Conference Papers

Permanent URI for this collectionhttp://repository.kln.ac.lk/handle/123456789/6561

This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine

Browse

Author: search.filters.author.Fernando, R.

Search Results

Now showing 1 - 10 of 22
  • No Thumbnail Available
    Item
    6542 Clinical profiles of children less than 5 years presenting with or high risk of cerebral palsy in the Western Province of Sri Lanka
    (BMJ, 2024) Sumanasena, S.; Heiyanthuduwage, T.M.; Fernando, R.; Sheedy, H.S.; Jagoda, J.; Wijesekara, S.; Wanigasinghe, J.; Muttiah, N.; Rathnayake, P.; Kitnasamy, G.; Khandaker, G.
    OBJECTIVES Cerebral palsy (CP) is the commonest physical disability in children globally.1 It is a clinical diagnosis based on clinical and neurological findings. International clinical practice guidelines recommend early diagnosis and CP specific interventions to invest in neural plasticity and achieve optimal functional levels.2 In the past diagnosis was confirmed at 12–24 months but now it is advanced to confirm or identify as high risk for CP before the age of six months.3 4 Sri Lanka is one of the few Asian countries that initiated a CP register and National Guidelines on management of CP.5 The objective of this paper is to describe the clinical profiles of children less than 5 years presenting to Western Province hospitals in Sri Lanka based on the data from the Sri Lanka Cerebral Palsy Register (SLCPR).METHODS A cross sectional hospital-based study was conducted in the Western Province from September 2018 – October 2021 in three teaching hospitals to collect a minimum data set for the Sri Lanka SLCPR. Data of children less than 60 months was extracted with a confirmed clinical diagnosis of CP or identified formally as ‘high risk’ of CP.Information on sociodemographic, pre/peri/neonatal, and post neonatal risk factors, and associated impairments were collected using hospital records and clinic notes. Clinical motor type, topography, and associated impairments were evaluated.RESULTS Data of 431 children were extracted, 254 (58.9%) were males. Mean age at diagnosis was 28.73 months (median 27, SD 14.98). Most children (n= 422, 97.9%) acquired CP in the pre/peri/neonatal period. The mean birth weight was 2304.4 g (median 37, SD 825.58g) and the mean POA was 35.82 months (median 37, SD 4.88). Main risk factors identified were prematurity (n=190, 44.1%), hypoxic ischaemic encephalopathy (HIE) (n= 234, 54.3%), jaundice (n=31, 7.2%) and sepsis (n= 13, 3.0%). While 183 children (42.5%) showed evidence of definitive spastic motor type, 184 (42.7%) showed predominant dyskinesia.CONCLUSION The age at diagnosis of this population from Sri Lanka is significantly lower than from other LMICs. HIE and prematurity, both preventable conditions remain the highest risk factors. Longitudinal follow up will ascertain the final motor outcomes as a higher proportion of children showed dyskinesia. The SLCPR is an important resource which will support new research towards investigating opportunities for prevention and service planning for children.
  • No Thumbnail Available
    Item
    6503 Using anthropometric data to investigate the nutritional status of children included on the Sri Lankan cerebral palsy register.
    (BMJ Publishing Group Ltd, 2024) Sumanasena, S.; Fernando, R.; Kurukulaarachchi, S.; Heiyanthuduwage, T.M.; Sheedy, H.S.; Wijesekara, S.; Jagoda, J.; Muttiah, N.
