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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Item Hemoglobin E-beta-thalassemia: Progress report from the international study group(Blackwell Publishing, 2005) Premawardhena, A.; de Silver, S.; Arambepola, M.; Olivieri, N.F.; Vichinsky, E.P.; Merson, L.; Muraco, G.; Allen, A.; Fisher, C.; Peto, T.; Weatherall, D.J.A long-term observational study of Hb E-beta-thalassemia in Sri Lanka is beginning to define some of the genetic and environmental factors that are responsible for its remarkable phenotypic variability. In this population there is a very small difference between the steady-state hemoglobin levels between the mild and severe phenotypes, and it has been possible to stop transfusion in many of those who have been on long-term treatment of this kind. These preliminary observations, made over the last 7 years, provide directions for future research into this increasingly important disease.Item An audit of patient perception regarding labour pain and provision of analgesia in a teaching hospital.(College of Anaesthesiologists of Sri Lanka, 2005) Gunetilleke, B.BACKGROUND: Provision of adequate analgesia in labour remains a neglected aspect of our health care system. The perception and attitudes of patients regarding labour pain and analgesia has not received sufficient attention. METHODS: A questionnaire was adminlstered by the investigator to parturients In a teaching hospital prior to and after delivery. RESULTS: All patients had received regular antenatal care. Patients anticipated severe pain In labour (PItem A patient with polytrauma including a severe head injury, haemothorax and cardiac tamponade(College of Anaesthesiologists of Sri Lanka, 2009) Gunetilleke, B.Item Long distance travel prior to major surgical procedure: Does it have an impact on post operative pulmonary embolism(Springer Nature, 2009) Wijesuriya, S.R.E.; Delriviere, L.D.; Mitchell, A.W.BACKGROUND: Long distance travel is a known risk factor for venous thrombo-embolism. In our hospital approximately 15% of surgical procedures are performed on patients from the country, needing prolong travel. The purpose of this study is to evaluate whether prolong travel prior to a surgical procedure increases the risk for post operative pulmonary embolism (PE). METHODS AND MATERIALS: Thirty patients with post operative pulmonary embolism confirmed by Computed Tomography Pulmonary Angiogram (CTPA), perfusion scan or by post-mortem, diagnosed during the same hospital admission were evaluated. Patients were categorised in to two groups, who travelled from the country or from metropolitan area in view of hospital admission. RESULTS: Operations in 25 metropolitan patients (12 males, 13 females, median age:71years, range:25-97, median distance:26km, range:5-55), and in five country patients (four males, one female, median age:65, range:33-73, median distance:183km, range:133-425) were complicated by post operative PE. Whilst 17 of 25 metropolitan patients (68%) received peri-operative prophylaxis against DVT/PE (pre-operatively or within 24hours of procedure), four of five patients (80%) from the country received prophylaxis. CONCLUSIONS: Long-distance travel prior to hospital admission seems to have no impact on the incidence of postoperative PE, as the proportion of country patients with postoperative PE (15%) is comparable to the proportion of country patients operated in a metropolitan hospital. Therefore the current policy of perioperative prophylaxis is adequate. Extended prophylaxis prior to initiation of travel seems unnecessary. © 2009 Indian Association of Cardiovascular-Thoracic Surgeons. AUTHOR KEYWORDS: Computed tomography; Pulmonary embolism; SurgeryItem Serum cystatin C as a marker to identify patients with moderately impaired renal function(Association of Clinical Biochemists of India,, 2008) Peiris, H.; Chandrasena, L.G.; Lanerolle, R.D.ABSTRACT: The low molecular weight protein cystatin C produced by all nucleated cells and eliminated by glomerular filtration is of special benefit as a marker of renal function. A study was therefore undertaken to investigate whether serum cystatin C could be used as a marker to identify patients with moderately impaired renal function. A cross-sectional descriptive hospital based study was carried out and serum cystatin C was measured in fifty subjects aged 12 to 74 years with a 24 hr creatinine clearance estimation done at the same time. The gold standard creatinine clearance was used to compare the predicted glomerular filtration rate measured using serum cystatin C. Predicted glomerular filtration rate gave a sensitivity of 82% and specificity of 68% with a diagnostic cut-off value of 1.25mg/L cystatin C for identification of patients with moderately impaired renal function with a single random blood sample. AUTHOR KEYWORDS: Creatinine; Cystatin C; Glomerular filtration rate; Moderately impaired renal functionItem Psychological status and physical disabilities of permanently disabled Sri Lankan servicemen(Scientific Communications International Ltd., 2004) Kasturiaratchi, S.K.; Jayawardana, P.L.OBJECTIVE: To describe the physical disabilities and to determine the prevalence of psychological ill health among permanently disabled servicemen. PATIENTS AND METHODS: 430 disabled servicemen were selected by stratified sampling from the 8 regiments of the Sri Lanka army. A self-dministered questionnaire was used to collect personal data and details of physical disabilities. The General Health Questionnaire and Bradford Somatic Inventory were used to detect psychological distress and the presence of somatic symptoms, respectively. RESULTS: Thirty-four (8.3%) of the 408 servicemen included in the analysis had more than 1 injury, giving a total of 442 injuries. The two most common disabilities were limb amputation (49.7%) and nerve injury (27.5%). 