53 research outputs found
Development of a model of three-dimensional imaging for the preoperative planning of TaTME
No full textSince total mesorectal excision (TME) was first described in the early 1930s and later popularised by Heald [1], efforts have been made to standardise the technique, following the correct embryological planes and using appropriate landmarks. Laparoscopic and robotically assisted approaches to the rectum have gained popularity during recent years, compelling colorectal surgeons to develop their skills and knowledge. Transanal TME (TaTME) is a new addition to the approaches in rectal surgery. Despite being associated with several benefits in selected patients, TaTME requires advanced technical skills and, more importantly, knowledge of the pelvic structures, planes and spaces as they are encountered moving cephalad from the perineum. Magnetic resonance imaging (MRI) is the gold standard for imaging of the pelvis and pelvic floor, but understanding of relevant anatomy when performing a new technique may be hampered by difficulty in interpretation of two-dimensional (2D) images when considering three-dimensional (3D) structures. We describe a new tool that could help understanding of TaTME planes and preoperative planning
Mental Health Problems during Pregnancy and the Postpartum Period: A Multicenter Knowledge Assessment Survey among Healthcare Providers
No full textBackground. Mental illness related to pregnancy can have long-lasting consequences. Healthcare providers are often the most frequent medical contact with the potential for early detection of these. Objectives were to study the awareness regarding mental health problems during pregnancy and the postpartum period among healthcare providers. Methods. A cross-sectional study was carried out with healthcare providers including the nursing staff, midwifery staff, and medical officers working at obstetric wards in three tertiary care hospitals in Sri Lanka. A self-administered questionnaire assessed staff experience with mothers having mental problems, knowledge on mental health problems related to pregnancy, and knowledge about risk factors, common symptoms, and possible consequences on a five-point Likert scale from “Strongly Agree” to “Strongly Disagree.” Results. A total of 300 staff were approached and invited to participate. Only 152 responded to the questionnaire (response rate of 50.1%). Mean (SD) age was 35.8 (9.7) years and mean (SD) years of experience was 10.1 (9.1) years. Age more than 35 years of healthcare providers is associated with statistically significant (p=0.02) average knowledge scores on the consequences of maternal mental health problems. The symptom of “excessively worrying about baby’s health” had the lowest score across all three categories with an average of 34.2%. Only 42.8% have ever heard of EPDS. Overall awareness and knowledge about risk factors, symptoms, and consequences regarding pregnancy-related maternal mental health problems are generally good among the healthcare providers studied. However, some of the few aspects are not satisfactory. Health education of pregnant women, promoting regular in-service training sessions, improvement of infrastructure, and involvement of family members from the antenatal period were discussed by the majority. Conclusion. Despite good overall awareness and knowledge, application into practice with the utilization of validated assessments is poor. This may probably explain why Sri Lanka has a high prevalence of postpartum depression suggesting urgent attention
Translation, cross-cultural adaptation, and validation of the Duke Activity Status Index (DASI) to Sinhala language
No full textAbstract 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, r s = 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
Colorectal cancer burden and trends in a South Asian cohort: experience from a regional tertiary care center in Sri Lanka
No full textAbstract Objective Colorectal cancer (CRC) burden is increasing in the south Asian region due to the changing socio-economic landscape and population demographics. There is a lack of robust high quality data from this region in order to evaluate the disease pattern and comparison. Using generalized linear models assuming Poisson distribution and model fitting, authors describe the variation in the landscape of CRC burden along time since 1997 at a regional tertiary care center in Sri Lanka. Results Analyzing 679 patients, it is observed that both colon and rectal cancers have significantly increased over time (pre 2000—61, 2000 to 2004—178, 2005 to 2009—190, 2010 to 2014–250; P < 0.05). Majority of the cancers were left sided (82%) while 77% were rectosigmoid. Over 25% of all CRC were diagnosed in patients less than 50 years and the median age at diagnosis is < 62 years. Increasing trend is seen in the stage at presentation while 33% of the rectal cancers received neoadjuvant chemoradiation. Left sided preponderance, younger age at presentation and advanced stage at presentation was observed. CRC disease pattern in the South Asian population may vary from that observed in the western population which has implications on disease surveillance and treatment
