Browsing by Author "Perera, M.T.P.R."

Now showing 1 - 9 of 9

Challenges for liver transplantation during recovery from the COVID-19 pandemic: Insights and recommendations
(New York Stratton., 2020) Niriella, M.A.; Siriwardana, R.C.; Perera, M.T.P.R.; Narasimhan, G.; Chan, S.C.; Dassanayake, A.S.
ABSTRACT: The coronavirus disease 2019 (COVID-19) pandemic is placing an increasing burden on liver transplant (LT) services worldwide. At the peak of the pandemic, many LT services worldwide reduced or halted their activities. With the gradual easing of lockdowns, LT teams face new challenges when restarting activities. The numbers of LTs are likely to drop in the immediate post-COVID era. Prolonged and intermittent lockdowns are likely to lead to a shortage of supplies, especially in poor resource settings. Special attention is needed to avoid nosocomial COVID-19 infection among cirrhotic patients awaiting transplant, post-transplant patients, and members of transplant teams. LT programs may have to revise existing strategies in selecting donors and recipients for transplants. Redesigning service provision, restructuring outpatient care, carefully screening and selecting donors and recipients, and performing LT with limited resources will have to be initiated in the post-COVID era if long-term recovery of LT services is to be expected. Costs involved with LT are likely to increase, considering the change in protocols of testing, quarantining, and interstate traveling. This paper discusses the different elements affecting and the widespread impact of the COVID-19 pandemic on LT and strategies to minimize the impact of these factors and to adapt so LT services can meet the health care needs during this pandemic and beyond.
Genetic and environmental risk for asthma in children aged 5-11 years
(Sri Lanka College of Paediatricians, 2005) Karunasekera, K.A.W.; Perera, K.P.J.; Perera, M.T.P.R.; Abeynarayana, J.
DESIGN: A cross sectional analytical study. METHOD: Data were collected from children aged 5-11 years in 3 schools in Gampaha District. 441 children with asthma and 1510 without asthma were evaluated for following risk factors viz. family history of atopy, gender, duration of breast feeding, commencement of formula in infancy, dusty home environment, passive indoor cigarette smoking, presence of firewood smoke in bedroom when cooking, burning of mosquito coil and incense stick/powder and presence of pets at home. Data were analyzed using Epi info version 6 and SPSS package. Chi Squared test was used in bivariate analysis and forward logistic regression was used to adjust confounding factors. RESULTS: Risk of asthma in child (on bivariate analysis) was increased when father has a history of asthma (odds ratio (OR) 6.4 (95% confidence interval (CI) 3.2 -13.2), mother has a history of asthma (OR 4.4, CI 2.6 -7.5), sibling has asthma (OR 4.3, CI 2.0 - 9.7), father has a history of allergic rhinitis (OR 2.0, CI 1.5-2.8), mother has a history of allergic rhinitis (OR 2.5, CI 1.9-3.4) and sibling has allergic rhinitis (OR 3.4, CI 2.1-5.4). Asthma risk was significantly increased with following environmental factors: non continuation of breast feeding beyond first 6 months in infancy (OR 1.5, CI 1.2-1.9), presence of firewood smoke in bedroom when cooking (OR 1.4, CI 1.1- 1.9), use of mosquito coil (OR 1.5, CI 1.2 -1.9) and dusty home environment (OR 1.8, CI 1.4-2.3). After adjusting for confounding factors, paternal history of asthma, maternal history of asthma, allergic rhinitis in mother and sibling, non continuation of breastfeeding beyond first 6 months of life and dusty environment remained significant with increased risk of asthma (p < 0.01). CONCLUSIONS: This study reinforces that asthma has a multifactorial aetiology. Childhood asthma is influenced by paternal asthma more than maternal asthma. Significant modifiable environmental factors in this study were duration of breastfeeding in infancy and dusty home environment
Inflammatory pseudotumour of the liver caused by a migrated fish bone
(Sri Lanka Medical Association, 2007) Perera, M.T.P.R.; Wijesuriya, S.R.E.; Kumarage, S.K.; Ariyaratne, M.H.J.; Deen, K.I.
No Abstract Available
Locally advanced breast cancer as a possible portal of entry in a patient with tetanus
(Sri Lanka Medical Association, 2007) Wijesuriya, S.R.E.; Wijesuriya, M.T.W.; Perera, M.T.P.R.; de Zylva, S.T.U.; Deen, K.I.
No Abstract Available
Prevalence of asthma and atopic symptoms in children aged 5-11 years
(Sri Lanka College of Paediatricians, 2003) Karunasekera, K.A.W.; Perera, K.P.J.; Perera, M.T.P.R.; Abeynarayana, J.
