A level was high (75.2 µg/dl). The other case showed high β-carotene (212.3 µg/dl) and β-cryptoxanthin (49.3 µg/dl) but no normal monohydroxy, dihydroxy, trihydroxy and polyhydroxy metabolites. Instead there was an atypical metabolite (343.9 µg/dl). According to the present study, excessive intake of boiled, homogenized carrot and ripe papaw is the main causative factor for hypercarotenemia. Over-consumption of carotenoids-rich plant foods may be complicated in the case of individuals having defects of either the control of the 15,15′-dioxygenase activity or metabolism of carotenoids.

Cerebral thrombosis in beta-thalassaemia major.

Two patients with homozygous beta thalassaemia complicated by cerebral thrombosis are reported. An alteration in coagulability due to a sudden increase in haematocrit and platelets was the probable cause in one patient. Although the other patient had many complications of thalassaemia, the cause for cerebral thrombosis was not identifiable.

Studies on hypercarotenemia due to excessive ingestion of carrot, pumpkin and papaw

Hypercarotenemia is diagnosed by yellowing of skin. The present study was carried out to study the carotenoids, their metabolites and the vitamin A levels in hypercarotenemics on reporting, changes in serum carotenoids following cessation of feeding carotenoid-bearing foods, and to determine the carotenoids in stools of hypercarotenemics and non-hypercarotenemics. Hypercarotenemic subjects (n = 35) were tested on reporting for a 2-month to 3-month period. Feces from hypercarotenemics (n = 5) and non-hypercarotenemics (n = 8) were extracted and subjected to reverse phase-high-performance liquid chromatography. A questionnaire was administered to parents (n = 35) of these hypercarotenemic children. The serum α- and β carotenoids varied from 119 g/dl to trace and from 149 g/dl to trace respectively, with the monohydroxy metabolites varying from 214 g/dl to nondetectable and polyhydroxy metabolites from 823 g/dl to 7.0 g/dl. Longitudinal studies indicated that serum carotenoid levels declined while vitamin A levels were maintained. α-Carotenes and β-carotenes were not detected in the feces of hypercarotenemics but were present in non-hypercarotenemics.

A snapshot of the pioneering personalities in the Paediatric Scenario in Sri Lanka

The Lady Ridgeway Hospital (LRH) for Children is the premier, exclusively paediatric hospital, in Sri Lanka. It was opened in 1910 and named after the former First Lady, Lina Ridgeway, the wife of the former British Governor of Ceylon, the name used to describe this resplendent island at that time. LRH is now, arguably, the largest Children’s Hospital in the world with a bed strength of over 1100.