    OBJECTIVES The nutritional data from children with cerebral palsy (CP) in low and middle income countries (LMIC) is sparse. In high income countries (HICs) well established nutritional care plans, commercial products and good psycho-social support are available.1 A multitude of complications arise due to malnutrition leading to poor quality of life.2 Here we investigated the nutritional status of children included in the Sri Lankan Cerebral Palsy Register (SLCPR).METHODS The study included 768 children aged 0–18 years with CP, attending three teaching hospitals in the Western Province, from September 2018 to November 2021. Data included clinical profile and anthropometry [weight (Kg), height (cm), BMI, mid upper arm circumference (MUAC) (cm), and OFC (cm)] based on WHO. Average was calculated using three repeated measurements. Children who could not stand independently (GMFCS level 4/5) underwent height estimations with the knee height equation: height = (2.69 X Knee height) + 24.2.Indicators used to measure the nutritional status were: weight for age Z score (WAZ), height for age Z score (HAZ), weight for height Z score (WHZ), BMI for age Z score (BAZ), and MUAC for age Z score (MUACZ). WHO Anthro and WHO AnthroPlus software calculated all Z scores.4 HAZ and BAZ were calculated for children aged <18 years, WAZ was calculated for children aged <10.1 years, and WHZ and MUACZ were calculated for children aged <5.1 years. The z scores < -2.0 SD were categorized as underweight (WAZ), stunted (HAZ), wasted (WHZ or MUAC), thin (BAZ).RESULTS Total of 768 children (mean age 59.6 months, SD 44.9, 62.5% males) participated. There were (n=431) children under 61 months and (n=520) from 0–10 years. Of them, 51.3% (n = 267/520) were underweight, 59.8% (n = 258/431) were stunted and 27.3% (n = 210/768) were thin. Among children aged < 5 years, 26.7% (n = 115/431) had severe wasting and severe acute malnutrition (SAM) according to MUACZ < -3SD. Both underweight and stunting were significantly higher among children with spastic CP compared with others (p<0.05). In the 5–19 year group 16.9% (n= 57/337) were obese (BAZ > + 2SD).CONCLUSION Predominant stunting and underweight in this population calls for urgent action to minimize chronic malnutrition. It is imperative to further explore nutritional intake and feeding difficulties in this group and offer structured nutritional care plans. The trend observed in older children towards obesity possibly indicates the need for coordinated nutrition and exercise programmes. It is recommended to regularly monitor growth and nutritional status of all children with CP as there may be serious implications for their activity levels.
  • Thumbnail Image
    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.
  • Thumbnail Image
    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.
  • No Thumbnail Available
    Item
    Elective cholecystectomy is associated with increased morbidity and mortality in patients with severe Thalassemia: A retrospective case control study.
    (Ferrata Storti Foundation, 2015) Premawardhena, A.; Fernando, R.; Kumarage, S.; Nishad, N.; de Silva, I.
    BACKGROUND: Haemoglobin disorders including thalassemia and sickle cell disease are often complicated with gall stone formation. The co-existence of Gilbert's syndrome together with these diseases further increases the risk of gall bladder disease. Some of these patients develop symptomatic disease which necessitates surgical intervention. At present the timing of cholecystectomy for thalassemia is no different from that of the general population with the exception of removal of the gall bladder at the time of splenectomy. This is no longer the case in sickle cell disease where, laparoscopic cholecystectomy is recommended even in asymptomatic patients. This practice however has not been extended to other types of haemoglobin disorders. AIM(S): 1.To assess the perioperative complications of patients with thalassaemia during cholecytetomy and to compare it with non thalassaemics who undergo the procedure. 2. To see if there is enough evidence to recommend elective cholecystectomy for thalassaemics. METHOD(S): We retrospectively studied case notes of thalassemia patients who had cholecystectomy (cases) in two of the biggest thalassaemia centres in Sri Lanka and also of 62 non-thalassaemics (controls) with gall bladder disease who had been scheduled to have gall bladder surgery in the same hospitals and looked at their peri-operative complications. RESULT(S): 98 out of 540 (18%) thalassaemics in the two centres had gall stones. Mean age of cases was 26.8 (SD 10.9) years and of controls 47.5 (SD 19.7) years. 19 (19%) thalassaemics with gall stones had undergone cholecystectomy. Ten patients had cholecystectomy simultaneously with splenectomy. The majority of non-thalassaemic "controls" had laparoscopic cholecystectomy 53/55 (96.3%) whilst the patients with thalassaemia were mostly operated with laparotomy 13/19 (68%). There was a significant excess complications occurring in both early (42.11 vs. 18.1%) and late (31.5 vs. 12.7%) phases in the thalassaemic patients compared with the controls. Among the early complications, sepsis (10.5% vs. 1.8%) and liver abscess formation (5.2 vs. 0%) was significantly different in the groups, adversely affecting the thalassaemics. Recurrent abdominal pain was more common among the thalassaemics as a late complication (P<0.05). Six thalassaemic patients with gall stone disease died during this study, 5(5%) while awaiting surgery and 1(1%) after surgery. There were no deaths among the controls. Out of the deaths, 3 (50%) were directly attributable to gallstone disease. In all three septicemia precipitated heart failure. We found a significant increase of both early and late post-surgical complications in the thalassemia group and also increased mortality most of which was related to severe sepsis. Higher perioperative mortality and morbidity were seen among symptomatic thalassaemic patients with gall stone disease undergoing cholecystectomy. This seems to suggest a strong case for supporting elective cholecystectomy in thalassemics before they develop symptoms. SUMMARY AND CONCLUSION(S): We suggest that laparoscopic elective cholecystectomy be considered for non-sickle, thalassemia patients too who have asymptomatic gall bladder disease, in an attempt to reduce this morbidity and mortality.
