Journal/Magazine Articles

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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine

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    Improving psychological well-being among healthcare workers during the COVID-19 pandemic with an online mindfulness intervention: A randomised waitlist-controlled trial
    (Wiley, 2024) Baminiwatta, A.; Fernando, R.; Solangaarachchi, I.; Abayabandara-Herath, T.; Wickremasinghe, A.R.; Hapangama, A.
    The high prevalence of psychological problems observed among healthcare workers (HCWs) during the COVID-19 pandemic called for interventions to safeguard their mental health. We assessed the effectiveness of a 6-week online mindfulness-based intervention in improving well-being and reducing stress among HCWs in Sri Lanka. Eighty HCWs were recruited and randomised into two groups: waitlist-control (WLC) and intervention groups. In the intervention, 1-hour online sessions were conducted at weekly intervals and participants were encouraged to do daily home practice. Stress and well-being were measured pre- and post-intervention using the Perceived Stress Scale and WHO-5 Well-being Index, respectively. One-way analysis of covariance was used to evaluate the effectiveness, in both intention-to-treat (ITT) and complete-case (CC) analyses. A significantly greater improvement in well-being occurred in the intervention arm compared to WLC on both ITT (p = .002) and CC analyses (p < .001), with medium-to-large effect sizes (partial η2 = .117-.278). However, the reduction in stress following the intervention was not significant compared to the WLC group on both ITT (p = .636) and CC analyses (p = .262). In the intervention arm, the median number of sessions attended by participants was 3. Low adherence to the intervention may have contributed to the apparent non-significant effect on stress.
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    Improving medical students' understanding of dementia using a movie ( The Father)
    (Taylor & Francis, 2023) Baminiwatta, A.; Fernando, R.; Williams, S.
    No abstract available
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    2021 Asia-Pacific Graves' Disease consortium survey of clinical practice patterns in the management of graves' disease
    (Humana Press, 2023) Parameswaran, R.; de Jong, M.C.; Kit, J.L.W.; Sek, K.; Nam, T.Q.; Thang, T.V.; Khue, N.T.; Aye, T.T.; Tun, P.M.; Cole, T.; Miller, J.A.; Villa, M.; Khiewvan, B.; Sirinvaravong, S.; Sin, Y.L.; Muhammad, R.; Jap, T.S.; Agrawal, A.; Rajput, R.; Fernando, R.; Sumanatilleke, M.; Suastika, K.; Shong, Y.K.; Lang, B.; Bartalena, L.; Yang, S.P.; Asian Graves Consortium Study.
    Aim: Although Graves' disease (GD) is common in endocrine practices worldwide, global differences in diagnosis and management remain. We sought to assess the current practices for GD in countries across Asia and the Pacific (APAC), and to compare these with previously published surveys from North America and Europe.Methods: A web-based survey on GD management was conducted on practicing clinicians. Responses from 542 clinicians were received and subsequently analysed and compared to outcomes from similar surveys from other regions. Results: A total of 542 respondents participated in the survey, 515 (95%) of whom completed all sections. Of these, 86% were medical specialists, 11% surgeons, and 3% nuclear medicine physicians. In addition to serum thyroid-stimulating hormone (TSH) and free thyroxine assays, most respondents would request TSH-receptor autoantibody (TRAb) measurement (68%) during initial work-up. Thyroid ultrasound is requested by about half of respondents (53%), while the use of nuclear medicine scans is limited. The preferred first-line treatment is anti-thyroid drug (ATD) therapy (79%) with methimazole (MMI) or carbimazole (CBZ), followed by radioiodine (RAI; 19%) and surgery (2%). In case of surgery, one-third of respondents would opt for a subtotal rather than a total thyroidectomy. In case of mild Graves orbitopathy (GO), ATDs (67%) remains the preferred treatment, but a larger proportion of clinicians prefer surgery (20%). For a patient with intention to conceive, the preferred treatment pattern remained unchanged, although propylthiouracil (PTU) became the preferred ATD-agent during the first trimester. In comparison to European and American practices, marked differences were noted in the relatively infrequent usage of nuclear medicine scans and the overall higher use of a ATDs and β-blockers and adjunctive ATD-treatment during RAI in the APAC-group.Conclusion: Although regional differences regarding the diagnosis and management of GD are apparent in this first pan-Asia-Pacific survey, this study reveals the overall approach to the management of this disease in Asia-Pacific generally tends to fall between the trends appreciated in the American and European cohorts.