201 servicemen (49.3%) had a positive General Health Questionnaire result and 119 (29.2%) had a positive Bradford Somatic Inventory result. Of the 119 servicemen positive for Bradford Somatic Inventory, 109 (91.6%) had a positive General Health Questionnaire result (odds ratio, 23.3; 95% confidence interval, 11.2-49.9). CONCLUSIONS: The findings of this study may be useful for the adoption of a holistic approach for rehabilitation of disabled servicemen, and they emphasise the need for early diagnosis and treatment of psychological distress. AUTHOR KEYWORDS: Disabled persons; Military personnel; Psychological; Stress. INDEX KEYWORDS: adolescent; adult; army; article; controlled study; demography; disease severity; distress syndrome; emotional stress; General Health Questionnaire; health status; human; limb amputation; major clinical study; male; mass screening; nerve injury; physical disability; prevalence; psychiatric diagnosis; Sri LankaItem Progress in the prevention and control of schistosomiasis and soil-transmitted helminthiasis(Societa Italiana di Medicina Tropicale, 2002) Albonico, M.; Engels, D.; Montresor, A.; Cromptons, D.W.T.; de Silva, N.R.; Savioli, L.ABSTRACT: In the last two decades important progress have been made in the understanding the epidemiology and the disease burden of schistosomiasis and soil-transmitted nematodes infection. In addition, practical tools for disease control have been developed and a strategy for the prevention and control of morbidy of schistosomaisis and soil-transmitted nematodes infection has been endorsed by the World Health Organization. This paper presents the recent progress in the prevention and control of these infections: the estimates of chronic and subtle morbidity in high risk groups and the evidence that these chronic and severe sequelae of infections can be reversed by appropriate treatment; the use of anthelminthic drugs during pregnancy and lactation; the relevance to control morbidity due to these infections also in pre-school children; the efficacy of anthelminthic drugs and the possible threat of drug resistance; price, quality and accessibility of treatment by delivering drugs through the school system and ways of reaching also non enrolled school-age children. Finally, the strategy, targets and recommendations of the World Health Organization for the control of schistosomiasis and soil-transmitted nematodes infection are described.Item Continuing medical education (CME) in pathology: the role of the college of pathologists of Sri Lanka.(College of Pathologists of Sri Lanka., 2003) Hewavisenthi, S.J.de S.; de Silva, M.V.C.No Abstract AvailableItem Colonoscopic ultrasound is associated with a learning phenomenon despite previous rigid probe experience(Springer India, 2009) Siriwardana, P.N.; Hewavisenthi, S.J.de S.; Pathmeswaran, A.; Deen, K.I.Colonoscopic ultrasound (CUS) enables total colonoscopic examination combined with staging of tumor. Rigid probe transrectal ultrasound (TRUS) is reliable in assessing rectal cancer. Both the modalities are associated with an initial learning curve. We evaluated the predictability CUS in preoperative staging of rectal cancer during the learning curve, despite experience with TRUS. Forty-four patients with non-obstructing rectal cancer were assessed by colonoscopy and colonic ultrasound using a 7.5 MHz rotating transducer. Accuracy of ultrasound staging was compared with pathological staging. Tumor staging and nodal staging at pathology and ultrasound were named pT, pN and uT, uN, respectively. The pathological staging was pT1 in two (4.5%), pT2 in 16 (36%), pT3 in 21 (48%) and pT4 in five (11.5%) rectal cancer specimens. CUS understaged the tumor in 11 cases and overstaged it in 10 cases. Overall, the positive predictive value was 61%, negative predictive value 73%, sensitivity 61%, and specificity 73%. Lymph nodes were not visualized in 14. The overall un-weighted kappa of CUS staging of RC was 0.18 (poor). The predictive value in tumor staging of CUS is suboptimal in the learning phase, despite previous experience with TRUS.Item Histopathology reporting in colorectal cancer: a proforma improves quality(Wiely-Blackwell, 2009) Siriwardana, P.N.; Pathmeswaran, A.; Hewavisenthi, J.; Deen, K.I.AIM: The histopathology report is vital to determine the need for adjuvant therapy and prognosis in colorectal cancer (CRC). Completeness of those in text format is inadequate. This study evaluated the improvement of quality of histopathology reports following the introduction of a template proforma, based on standards set by the Royal College of Pathologists (RCP), UK. METHOD: Sixty-eight consecutive histopathology reports based on 19 items for rectal cancer (RC) and 15 items for colon cancer (CC) using the proforma were prospectively analysed and compared with results of a previous audit of 82 consecutive histopathology reports in text format. The percentage of reports containing a statement for each data item for both series was compared using the Normal test for difference between two proportions. Completeness of each report was assessed and a percentage score (percentage completeness) was given. Mean percentage completeness was calculated for each format and compared using the two sample t-test. RESULTS: Except for comments on the presence of 'histologically confirmed liver metastases' in CC and RC, 'distance from dentate line' and 'distance to circumferential margin' in RC, all other items were commented in more than 90% of reports, where 71% of the items based on the minimum data set were present in all reports. Compared to prose format, the mean percentage completeness (SD) improved from 74% (8) to 91% (4) (P < 0.0001) and from 81% (5) to 99% (1) (P < 0.0001) for RC and CC respectively in template proforma format. CONCLUSION: A template proforma and surgeon's contribution in relation to operative findings improves the quality of the histopathology report in CRC.