Browsing by Author "Nandamuni, Y."

Now showing 1 - 5 of 5

Association between road accidents and minimal hepatic encephalopathy in a cohort of Sri Lankan cirrhotic drivers
(Wiley Blackwell Scientific Publications, 2014) Subasinghe, S.K.C.E.; Nandamuni, Y.; Ranasinghe, S.; Kodisinghe, K.; Niriella, M.A.; de Silva, A.P.; de Silva, H.J.
OBJECTIVE: Minimal hepatic encephalopathy (MHE) has no recognizable clinical symptoms of hepatic encephalopathy (HE) but has mild cognitive and psychomotor deficits which can interfere with executive decision making and psychomotor speed. It affects driving ability and previous studies in Western countries have demonstrated an association between MHE and increased road accidents. Our objective was to investigate this association in a cohort of Sri Lankan cirrhotic drivers. METHODS: A prospective, case controlled study ongoing study has been conducted in the Gastroenterology Clinic, University Medical Unit, North Colombo Teaching Hospital, Ragama, from August 2013. Patients with cirrhosis of any aetiology, without overt HE, who had been driving any vehicle during the past one month were subjected to 5 standard pencil-paper based psychometric tests used to detect MHE. Road accidents were recorded for both cirrhotic drivers with MHE and controls. Accidents were categorized as major when they resulted in hospitalization of the involved person/s, and minor when there were no serious injuries. RESULTS: Among 55 cirrhotic drivers with MHE [males, median age 53 years (range 30-60)], 7 (12.7%) reported any type of accident compared to 6 (10.9%) among 55 controls [males; median age 51 years (range 30-60)]. 2/55 (3.6%) cases and 2/55 (3.6%) controls reported minor accidents. There were no major accidents in either group. CONCLUSION: Preliminary results of this ongoing study do not indicate an increased frequency of road accidents in a cohort of Sri Lankan cirrhotic drivers with MHE
Association between road accidents and minimal hepatic encephalopathy in a cohort of Sri Lankan drivers with cirrhosis
(Sri Lanka Medical Association, 2014) Subasinghe, S.K.C.E.; de Silva, A.P.; Niriella, M.A.; Kodisinghe, S.K.; Nandamuni, Y.; Sameera, R.A.C.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Minimal hepatic encephalopathy (MHE) has no recognizable clinical symptoms of hepatic encephaiopathy (HE) but has mild cognitive and psychomotor deficits. Previous studies in Western countries have demonstrated an association between MHE and increased road accidents. Our objective was to investigate this association in a cohort of Sri Lankan drivers with cirrhosis. Study design; Prospective, case controlled study. Study setting; Ongoing study conducted in the Gastroenterology Clinic, University Medical Unit, North Colombo Teaching Hospital, Ragama, from August 2013. METHODS: Patients with cirrhosis of any aetiology, without overt HE, who had been driving any vehicle during the past one month were subjected to 5 standard pencil-paper based psychometric tests to detect MHE. An abnormality in 3 or more tests was considered diagnostic of MHE. Road accidents were recorded among drivers with cirrhosis with MHE. Age and sex matched healthy drivers (controls) who also underwent the 5 psychometric tests. RESULTS: Among 54 drivers with cirrhosis with MHE [males, median age 53 years (range 30-60}], 7 (13%) reported any type of accident compared to 6 (11%) among 54 controls [males; median age 51 years (range 30-60)]. 2 (3.7%) cases and 2 (3.7%) controls reported minor accidents involving another person. There were no major accidents in either group. CONCLUSIONS: Preliminary results of this ongoing study do not indicate an increased frequency of road accidents in a cohort of Sri Lankan drivers with cirrhosis with MHE.
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.
A Randomized control study of audio versus visual distraction to reduce patient discomfort during colonoscopy
(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2015) de Silva, A.P.; Nandamuni, Y.; Nanayakkara, S.; Perera, K.R.; Kodisinghe, S.K.; Subasinghe, S.K.C.; Niriella, M.A.; Dassanayake, A.S.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION : Colonoscopy can cause anxiety and discomfort in patients who undergo this procedure. Heavy sedation and analgesia as premedication can lead to complications in the elderly and those with co-morbidities. This has led to an interest in use of audio-visual distraction during the colonoscopy as an adjunct. Our aim was to compare effects of audio (AD) versus visual distraction (VD) in reducing discomfort and need for sedation during colonoscopy. METHODS : Consecutive consenting patients who were 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 film of their choice (VD) (using SONY head mounted display:HMZ-T3W-H) and the third group with neither during colonoscopy acted as a control (C). Patient controlled sedation (PCS) was administered to all three groups. We used 25 mg pethidine in 5 mg aliquots and 2.5 mg midazolam in 0.5 mg aliquots. All patients were assessed for pain, number of ‘top-ups’ of sedation, total dose of pethidine and midazolam, patient cooperation and willingness to repeat the procedure. RESULTS :There were 77 patients [AD, n=25 (16 males, median age 57 years); VD, n=26, (18 males, median age 58 years); C, n=26 (10 males, median age 59 years)]. The AD group had significantly less pain (p=0.048), number of ‘top-ups’ of sedation (p=0.03), total doses of pethidine (p=0.03) and midazolam (p=0.032), and better patient cooperation (p=0.001) compared with controls. There was no difference between the AD (72%) and VD (73%) groups in willingness to undergo a repeat procedure. Conclusions AD reduces pain and discomfort and the requirement for sedation and seems a useful and simple adjunct to low dose sedation use during colonoscopy.
A randomized control study of audio versus visual distraction to reduce patient discomfort during colonoscopy
(Sri lanka Medical Association, 2015) de Silva, A.P.; Nandamuni, Y.; Rajapakshe, N.N.; Nanayakkara, S.; Perera, K.R.; Kodisinghe, S.K.; Subasinghe, S.K.C.; Niriella, M.A.; Dassanayake, A.S.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Colonoscopy can cause discomfort and anxiety in patients. Heavy sedation as premedication can lead to complications in elderly and those with co-morbidities. This has led to possible use of audio-visual distraction during the procedure. We compared effects of audio versus visual distraction in reducing discomfort during colonoscopy. METHOD: 131 consecutive patients who underwent colonoscopy were randomized into three groups: allowed to listen to music of their choice during colonoscopy (AD), allowed to watch a film of their choice (VD) and neither as control (C). Patient controlled sedation (PCS) was administered to all three groups; 25 mg pethidine in 5 mg aliquots and 2.5 mg midazolam in 0.5 mg aliquots. All patients were assessed for pain, number of 'top-ups' of sedation, total dose of pethidine and midazolam and patient cooperation and willingness for a repeat procedure. RESULTS: There were 131 patients (AD=43; VD=44; O44). The AD group had significantly less pain and discomfort (p=0.033) compared to VD and Cgroups. There was no significant difference in number of 'top-ups' of sedation, total doses of pethidine and midazolam among the groups. Better patient cooperation (p=0.002) was evident in ADgroup compared with VD and C groups. There was nt> difference between the AD and VD groups in willingness to undergo a repeat procedure. CONCLUSION: Listening to music of your choice during colonoscopy seems to reduce pain and discomfort and increase the patients' cooperation. This may be a useful and simple tool in screening colonoscopy.