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    Hypocalcemia and hoarseness following total thyroidectomy for benign disease: Relationship of incidence to the size of the gland
    (Jaypee Brothers Medical Publishers (P) Ltd, 2011) Fernando, R.; Chandrasinghe, P.C.; Bandara, M.; Renuka, M.B.S.; Athulugama, N.S.
    INTRODUCTION: Total thyroidectomy is considered as the standard surgical procedure for most malignancies and benign disease involving both lobes of the thyroid gland. Postoperative complications are likely to be commoner when the thyroid gland is large in size due to the alteration of structural anatomy. METHODS: Postoperative complications of 102 patients who underwent total thyroidectomy for benign disease, by the same surgeon, were analyzed. Patients were prospectively followed up and presence of hoarseness and hypocalcemia, both transient and temporary, were compared with the weight of the gland. RESULTS: Fourteen patients developed hypocalcemia of which 12 (11.7%) had transient and 2 (1.96%) had permanent deficiencies. Eight patients developed hoarseness following surgery of which seven (6.86%) had transient and only one (0.98%) had permanent hoarseness. A mean thyroid weight of 91.78 gm was observed in the uncomplicated group. Those who developed postoperative hypocalcemia and transient hoarseness had a mean thyroid weight over 100 gm. One patient, who had a thyroid weighing 195 gm developed permanent hoarseness due to RLN injury. CONCLUSION: There is no statistically significant difference in the incidence of transient RLN and transient or permanent hypocalcemia. With increased size of the thyroid gland increased rate of complications was observed with a mean thyroid weight above 100 gm. There may be a significant risk of permanent RLN injury when the thyroid gland is enlarged over 10 times (closer to 200 gm) its normal size. © Jaypee Brothers Medical Publishers (P) Ltd. AUTHOR KEYWORDS: Complications; Size of the gland; Thyroidectomy. INDEX KEYWORDS: adult; aged; article; controlled study; female; goiter; hoarseness; human; hypocalcemia; incidence; major clinical study; male; nerve injury; postoperative complication; recurrent laryngeal nerve injury; risk assessment; thyroid weight; thyroidectomy
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    Use of laryngeal mask airway in total thyroidectomy in a patient with ocular myasthenia and graves’ disease
    (Jaypee Brothers Medical Publishers (P) Ltd, 2019) Shilpage, S.; Fernando, R.; Munasinghe, N.; Gunetilleke, B.
    ABSTRACT: BACKGROUND: The association between Graves’ disease (GD) and ocular myasthenia (OM) is well known. Total thyroidectomy gives a permanent “cure” for GD and the literature reports a varying progression of myasthenia gravis (MG) in such patients after surgery. The main issue in patients with MG is the difficulties with the use of muscle relaxants during anesthesia. In the ensuing case report, a patient with OM and GD who had a total thyroidectomy under general anesthesia (GA) with laryngeal mask airway (LMA) without muscle relaxants is described. CASE REPORT: A 40-year-old man was clinically and biochemically diagnosed to have GD. Subsequently, he developed bilateral ptosis which was diagnosed as OM by a neurologist. Though his OM responded to treatment, his GD was not well controlled. He was admitted, monitored, and made euthyroid by adjusting the carbimazole dose. A decision was made to undertake total thyroidectomy for GD, with total intravenous anesthesia and Proseal® LMA without muscle relaxants following a discussion with the anesthetic team. A conventional total thyroidectomy was performed using nerve encountering, parathyroid preserving, and capsular dissection technique. The patient made an uncomplicated recovery. CONCLUSION: A technique combining total intravenous anesthesia and a LMA without muscle relaxants for thyroid surgery in a patient with MG has advantages over a standard method. The use of LMA in other thyroid surgeries must be further evaluated for future use. CLINICAL SIGNIFICANCE: Coexistence of MG and GD should be in mind when treating the patients with GD. Individualize the use of muscle relaxants in GA and best to avoid whenever possible. © The Author(s). 2019.
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    Recurrent goiters
    (Jaypee Brothers Medical Publishers (P) Ltd, 2019) Fernando, R.
