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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Effect of audio and visual distraction on patients undergoing colonoscopy: a randomized controlled study(Stuttgart : Georg Thieme Verlag KG, 2016) de Silva, A.P.; Niriella, M.A.; Nandamuni, Y.; Nanayakkara, S.D.; Perera, K.R.P.; Kodisinghe, S.K.; Subasinghe, K.C.E.; Pathmeswaran, A.; de Silva, H.J.BACKGROUND AND STUDY AIMS : Colonoscopy can cause anxiety and discomfort in patients. Sedation and analgesia as premedication can lead to complications in the elderly and those with comorbidities. This has led to an interest in the use of audio-visual distraction during the colonoscopy. We compared the effects of audio (AD) versus visual distraction (VD) in reducing discomfort and the need for sedation during colonoscopy. PATIENTS AND METHODS: Consecutive patients undergoing colonoscopy were randomized into three groups: one group was allowed to listen to the music of their choice (AD), the second group was allowed to watch a movie of their choice (VD), and the third group was not allowed either distraction during colonoscopy and acted as a control (C). Patient controlled analgesia and sedation were administered to all three groups. We used 25 mg of pethidine in 5-mg aliquots and 2.5 mg of midazolam in 0.5-mg aliquots. All patients were assessed for perceived pain and willingness to repeat the procedure. Number of "top-ups" of sedation and total dose of pethidine and midazolam were noted. Patient cooperation and ease of procedure were assessed by the colonoscopist. RESULTS: In total, 200 patients were recruited [AD, n = 66 (32 males, median age 57 years); VD, n = 67 (43 males, median age 58 years); C, n = 67 (35 males, median age 59 years)]. The AD group had significantly less pain (P = 0.001), better patient cooperation (P = 0.001) and willingness to undergo a repeat procedure (P = 0.024) compared with VD and C groups. CONCLUSIONS: AD reduces pain and discomfort, improves patient cooperation and willingness to undergo a repeat procedure, and seems a useful, simple adjunct to low dose sedation during colonoscopy.Item One hour fast for liquids prior to endoscopy is safe, effective and results in minimum patient discomfort(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2006) de Silva, A.P.; Amarasiri, L.; Kottahachchi, D.C.; Sabhapathige, R.D.; Dassanayake, A.S.; de Silva, H.J.INTRODUCTION: Current guidelines for endoscopy advice at least 6-8 hours fasting for solids and at least 4 hours for liquids. This is claimed to ensure safety and a clear endoscopic view. However, prolonged fasting may result in patient discomfort. Also due to practical delays the fasting period for endoscopy may be much longer, thus causing even more discomfort to patients. Several anaesthesia societies now recommend a 2-h pre-operative fast for clear fluids and a 6-h fast for solids in most elective patients. A pilot study done by us showed the time for a clear liquid (tea) or water to empty from the stomach using real-time ultrasonography was one hour. AIMS: To determine whether a one-hour fast prior to endoscopy was safe, effective and resulted in less patient discomfort. METHODS: 63 patients referred for endoscopy, without alarm symptoms or clinically obvious motility problems, were recruited. Patients were given a standard meal 6 hours before endoscopy. They were then randomized to either nil by mouth for 6 hours (group A, n = 31) or allowed to take clear fluids up to one hour prior to endoscopy (group B, n = 32). Just prior to endoscopy patients indicated discomfort due to fasting on a visual analog scale (0-no discomfort to 10-severe discomfort). Investigators were blinded to the period of fasting. Presence of fluid in the gastric fundus was noted, and endoscopic vision was graded as good, average or poor. Patients were followed one week after the procedure for the presence of any late complications. RESULTS: Discomfort was significantly lower in group B than group A (median visual analog score 0.3 vs. 5.1; p < 0.0001, Wilcoxon two-sample test). Endoscopic vision was good in all 31 patients in group A and 30 in group B, and average in 2 patients in group B. None were graded as poor. Fluid in the gastric fundus was noted in 7 patients in group A and 10 in group B. There were no complications in either group. CONCLUSIONS: A one-hour fast for clear liquids seems safe and effective and has minimum discomfort for the patient. However, a larger study should be done before the current endoscopic guidelines are revised.Item Is a six hour fast after a rice meal sufficient before upper gastrointestinal endoscopy?