Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item North Colombo diverticular disease snap shot audit (VISTA study): a collaborative research initiative(The College of Surgeons of Sri Lanka, 2023) Chandrasinghe, P.; Ediriweera, E.P.D.S.; Niriella, M.; Ranwaka, C.; Fernando, A.; Gunawardena, H.; Kumarage, S.INTRODUCTION Diverticulosis and diverticular disease (DD) is a common occurrence in clinical practice in the local setting with a lack of documented literature. A snapshot audit was conducted at North Colombo Teaching Hospital (NCTH) to ascertain the disease burden in clinical practice as a pilot study to assess feasibility and response rate for a nation wide snapshot audit. METHODOLOGY All surgical and gastroenterology units at NCTH were requested to enter the data between 1st January 2022 to 30th of June 2022 on all patients presenting with DD or those detected with diverticulosis during screening colonoscopy. Prospective data collection was done using RedCap© data capturing platform. RESULTS Out of the 8 units invited (general surgery – 5, GI surgery – 1, gastroenterology – 2), 5 units participated (general surgery – 2, GI surgery – 1, gastroenterology – 2); response rate is 62%. A total of 46 patient records (median age- 68 years; range 29- 86; female 51%) were received within 6 months. Of the total 54.3% had symptomatic uncomplicated diverticular disease (SUDD) while 33% were detected with diverticulosis at screening. Only 13% (n=6) required inward care (bleeding – 3, diverticulitis – 2, perforation – 1) and detected using colonoscopy in 4 and CT scan in 2. In the DD group, 20% (6/31) had complicated DD while 80% had Symptomatic Uncomplicated Diverticular Disease (SUDD). CONCLUSION In this pilot study, a majority of the patients with DD presented with SUDD while around 20% came with complicated DD. The response rate from collaborators was satisfactory. The secure online database usage is feasible and will be used for a national level study in the future to assess the disease burden in the healthcare setting in Sri Lanka.Item Effectiveness of prophylactic central compartmental neck dissection in papillary thyroid cancer(College of Surgeons of Sri Lanka, 2015) Atulugama, N.S.; Bandaranayake, B.M.V.C.; de Silva, G.K.S.; Ariyapala, K.S.K.; Ediriweera, E.P.D.S.INTRODUCTION: Standard treatment for Papillary thyroid cancer is Total Thyroidectomy (TT) and selective block dissection for node positive disease. Incidence of central compartmental nodal (CCN) involvement esimated to be 30-70% though preoperative staging is suboptimal due to anatomical location. Therefore, many advocate Prophylactic Central Compartmental Neck Dissection (PCCND) as a staging and therapeutic procedure, but others believe no added therapeutic value despite higher incidence of complications. MATERIAL AND METHODS: All pathological reports of patients who have undergone TT with PCCND for Papillary thyroid cancer in a single unit from 2014 January to 2015 June was collected and entered into a database. Clinical node negativity was considered when both examination and pre-op USS was negative. This is a single unit experience and our routine practice is to do PCCND in all clinically node negative disease patients. Pearson's chisquare test and Fishers exact statistical tools were used to assess predictors of CCN involvement. P < 0.05 was considered as significant. RESULTS: Total of 27 cases found and 20 (74%) cases didn't reveal a single positive node. Nineteen had unifocal disease of thryroid and only 5 (26%) had ipsilateral CCN positivity. Six patients had multifocal disease and 3 had positive CCN disease. Positive predictors of CCN: Clinical stage, Multifocal disease, Histological type, Vascular invasion and age are not significantly associated. Fourteen (52%) patients had at least 1 parathyroid gland included in the specimen. CONCLUSIONS: Nearly 3/4 of patients undergo unnecessary PCCND. Further studies are needed assess the predictors of CCN involvement.Item Outcome of minimally invasive procedures for early breast cancer(College of Surgeons of Sri Lanka, 2015) Atulugama, N.S.; Bandaranayake, B.M.V.C.; de Silva, G.K.S.; Ariyapala, K.S.K.; Ediriweera, E.P.D.S.INTRODUCTION: Worldwide incidence of stage I breast cancer is around 41%. For primary breast lesions management trend has changed from mastectomy to breast conservation (BCS) and for axillary staging from routine nodal dissection (ALND) to Sentinel Lymph node Biopsy (SLNB) in clinically negative axillae. In