    ABSTRACT: A recurrent goiter is the regrowth of thyroid tissue after thyroidectomy. The causes of recurrence following surgery for the benign disease can be broadly attributed to inadequate surgery, embryological remnants left behind inadvertently, and the development of a malignancy in the remnant. Recurrence after surgery for the benign disease should be preventable. Subtotal thyroidectomy (STT) was the main operation for goiters until the 1980s. The main issue with a subtotal surgery is a recurrence. One of the primary reasons why STT fails can be attributed to the fact that STT does not treat the underlying generalized disease adequately. The consensus is emerging that the best surgical option for multinodular goiter is total thyroidectomy. Even after “total” thyroidectomy, there is recurrence, what is left behind is related to the three embryological remnants of thyroid, namely pyramidal lobe recurrences, recurrence of the tubercle of Zuckerkandl, and thyrothymic recurrences. The surgical technique at the initial total thyroidectomy must be meticulous, ensuring that all embryological remnants are excised properly. Goiter recurrence is a failure of surgical treatment of goiter. Inadequate surgery and failure to excise all thyroid tissues are two preventable causes for recurrence. The technique of reoperative thyroidectomy must include capsular dissection, removal of all embryological remnants, and parathyroid autotransplantation. Surgery for recurrent goiter is challenging. It is thought to entail a higher complication rate and complication rates may be high in inexperienced hands; low complication rates have been achieved in specialized centers. The fear of complications should not deter experienced surgeons from performing reoperative thyroid surgery. In terms of technique, the lateral approach to thyroid offers a good alternative for recurrent goiters. A meticulous technique and parathyroid autotransplantation will help minimize the complication rate. © The Author(s). 2019.
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    Microcytic anemia in children: Parallel screening for iron deficiency and Thalassemia provides a useful opportunity for Thalassemia prevention in low- and middle-income countries
    (Hemisphere Pub. Corp., 2020) Mettananda, S.; Paranamana, S.; Fernando, R.; Suranjan, M.; Rodrigo, R.; Perera, L.; Vipulaguna, T.; Fernando, P.; Fernando, M.; Dayanath, B.K.T.P.; Costa, Y.; Premawardhena, A.
    ABSTRACT:Microcytic anemia in children is commonly attributed to iron deficiency without attempting to find the cause. Inadequate investigations to exclude hemoglobinopathies lead to missed opportunities for identification of thalassemia carriers. Here we aim to describe the relative contribution of iron deficiency and thalassemia to microcytic anemia in children. This hospital-based prospective study was conducted at the Colombo North Teaching Hospital, Ragama, Sri Lanka. All newly diagnosed patients with microcytic anemia were recruited and data were collected using an interviewer-administered questionnaire. Full blood count, blood film, serum ferritin, c-reactive protein, quantification of hemoglobin sub-types and α-globin genotype were performed using 4 ml of venous blood. A total of 104 children (Male- 60.5%) were recruited. Iron deficiency was the cause for anemia in 49% whilst 16% and 10% had α- and β-thalassemia trait respectively. Seven (6.7%) children had co-existing iron deficiency and thalassemia trait while two coinherited α- and β-thalassemia trait. Children with β-thalassemia trait had significantly higher red cell count and lower mean corpuscular volume compared to children with iron deficiency. However, none of the red cell parameters were significantly different between children with α-thalassemia trait and iron deficiency. Iron deficiency contributes only to half of children with microcytic anemia; one-fourth had thalassemia trait. Co-existence of iron deficiency and thalassemia trait or co-inheritance of α- and β-thalassemia trait were found in 9%. Parallel investigation of children with microcytic anemia to diagnose iron deficiency and thalassemia provides an opportunity to identify thalassemia carriers which is beneficial for thalassemia prevention.
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    Incidental thyroid carcinoma in benign thyroid disease: A Cohort study
    (World Journal of Endocrine Surgery., 2018) Pinto, D.; Munasinghe, N.; Chandrasinghe, P.C.; Fernando, R.
