Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item Assessing motivation to lose weight: the psychometric properties of the Sinhala version of University of Rhode Island Change Assessment (URICA) scale(Sri Lanka Medical Association, 2023) Niriella, M.A.; de Silva, S.T.; Hapangama, A.; Baminiwatta, A.; Fernando, R.; Ediriweera, D.INTRODUCTION: Weight reduction through lifestyle modifications is an important component in the management of various chronic diseases. The degree of motivation to change has been shown to predict outcomes in weight reduction interventions. Thus, the availability of a validated self-report tool assessing the degree of motivation for weight management would be useful for both clinical and research purposes in Sri Lanka. OBJECTIVES: To examine the structural validity and internal consistency of the URICA for weight management in a sample of Sri Lankan adults with chronic medical conditions. METHODS: Standard procedures for cross-cultural adaptation of a questionnaire were followed in translating the 32-item URICA into Sinhala. The Sinhala version was administered to 208 patients aged 18-60 years attending outpatient clinical services for non-disabling chronic medical diseases. Psychometric testing included confirmatory factor analysis and the assessment of internal consistency (Cronbach α). RESULTS: The commonly accepted four-factor structure of URICA reflecting Prochaska and Di Clemente’s transtheoretical model (pre-contemplation, contemplation, action and maintenance) showed good model fit, after the removal of four items from the pre-contemplation subscale due to inadequate factor loadings (<0.4). In line with theory, factor correlations indicated that the pre-contemplation factor was inversely correlated with the other three factors, while the other three factors were positively correlated with one another. All four subscales showed good internal consistency (Cronbach α ranging from 0.73 to 0.89). CONCLUSIONS: The Sinhala version of a modified 28-item URICA was found to have sound psychometric properties as a measure of motivation for weight management among Sinhala-speaking adult patient.Item Identification of type 2 diabetes patients with non-alcoholic fatty liver disease who are at increased risk of significant hepatic fibrosis: a cross-sectional study(Sri Lanka Medical Association, 2023) Mettananda, K.C.D.; Egodage, T.; Dantanarayana, C.; Solangarachchi, M.B.; Fernando, R.; Ranaweera, L.; Siriwardhena, S.; Ranawaka, C.K.; Kottahachchi, D.; Pathmeswaran, A.; Dassanayake, A.S.; de Silva, H.J.INTRODUCTION: Annual screening of patients with diabetes for fatty liver, and identifying those with significant hepatic fibrosis using the FIB-4 score and vibration-controlled transient elastography (VCTE) has been recommended to detect patients who may progress to advanced hepatic fibrosis/cirrhosis. However, VCTE is not freely available in resource-limited settings. OBJECTIVES: To identify clinical and biochemical predictors of significant liver fibrosis in diabetics with fatty liver. METHODS: We conducted a cross-sectional study among all consenting adults with T2DM and non-alcoholic fatty liver disease (NAFLD) attending the Colombo North Teaching Hospital, Ragama, Sri Lanka from November 2021 to November 2022. FIB-4 scores were calculated and patients with a score ≥1.3 underwent VCTE. Risk associations for liver fibrosis were identified by comparing patients with significant fibrosis (LSM ≥8 kPa) with those without significant fibrosis (FIB-4<1.3). RESULTS: A total of 363 persons were investigated. Of these, 243 had a score of FIB-4 <1.3. Of the 120 with a FIB-4 ≥1.3, 76 had LSM ≥8 kPa. Significant fibrosis was individually associated with age (OR 1.01, p<0.0001), duration of diabetes (OR 1.02, p=0.006), family history of liver disease (OR 1.42, p=0.035), waist (OR 1.04, p=0.035), and FIB-4 (OR 2.08, p<0.0001). However, on adjusted analysis, significant fibrosis was only associated with a family history of liver disease (OR 2.69, p=0.044) and FIB-4 (OR 1.43, p<0.001). CONCLUSION: In patients with T2DM and fatty liver, advancing age, increased duration of diabetes, a family history of liver disease, waist circumference and a high FIB-4 score increase the risk of significant hepatic fibrosis. Targeted interventions in this group may help prevent progression to advanced hepatic fibrosis/cirrhosis.Item Novel technique for uninterrupted confirmation of endotracheal tube position for awake fiberoptic intubation(Elsevier B.V, 2020) Kerner, V.; Gunetilleke, B.; Fernando, R.Misplacement