Browsing by Author "Nishad, A.A.N."

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Burnout among Intern Medical Officers in selected Teaching Hospitals: a cross-sectional descriptive study
(Sri Lanka Medical Association, 2016) de Silva, S.T.; Dahanayaka, N.; Ralapanawa, U.; Nishad, A.A.N.; Silva, F.H.D.S.; Shyamali, N.L.A.; Wanigasuriya, K.
INTRODUCTION: Burnout is characterized by emotional exhaustion, depersonalization and reduced personal accomplishment, occurring due to chronic emotional and interpersonal stressors. Burnout is well recognized among medical doctors. Identifying and, where possible, treating burnout is critical, as it has a major impact on the quality of life of doctors, patient safety and health outcomes. OBJECTIVES: Research on burnout in the medical community of Sri Lanka is scarce. Our objective was to determine the prevalence and risk factors for burnout among intern medical officers (IMOs), who are likely to be at high risk. METHOD: Consenting IMOs in Medical, Surgical, Paediatrics and Obstetric and Gynaecology Units of Teaching Hospitals in Colombo South, Colombo North, Peradeniya, Kandy and Karapitiya were administered three standard, validated, self-administered questionnaires on burnout. RESULTS: 124 IMOs participated; 79(62.9%) were females. Mean age was 27.4 years. Oldenburg Burnout Inventory: 75/124(60.5%) suffered from disengagement, and 77/124(62%) from exhaustion. Abbreviated Maslach Inventory: 47/124(38%) suffered from emotional exhaustion, 20/124(16.1%) from depersonalization, and 6/124(5%) from poor personal accomplishment. Work and lifestyle-related causes (ie heavy and monotonous work-load, lack of control over work-load, chaotic work environment, inadequate rest and sleep, lack of help, and absence of a supportive relationship) were significantly associated with higher burnout scores. CONCLUSIONS: Burnout appears to affect approximately 1 in 3 IMOs in our sample. Most work and lifestyle related risk factors for burnout are modifiable. Further studies are needed to identify causes of burnout among IMOs. A system to detect and treat burnout, particularly among IMOs, is an urgent
Developing a severity index on day 4 to predict severe dengue infection in adults
(Sri Lanka Medical Association, 2012) Wijewantha, H.S.; Premaratna, R.; Nishad, A.A.N.; Mabharana, I.D.M.; de Silva, A.P.; Waraketiya, P.R.; Niriella, M.A.; de Silva, H.J.
INTRODUCTION: Dengue causes high morbidity and mortality among adults in Sri Lanka. Early prediction of severe illness would help to reduce morbidity and mortality. Studies to identify predictors of severe dengue in adults are sparse. AIMS: To identify predictors of severe dengue infection by the fourth day of illness. Methods: Symptoms, signs and investigation results on the 4th day of illness were compared between two groups of patients with serologically confirmed dengue over 6 months from 1st of March 2011; Group A (severe illness: evidence of fluid leakage, compensated shock, profound shock). Group B (non-severe illness). RESULTS: Of 117 adults 9meanage 32 yrs (SD= 13.3) and 95 males) 27 fell into Group A and 90 into group B. On day 4 of illness serum aminotransferases (AST and ALT) were significantly higher in Group A than group B [AST: 260 iu/1 (SD=168.8] vs 145 iu/l(SD 135.11), p=0.005; ALT: 247 iu/1 (SD= 161.5) vs 105 iu/1 (SD= 91.5), p=0.002]. Overall AST (r=0.3, p=0.038) and ALT (r=0.3, p=0.045) had a positive correlation with haematocrit (PCV). An index was developed using stepwi-se multivariate discriminant function analysis to predict severe infection by the 4th day. A severity Index, [(0.082 x PCVD4) + (0.02 x PlateIetD4) + (-0.006 x ASTD4) -3.677] of <-0.258 predicted severe infection with 73.7 % specificity, 73.8% sensitivity, 56% positive predictive value and 86% negative predictive value. CONCLUSIONS: A severity index <-0.258 calculated on the 4th day of illness may predict severe infection among adult dengue patients. This must now be validated prospectively.
Do thalassaemic patients, their parents and caregivers support termination of pregnancy as a method for thalassaemia prevention?
