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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Translation, cross-cultural adaptation, and validation of the duke activity status index (DASI) to Sinhala language(BioMed Central, 2024) Ranasinghe, C.; Kariyawasam, K.; Liyanage, J.; Walpita, Y.; Rajasinghe, U.; Abayadeera, A.; Chandrasinghe, P.; Gunasekara, M.; Kumarage, S.; De Silva, M.; Ranathunga, K.; Deen, K.; Ismail, H.BACKGROUND Duke Activity Status Index (DASI) is a widely used tool to assess functional capacity among patients, but there is no Sinhala version validated for patients in Sri Lanka. This study aimed to cross-culturally adapt and test the validity and reliability of the Sinhala version of DASI (DASI-S).METHODS The translation and cross-cultural adaptation of the DASI questionnaire were conducted following the standard guidelines. It was pre-tested on ten pre-operative patients and further modified. The construct validity and reliability of DASI-S were evaluated by administering the modified final DASI-S, which comprised 12 items, along with the physical functioning sub-scale of the 36-item short-form health survey (SF-36), consisting of 10 items to eighty-one patients who were awaiting non-cardiac surgeries at university surgical wards, National Hospital of Sri Lanka (NHSL), and Colombo North Teaching Hospital (CNTH), Sri Lanka. Reliability was assessed through Cronbach alpha, while the validity was evaluated using factor analysis and Spearman's correlation. The ethical approval was obtained from the Ethics Review Committee, Faculty of Medicine, University of Colombo, Sri Lanka.RESULTS The mean age of the participants was 46.2 (± 16.6) years and the majority were females (54.3%). The mean height, weight, and body mass index of the sample were 160.5 (± 9.6) cm, 60.3 (± 11.9) kg, and 23.4 (± 4.5) kgm-2 respectively. The Cronbach's alpha coefficient for the internal consistency of DASI-S was 0.861. The concurrent validity of DASI-S was substantiated by positively correlating (p < 0.01, rs = 0.466) with the physical sub-scale of SF-36. There was a significant difference (p < 0.01) in the total score of DASI-S between the two age groups.CONCLUSIONS Sinhala version of the DASI appears to be a valid, reliable and easy-to-administer tool to assess functional capacity among patients who are awaiting non-cardiac surgeries.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 Improving quality of life after pouch surgery with a dedicated nurse led follow up programme(Wiely-Blackwell, 2016) Chandrasinghe, P.; Leo, A.; Alison, L.; Perry-Woodford, Z.; Warusavitarne, J.AIM:Bowel function after ileal pouch affects the quality of life (QOL). The aim of the study was to assess if objective evaluation and specialised supportive care improves QOL after pouch surgery.METHOD: Consecutive patients who had an ileoanal pouch were invited to participate in a systematic follow-up regime led by specialised pouch nurse practitioners. The Cleveland global Quality of Life (CGQOL) and specific pouch related symptoms were documented at 6, 12, 24 and 52 weeks after ileostomy reversal. Pearson's Rho coefficient was used to assess the correlation between symptoms and CGQOL. RESULTS: Thirty-nine consecutive patients who had ileoanal pouch surgery were evaluated. Thirty-four had more than two visits and improvement in CGQOL (mean-1.36 ± 0.95) was seen in 27 (79%). There was reduction in CGQOL in 5 patients (15%) and no change in 2 (6%). Daytime frequency (DTF) significantly correlated with mean CGQOL (R = −0.7, P < 0.01). Twenty (59%) of 34 had reduced DTF after intervention. Nocturnal frequency only showed correlation with CGQOL up to 3 months. Incontinence had no impact on the QOL in this cohort. CONCLUSION: DTF has the highest impact on QOL in this cohort. Regular systematic specialised pouch care follow up may achieve better QOL.Item Trends in early onset colorectal cancer (EOCRC) in a South Asian cohort: data from a specialized tertiary care center in western Sri Lanka(The College of Surgeons of Sri Lanka, 2022) Chandrasinghe, P.; Godahewa, S.; Mahendra, G.; Hewavissenthi, J.; Kumarage, S.Introduction Early onset colorectal cancer [EOCRC] has significantly increased during the past decade globally. It is defined as cancers diagnosed in those aged 50 years or less. Most research on EORC are from western populations where the tumour biology and risk factors may differ from other regions. Evidence on EOCRC from the South Asian region is particularly scarce. This study presents the basic trends in presentation and overall survival [OS] pattern of EOCRC using data from