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 Single incision laparoscopic surgery (SILS) as surgical option in Crohn’s disease: our experience(Wiely-Blackwell, 2016) Leo, A.; Samaranayake, S.F.; Hodgkinson, J.D.; Santorelli, C.; Chandrasinghe, P.C.; Warusavitarne, J.H.AIM: Single Incision Laparoscopic Surgery (SILS) is a newer mini-invasive. Benefits of SILS in complex Crohn’s disease (CCD), which includes a significant cohort of young patients sometimes needing multiple operations has not been comprehensively assessed. This study analyses our early experience. METHOD: Data were collected prospectively from January 2013 to December 2015. Ileocolic resections, right hemicolectomy, small bowel stricturoplasties and resections SILS were included in the CCD cohort. Primary and re-do surgeries were analysed separately. RESULTS: A total of 45 patients were included: 39 ileocolic resections, 6 small bowel stricturoplasty/resections. Median hospital stay was 8 days (Range - 3 days – 28 days). Three patients from primary (11%) and 2 from re-do group (11%) had to be converted to open surgery. Total complication rate was 35.5% including 31.1% ClavienDindo 1 and 2. In term of operating time, average blood loss, conversion rates, complication rate and hospital stay, there was no significant difference between the groups. Six months follow-up showed no major complications. CONCLUSION: We have demonstrated the feasibility of SILS in patients with CCD. There were no significant differences between primary and re-do surgeries. More robust data and longer follow-up is needed in future studies to evaluate this further.Item Single incision laparoscopic surgery (SILS) for primary surgery in medically refectory ulcerative colitis: a case series(Wiely-Blackwell, 2016) Chandrasinghe, P.C.; Leo, C.A.; Samaranayake, S.F.; Santorelliei, C.; Strouhal, R.; Warusavitarne, J.INTRODUCTION: Medically refractive ulcerative colitis (UC) requires surgical intervention. Due to the ongoing inflammation in the colon this patient group is considered as high risk. Primary surgery includes subtotal colectomy (STC) as the first step of a staged restorative procedure, restorative proctocolectomy (RPC) or panproctocolectomy (PPC) with end ileostomy. Single incision surgery is gaining popularity in this group of patients. METHOD: Patients who underwent single incision surgery for medically refractory UC from 2013 January to 2015 December were prospectively followed up. Demographics, hospital stay and early complications were analyzed. Mann-Whitney U test was used to compare the medians. RESULTS: A total of 34 patients (male – 24, median age – 41.5 years; range 17–69 years) were included. There were 21 STCs, 9 PPCs and 4 RPCs done as primary surgery for medically refractory UC. The median hospital stay was 7 days (4–41 days). Four out of 34 patients had a complication with Clavien-Dindo score above 3; (2-re-operation for obstruction (5%), 2 required intensive care for sepsis (5%). Two procedures (5.8%) had to be converted strategically to open. Three patients had cancer in the resected specimen. The median age of those who had PPC was significantly higher compared to those who had restorative procedures (48 years: range 17–69 Vs 38 years: range 34–64; P < 0.005). CONCLUSION: Single incision surgery for medically refractory UC is safe with an acceptable complication profile in this group of medically unwell patients. The quality of life implications of this procedure require further evaluation.Item Single Incision Laparoscopic Surgery (SILS) as surgical option in Crohn's disease: our experience(Wiely-Blackwell, 2016) Leo, C.A.; Samaranayake, S.F.; Hodgkinson, J.D.; Santorelli, C.; Chandrasinghe, P.C.; Warusavitarne, J.AIM :Single Incision Laparoscopic Surgery (SILS) is a newer technique which is increasing in popularity. The benefit of SILS in complex Crohn's disease (CCD), which includes a significant cohort of young patients sometimes needing multiple operations has not been comprehensively assessed. This study analyses our early experience with this technique. METHOD: Patients who underwent SILS for CCD were included. Data were collected prospectively from Januray 2013 to December 2015. Ileocolic resections, right hemicolectomy, small bowel stricturoplasties and resections were included in the CCD cohort. Primary and re-do surgeries were analysed separately. RESULTS: A total of 45 patients were included: 39 ileocolic resections, 6 small bowel stricturoplasty/resections. Of the total, 27 were primary resections and 18 were re-do resections. In overall, the median age was 41 years (Range – 14 years–72 years), the median hospital stay was 8 days (Range - 3 days–28 days). Three patients from primary (11%) and 2 from re-do group (11%) had to be converted to open surgery. Total complication rate was 35.5% including 31.1% Clavien Dindo 1 and 2. In term of operating time, average blood loss, conversion rates, complication rate and hospital stay, there was no significant difference between the groups. Six months follow-up showed no major complications. CONCLUSION:We have demonstrated the feasibility of SILS in patients with CCD undergoing both primary and re-do surgeries. There were no significant differences between the two groups. More robust data and longer follow-up is needed in future studies to evaluate this further.Item Single incision laparoscopic surgery (SILS) for primary surgery in medically refectory ulcerative colitis: a case series(Wiely-Blackwell, 2016) Chandrasinghe, P.C.; Leo, C.A.; Samaranayake, S.F.; Santorelli, C.; Strouhal, R.; Warusavitarne, J.AIM:Medically refractive ulcerative colitis (UC) requires surgical intervention. Primary surgery includes subtotal colectomy (STC), restorative proctocolectomy (RPC) or panproctocolectomy (PPC) with end ileostomy. Single incision surgery is gaining popularity in this group of patients. METHOD: Patients who underwent single incision surgery for medically refractory UC from 2013 January to 2015 December were prospectively followed up. Demographics, hospital stay and early complications were analysed. RESULTS: A total of 34 patients were included. There were 21 STCs, 9 PPCs and 4 RPCs done as primary surgery for medically refractory UC. The median hospital stay was 7 days (range: 4–41 days). Four out of 34 patients had a complication with Clavien-Dindo score above 3; (2-re-operation for obstruction (5%), 2 required intensive care for sepsis (5%). Two procedures (5.8%) had to be converted strategically to open. Three patients had cancer in the resected specimen. The median age of those who had PPC was significantly higher compared to those who had restorative procedures (48 years: range 17–69 vs 38 years: range 34–64; P < 0.005). CONCLUSION: Single incision surgery for medically refractory UC is safe with an acceptable complication profile. The quality of life implications of this procedure require further evaluation.Item Improving quality of life after pouch surgery with a dedicated nurse led follow up programme(Wiely-Blackwell, 2016) Chandrasinghe, P.; Leo, A.; Alison, L.; Perry-Woodford, Z.; Warusavitarne, J.AIM:Bowel function after ileal pouch affects the quality of life (QOL). The aim of the study was to assess if objective evaluation and specialised supportive care improves QOL after pouch surgery.METHOD: Consecutive patients who had an ileoanal pouch were invited to participate in a systematic follow-up regime led by specialised pouch nurse practitioners. The Cleveland global Quality of Life (CGQOL) and specific pouch related symptoms were documented at 6, 12, 24 and 52 weeks after ileostomy reversal. Pearson's Rho coefficient was used to assess the correlation between symptoms and CGQOL. RESULTS: Thirty-nine consecutive patients who had ileoanal pouch surgery were evaluated. Thirty-four had more than two visits and improvement in CGQOL (mean-1.36 ± 0.95) was seen in 27 (79%). There was reduction in CGQOL in 5 patients (15%) and no change in 2 (6%). Daytime frequency (DTF) significantly correlated with mean CGQOL (R = −0.7, P < 0.01). Twenty (59%) of 34 had reduced DTF after intervention. Nocturnal frequency only showed correlation with CGQOL up to 3 months. Incontinence had no impact on the QOL in this cohort. CONCLUSION: DTF has the highest impact on QOL in this cohort. Regular systematic specialised pouch care follow up may achieve better QOL.Item Comparison of urban diabetics with optimal and suboptimal control(British Medical Association, London, 2011) Pinidiyapathirage, M.; Warnakulasuriya, T.; Kasturiratne, A.; Ranawaka, U.; Gunasekera, D.; Wijekoon, N.; Medagoda, K.; Perera, S.; Takeuchi, F.; Kato, N.; Wickremasinghe, A.R.Introduction The prevalence of Diabetes Mellitus in Sri Lanka is increasing. We describe the characteristics of patients with optimal and suboptimal control of diabetes among known diabetics in a 35–64-year-old urban population resident in the Ragama Medical Officer of Health (Ragama MOH) area of Sri Lanka. Methods A cross sectional study was conducted among 2986 randomly selected 35–64 year olds in the Ragama MOH area from January to September 2007. A detailed history was taken and participants were subjected to a physical examination and assay of fasting blood glucose and HbA1C. A HBA1C <6.5 was taken as evidence of optimal control. Results There were 474 persons (194 males and 280 females) who gave a past history of diabetes. 