  • Thumbnail Image
    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.
  • No Thumbnail Available
    Item
    Awareness regarding electroconvulsive therapy (ECT) among service users at a tertiary care hospital
    (Sri Lanka Medical Association, 2019) Hapangama, A.; Gunasekera, T.; Pieris, M.U.P.K.; Fernando, R.; Kuruppuarachchi, K.A.L.A.
    INTRODUCTION & OBJECTIVES: ECT saves lives and is extremely effective in treatment resistant psychiatric conditions. Despite this there appear to be an unease and stigma attached to ECT. Exploration about the awareness regarding ECT among service users can improve the practice of ECT. Objective was to demonstrate awareness about ECT among services users at a tertiary care hospital. METHODS: Cross-sectional study carried among all consenting service users at a tertiary care Hospital in Sri Lanka using an interviewer administered questionnaire. RESULTS: Out of 221 participants, 54% were careers. 65% thought ECT is a treatment for psychiatric conditions while 58% and 19% thought ECT is used to violence in the absence of a mental illness and to punish opponents respectively. There was no-significant association between educational level and awareness about ECT (p>0.05). The commonest source of ECT was doctors (43%). Cognitive side effects (46%) and headache (59%) were the commonly feared side effects. 5% thought ECT doesn’t 't have a scientific basis-and 20% felt it is an inhuman mode of treatment. 38% felt they would receive ECT if recommended. CONCLUSION: Doctors were the commonest source of information regarding ECT and more than half of the participants knew it was used to treat a psychiatric condition. Surprisingly only a minority thought ECT didn't have scientific basis however 20% felt it was an inhumane mode of treatment. However, a considerable proportion were willing to undergo ECT if recommended. Despite popular beliefs this cohort of participants appeared to have a more favourable awareness about ECT.
  • No Thumbnail Available
    Item
    Awareness and usage patterns of substances among pre-clinical phase students at a Medical Faculty in Sri Lanka
    (Sri Lanka Medical Association., 2019) Hapangama, A.; Fernando, R.; Pathmeswaran, A.; Kuruppuarachchi, K.A.L.A.
    INTRODUCTION AND OBJECTIVES: Availability and usage patterns of psychoactive substances have changed worldwide. Knowledge about new trends of substance use is important for future generation of medical professionals to deliver appropriate treatment. Objective of the study was to determine the awareness and prevalence of substance use among pre- clinical phase medical students in a university in the Western Province, Sri Lanka. METHODS: A cross-sectional descriptive study was carried out using a self-administered questionnaire. RESULTS: Out of 162 students, 61.7% were female, 97.5% were between 20-25 years. 99% were aware of alcohol being a substance of abuse. 34% and 30% were not aware that heroin and cannabis were substances of abuse. Less than half of participants were aware of corex-D (44.4%), volatile substances (39.5%), and methamphetamines (32.7%). Figures for awareness about Psilocybin (9.9%), MDMA (8.6%), LSD (8%), GHB (4.3%), DXM (2.5%). Main sources of information regarding substances were peers and internet. 21% and 18 % of participants had used alcohol and betel respectively at least once while tobacco and corex-D was used among 7.4% and 6.2% respectively. 69% of substance users were male. Use of substances was significantly associated with male gender. CONCLUSION: Alarmingly majority of the participating pre-clinical phase students were not aware of the abuse potential of heroin and cannabis as well as of newer generation recreational drugs. Awareness regarding current trends and misuse potential of psychoactive substances and their consequences should be enhanced among medical students.