(Sri Lanka Medical Association, 2011) Nandasiri, A.S.D.; Dissakaruna, A.M.D.D.; Silva, D.P.S.I.; Nishad, A.A.N.; Premawardhena, A.P.
INTRODUCTION AND OBJECTIVES: The only proven way to prevent thalassaemia, the commonest monogenic disease in Sri Lanka, is premarital and ante natal counselling followed by pre-natal diagnosis (PND) and termination of affected fetuses. Termination of pregnancy (TOP) of a thalassaemic fetus is illegal in Sri Lanka. This study assesses the attitudes towards termination of thalassaemic fetuses among the patients themselves, their immediate family members and hospital staff. METHODS: A single operator administered a pre-formed questionnaire to test the knowledge and attitudes towards TOP among patients, parents, immediate family members and hospital staff associated with the thalassaemia unit; over a two month period from Is' of March 2010, at the Thalassaemia Unit, NCTH, Ragama. RESULTS: A total of 24 adult patients with thalassaemia major (TM) and 15 with thalassaemia intermedia (TIM) 39 parents and 25 hospital staff were interviewed. 39.1% of TMs, 60% TIMs, 60% hospital staff, 54.5% parents were aware of PND. 78.8% of TMs, 87% TIMs, 60% hospital staff, 85.3% parents knew that abortion of a thalassaemic fetus was illegal. Only 39.1% of TM supported TOP, if thalassaemia was diagnosed antenatally whilst 73.3% TIMs, 80% hospital staff and 88.57% parents were supportive (pO.OQl). 78.2% of TMs, 100% in all other groups support premarital screening and making partner screening compulsory. CONCLUSIONS: Though there is strong support for TOP from parents and hospital staff, this is not so with patients with TM. However partner selection prior to marriage seems to have more uniform support.
Does Sanders-Retzlaff-Kraff (SRK-2) formula suit a Sri Lankan population in phacoemulsification cataract surgery of medium axial length?
(Sri Lanka Medical Association, 2012) Amaratunge, M.S.; de Silva, J.; Wasthuhewaarachchi, I.M.; Uyangoda, S.H.; Mallawaarachchi, M.A.J.I.; Premaratna, R.; Nishad, A.A.N.
INTRODUCTION: After introduction of phacoemulsification with small incision techniques, intraocular lens (IOL) power calculation predictionhas become a crucial step for good refractive outcomes. SRK-2 formula is widely used for that purpose in many locations. AIMS: To evaluate the predictive accuracy of post operative refraction using SRK-2 formula in phacoemulsification of eyes with 22-26mm axial length. METHODS: Patients with senile cataracts undergoing phacoemulsification and IOL during 2011 in Gampaha district by a single surgeon were selected randomly. Single examiner measured simulated manual keratometry preoperatively, seven days postoperatively. Uncorrected visual acuity, slit lamp examination of anterior segment and best spectacle-corrected visual acuity (BSCVA) were measured. The implanted IOL power was used to calculate the predicted postoperative refractive error using time SRK-2 formula. RESULTS: Of 274 patients (56% females, mean (SD) age 65.3(10) years), the right eye was operated in 142(51.8%). On postoperative seventh day, 79% had VA of 6/6 and 14% to 6/9, 4% to 6/12 to 6/36 in the operated eye. Mean (SD) of IOL power used 21.50 (1.90)D. The predicted refractive error with SRK-2 was -0.3(0.145)0 and the achieved refractive error was -0.22(0.732)0. Difference between predicted and achieved refractive error presented a slight hyperopic shift (mean(SD) 0.054(0.397)0}. There was a negative Pearson correlation (-0.126) between the predicted refractive error and achieved refractive error (p=0.04). Predictive error was less than 0.5 in 80.2%, <0.75 in 88.6% and <1.0 in 96.7%. CONCLUSIONS: SRK-2 formula is a good option to predict the refractive error after cataract extraction by phacoemulsification in eyes with medium axial length.
Efficacy of two sperm preparation techniques in reducing non-specific bacterial species from human semen
(Medknow Publications, 2013) Abeysundara, P.K.; Dissanayake, D.M.A.B.; Wijesinghe, P.S.; Perera, R.R.D.P.; Nishad, A.A.N.