many studies it has been proven that this paradigm shift has brought increase patient satisfaction with less morbidity and with same oncological outcome. MATERIAL AND METHODS: Patients with early breast cancer and clinically negative axillae were prospectively analysed in a single unit from January 2013. They were offered breast conservation or mastectomy (on patient's request) with SLNB. We used Isolated Methylene Blue technique (IMBT) for SLNB. All patients followed up for 2 years with standard surveillance protocol and data comprising of pre-op evaluation, surgical data, histological details and surveillance were recorded in a database. RESULTS: Total number of patients included were 253. BCS was offered for 157 (62.05%) patients. Ninety five (60.5%) had Primary closure, 49(31.2%) had Volume displacements and 15 (9%) had Volume replacements. Twenty eight patients needed re-surgery immediately due to inadequate margins and 14 ended up in mastectomy. Out of mastectomy patients 6 had TRAM and 4 had LD immediate reconstructions. Median age for BCS 53yrs and mastectomy 54yrs. Only 3 patients had axillary recurrences but no breast recurrences during the study period. CONCLUSIONS: BCS and SLNB with IMBT can be offered for early breast cancer patients with non-inferior oncological outcome compared to standard treatment of mastectomy and axillary clearance.Item Positive predictors of sentinel Lymphnode positivity(College of Surgeons of Sri Lanka, 2015) Atulugama, N.S.; Bandaranayake, B.M.V.C.; de Silva, G.K.S.; Ariyapala, K.S.K.; Ediriweera, E.P.D.S.INTRODUCTION: Lymph node status is the single most important prognostic and predictive factor in breast cancer. Therefore, place of proper axillary staging is invaluable and it was routine to perform an axillary Lymph node dissection. Currently, Sentinel Lymph node Biopsy (SLNB) is an oncologically accepted technique for axillary staging in clinically negative axillae with less morbidity. Positive predictors for a histologically positive sentinel lymph node (SLN) are multifactorial. MATERIAL AND METHODS: We did a prospective analytical study since January 2013 in a single unit in patients with early breast cancer and clinically negative axillae. They were offered mastectomy or breast conservation with SLNB. We used Isolated Methylene Blue technique for SLNB. All data regarding pre-op evaluation, surgical data and histological details are recorded in a database. Pearson's chisquare test, Fishers exact test and logistic regression statistical tools were used. P < 0.05 was considered as significant. RESULTS: Total number of patients included were 253 and 48 (18.97%) had histologically Positive SLN. Median SLN harvest was 3. Predictors SLN positivity: on univariate analysis Pathological SLN size, Clinical T stage (T2 vsItem Usage of social media as an education resource among medical students at Faculty of Medicine, University of Kelaniya(Sri Lanka Medical Association, 2019) Dasanayaka, I.P.E.U.; Wickramaarachchi, G.K.; Hettiarachchi, W.G.; Hettige, S.; Ediriweera, E.P.D.S.INTRODUCTION & OBJECTIVES: Social media (SM) networks has become a popular educational tool at present. There is limited data in Sri Lanka on SM usage as an educational tool. The aim of this study is to evaluate the usage of SM for academic purposes among medical students of faculty of Medicine University of Kelaniya. METHODS: Stratified sampling with proportional allocation was used to select students from each batch and 287 students were recruited from 1st to 5th year. Informed written consent was obtained and a self-administered questionnaire was given. 255 completed questionnaires were returned. RESULTS: Of 255, 86.95% students used SM for educational purposes with no male and female difference (P=0.06). 90.6%, 61.6% and 56.1% accessed Facebook, Google + and YouTube respectively. Of them, 67.1%, 44.7% and 33.9% respectively accessed them daily for academic purposes respectively. 84.2% students followed medical related web sites through SM. 84.5% had joined educational groups in SM and 44.9% had joined academic discussions or information sharing groups in other local and foreign universities. 43.3% could not find information that they want due to information overload and 38.1% mentioned that SM disturbed their academic work. CONCLUSION: Majority had used SM for educational purposes without gender preference. Facebook, Google+ and YouTube are the commonest SM educational tools and majority had joined educational groups. SM had disturbed academic work of students and difficulty to find correct information was major concern among students.Item Pre-operative hypoalbunaemia is associated with poor overall survival in rectal cancer.