of an endotracheal tube in a patient with a difficult airway is catastrophic. Currently used techniques do not permit simultaneous bronchoscopic and capnographic confirmation of tube placement. We report a novel technique for seamless monitoring of the endotracheal tube position in the tracheobronchial tree during Awake Fibre Optic Intubation (AFOI). The simple modification described improves the safety profile of AFOI in several ways. The modification allows an overlap between the bronchoscopic viewing of the endotracheal tube in the trachea and the appearance of the typical wave on the capnograph. It only requires an endotracheal tube connected to a catheter mount. The bronchoscope is then introduced via the port on the catheter mount. The tube-catheter mount unit is secured to the scope (Figure 1). A ventilator circuit with attached capnograph adapter is connected to the catheter mount once the endotracheal tube is advanced into the trachea. Ventilation is then initiated. Appearance of the characteristic wave on capnograph confirms the correct position before the extraction of the bronchoscope Migration of the tube into the oesophagus is unnoticed until the bronchoscope is completely removed from the trachea in 5±10% of AFOIs1,2. Displacement of endotracheal tube into the oesophagus despite the bronchoscope tip being positioned in the trachea has been described3. Resistance that is felt as the tube is advanced over the mid part of the scope looped into the oesophagus may be misinterpreted as the tube tip impinging on the arytenoid cartilages3. The tube slides into the oesophagusas the scope is extracted. This usually occurs before capnographic confirmation is possible3. The technique we propose will be useful since ventilation is initiated with the scope in-situ. Loss of the capnographic trace is evidence of misplacement of the tube, though the bronchoscope is within the trachea. We propose this should be the standard of care and should be included in the AFOI training protocols.Item Variations in the topographical anatomy of the recurrent laryngeal nerve and the inferior thyroid artery(Sri Lanka Medical Association, 2008) Subasinghe, T.V.; Salgado, L.S.S.; Fernando, R.; Abeysuriya, V.; Casather, D.M.; Willaraarachchi, W.A.M.A.OBJECTIVE: Thyroidectomy is a commonly performed surgery. Comprehensive knowledge in anatomical variation of the inferior thyroid artery (ITA) in relation to the recurrent laryngeal nerve (RLN) is mandatory for safe thyroid surgery. Data on variations in Sri Lankans is incomplete. DESIGN, SETTING AND METHODS: Thirty cadavers (20 male:10 female; range 56-87 years) were dissected to study the anatomical variations of the ITA in relation to the RLN. RESULTS: In 22 cadavers the right ITA originated from thyrocervical trunk, and in 8 it was a branch of the transverse cervical artery. On left, ITA originated from the thyrocervical trunk in 26 and from the transverse cervical artery in 4 cadavers. Branching of the artery was extra-capsular in 22(72%) on the right and 23(75%) on the left. On the right, the RLN was seen posterior to all the extra-capsular divisions of the ITA in 18(60%) cadavers, while in 7(22%) it was anterior. In 5(18%) cadavers it was between the divisions of ITA. On the left, it was 28(95%) and 2(5%) respectively (Z=2.74, P=0.006). The right RLN was seen in the tracheo-oesophageal groove in 26 cadavers (85%), while in 4(15%) it was on the antero-lateral side of die trachea. On the left, all the recurrent laryngeal nerves was seen in the tracheo-oesophageal groove. CONCLUSION: The anatomical variation is common in relation to the right RLN. These have implications in thyroid surgery and follow up.Item FNAC in the 'field'- a new experience(Sri Lanka Medical Association, 2008) Fernando, R.; Hewavisenthi, J.; Pathmeswaran, A.; Edirisinghe, D.; Abeysinghe, S.; Atulugama, N.; Bandara, D.; Premathileke, M.BACKGROUND: Fine needle aspiration cytology (FNAC) is an important diagnostic test in thyroid diseases. It usually is undertaken at a hospital or laboratory setup. As part of an islandwide field based study, FNAC was undertaken in the field. Literature review revealed that FNAC accuracy rate was around 65-70% in most Centres with full-fledged facilities. OBJECTIVES: To determine the effectiveness of FNAC done in the field DESIGN, SETTING AND METHODS: Informed written consent was obtained and the goitre was delineated with a marker pen. FNAC was carried out by a trained team member in the standard manner. Four slides were prepared from each patient. All slides were processed and examined by a cytologist RESULTS: 308 FNAC were done. 226 FNAC were diagnostic (73.36%) and 82(26.64%) were non diagnostic. 