CONTEXT: Artificial reproductive techniques using seminal preparations with bacteria may cause pelvic inflammatory disease and its sequalae. AIMS: To assess efficacy of two sperm preparation techniques to clear bacteria and the effect of bacteriospermia on sperm recovery rates. SETTINGS AND DESIGN: A descriptive cross-sectional study was carried out among males of subfertile couples. SUBJECTS AND METHODS: Semen samples were randomly allocated into swim-up method (group S, n = 68) and density gradient method (group D, n = 50) for sperm preparation. Seminal fluid analysis and bacterial cultures were performed in each sample before and after spermpreparation. STATISTICAL ANALYSIS: McNemar's chi-squared test and independent samples t-test in SPSS version 16.0 were used. RESULTS: Organisms were found in 86 (72.88%) out of 118 samples, before sperm preparation; Streptococcus species (n = 40, 46.51% of which 14 were Group D Streptococcus species), Coagulase negative Staphylococcus species (n = 17, 19.76%), Staphylococcus aureus (n = 13, 15.11%), Coliform species (n = 11, 12.79% of which 09 were Escherichia coli) and Corynebacterium species (n = 5, 5.81%). There was a statistically significant reduction of culture positive samples in raw vs. processed samples; in group S, 49 (72.05%) vs. 16 (23.52%) and in group D, 37 (74%) vs. 18 (36%). In group S and D, mean (SD) recovery rates of culture positive vs. culture negative samples were 39.44% (SD-14.02) vs. 44.22% (SD-22.38), P = 0.39 and 52.50% (SD-37.16) vs. 49.58% (SD-40.32), P = 0.82 respectively. CONCLUSIONS: Both sperm preparation methods significantly reduced bacteria in semen, but total clearance was not achieved. Spermrecovery rate was not affected by bacteriospermia.
A Fatal case of dissecting aortic root aneurysm due to undiagnosed Marfan syndrome in the puerperium
(Sri Lanka College of Obstetricians and Gynaecologists, 2012) Nishad, A.A.N.; Herath, R.; Silva, G.R.C.; Mohamed, R.; Wijesinghe, P.; Padumadasa, S.; Premawardhena, A.; Premaratna, R.
Aortic dissection in pregnancy is a lethal cardiovascular complication in women with Marfan syndrome. The course of the treatment would be decided upon by the size of aortic root dilation. We report a case where the unawareness of the diagnosis of Marfan syndrome antenatally led to disastrous post partum consequences even after an uneventful childbirth.
Histological types of Gynaecological tumours in the teaching hospital, Ragama over a 9 year period
(Sri Lanka College of Obstetricians and Gynaecologists, 2008) Nishad, A.A.N.; Herath, H.M.R.P.; Padumadasa, S.G.J.; Wijesinghe, P.S.; Feranando, W.S.; Rathayake, R.M.U.S.; Hewavisenthi, S.J.de S.
INTRODUCTION: Gynaecological malignancies contribute significantly to the mortality of women. The pathological spectrum of ovarian and uterine malignancies is wide and diverse. Differences in incidence of histological types and stages at presentation have been reported. OBJECTIVE: To describe the histological types of ovarian, uterine and fallopian tube malignancies diagnosed at Professorial unit Ragama during the period of 1st January 1999 to 1st May 2008. METHODOLOGY: A descriptive, retrospective study was done using the histopathological reports during the study period. RESULTS: There were 96 ovarian, 44 uterine and 1 fallopian tube malignancies detected during the study period. Out of the 96 ovarian malignancies, 94 (97.9%) were primary ovarian tumours while 2 (2.1%) were secondary tumours. Epithelial tumours were the commonest accounting for 80.9% of primary ovarian malignancies while stromal and germ cell tumours contributed to 9.6% and 5.3% respectively. There were 39 (51.3%) serous tumours, 18 (23.7%) endometrioid tumours and 9(11.9%) mucinous tumours among the epithelial tumours. Immature teratomas were the commonest (60%) germ cell tumour. At presentation 22 (23.4%) were bilateral tumours. Majority 29 (31%) of ovarian malignancies were FIGO stage T11C at diagnosis. Among the uterine malignancies there were 33(75%) endometrial carcinoma, 3(7%) Endometrial stromal sarcoma, 2 (4.5%) leiomyosarcomas, ,and 6 (13.5%) other sarcomas. Most (67%) of the patients who had endometrial carcinomas were FIGO stage 1 at the time of diagnosis. DISCUSSION: Though the proportion of the epithelial tumours were similar to the standard figures, germ cell tumours seems to be less in number. Secondary ovarian tumours seem to be less in our study population. The fact that the ovarian malignancies are diagnosed late is evident by the study.