Pre-operative hypoalbuminaemia predicts poor overall survival in rectal cancer: a retrospective cohort analysis
No full textNeoadjuvant Chemoradiation for Rectal Cancer Achieves Satisfactory Tumour Regression and Local Recurrence – Result of a Dedicated Multi-disciplinary Approach from a South Asian Centre
No full textAbstract Background Pre-operative long-course chemoradiotherapy (CRT) for rectal cancer has resulted in improvement in rates of restorative rectal resection and local recurrence by inducing tumour downstaging and downsizing. Total mesorectal excision (TME) is a standardised surgical technique of low anterior resection aimed at the prevention of local tumour recurrence. The purpose of this study was to evaluate tumour response following CRT in a standardised group of patients with rectal cancer. Methods One hundred and thirty-one patients (79 male; 52 female, median age 57; interquartile range 47–62 years) of 153 with rectal cancer who underwent pre-operative long-course CRT were treated by standardised open low anterior resection at a median of 10 weeks post-CRT. Sixteen of 131 (12%) were 70 years or older. Median follow-up at the time of analysis was 15 months (interquartile range 6–45 months). Pathology reports were analysed based on AJCC-UICC classification using the TNM system. Data recorded were overall/subgrades of tumour regression; good, moderate or poor, lymph node harvest, local recurrence, disease-free and overall survival using standard statistical methods. Results 78% showed tumour regression post-CRT; 43% displayed good tumour regression/response while 22% had poor tumour regression/response. All patients had a pre-operative T-stage of either T3 or T4. Post-operation, good responders had a median T stage of T2 vs. T3 in poor responders (P = 0.0002). Overall, the median lymph node harvest was < 12. There was no difference in the number of nodes harvested in good vs. poor responders (Good/moderate-6 nodes vs. Poor- 8; P = 0.31). Good responders tended to have a lesser number of malignant nodes vs. poor responders (P = 0.31). Overall, local recurrence was 6.8% and the anal sphincter preservation rate was 89%. Predicted 5-year disease-free and overall survival were similar between good and poor responders. Conclusion Long-course CRT resulted in satisfactory tumour regression and enabled consideration for safe, sphincter-saving resection in rectal cancer. A dedicated multi-disciplinary team approach achieved a global benchmark for local recurrence in a resource-limited setting
Literature review and a preliminary study on leishmaniasis to inform community awareness campaigns in Sri Lanka
No full textBackground: Accurate knowledge about transmission and potential risk factors of leishmaniasis among residents in endemic areas is imperative. This paper presents a review of the existing literature on leishmaniasis risk factors in Sri Lanka and a preliminary study of the disease related awareness, attitudes and practices in an endemic area.Methods: Publications on epidemiology of leishmaniasis in Sri Lanka were reviewed. Data were collected using an interviewer administered questionnaire from 120 inhabitants in Dickwella Divisional Secretariat in the District of Matara by a multistage cluster sampling method.Results: Around 20 publications were reviewed, and potential risk factors identified. In the field survey, 21.7% (n=26/120) were aware of the name “leishmaniasis”. Disease vector was identified by 68.1% (n=64/94) through the shown picture and description. Acne form was known as a type of early leishmanial skin lesion by 81.1% (n=73/90). Potential risk factors such as cracks of house walls (55.8%, n=67/120), damp areas in houses (60.0%, n=72/120), animal burrows (45%, n=54/120) and livestock pens (12.5%, n=15/120) were abundant in this area. Western medical treatment was preferred by 78.9% (n=71/90) as the treatment option. Around 58.9% (n=53/90) of respondents felt that disease prevention is a combined responsibility of community and the government.Conclusions: Even though, potential environmental risk factors were abundant, this study found poor awareness regarding the salient aspects of leishmaniasis among the participants. They possessed positive attitudes towards curability of the disease, obtaining proper treatment and disease control.</p
P482 Transanal minimally invasive proctectomy (TaMIP) in patients with inflammatory bowel diseases (IBD) within the TaTME international database
No full textP605 Transanal minimally invasive proctectomy (TaMIP) in patients with Crohn’s disease: A cohort study from the TaTME international database
No full textOP017 Transanal minimally invasive proctectomy with ileal pouch anal anastomosis (Ta-IPAA) in patients with ulcerative colitis: a cohort study from the TaTME international database
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