North Colombo Teaching Hospital

Ragama, Sri Lanka

North Colombo Teaching Hospital

Ragama, Sri Lanka
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Ekanayake C.D.,District General Hospital | Pathmeswaran A.,University of Kelaniya | Herath R.P.,University of Kelaniya | Perera H.S.S.,University of Kelaniya | And 2 more authors.
International Urogynecology Journal | Year: 2017

Introduction: The multifaceted nature of pelvic floor disorders means that a systematic evaluation is required for optimal treatment outcome. It is also generally acknowledged that a valid tool is necessary to objectively assess symptoms reported by affected women. Methods: The International Consultation on Incontinence Questionnaire—Vaginal Symptoms (ICIQ-VS) questionnaire was translated to Sinhala and Tamil and a validation study carried out among women attending gynecology clinics at North Colombo Teaching Hospital, Ragama, and the district general hospitals Mannar and Vavuniya. Results: Content validity was assessed by the level of missing answers, which was < 4% and 2% for each item in Sinhala and Tamil, respectively. Construct validity was assessed by the ability of the questionnaire to differentiate between patients and controls. Both differentiated patients from controls on vaginal symptoms score (VSS) (p < 0.001), sexual symptoms score (SSS) (p < 0.01), and quality of life (QoL) (p < 0.001). There was a strong positive correlation between Pelvic Organ Prolapse Quantification (POP-Q) scores and VSS (Sinhala rs = 0.64, p < 0.001, Tamil rs = 0.65, p < 0.001), and QoL (Sinhala rs = 0.49, p < 0.001, Tamil rs = 0.60, p < 0.001). Internal consistency as assessed using Cronbach’s coefficient alpha: 0.78 (0.76–0.78) and 0.83 (0.80–0.84) in Sinhala and Tamil, respectively. Test–retest reliability was assessed by weighted kappa scores (Sinhala 0.58–0.88 and Tamil 0.76–0.90). Both questionnaires were sensitive to change and showed that VSS and QoL improved following surgery (Wilcoxon matched-pairs signed-rank test p < 0.001). Conclusion: The validated Sinhala and Tamil translations of ICIQ-VS will be useful for assessing vaginal and sexual symptoms among women speaking Sinhala and Tamil. © 2017 The International Urogynecological Association

Kahandawaarachchi I.C.I.,North Colombo Teaching Hospital | Premawansa G.S.,North Colombo Teaching Hospital | Warnasuriya W.,North Colombo Teaching Hospital | Dassanayake M.,North Colombo Teaching Hospital | Corea E.,University of Colombo
BMC Infectious Diseases | Year: 2017

Background: Leishmaniasis and melioidosis are frequently reported from the North Central Province of Sri Lanka. However, only one case of co-infection of the two diseases has been reported to date over the world. This is a case report of a patient who had co-infection with cutaneous leishmaniasis and melioidosis and was successfully treated and recovered from the illness. Case presentation: A 61year old female patient with diabetes mellitus presented with fever for one month's duration and was found to have hepatosplenomegaly and an ulcer over the left arm. She had elevated inflammatory markers and blood culture grew Burkholderia pseudomallei and serum was highly positive for melioidosis antibodies. A slit skin smear of the ulcer showed Leishmania amastigotes. Conclusion: Melioidosis and leishmaniasis are emerging infectious diseases in endemic countries and can be severe. The high prevalence rates in Sri Lanka should keep the treating physicians' threshold for suspicion low for these two diseases. © 2017 The Author(s).

De Silva A.P.,University of Kelaniya | Kumarasena R.S.,North Colombo Teaching Hospital | Perera Keragala S.D.,University of Kelaniya | Kalubowila U.,North Colombo Teaching Hospital | And 4 more authors.
BMC Gastroenterology | Year: 2011

Background: Ileal intubation is the gold standard for a complete colonoscopy. However, despite evidence of clinical benefit ileoscopy is not always attempted due to perceived technical difficulty. Our aim was to compare time taken for ileal intubation using a new position-the prone 12 o'clock position (PP) with the standard method (left lateral 6 o'clock position-LLP).Methods: We performed a pilot study using fluoroscopy to determine the best patient position for ileal intubation. This was the prone 12 o'clock position. Patients were colonoscoped in the left lateral position and then randomized to ileal intubation in the 6 o'clock position(LL) or the 12 o'clock (PP) position.Results: 202 consecutive patients were referred for colonoscopy. Colonoscopy was performed on 150 patients [82 females, mean (SD) age 53 (16) years]. 75 patients were randomized for ileal intubation in the PP and 75 patients in the LLP. Overall, the ileum was successfully intubated in 145 (96%) patients [74 (98.7%) in the PP and71 (94.7%) in the LLP]. The median (Interquartile Range) ileal intubation time was 12 (10) seconds in the PP and 87 (82) seconds in the LLP (p < 0.0001; Mann-Whitney U test). The ileum was abnormal in 11 (7.5%) patients.Conclusions: During colonoscopy, the prone 12 o'clock position gives a more direct approach to the ileo-caecal valve and significantly reduces ileal intubation time.Trial registration: Trial registry: Sri Lanka Clinical Trial Registry. Clinical trial registry number: SLCTR/2009/002. © 2011 De Silva et al; licensee BioMed Central Ltd.