How Young adults with Thalassaemia major feel and what they want?
(Sri Lanka Medical Association, 2012) Nishad, A.A.N.; Premawardhena, A.
INTRODUCTION: During last few decades with introduction of regular blood transfusion and effective iron chelating therapy, life expectancy of Thalassaemia major patients has improved. There is little data regarding quality of life of these patients. METHODS: Prospective quantitative and qualitative study was carried out at Ragama and Kurunegala with transfusion dependent patients of 16 years or older during 2011. SF-36, Becks depression inventory, GHQ-30 and in-depth interviews were used. RESULTS: Of 37 patients (19 females) 64% had at least grade 11 education. Median age was 20(25ch=17, 75th=22] years. Forty percent girls and 33% of boys told illness had a negative impact on romantic relationships. Forty four percent boys, 10.5% girls wanted to marry. Thirty three percent boys and 5% girls wanted to have children. Seventy percent girls and 56% boys wanted to engage in an occupation. SF-36 (Cronbach alpha=0.88) analysis, found that 66% thought they get sick easily and 70% thought they were not healthy. But 70% thought their health would not get worse. Limitation of activities was seen (highly active=64%, moderately active=18%). But 81% did not limit routines and 61% had no routine work difficulty. Seventy seven percent had good life satisfaction although 39% felt a great tiredness. Becks depression inventory reported 31% (95%CI=19-48J had reduced sleep and 26% (95%CI=14-42) had disturbed sleep. Mild depression was seen in 5.4%. CONCLUSIONS: Patients with thalassaemia want to live a normal life like healthy people. They seem to have a satisfactory quality of life.
Is splenic stiffness measurement(SSM) better than Baveno VII criteria to predict oesophageal and cardio- fundal varices in patients with compensated advanced liver cell disease (cACLD)?
(Sri Lanka Medical Association, 2023) de Silva, A.P.; Niriella, M.A.; Nishad, A.A.N.; Samarawickrama, V.T.; Jayasundara, H.; Ranawaka, C.K.; de Silva, S.T.; Withanage, M.; Ediriweera, D.; de Silva, H.J.
INTRODUCTION: Liver and splenic stiffness measurements (LSM and SSM) using transient elastography (TE) are being increasingly used as a screening tool to predict varices. OBJECTIVES: We aimed to test the utility of Baveno-VII criteria (LSM>25kPa, LSM>20kPa with platelet count <130,000 and LSM>15kPa with platelet count <110,000) and SSM to predict oesophageal and cardio-fundal varices in a cohort of Sri Lankan patients with aALCD. METHODS: Consecutive patients with newly diagnosed Child’s class A cALCD (non-viral, BMI<30) were recruited prospectively. They underwent upper gastrointestinal endoscopy by an endoscopist followed by a Fibroscan by an operator who is unaware of endoscopy findings using ECHOSENS-Fibroscan-502 to measure LSM and SSM. Validity measurements of three Baveno-VII criteria and SSM values to predict oesophageal and cardio-fundal varices were calculated. RESULTS: One hundred and seventy-four individuals were recruited [Mean (95%CI) age 61.4 (59.7-62.8) years, 110 males], and 106 had varices. Our results indicate that the three Baveno VII criteria had sensitivities of 61%, 63% and 42%, and specificities of 79%, 77% and 87%. SSM>30kPa alone or in combination with LSM>15kPa had sensitivity of 81&75%, specificity of 72&83%, PPV of 82&87%, NPV of 71&67% and accuracy of 78&78% consecutively to predict oesophageal and cardio-fundal varices. CONCLUSION: Baveno VII criteria had low sensitivity but high specificity to predict oesophageal and cardio-fundal varices. SSM>30kPa alone or in combination with LSM>15kPa seemed to predict oesophageal and cardio-fundal varices better.
Neurological melioidosis complicated by cerebral venous sinus thrombosis
(Ceylon College of Physicians, 2020) Abeysundara, P.K.; Nishad, A.A.N.; Perera, W.N.M.; de Silva, H.; Piyarathne, R.; Rathnayaka, R.M.P.M.; Arulmoly, K.; Umakanth, M.; Premaratna, R.; Tilakaratne, Y.