  • No Thumbnail Available
    Item
    Dietary goitrogens and prevalence of goitre in Sri Lanka
    (The College of Surgeons of Sri Lanka, 2011) Pinto, M. D. P.; Fernando, R.; Pathmeswaran, A.; Premathilake, M.; Fernando, T.; Edirisinghe, D.; Bandara, D.; Athulugama, N.; Abeysinghe, S.
    OBJECTIVE: To assess the relationship between dietary goitrogens and the prevalence of goiter. METHODS:A descriptive cross-sectional study on the prevalence of goitre was conducted involving all areas of the country, except North and Batticaloa district from December 2006 to June 2007. A pre-tested interviewer administered questionnaire was used on all participants as a screening tool. Consumption of 6 possible dietary goitrogens was assessed. Sufficient frequency of consumption was taken as consumption >3 times a week. Pearson's chi-square test was used to analyze the significance of dietary goitrogens to the prevalence of goiter. RESULTS: 5200 participants were assessed (n=5200) island wide and 426 were detected with goitre. Mean age for occurrence of goitre was 36.3(+_17.3) years. Frequency of consumption of these food items was low, none being higher than 10% among the 5200 participants. Consumption of each goitrogen was as follows; Cabbage "[2.9%], Lima beans [9.9%], Kurakkan (Millet) [4%], Turnip [2.9%], Manioc(Cassava) [2.2%] and Peanuts [5.5%]. All six dietary goitrogens showed no significant association with the occurrence of goitre (p<0 05).CONCLUSION:Dietary goitrogens do not appear to have an association with prevalence of goitre in this cohort. As this cohort is a representative sample, dietary goitrogens are unlikely to be associated with prevalence of goitre in Sri Lanka.
  • No Thumbnail Available
    Item
    Thyroidectomy: no place for routine drainage- experience of two centres
    (The College of Surgeons of Sri Lanka and SAARC Surgical Care Society, 2003) Fernando, R.; Esufali, S. T.
    INTRODUCTION: Insertion of drains following thyroidectomy is considered a 'hallowed' practice. This practice has remained unchallenged because of fear and tradition. There is sufficient scientific evidence to show that routine drainage following thyroidectomy is not necessary. METHODS: Twosimultaneousprospective studieswere undertaken at University Surgical uriits of'Kelaniya and Peradeniya 150 patients undergoing elective thyroidectomy from 1999to 2002 were included in thestudy, The researcher in Kelaniya had NOT undertaken routine drainage for several years arid 100 consecutivepatientsundergoingthyroidectomywithout drainage were included in the study In Peradeniya 25 patients underwent thyroidectomy with drains and 25 patients underwent thyroidectomy without drains. All types of thyroidectomies were included in the study. Total- Thyroidectomy - 23 (Kelaniya) ,- 03 (Peradeniya) Subtoal - thyroidectomy - IO (Kelaniya),- 29 (Peradeniya) Thyroid- Lobectomy - 55 (Kelaniya) ,- 18 (Peradeniya) Redo- Thyroidectomies - 12 (Kelaniya) Parameters assessed: 1. Prospective complications - Wound infection, Haematoma, Hypocalcaernia and Recurrent laryngeal nerve injury 2 Re-exploration and indications RESULTS: Wound infection rate:With drains-8% Hypocalcaemia-1%(permanent) Without drains-0% (both groups) Wound Haematoma: With drains-6% Nerve injury-2% (transient) Without drains-2%(Seroma) (both groups) No patient required re-exploration for a life threatening complication in either group. CONCLUSIONS: 1. Thyroidectomy without drainage can be done safely. 2. Routine drainage in thyroidectomy is NOT indicated