    ABSTRACT: AIM: An incidental thyroid carcinoma (ITC) is a thyroid malignancy that is not clinically or cytologically detected preoperatively. The incidence of ITC is between 10% to 20% in the literature. A study was undertaken to assess the incidence of ITC in patients undergoing total thyroidectomy for benign disease of the thyroid to University Surgical Unit, North Colombo Teaching Hospital (NCTH), Sri Lanka. MATERIALS AND METHODS: Prospective cohort study was undertaken from November, 2002 to October, 2015. Patients with palpable thyroid nodules were assessed with fine needle aspiration cytology (FNAC) and ultrasound scan (USS) to ascertain benign thyroid disease (BTD). Hormone assays were conducted to detect thyroid status. All patients with BTD who underwent total thyroidectomy were included in the study. Histopathological assessments were made by a panel of pathologists. Patients with autoimmune thyroiditis (AIT) were excluded due to the known association with malignancy of the thyroid. Post-thyroidectomy histopathological diagnoses were collected prospectively and patients with ITC were identified. Statistical analysis was done using statistical package for the social sciences (SPSS) software, version 20. RESULTS: Hundred and sixty seven patients (n = 167) who fulfilled the inclusion criteria were analysed (Male–20, female–147, median age = 40.25 year, range 28 year–62 year). ITC was found in 19 patients with an incidence of 11.38%. No significant association was noted with morphology, biochemical status of the thyroid or gender. CONCLUSION: Incidence of ITC is 11.38% in this cohort. Incidence of ITC being approximately 1:10 emphasizes the need to consider total thyroidectomy in the management of BTD.
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    A Juvenile sex offender with Attention Deficit Hyperactivity Disorder
    (BbW Publisher, 2018) Chandradasa, M.; Hettiarachchi, D.; Fernando, R.; Gunathilake, M.; Wijetunge, S.; Tennakoon, A.
    BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder manifesting in early life. These children are more vulnerable to sexual abuse as victims and offenders. This is a case report of a teenager with previously undiagnosed ADHD presenting with an alleged act of sexual offending. CASE REPORT: According to the 14-year-old accused, he has engaged in penetrative anal intercourse with another schoolmate. that similar past incidents had involved a teenage male relative and insertion of foreign bodies to his anus repeatedly by him. On assessment the accused had features of inattention, such as difficulty in sustaining attention, failing to finish work and features of impulsivity, such as difficulty waiting for his turn and intruding on others. He was diagnosed with ADHD according to Diagnostic and Statistical Manual of Mental disorders (DSM 5) clinical criteria which were supported by the Sinhalese adaptation of the Swanson, Nolan and Pelham questionnaire. The assessment of the non-verbal intelligence was in the normal range, but his school performance was far below the average. DISCUSSION: Undiagnosed ADHD contributes to academic impairment and inappropriate sexual behaviour. It is possible that the described adolescent’s impulsiveness and inattention contributed to his academic failure and risky sexual behaviour. Early detection and proper management of this disorder may have reduced the risk of such behaviour in him.
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    A Comparative international study on the management of acute appendicitis between a developed country and a middle income country
    (Elsevier, 2014) Markar, S.R.; Pinto, D.; Penna, M.; Karthikesalingam, A.; Bulathsinhala, B.K.S.; Kumaran, K.; Hashemi, M.; Fernando, R.
    BACKGROUND: In the past decade there has been an exponential increase in the use of Computerised Tomography (CT) imaging in the assessment of patients with acute appendicitis. The aim of this study was to compare management approaches and clinical outcomes of acute appendicitis in Sri Lanka and the United Kingdom. METHODS: Data was collected prospectively from 400 patients referred to the General Surgical department with a differential diagnosis of acute appendicitis, 200 at University Kelaniya Sri Lanka (SL group), and 200 at University College London Hospital (UK group). RESULTS: The groups were similar with respect to gender, but the SL group was younger. Preoperative work-up included ultrasound more commonly in SL patients, and CT more commonly in UK patients. More patients underwent appendicectomy in the SL group, however a laparoscopic approach was utilised more often in the UK group (50.5% vs. 11.9%). Post-operative complications were similarly represented in both groups, but re-admission occurred with greater frequency in the UK group (16.2% vs. 0%). Histologically confirmed appendicitis was seen in a significantly greater proportion of SL patients (93.1% vs. 79.8%). Multivariate analysis confirmed male gender, and diagnosis and treatment in Sri Lanka to be only factors significantly associated with positive appendicitis. DISCUSSION: Expensive investigations such as CT do not appear to improve the diagnostic accuracy of appendicitis or prevent complications. This study suggests diagnostic and treatment algorithms in the SL hospital are more accurate and efficient in confirming appendicitis than those seen in the UK hospital under investigation. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.