ABSTRACT: Melioidosis is a systemic disease endemic in Southeast Asia and Northern Australia. The spectrum of the disease varies from asymptomatic infection to severe systemic manifestations. Timely diagnosis and treatment of melioidosis is a challenge due to its atypical presentations. We report a case of melioidosis causing cerebral abscesses and cerebral venous sinus thrombosis. Occurrence of these neurological manifestations in melioidosis is rare and it is a difficult condition to diagnose and treat. Timely diagnosis was a challenge in this patient due to the atypical presentation and the use of empirical antibiotics in the primary care setting. Limited laboratory diagnostic capability also contributed to this delay. KEYWORDS: Melioidosis, Cerebral abscess, Cerebral venous sinus thrombosis
Parental awareness and cascade screening of thalassaemia
(Sri Lanka Medical Association, 2010) Nishad, A.A.N.; Premawardhena, A.P.
INTRODUCTION: A strategy to prevent new births with thalassaemia major in countries where abortion is illegal is to screen the at risk population for the carrier state and advocating "safe marriages". One of the highest risk groups for the thalassaemia gene are relatives of individuals with a child with 'thalassaemia major'. 'Cascade screening' of such relatives is an effective way to initiate and precede a much wider population screen. We wanted to identify the level of awareness of disease transmission and the extent to which cascade screening was already happening in Sri Lanka. METHODS: A self-administered questionnaire was used on 100 parents of children with transfusion dependent thalassaemia attending the thalassaemia units at Ragama and Kurunegala from 1st January to 31st December 2009. RESULTS: 73% fathers and 91% mothers knew their carrier state and 59 (64.1%) fathers and 98 (88.1%) mothers knew their carrier state bad caused the illness to the child. Mothers had 382 and fathers had 291 siblings. Those siblings had 714 and 610 children respectively. 40 (10.8%) of maternal siblings and 15 (5%) of the paternal siblings had been screened for thalassaemia. Only 48 (6.72%) of maternal side children and 23 (3.77%) of paternal side children had been screened. CONCLUSION: Screening of relatives of patients with thalassaemia in this group of people seems to be limited. A screening programme targeting those at high risk is necessary.
Prevalence of diabetes mellitus and hypertension among three populations with cataract in Vavuniya and Gampaha districts in the post conflict era
(Sri Lanka Medical Assosiation, 2012) Amaratunge, M.S.; de Silva, J.; Wasthuhewaarachchi, I.M.; Uyangoda, S.H.; Mallawaarachchi, M.A.J.; Premaratna, R.; Nishad, A.A.N.
INTRODUCTION: Identification of socio economic factors and non communicable disease profiles of patients with cataract is important to plan vision related health services. AIMS: To compare prevalence of diabetes mellitus [DM] and hypertension (HT) among three groups of cataract patients. METHODS: Prevalence of diabetes-and hypertension was compared in groups of patients with cataracts during second quarter of 2011. Group A: a rural population in Vavuniya, B: semi-urban low socioeconomic group and C: semi-urban higher socioeconomic group in Gampaha. Standard criteria used to detect diabetes and hypertension. RESULTS: Population in A 167(36% males), B 207(62% males) and C 407(40% males). Mean (SD) age was 65(10) years. Male diabetes prevalence (95% CI) were A 20% (9.3-28), B 30%(22.6-38.4) and C 37.9%(30.8-45.6) (p=0.009). Prevalence (95%CI) of diabetes in females were A 17.8% (11.7-26), B 19% (11.9-29) and C 33.7% (28.1-39.9) (p=0.002). Hypertension prevalence in males (95%CI) A 23.3% (15- 35.4), B 35.4% (27.6-44) and C 36-6% (29.6-44.3) (>=0.16) a"d in females A 26.2% (18.8-35.2), B 15.2% (9-24.7) and C 45.1% (39-51.4) (p=0.001). Prevalence of either diabetes or hypertension among males A 31.7% (21-44), B 54.3% (45.7-62.7) and C 56% (48.2-63.3) (p=0.001) and among females A 34.6% (26- 44), B 26.6% (18-37.2) and C 57.8% (51,5-63.7) (p=0.001). Conclusions: Females in higher socioeconomic group of Gampaha district had higher diabetes and hypertension prevalence than in lower socioeconomic populations. Male groups showed same pattern for diabetes but not for hypertension. Overall prevalence of hypertension and diabetes mellitus were higher than for general population in Sri Lanka.