a single specialized tertiary care institution over two decades. Methods A total of 723 patients treated at the University surgical unit of the North Colombo teaching hospital from 1995 to 2020 were included in the analysis. Overall survival of the EOCRC was compared with that of the older population using Kaplan- Meier survival curves. Survival patterns over two time periods [pre-2010 vs post-2010] were also compared between the two populations. The stage at presentation, family history of colorectal or related cancers, tumour site, and tumour stage were also compared. Results The proportion of EOCRC in this cohort has not shown a significant increase over the past two decades [2001-2010: 24% vs 2011-2020: 21%]. The advanced tumour stage at presentation and the presence of significant family history are also comparable. EOCRC cohort demonstrates a better OS for the entire study period [Median survival: < 50 years – not reached; >50 years – 91 months; 95%CI – 72-132; P<0.001]. However, this survival advantage is only observed during the pre-2010 period [Median survival: < 50 years – 160 months; 95%CI – 120 – not reached; >50 years – 84 months; 95%CI – 62-132; P=0.01] and becomes comparable in the 2010-2020 period [P=0.16]. OS of the EORC has not also improved over the two decades from 2001 to 2020 [P=0.51]. Conclusion There is no significant increase in the EOCRC rates in this population over time although the rate has remained high throughout. The OS of the EOCRC population is better compared to the older population. A significantly better OS is observed during the pre-2010 period in the EOCRC but is not present in the post-2010 period. Advancement in therapy may have improved the survival of the older population during the latter part but not that in the EOCRC due to its inherently aggressive nature. This paper provides preliminary data on EOCRC from Sri Lanka. The South Asian population may have a different disease pattern with younger age at onset compared to the western populations and needs to be further explored.Item Surgical management of small bowel Crohn's Disease(Frontiers Media S.A, 2022) Chandrasinghe, P.Crohn’s disease in the small bowel could present itself as an inflammatory stricture, a fibrotic stricture as penetrating disease or a combination of both. It is pertinent to differentiate the disease process as well as its extent to effectively manage the disease. Currently, a combination of medical and surgical therapies forms part of the treatment plan while the debate of which therapy is better continues. In managing the strictures, identification of the disease process through imaging plays a pivotal role as inflammatory strictures respond to anti-tumor necrosis factor (TNF) and biological agents, while fibrotic strictures require endoscopic or surgical intervention. Recent evidence suggests a larger role for surgical excision, particularly in ileocolic disease, while achieving a balance between disease clearance and bowel preservation. Several adaptations to the surgical technique, such as wide mesenteric excision, side to side or Kono-S anastomosis, and long-term metronidazole therapy, are being undertaken even though their absolute benefit is yet to be determined. Penetrating disease requires a broader multidisciplinary approach with a particular focus on nutrition, skincare, and intestinal failure management. The current guidance directs toward early surgical intervention for penetrating disease when feasible. Accurate preoperative imaging,medicalmanagement of active diseases, and surgical decision-making based on experience and evidence play a key role in success.Item Double single-port pan-proctocolectomy with transanal total mesorectal excision [TaTME] and ileal pouch-anal anastomosis [IPAA]: improvisation under limited resources(College of Surgeons of Sri Lanka, 2020) Chandrasinghe, P.; Kumarage, S.ABSTRACT: Novel surgical techniques fail to reach all parts of the world equally due to financial constraints. Non-availability of high-cost equipment in the developing world hinders progress. Transanal total mesorectal incision [TaTME] is a novel technique becoming popular world over due to many perceived benefits. Some of the equipment requirements prevent surgeons in resource-limited environments from taking up this technique. We describe the performance of a double single port panproctocolectomy with TaTME and ileal pouch-anal anastomosis for a patient with colitis-associated rectal cancer under improvised conditions at a tertiary care centre in Sri Lanka. Standard practice requires two laparoscopic stacks and an integrated air