(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2009) de Silva, A.P.; Niriella, M.A.; Perera, N.J.A.H.D.; Aryasingha, J.S.; Kalubowila, U.P.; Dassanayake, A.S.; Pathmeswaran, A.; Manchanayake, M.M.J.H.; Devanarayana, N.M.; de Silva, H.J.OBJECTIVE: Rice is the staple diet in many Asian countries. Current endoscopic guidelines advice a 6 h fast for solids and a 4 h fast for liquids before the procedure. However, these guidelines focus on a Western type diet. The aim of the study was to determine if a 6 h fast for rice is sufficient prior to upper gastrointestinal endoscopy (UGIE). PATIENTS AND METHODS: After informed consent, 212 patients referred for UGIE, who had no alarm symptoms, were randomized into two groups in preparation for UGIE. Fasting 6 h after a rice meal (R6) or fasting 10 h after a rice meal (R10). All meals contained lentils and an egg, and were isocaloric. Endoscopic vision was graded as poor, average, or good. RESULTS: In the R10 group (n = 107) vision was poor in 2 (1.9%), average in 7 (6.5%), and good in 98 (91.6%). While in the R6 group (n = 105) vision was poor in 30 (28.6%), average in 19 (18.1%), good in 56 (53.3%). The observed difference of percentages among the two groups for endoscopic vision was significant (M-H Chi-Square for trend = 25.67; df = 1; p < 0.001). CONCLUSIONS: Fasting for 6 h after a rice based meal seems inadequate for UGIE. Fasting for 10 h significantly improves endoscopic vision. Current guidelines need to be re-evaluated for populations where rice is the staple diet.Item Profile of gastric varices among Sri Lankan cirrhotics(Wiley Blackwell Scientific Publications, 2012) Ranawaka, C.K.; Mettananda, K.C.D.; de Alwis, R.; Miththinda, J.K.N.D.; Wijewantha, H.S.; Niriella, M.A.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.BACKGROUND AND AIMS: Gastric varices (GV) can result in life threatening bleeding with a higher mortality than esophageal varices. There have been no studies on the characteristics of GV among Sri Lankan cirrhotics. Aim of this study was to perform a descriptive analysis of GV among a cohort of Sri Lankan cirrhotic population. METHODS: We analyzed medical records of all upper gastrointestinal endoscopies performed on cirrhotics, at the University Endoscopy Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka from 2006 to 2011. Characteristics of GV, demographics, indications and fi ndings at endoscopy were analyzed and they were compared among patients with Oesophageal varices (EV). RESULTS: Out of 641 cirrhotics screened, 628 had a complete data set for analysis. GV was detected in 70 (11%) patients; male:female 8.7:1.3; mean age 55 (SD = ± 10.7) years. From these 48/70 had EV (Gastro Oesophageal Varices GOV1 – 18/48, GOV2 – 30/48) in addition to GV. Only 22/70 had Isolated GV (IGV1–10, IGV2–12). Among patients with GV 38 (54%) had portal hypertensive gastropathy and 3 (4%) had gastric antral vascular ectasia. Nineteen (27%) of GV were detected on presentations with UGIB (6 with IGV, 13 with GOV), whereas 51 (73%) were detected on routine screening. EV was detected in 288 (46%) of cirrhotics (Isolated EV 240, GOV 48). Seventy seven (32%) of EV were detected on presentations with UGIB, whereas 163 (68%) were detected on routine screening. There was no statistically significant difference on presentation with UGIB between isolated EV (77/240) vs. IGV (6/22) patients (p = 0.64; χ2 = 0.2). CONCLUSION: The profi le of GV among our cirrhotics is comparable to previous reports from other centres. Findings suggest that in cirrhotic patients presenting with UGIB, a careful search for the presence of GV is as important as identifying EV, even among patients who have EV.