9 males and 9 females were not on any treatment. 27 persons (9 males and 18 females) were on insulin. Of the 474 diabetics, 113 (48 males and 65 females) had a HbA1c <6.5. The average fasting blood glucose of diabetics with optimal control was 120+21 mg/dl. The mean fasting blood glucose level of the 361 subjects with sub optimal control was 190+70 mg/dl. Optimal glycaemic control was not associated with alcohol intake, smoking, obesity, central obesity and low physical activity levels. Conclusions Most known diabetics had access to treatment but only approximately 25% were optimally treated. The need to optimally manage these patients is highlighted.Item Seven–minute neurocognitive test battery: A reliable test for dementia(Elsevier, Inc. (2020-Wiley), 2006) de Silva, A.; Pathmeswaran, A.; de-Jager, C.; Kuruppuarachi, L.A.BACKGROUND: The increasing prevalence of Alzheimer’s disease (AD) suggests that there is an increasing need for accurate and easily administered screening instruments to assess cognitive function. OBJECTIVE(S): To examine the reliability of the 7-minute screen as a cognitive screening instrument for AD in a Sri Lankan population. METHODS: 53 patients with mild-moderate AD, 34 with other dementias, 36 with mild cognitive impairment (MCI) referred to a memory clinic, and 60 patients with depression with no evidence of dementia and 56 healthy volunteers (controls) were recruited to the study after informed consent. All were community-dwelling and aged _60 years. Patients with severe dementia, receptive aphasia, visual and motor impairment, and severe depression were excluded. All diagnoses were made according to established criteria and the diagnosis of depression was confirmed after psychiatric evaluation. All subjects underwent cognitive assessment with the Mini Mental State Examination (MMSE) and the 7-minute screen. This screen consists of four components (enhanced cued recall, temporal orientation, verbal fluency, and clock drawing) that assess memory, orientation to time, fluency of expression, and executive function, cognitive functions typically compromised in AD. RESULTS: Baseline characteristics did not differ significantly in the five groups. (see the table). CONCLUSIONS: The 7-minute neurocognitive screen is a highly sensitive instrument to screen for AD and was more reliable than the MMSE to detect AD, MCI, and other dementias in this Sri Lankan population. However, the accuracy of the screen may be confounded by the presence of depression.Item Local infiltration versus Laparoscopic e guided transverse abdominis plane block in laparoscopic cholecystectomy e double blinded randomized control trial(Elsevier, 2018) Siriwardana, R.C.; Kumarage, S.K.; Gunetilleke, M.B.; Thilakarathne, S.B.BACKGROUND: Transverse abdominal plane block (TAP) is a new technique of regional block described to reduce postoperative pain in laparoscopic cholecystectomy (LC). Recent reports describe an easy technique to deliver local anesthetic agent under laparoscopic guidance. METHODS: This randomized control trial was designed to compare the effectiveness of additional laparoscopic guided TAP block against the standard full thickness port site infiltration. 45 patients were randomized in to each arm after excluding emergency LC, conversions, ones with coagulopathy, pregnancy and allergy to local anesthetics. All cases were four ports LC. Interventions - Both groups received standard port site infiltration with 3-5ml of 0.25% bupivacaine. The test group received additional laparoscopic guided TAP block with 20ml of 0.25% bupivacaine subcostaly, between the anterior axillary and mid clavicular lines. As outcome measures the pain score, opioid requirement, episodes of nausea and vomiting and time to mobilize was measured at 6 hourly intervals. RESULTS: The two groups were comparable in the age, gender, body mass index, indication for cholecystectomy difficulty index and surgery duration. The pain score at six hours (P = 0.043) and opioid requirement at six hours (P =0.026) was higher in the TAP group. These were similar in subsequent assessments. Other secondary outcomes were similar in the two groups. CONCLUSION: Laparoscopic-guided transverses abdominis plane block does not give an additional pain relief or other favorable outcomes. It can worsen the pain scoresItem Mental health status among females aged 15 to 45 years in Medical Officer of Health area, Kayts(College of the Community Physicians of Sri Lanka, 2007) Thatparan, R.; Abeysena, C.OBJECTIVE: To describe mental health status among females aged 15-45 years in Medical officer of Health