62(23.8%) showed benign cells only. The pathological entities detected were: 112 (49.5%) auto immune thyroiditis, 32 (14.1%) colloid storing nodules, 14(6.1%) colloid storing nodules with autoimmune thyroiditis, 5 (2.2%) follicular lesions and one toxic lesion. There were no significant complications noted in any of the patients. CONCLUSIONS: Field FNAC has a high diagnostic accuracy if done by a trained person. It is a safe procedure in the field.Item Goitre prevalence in diabetes - results of an islandwide study(Sri Lanka Medical Association, 2008) Fernando, R.; Hewavisenthi, J.; Atulugama, N.S.; Edirisinghe, E.M.D.A.R.; Abeysinghe, A.P.S.D.; Fernando, W.M.T.P.S.; Premathilaka, H.M.M.S.; Bandara, S.D.Abstracts AvailableItem Epidemiology of goitres in Sri Lanka - results of a community based study(Sri Lanka Medical Association, 2008) Fernando, R.; Pathmeswaran, A.; Edirisinghe, D.; Abeysinghe, S.; Atulugama, N.; Bandara, D.; Premathileke, M.BACKGROUND: lodization of salt was made mandatory in Sri Lanka in 1995. Data on the current prevalence and geographic distribution of goitre among the general population is not available. Objectives: To describe the epidemiology of goitre in the population over the age of 10 years in Sri Lanka DESIGN, SETTING AND METHODS: The country (excluding the Northern Province) was divided into 6 ecological zones based on annual rainfall and altitude. From each zone, 18 Grama Niladhari (GN) areas were selected, using the probability proportionate to size (PPS) technique. First household to be sampled was selected at random from the list maintained by the midwife and all eligible people in the house were sampled. The closest household, next to the index household,, was visited and sampling carried out next. The process was repeated until 50 subjects were sampled in a GN area. Each subject was examined by at least two researchers for the presence of a goitre. RESULTS: Total of 5200 subjects were assessed. 66 %( 3,433) were females. Mean (SD) age 36.3(17.3) years. 425 subjects had a goitre. The distribution of goitres according to the WHO categorization - Grades 1, 2, 3 and 4 was 18.6, 68.0, 12.5 and 0.9 percent respectively. Adjusted (age and zone) prevalence among females and males was 11.2% and 2.3% respectively. Adjusted (age and sex) prevalence (95% CI) in the different zones varied between 5.34% in the intermediate zone-south to 7.93% in the wet zone-hills. Overall adjusted prevalence was 6.8% (6.0-7.6). CONCLUSIONS: The prevalence of goitres is 6.8%. There is definite female preponderance. No obvious goitre belt can be discerned.Item Incidental finding of occult carcinoma in histology in total thyroidectomy for benign thyroid disease(2006) Fernando, R.; Mettananda, D.S.G.; Kariyakarawana, L.OBJECTIVES: The incidence of occult carcinoma of thyroid varies from 1%-10% in the literature. These unexpected cancers do not show any pre or intra-operative indication of malignancy. Total thyroidectomy in benign thyroid disease is receiving wider acceptance. If a lesser surgery is performed and an occult carcinoma is detected a difficult therapeutic dilemma ensues. This study presents the incidence and clinical presentation of occult carcinomas in a series of total thyroidectomies performed for benign disease. METHODS: Analysis was performed on 55 patients who have undergone total thyroidectomy for benign diseases. Surgeries were performed at the University Surgical Unit of North Colombo Teaching Hospital by a single surgeon from January 2000 to August 2005. Clinical manifestations, surgical details and histological findings were obtained from the patients' records. RESULTS: Five cases of occult carcinomas were discovered with an incidence of 9.1%. Histology confirmed 2 papilary, 2 medullary and 1 follicular carcinomas. Mean age was 52.0 (SD ±13.3) years and 80% were females. Majority (80%) presented with multinodular goiters; 60% were euthyroid and 40% were hyperthyroid. Fine needle aspiration cytology confirmed benign aetiology in all. None of these patients developed transient or permanent complications following total thyroidectomy. CONCLUSIONS: Incidence of occult thyroid carcinoma is 9.1% in this series. None of the patients had problems following total thyroidectomy. The policy of performing total thyroidectomy in benign disease appears to be beneficial as it obviate the need for further surgery if an occult carcinoma is found.