Pseudoainhum associated with lepromatous leprosy: A very rare association in modern world
(Chinese Medical Association Publishing House, 2023) Nishad, A.A.N.; Pathman, M.; Uwyse, S.A.; Mendis, A.; Abeysundara, P.K.; de Silva, A.P.
INTRODUCTION: Pseudoainhum (dactylolysis spontanea) is characterized by the development of a fibrous band around the digit that gradually leads to autoamputation. Digital pain associated with Pseudoainhum may not be evident in patients with neuropathic conditions. Here, we present a rare case of pseudoainhum patient, which describes a very rare association of pseudoainhum with leprosy. CASE PRESENTATION: A 48 year old male with lepromatous leprosy, with resorption of digits, charcot joints and tropical ulcers was seen in the clinic. The forth digit of the left hand had a narrowing due to a fibrous band at the 2nd inter phalangeal joint with shiny tethering distal phalanx. He could not recall the duration of the ainhum. He was not suffering from any pain.DISCUSSION: The current report describes a very rare association of pseudoainhum with leprosy. The case involved a 48-year-old man in the dermatology ward with lepromatous leprosy presenting with a pseudoainhum. CONCLUSION: This case highlights the possibility of delayed presentation of patients with pseudoainhum to physicians when the patients have underlying neuropathic conditions that prevent feeling finger pain and cause abnormal appearance of the digits, especially in leprosy.
Pulmonary arterial hypertension in thalassaemia patients- does splenectomy and disease severity increase the risk?
(Sri Lanka Medical Association, 2011) Premawardana, N.P.; Nandasiri, A.S.D.; Ranaweera, A.G.R.M.A.; Nishad, A.A.N.; Silva, D.P.S.I.; Premawardhena, A.P.
INTRODUCTION AND OBJECTIVES: Pulmonary arterial hypertension (PAH) has been described in patients with thalassaemia. A causative association with splenectomy has been postulated. Our previous observations differed from this. We aimed to study these factors in our patients. METHODS: Pulmonary artery pressure (PAP) and other data of thaiassaemics attending the Thalassaemia Unit, Ragarna were studied using clinic records. PAP was measured using trans-thoracic 2D echocardiography. Four categories were separately analysed: thalassaemia major (TM) with splenectomy (A) and without (B), thalassaemia intermedia (TI) with splenectomy (C) and without (D). PAH was defined as PAP over 25 mm Hg. RESULTS: A total of 74 patients were studied, 60 (81%) with TM and 14 (19%) with TI. 25 of TMs (41%) and 10 of TIs (71%) had splenectomy (p <0.05). Mean ages (SD) of TM and TI were 20.71(8.4) and 32.6 (13.3) years respectively. Those of categories ABCD were 20.9 (7.4), 20.7 (9.1), 27 (9.6) and 46 (12.3) years. A total of 16 (21.6%) of all patients had PAH (95% CI13.8-32.3). This included 13 (21.7%) TM patients and three (21.4%) with TI (p-0.98). The prevalence of PAH was 17.1% (95 CI 8.4-33.5) in splenectomised thalassaemia patients and 25.6% (95% CI 16.5-43.8) in non splenectomised patients (p= 0.37), and in categories A,B,C,D were 16%, 23%, 20% and 25% respectively. Mean of PAP of splenectomised with PAH is 39 mmHg (SD=4.5) and in non splenectomised with PAH was 34.9 mmHg (SD=5.3) (p=0.8). CONCLUSIONS: PAH is a significant complication in patients with thalassaemia. However the severity of disease nor the splenectomy status were found to be causatively linked in our study.
Role of red cell distribution width in screening for Hb E trait in population screening for haemoglobin disorders
(Sri Lanka Medical Association, 2013) Nishad, A.A.N.; de Silva, I.S.; Perera, H.L.; Pathmeswaran, A.; Premawardhena, A.P.