Chandrasinghe P.C.,North Colombo Teaching Hospital | Ediriweera D.S.,North Colombo Teaching Hospital | Hewavisenthi J.,University of Kelaniya | Kumarage S.,North Colombo Teaching Hospital | Deen K.I.,North Colombo Teaching Hospital
Indian Journal of Gastroenterology | Year: 2014

Background: Lymph node status is important in staging colorectal cancer (CRC). Presence of metastatic nodes differentiates stage III from stage II. The role of adjuvant therapy is still unclear in stage II CRC. Inadequate node sampling may result in inaccurate staging. Method: Records of 131 patients with stages II and III CRC who underwent curative resection, having five or more lymph nodes harvested from the specimen, were prospectively followed up and analyzed. The Kaplan-Meier method was used to analyze survival, based on groups of serially ascending values of lymph nodes harvested. Regression analysis was performed by Cox proportional hazards ratio model with right-censored CRC survival data at a 10 % significance level. The effect of nodal harvest on survival was adjusted for age, sex, preoperative carcinoembryonic antigen (CEA) level, neoadjuvant chemoradiation, pathological tumor stage, histological type, differentiation, margin positivity, angioinvasion, perineural invasion, and lymphovascular infiltration. Results: The total population showed improved survival with 14 or more nodes harvested (p= 0.005). For both rectal (n= 83; p= 0.03) and colon cancers (n= 46; p= 0.08), most significant survival benefits were seen with over 14 nodes harvested, irrespective of the stage. With multiple regression analysis, advanced age (p= 0.003), male sex (p= 0.017), lymphovascular infiltration (p= 0.015), and preoperative CEA levels (p= 0.096) were found to be other significant factors. The lymph node effect remained significant (HR = 0.19, p= 0.004) after adjusting for the above factors. Conclusion: A lymph node harvest of 14 or more resulted in better survival outcome from CRC in this population. Staging of the disease could be accurate with increased nodal harvesting. © 2013 Indian Society of Gastroenterology.

PubMed | North Colombo Teaching Hospital and University of Kelaniya
Type: | Journal: BMC research notes | Year: 2016

Low-grade hepatic encephalopathy (LGHE) comprises minimal hepatic encephalopathy (MHE) and grade 1 hepatic encephalopathy. LGHE has no or minimal recognizable symptoms but has mild cognitive and psychomotor deficits. Studies in Western countries have demonstrated increased road accidents (RA) among patients with MHE. Our objective was to investigate the association between Sri Lankan LGHE phenotype and RA.A prospective, case-control study was conducted in the University Medical Unit, North Colombo Teaching Hospital, Ragama Sri Lanka. Patients with cirrhosis of any aetiology, without OHE, who had been driving during previous 1month were included. A similar number of age matched, healthy control drivers were also enrolled. Both groups were subjected to five pencil-paper based psychometric tests used to detect LGHE in cirrhotics. Self-reported RA during the previous 1month were recorded: categorized as major when resulted in hospitalization of the involved, minor when there were injuries, but not serious enough for hospitalization of the involved and other when limited to damages to vehicle or environment without injuries.Among 55 drivers with cirrhosis and LGHE [males, median age 53years (range 30-60)], 7 (12.7%) reported RA compared to 6 (10.9%) among 55 controls [males; median age 51years (range 30-60)]. There were no major accidents in either group. 2/55 (3.6%) cases and 2/55 (3.6%) controls reported minor accidents.There was no increased frequency of RA among Sri Lankan drivers with LGHE compared to healthy controls. This is with the limitation of the study based only on self reported RA.

PubMed | North Colombo Teaching Hospital and University of Kelaniya
Type: | Journal: BMC gastroenterology | Year: 2015