OBJECTIVE: To assess prevalence of asthma and atopic symptoms in a group of school children aged 5-11years and to look at prevalence of usage of asthma medications. SETTING: Three schools in Gampaha District in August 1998. METHOD: A questionnaire translated into Sinhala was distributed to parents/guardians of 2195 children aged 5-11 years in Grades 1-5 of the schools and the filled questionnaires were collected through class teachers. Asthma, allergic rhinitis and eczema were defined using the clinical criteria of the International Study of Asthma and Allergic Conditions (ISAAC). Data was analysed using Epi Info version 6. Chi squared test and Chi squared test for trend were used for significance testing. RESULTS: Return rate of questionnaire was 93%. Sixty six percent were completed by mother, 30% by father and rest by guardian. Prevalence of asthma was 23% and of exercise induced asthma 11%. Prevalence rate of allergic rhinitis was 10% and eczema 3%. Within the specific group of asthma, in response to leading question "Has your child had asthma" only 19% of parents gave a positive answer. Prevalence of asthma in males did not significantly differ from that in females (p=0.5). A decreasing trend of asthma was observed with increasing age in girls (p less than 0.05). Eighty four percent of asthmatic children were using salbutamol orally and 9% without asthma in study population were also using salbutamol. CONCLUSIONS: One in 5 children aged 5-11 years in study population had asthma but parental perception about asthma was poor. More than 80% of asthmatics had some medications for the disease.
The prevalence of urinary and sexual dysfunction following rectal excision
(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Perera, M.T.P.R.; Ratnayake, G.; de Silva, G.S.; Deen, K.I.
INTRODUCTION: With improved survival following rectal excision for cancer and focus on nerve sparing operation, recent interest has centered on urinary and sexual dysfunction. OBJECTIVE: To identify the prevalence of urinary and sexual dysfunction in patients after rectal excision.METHODS: 43 patients (17 male, median age 55 years, range 24 to 74) underwent anterior resection (23), restorative proctocolectomy (13), abdomino-perineal excision (04), and rectal excision as part of subtotal colectomy (03). Structured interview was performed at least 03 months after stoma closure. Data were compared with age and gender matched controls. Statistical evaluation was by the McNemar test and test of proportions. Significance was assigned to a P value <0.05. RESULTS: Median (range) duration after operation was 28 months (8 - 84). Preoperatively, urinary function was similar in patients and controls. After operation, a significant number of patients had transient urinary dysfunction [urinary symptoms, pre vs post; 07 (16%) vs. 28 (65%) p< 0.05]. Long-term prevalence of poor stream and urinary hesitancy after operation were significant [poor stream; pre vs. post- 6 vs. 16: P=0.006 and hesitancy; pre vs. post - 6 vs. 18: P=0.004]. Sexual function was also significantly reduced in patients after operation [sexually active; pre vs. post- 29 vs. 17: P=0.004]. Fourteen (9 male,5 female) of 29 (48%) reported transient abstinence from sexual activity 6 months after operation whilst eight of 29 (27 .5%) reported more permanent abstinence (lack of interest-6, dyspareunia-1, erectile failure/ retrograde ejaculation - 7). CONCLUSION: Counseling regarding sexual and urinary function should be an integral part of the pre-operative work-up in patients having rectal excision
Result of trans-anal inter-sphincteric resection(taisr) combined with total mesorectal excision (ime) and colo- anal anastomosis for distal rectal cancer
(The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Deen, K.I.; Rajendra, S.; Hewavisenthi, J.; Perera, M.T.P.R.; Satheesan, B.
INTRODUCTION: The treatment of distal rectal cancer is controversial. Most prefer abdomino-perineal excision because of the potential for wide local clearance. Staplers have limitations in restorative resection for distal rectal cancer. OBJECTIVE: To audit the results ofcombinning TAISR with TME and handsewn colo-anal anastomosis for distal rectal cancer. METHODS: I 08 Patients (45 male, median age 59 years, range -22-87) with rectal cancer underwent abdomino-perineal resection -15 ( 14%), Hartmann's procedure - 7 (6.5%), anterior resection -39 (36%) and anterior resection or total colectomy with TAISR and colo-anal anastomosis -47 (43.5%). TAISR was undertaken for tumours between O and 7 ems from the anal verge for rectal cancer with familial polyposis. Data sought were; overall survival, local clearance (RO- clear margins; R l-at least one involved margin) and local recurrence at 24 month median follow up (range- 5 -89 months). Data in the TAISR group were compared with the rest by the test for proportions. Significance was assigned to p<0.05. RESULTS: For the entire group, operative 30-day mortality was 4.6%. Overall disease related mortality at 24 months was 18%. For the entire group, curative resection (RO) was achieved in 93(86%) { TAISR- 39 of 47 (83%) vs. resection without TAJSR- 54 of61(88.5%)- P>0.05}. Overall, local recurrence was seen in 8 (7.4%) {TAISR - 4 of 47 (8.5%) vs. resection without TAISR- 4 of 61 (6.5%). CONCLUSION: There was no significant difference in achievement of free resection margins and local recurrence, in the-short-term, employin anal inter-sphincteric resection with TME for distal rectal cancer co with resection for proximal rectai cancer. Trans-anal inter-sphincteric r with TME for distal rectal cancer is safe in trained hands and should preferred choice in surgical management of distal rectal cancer.
Shunt surgery and long term follow-up in extra-hepatic portal venous obstruction
(College of Surgeons of Sri Lanka, 2006) Perera, M.T.P.R.; Athem, A.Y.A.R.; Deen, K.I.
No Abstract Available
Shunt surgery in acute variceal bleeding
(College of Surgeons of Sri Lanka, 2005) Perera, M.T.P.R.; Athem, A.Y.A.R.; Deen, K.I.
No Abstract Available