insufflator both of which are not available in the local setting. A flexible endoscope was used to replace the need for a second laparoscopic stack and a simple drainage bag connection to the standard insufflator to provide a stable pneumo-peritoneum. The patient had a rapid uneventful recovery. KEYWORDS: TaTME, Double single port, Innovation, Pouch surgeryItem Complete migration of a composite mesh into small bowel incidentally found during laparotomy for colectomy in an asymptomatic patient: a case report(BioMed Central, 2020) Chandrasinghe, P.; de Silva, A.; Welivita, A.; Deen, K.I.BACKGROUND: Composite meshes are used for incisional hernia repair because they enable intraperitoneal mesh placement due to their dorsal surface, which is made of inert material. We report, for the first time, to our knowledge, a case of composite mesh migration detected incidentally during a laparotomy for colon cancer in an asymptomatic patient. CASE PRESENTATION: Our patient was a 71-year-old South Asian man who underwent ventral mesh repair following a postoperative complication after right hemicolectomy for colon cancer. The patient was diagnosed with a metachronous sigmoid cancer 5 years later, for which he underwent laparotomy. During laparotomy, a migrated mesh was incidentally found and extracted from his proximal ileum without any evidence of abscess or fistula formation. CONCLUSION: To our knowledge, this is the first report of an incidentally found migrated composite mesh from a bowel lumen in an asymptomatic patient. KEYWORDS: Case report; Composite mesh; Mesh complications; Mesh migration.Item Technical tips and tricks of outpatient treatments for Hemorrhoids.(Springer, 2018) Chandrasinghe, P.; Leo, C. A.; Hodgkinson, J. D.; Vaizey, C. J.; Warusavitarne, J.Hemorrhoids are a common condition affecting the anorectum. The clinician must accurately diagnose the condition and exclude more sinister causes responsible for the same symptoms. A focused history and thorough examination help in establishing a differential diagnosis. The treatment modality is guided by the degree of the hemorrhoids. Conservative measures should be employed, including dietary advice and toileting techniques, to treat acute inflammation and as a long-term method of reducing symptom recurrence and worsening disease. A wide range of out-patient therapies are available and all have been shown to be effective in experienced hands and when used in the correct clinical context. Here we present an approach to out-patient treatment methods including conservative treatments, medical therapies, and simple interventions.Item Correction: The benefit of tumor molecular profiling on predicting treatments for colorectal adenocarcinomas(Impact Journals LLC, 2018) Carter, P.; Alifrangis, C.; Chandrasinghe, P.; Cereser, B.; Del Bel Belluz, L.; Leo, C.A.; Moderau, N.; Tabassum, N.; Warusavitarne, J.; Krell, J.; Stebbing, J.This corrects the article DOI: 10.18632/oncotarget.24257. Erratum for The benefit of tumor molecular profiling on predicting treatments for colorectal adenocarcinomas [Oncotarget. 2018 ;9(13):11371-11376]Item Investigating the benefits of molecular profiling of advanced non-small cell lung cancer tumors to guide treatments(Impact Journals, 2018) Alifrangis, C.; Carter, P.; Cereser, B.; Chandrasinghe, P.; Belluz, L.D.B.; Lim, E.; Moderau, N.; Poyia, F.; Tabassum, N.; Zhang, H.; Krell, J.; Stebbing, J.In this study we utilized data on patient responses to guided treatments, and we evaluated their benefit for a non-small cell lung cancer cohort. The recommended therapies used were predicted using tumor molecular profiles that involved a range of biomarkers but primarily used immunohistochemistry markers. A dataset describing 91 lung non-small cell lung cancer patients was retrospectively split into two. The first group's drugs were consistent with a treatment plan whereby all drugs received agreed with their tumor's molecular profile. The second group each received one or more drug that was expected to lack benefit. We found that there was no significant difference in overall survival or mortality between the two groups. Patients whose treatments were predicted to be of benefit survived for an average of 402 days, compared to 382 days for those that did not (P = 0.7934). In the matched treatment group, 48% of patients were deceased by the time monitoring had finished compared to 53% in the unmatched group (P = 0.6094). The immunohistochemistry biomarker for the ERCC1 receptor was found to be a marker that could be used to predict future survival; ERCC1 loss was found to be predictive of poor survival.