(The College of Surgeons of Sri Lanka, 2012) Chandrasinghe, P.C.; Ediriweera, E.P.D.S.; Kumarage, S.K.; Deen, K.I.INTRODUCTION: Serum albumin is a marker of nutrition and inflammation. It has recently emerged as a predictor of outcome after surgery for rectal cancer. Our aim was to evaluate if pre-operative serum albumin would predict survival after resection for rectal cancer. METHOD: 226 Patients with rectal cancer of all stages undergoing resection with curative intent were studied. Kaplan-Meier curves analysed survival based on a pre-operative albumin level of <35g/L vs. >35g/L. We sought for significant associations of survival with age, sex, stage, tumour site, use of neoadjuvant chemoradiation, microscopic positive resection margins (R1 ), differentiation, angio, peri-neural, and lymphovascular invasion using individual variable analysis. Multifactorial analysis was performed using type III analysis with Weibull hazard model and Cox-proportional hazard model. Significance was assigned to a P value <0.05. RESULTS: Of 226 patients (median age- 59 years; range 19 - 88, Male - 54%), forty five (20%) had an albumin level < 35g/L and was associated with a poor overall survival (P=0.01). Mean survival in months for <35g/ s. >35g/L was 64.7 (SE - 9.3) vs. 95.8 (SE - 7.0). Individual variable anaysis revealed age, circumferential margin, stage,, perineural, lymphovascular and angio invasion to be also significant. With multifactorial analysis hypo-albunaemia (HR= 0.58, P=0.03), advanced stage (HR= 2.0, P < 0.01 ) and R1 circumferential margin (HR= 2.2, P < 0.01) remained significant. CONCLUSION: Preoperative hypoalbunaemia is an independent risk factor for poor overall survival in rectal cancer. Advanced tumour stage and R1 circumferential margin were the other associations with poor survival.Item Profile of spinal cord injuries and the prevalence of malnutrition risk among spinal cord injury patients admitted to Rheumatology and Rehabilitation Hospital, Ragama ,(Sri Lanka Medical Association, 2018) Dilina, A. K. N.; Ediriweera, E.P.D.S.INTRODUCTION AND OBJECTIVES: Malnutrition is a problem with a long period of debilitation. This study describes socio demographic characteristics and malnutrition risk of Spinal Cord Injury (SCI) patients at Rheumatology and Rehabilitation Hospital, Ragama (RRH). METHODS: All SCI patients admitted to RRH during September to November 2015 were studied. Mid upper arm circumference (MUAC) was measured to assess the body mass index (BMI) category and nutritional screening was done with the Malnutrition Universal Screening tool (MUST). RESULTS: There were 138 SCI patients. 124 (90%) of them were males, median age was 39 (IQR: 27 to 57) years. Cause of spinal injury was as follows: 62 (45%) falls, 35 (25%) road traffic accidents (RTA), 20 (14%) disease related, 5 (3.6%) each from assault, blunt trauma and spinal tumors. The median (IQR) MUAC was 25 (22-27) cm and 23% were in BMI category less than 20 kg/m2 and 7% were in BMI category more than 30kg/m2. 84 (61 %) were at risk ofundernutrition (MUST score 1 or more). 27 (19.5%) were at high risk ofundernutrition (MUST score 2 or more), where the high risk was seen in 37.5% ofbedbound patients compared to 12.27% in others (P<0.01). 44 (32%) of SCI patients had pressure ulcers and 38.6% of them were at high risk ofundernutrition (MUST score 2 or more) compared to 10.6% in non-ulcer patients (p<0.01). CONCLUSION: According to MUST, more than half of the SCI patients were at risk of undernutrition and 19.5% were at high risk of undernutrition, where this was specifically seen in bedbound patients and patients with pressure sores.Item Perception of self-weight among knee osteoarthritis patients(Sri Lanka Medical Association, 2018) Dilina, A.K.N.; Ediriweera, E.P.D.S.INTRODUCTION AND OBJECTIVES: Overweight and obesity are the major risk factors of osteoarthritis (OA). Weight reduction is important to treat OA and it is important to understand the perception of self-weight among patients to implement weight reduction programs and improve self-motivation for weight reduction. This study was done to assess the perception of weight among OA patients attending the RRH. METHODS: Systematic sampling was used to recruit 255 patients from the Rheumatoid and Rehabilitation Hospital, Ragama. A self-administered questionnaire was used to collect data. RESULTS: Median age of the patients was 57 (IQR: 50 - 65) years and 235 (92%) of them were females. Among them, 49.6% were obese (BMI > 30) and 36.6% (BMI between 25 and 30) were overweight. 