INTRODUCTION AND OBJECTIVES: The national screening policy for haemoglobinopathies uses the red cell indices MCV <80 and MCH<27 as cut offs, a strategy known to miss some individuals with Hb E trait (EBT), the commonest abnormal haemoglobin in Sri Lanka. We investigated the possibility of increasing the accuracy of red cell indices in detecting Hb E trait. Objective was to determine if red cell distribution width (RDW) cut off values would help increase sensitivity of screening for Hb E trait. METHODS: Mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and red cell distribution width (RDW) of all samples referred for thalassaemia screening were measured using the Coulter counter. High Performance Liquid Chromatography (HPLC) was carried out as the gold standard to detect haemoglobinopathies. Receiver Operating Characteristic (ROC) curve was drawn to determine the cut-off value for EBT against Beta trait (BTT) and other anaemias. RESULTS: There were 246 BTT, 110 EBT and 151 other anaemias. Mean (SD) MCV of BTT 62.7 (5.9), EBT 73.4 (7.4) and other anaemias 71.3 (8.3) femtolitres (p<0.001). Mean (SD) MCH of BTT 19.6 (2.1), EBT 24 (2.7) and other anaemias 22.8 (3.6) (p<0.001). Mean (SD) RDW among BTT were 16 (2.8), EBT 14.5 (2.9) and other anaemias 15.8 (4.2) (p<0.001). Using 14.45 as cut off for RDW in addition to accepted cut off values for MCV<80 and MCH<27, gave a predictive sensitivity of 98.2% for EBT. DISCUSSION: By using RDW cutoff at 14.45 in addition to the accepted screening indices, sensitivity of Hb E trait detection went up from 86.6% to 98.2%. This study highlights the importance of taking RDW into consideration for screening.
Role of red cell distribution width in screening for Hb Etrait in population ccreening for hemoglobin disorders
(Lippincott Williams and Wilkins, 2014) Nishad, A.A.N.; de Silva, I.S.; Perera, H.L.; Pathmeswaran, A.; Kasturiratne, K.T.A.A.; Premawardhena, A.P.
The national screening policy for hemoglobinopathies uses the cutoffs for red cell indices mean corpuscular volume >80 and mean corpuscular hemoglobin >27, a strategy known to miss some individuals with Hb E trait (EBT), the most common abnormal hemoglobin in Sri Lanka. We wanted to determine if red cell distribution width (RDW) cutoff values would help in increasing the sensitivity of screening for Hb E trait. High-performance liquid chromatography was carried out as the gold standard to detect hemoglobinopathies and red blood cell parameters with colter counter. Receiver operating characteristic curve was drawn to determine the cutoff value for EBT against β-trait (BTT) and other anemias. Of the 504 patients, 246 had BTT, 110 had EBT, and 151 had other types of anemias. Mean (SD) RDW among patients with BTT was 16 (2.8), with EBT 14.5 (2.9), and with other anemias 15.8 (4.2) (P>0.001). With 14.45 as the cutoff for RDW and considering accepted values for mean corpuscular volume >80 and mean corpuscular hemoglobin >27, it gave a predictive sensitivity of 98.2% for EBT. By using RDW cutoff at 14.45 in addition to the accepted screening indices, sensitivity of Hb E trait detection went up to 98.2% from 86.6%. This study highlights the importance of taking RDW into consideration for screening
The Thal-index with the BTT prediction.exe to discriminate ß-thalassaemia traits from other microcytic anaemias
(Pagepress, Italy, 2012) Nishad, A.A.N.; Pathmeswaran, A.; Wickremasinghe, A.R.; Premawardhena, A.
Several attempts have been made previously to differentiate -thalassaemia trait (BTT) from other microcytic anaemias using formulae with red cell (RC) parameters. Presently available formulae have low sensitivity and specificity. We wanted to develop a more precise algorithm, which could be used in situations where the gold-standard test for thalassaemia diagnosis: the high performance liquid chromatography (HPLC) is not available. The study was carried out prospectively from November 2008 to March 2010 from randomly collected blood samples with a mean cell volume (MCV) of less than 80 fL. HbA2 measured by HPLC was used to diagnose BTT. We used Fishers stepwise linear discriminant function analysis to develop an algorithm with RC parameters. Calculated new index Thal-index was then subjected to receiver operating characteristic curve analysis to identify best cutoff to discriminate BTT from other microcytic blood films. Software was developed to predict the BTT status (BTT prediction.exe). New index, referred to as the Thal-index, was calculated using discriminant function analysis and is given as Thal-index=[(0.615MCV) +(0.518mean corpuscular hemoglobin)+ (0.446red cell distribution width)]. A value of 59 for Thal-index has 90% sensitivity and 85% specificity for differentiating BTT from other microcytic anaemias. This showed better sensitivity and specificity compared to other formulae presently used (i.e., Mentzer in Eshani, et al.). Our study gives a better answer to set-up where HPLC is not available. Although this cannot replace HPLC, BTT prediction.exe is useful to predict instantly and is the first ever computer program available for this function
The "Thal-index" with the BTT prediction, exe to discriminate Beta thalassaemia traits from other microcytic anaemias
(Sri Lanka Medical Association, 2011) Nishad, A.A.N.; Wickremasinghe, A.R.; Pathmeswaran, A.; Premawardhena, A.P.