area, Kayts. METHODOLOGY: This was a descriptive cross-sectional study carried out in Kayts MOH Division during the period between October and November 2006. The study population consisted of 365 females of age 15- 45 years. Data collection was made using the GHQ-30 and a self-administered questionnaire, which included socioeconomic data and exposure to adverse effects of war and social support received. Data analysis was done by applying chi-square test and multiple logistic regression. RESULTS: Of 365, 278 females had a GHQ-30 >5 giving a prevalence of poor mental health status of 76.4%. of them 27(7.7%) experienced loss of a limb, 126(35.9%) complained loss of assets such as jewelry or furniture, 17(4.8%) experienced disappearance of family members or relatives, 94(26.8%) had partially and 84(23.9%) fully damaged houses. There were statistically significant association between poor mental health status and single marital status (OR:2.2; 95% Cl:1.3-3.7; P=0.005), experience of displacement (OR:2.4; 95 % Cl: 1.1-5.2; P=0.03) and receiving of any form of assistances (OR:0.3; 95% Cl: 0.2-0.6; P=O.OO1). There were no statistically significant associations between poor mental health status and age, religion, educational level, employment, income, experience of injury, loss of a family member and property or having partially or fully damaged houses. After controlling for confounding effect by applying multiple logistic regression statistically significant associations were observed between poor mental health status and experience of displacement (OR:3.4; 95% Cl: 1.4-8.2; P=0.006) and receiving any form of assistance (OR:0.3; 95% Cl: 0.1-0.5; P=O.OOO). There was no statistically significant association between poor mental health status and single marital status (OR: 1.7; 95% Cl: 0.9-3.0; P=O.08). CONCLUSION: Prevalence of poor mental health status was very high in the area. It was associated with experience of displacement and receiving assistance.Item Presenting symptoms/conditions and selected aspects of health care quality at the Outpatient Department (OPD) of the Wickramarachchi Ayurvedic Hospital, yakkala(College of the Community Physicians of Sri Lanka, 2007) Wanigasekara, C.; Weerasinghe, P.; Weerasinghe, A.; Weerasooriya, S.; Wellagiriya, S.; Wickramarathne, S.; Wijerathne, B.; Abeysena, C.OBJECTIVE: To describe the presenting symptoms/conditions and selected aspects of health care quality of the Outpatient Department (OPD) of the Wickramarachchi Ayurvedic Hospital. METHODOLOGY: A descriptive cross sectional study was conducted on patients seeking treatment from the CPD oi the Wickramarachchi Ayurvedic Hospital. Yakkala between February to April 2007. A pre-tested interviewer administered questionnaire was used to gather information from 250 patients. RESULTS: Fever, cold and respiratory symptoms (44.2%; n=46), musculoskeletal complaints (28.8%; n=30) and dermatological conditions (14.4%; n=15) were the commonest presentations among persons up to 40 years old. Musculoskeletal complaints (26.8%; n=38). lever, cold and respiratory symptoms (24.6%; n=35) diabetes and hypertension (20.4%; n=29) and eye problems (9.8%; n=14) were the commonest presentations among persons above 40 years. Out of 250 patients, 56(22.4%) had visited the Ayurvedic Hospital as the first preference for the current illness and the balance 194(77.6%) patients had taken treatment from other health care institutions. The majority (86%: =168) sought ayurvedic medicine after taking western medicine. The most common reason for giving up previous treatment methods was treatment failure (69%; n=135). The distance between home and the hospital was <10 km for 52.4%(n=137) patients and >20 km for 11.6%(n=54) patients. Median total expenditure for one visit to the Ayurvedic hospital was Rs.200 (Range Rs. 00500 to 3000.00) and 57.6%(n=144) had spent Rs.100-500 for one visit. Median waiting time for consultation was 90 minutes (Range 5 — 300min). Consultation time was <5 minutes in 52%(n=131) and >10minutes in 24%(n=60) of patients. Two hundred and seven (83%) patients were satisfied with treatment given and 224 (69.6%) on facilities provided by the Ayurvedic hospital. Statistically significant associations were observed between high satisfaction and low educational level (p<0.001) and previous treatment failure from other systems (p<0.001). CONCLUSION: Patients seek ayurvedic treatment for various symptoms/diseases irrespective of their severity. patient's age and the distance to the hospital. The commonest reason for seeking ayurveda treatment was treatment failure at other methods. A majority were satisfied with the treatment provided and facilities available.