78% knew their weight, of them, 78% had checked weight within last six months. 3% felt overweight was a sign of prosperity, 43% felt overweight disfigured them and 93% knew it was unhealthy. Recalled and measured weights showed significant correlation (P<0.01). Among obese, 55% knew they were considerably above the normal weight and 28% felt they were somewhat above the normal weight and 2% believed they were just above the normal weight. Among the overweight, 25% felt they were considerably overweight, 48% somewhat above normal weight and 12% felt they were just above normal weight. 15% of both obese and overweight believed they were overweight but could not quantify their weight. CONCLUSION: Majority among obese, and overweight perceived their weight and 93% believed overweight is unhealthyItem Opportunities and challenges to reduce weight among knee osteoarthritis patients(Sri Lanka Medical Association, 2018) Dilina, A. K. N.; Ediriweera, E.P.D.S.INTRODUCTION AND OBJECTIVES: Osteoarthritis (OA) is the single most common cause of disability in older adults and overweight is a major risk factor of OA. Weight reduction is important to treat OA and it is important to understand the knowledge and attitudes among OA patients to implement interventional programs. METHODS: Systematic sampling was used to recruit 255 patients from the Rheumatoid and Rehabilitation Hospital, Ragama. A self-administered questionnaire was used to collect data and anthropometric assessments were done. RESULTS: Median age of the patients was 57 (IQR: 50 - 65) years and 235 (92%) of them were females. 21 % mentioned that they do not want to reduce weight, of them, 41 % were overweight and 8% were obese. 19% wanted to reduce weigh due to disfiguration and 75% of patients knew overweight is related to OA, however, less than 35% knew the association between overweight and diabetes, hypertension and psychological disturbances. 25% did not know the causes for overweight and 45% believed it was familial. Only 43%, 41% and 38% mentioned that heavy meals, meals with high fat and sugar and lack of activity/exercise cause overweight/obesity respectively. 56% believed exercises were bad for OA and 40% did not know the suitable exercises. 8% mentioned that they felt embarrassed to exercise and 14% did not have time. CONCLUSION: There are considerable misconceptions of overweight and weight management among OA patients and one fifth did not want to reduce weight. It is important to conduct educational programs for these patients and encourage weight reduction.Item A profile of knee osteoarthritis patients attending Rheumatology and Rehabilitation Hospital, Ragama(Sri Lanka Medical Association, 2018) Dilina, A. K. N.; Ediriweera, E.P.D.S.INTRODUCTION AND OBJECTIVES: Osteoarthritis (OA) is the single most common cause of disability in older adults and 10% to 15% of all adults aged over 60 have some degree of OA. Data on OA is scarce in Sri Lanka and this study was done to describe the profile of OA patients who are attending the RRH. METHODS: Systematic sampling was used to recruit patients. Sample characteristics were presented using descriptive statistics. Wilcoxon Rank Sum test was used for group comparisons and a P value of< 0.05 was considered as significant. RESULTS: Of255 clinic attending patients, median age of the patients was 57 (IQR: 50 - 65) years, 235 (92%) were females and 61 (24%) were employed. Median (IQR) weight and body mass index of patients were 69.0 (62.0 -76.7) kg and 30.0 (27.1 - 32.9) respectively. Among them, 49.6% were obese (BMI > 30), 36.6% (BMI between 25 and 30) were overweight, 0.9% were underweight. Females showed significantly high BMI compared to males (30.0 (27.4 - 33.1) vs 27.5 (23.5 - 30.1), P < 0.01). Median (IQR) waist and hip measurement were 95.0 (88.0 -102.0) cm, 108.0 (102.0 - 114.0) cm and waist hip ratio (IQR) for females was 0.87 (0.83 - 0.91) and males was 0.97 (0.96 - 0.98) respectively. CONCLUSION: Majority of clinic attending OA patients were females and more than 85% of patients were either overweight or obese. Weight reduction programs are necessary for these patients and should be encouraged at early age to prevent OA in later life.
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