INTRODUCTION AND OBJECTIVES: Attempts have been made previously to differentiate beta-thalassaeima trait (BTT) from other microcytic anaemias using formulae with red cell (RC) parameters. Presently available formulae have low sensitivity and specificity. We wanted to develop a more precise algorithm which could be used in situations where the gold standard test for thalassaemia diagnosis the High Performance Liquid Chromatography (HPLC) is not available. METHODs: The study was carried out prospectively from November 2008 to March 2010 using 326 randomly collected blood samples with a mean-cell volume (MCV) of less than 80 fi. HbA2 measured by HPLC was used to diagnose BTT. We used Fishers step wise linear discriminant function analysis to develop an algorithm with RC parameters. Calculated new index "Thai-index" was then subjected to Receiver operating characteristic curve analysis to identify best cutoff to discriminate BTT from other microcytic blood films. Software was developed to predict the BTT status (BTT prediction .exe). RESULTS: New index, referred to as the "Thai-index", was calculated using discriminant function analysis and is given as "Thai-index" = [(0.615 x MCV) + (0.518 x MCH) + (0.446 x ROW)]. A value of 59 for "Thai-index" has 90% sensitivity and 85% specificity for differentiating BTT from other microcytic anaemias. CONCLUSIONS: This showed better sensitivity and specificity compared to other formulae presently used (i.e Mentzer in Eshani et al). Although this cannot replace HPLC, BTTprediction.exe is useful for quick prediction and is the first computer programme available for this function.
Validation of the Tamil translation of the International Consultation on Incontinence modular Questionnaire on Vaginal Symptoms (ICIQ-VS)
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Ekanayake, C.D.; Wijesinghe, P.S.; Pathmeswaran, A.; Samaranayake, K.U.; Herath, C.; Nishad, A.A.N.
OBJECTIVES: To translate and validatethe International Consultation on Incontinence Modular Questionnaire on vaginal symptoms (ICIQ VS) from English to Tamil. METHOD: With permission, ICIQ-VS questionnaire was translated to Tamil and a validation study was done on women attending the gynaecology clinics at district general hospitals, Mannar and Vavuniya. RESULTS: The basic characteristics of women with prolapse (n=63) versus women without prolapse (n=83) were as follows; age 60.68 (SD 11.64), median parity=4 (IQ1-IQ3=3-5), BMI 23.90 kg/m2 (SD 3.36) versus age 40.49 (SD 12.54), median parity=2(IQ1IQ3=1-3), BMI 25.84 kg/m2 (SD 4.84) respectively. Content validity was assessed by the level of missing data which was less than 3% for each item. Internal consistency as assessed by Cronbach’s coefficient alpha score was 0.83 (0.80-0.84). Kappa values for test–retest reliability of individual items ranged from0.59 to 0.74. The questionnaire differentiated between patients and controls in vaginal symptoms score(VSS) (P<0.001), sexual symptoms score(SSS) (p<0.05) and quality of life p<0.001). There was a positive correlation between pelvic organ prolapse quantification system (POP-Q) scores and VSS (rs= 0.67, p<0.001), SSS (rs= 0.26p<0.05) and quality of life (rs = 0.62, p<0.001).Vaginal symptoms (n=24) and quality of life (n=21) showed an improvement following surgery(Wilcoxon matched– pairs signed-rank test p<0.001 and p<0.001 respectively). CONCLUSION: The preliminary results for ICIQ VS (Tamil) validation are satisfactory and once completed it will be invaluable to objectively assess vaginal and sexual symptoms in Tamil speaking population in Sri Lanka