Transarterial-chemo-embolization (TACE) is used for palliation of unresectable hepatocellular carcinoma (HCC). We studied the tolerability of TACE in a cohort of patients with NASH and alcoholic cirrhosis related HCC.Of 290 patients with HCC (July 2011 - December 2014), 84 underwent TACE. They were monitored for post-TACE complications: postembolization fever (PEF), nausea and vomiting (NV), abdominal pain, infection, acute hepatic decompensation (AHD) and acute kidney injury (AKI).84 patients [90.5% males, 89.2% cirrhotics, 89.2% nodular HCC, median age 63 (34-84) years] underwent 111 TACE sessions. All were Child class A [69.4% sessions (n=77)] or B; ascites and portal vein invasion was present in 18 (16.2%) and 15 (13.6%), respectively. 42 (38.2%) TACE procedures resulted in complications [PEF 28 (25.2%), NV 4 (3.6%), abdominal pain 9 (8.1%), infection 7 (6.3 %), AHD 13 (11.7%), AKI 3 (2.7 %)]. There were no immediate post-TACE deaths. On univariate analysis elevated serum bilirubin (p=0.046) and low serum albumin (p=0.035) predicted PEF while low serum albumin (p=0.021) and low platelet counts (p=0.041) predicted AHD. In the multivariate model, factors with p<0.200 on univariate analysis and factors derived from the previous literature were considered covariates. Female gender (p=0.029, OR=1.412), ascites (p=0.030, OR=1.212), elevated serum bilirubin (p=0.007, OR=4.357) and large tumour size (p=0.036, OR=3.603) were independent risk factors for PEF. Tumour diameter >5 cm (p=0.049, OR=2.410) and elevated serum bilirubin (p=0.036, OR=1.517) predicted AHD.In NASH and alcoholic cirrhosis related HCC patients pre-procedure serum bilirubin, ascites, tumour size and female gender predicted PEF post-TACE. Tumours larger 5 cm with elevated bilirubin predicted AHD post-TACE.

Wimalaratna H.,Teaching Hospital | Nandasiri A.S.D.,North Colombo Teaching Hospital
Journal of the Royal College of Physicians of Edinburgh | Year: 2013

Berardinelli-Seip congenital lipodystrophy (BSCL) is a rare autosomal recessive disorder of generalised lipoatrophy, characterised by the absence of functioning adipocytes, with lipid being stored in muscles, the liver and the pancreas. The usual presentation is in adulthood, with manifestations of insulin resistance, hypertriglyceridaemia and liver steatosis. Cirrhosis as the first presentation of BSCL in a young adult is rare. We describe a patient with BSCL presenting with cirrhosis. To the best of our knowledge this is the first case of BSCL reported in a Sri Lankan patient. © 2013 Royal College of Physicians of Edinburgh.

Dissanayake M.,North Colombo Teaching Hospital | Wijesuriya N.,North Colombo Teaching Hospital
Sri Lankan Journal of Anaesthesiology | Year: 2015

Introduction Fracture neck of femur is the commonest reason for surgery in sick, elderly patients. For many of them, hip fracture is said to be the beginning of the end of their journey of life. Early surgery may lead to better outcomes. The aim of this audit was to study current practice and adherence to safety guidelines published by the AAGBI (Association of Anaesthetists of Great Britain and Ireland) UK, as no local guidelines are available at present.Method A retrospective audit was carried out at Colombo North Teaching Hospital Ragama in 10 wards on all patients above 60 years (n=41) and had surgery for fracture neck of femur from 15thJanuary to 15th June 2014. Data were extracted from patient records using a data collection form.Results Mean age of the population was 75.8 years and72.9% were females and 27% were males. Only four patients (11%) had surgery within the recommended period of 48 hours after admission. 50% of patients had surgery only after 7-8 days. Delays were compounded by late admission to hospital following injury. One patient died of a probable acute coronary event or pulmonary embolism. Lack of close monitoring of these patients due to inadequate intensive care beds, complicates the postoperative management. None of these patients received thrombo-prophylaxis despite current guidelines.Conclusions and Recommendations Adherence to standard practice guidelines for management of patients with fracture neck of femur is found to be unsatisfactory at CNTH, Ragama. The delays are due to late admission, late referral to orthopaedic team and anaesthetists and lack of dedicated theatre time and intensive care beds. Thromboprophylaxis in this high risk category of patients is not carried out. There is an urgent need to address these issues and plan perioperative management of these patients according to available standard practice guidelines. © 2015, College of Anaesthesiologists of Sri Lanka. All rights reserved.

Hall J.M.,University of Western Australia | Corea E.,University of Western Australia | Corea E.,University of Colombo | Anusha Sanjeewani H.D.,North Colombo Teaching Hospital | And 2 more authors.
Journal of Medical Microbiology | Year: 2014

Carbapenemases are increasingly important antimicrobial resistance determinants. Little is known about the carbapenem resistance mechanisms in Sri Lanka. We examined 22 carbapenemresistant Klebsiella pneumoniae from Sri Lanka to determine their β-lactam resistance mechanisms. The predominant resistance mechanisms we detected in this study were OXA-181, NDM-1 carbapenemases and extended-spectrum β-lactamase CTX-M-15. All isolates were then genotyped by pulsed-field gel electrophoresis, variable-number tandem repeat sequence analysis and multilocus sequence typing, and seven distinct genotypes were observed. Five OXA-181- positive Klebsiella pneumoniae isolates were genotypically related to an isolate of Indian origin. Multilocus sequence typing found that these related isolates belong to ST-14, which has been associated with dissemination of OXA-181 from the Indian subcontinent. Other genotypes we discovered were ST-147 and ST-340, also associated with intercontinental spread of carbapenemases of suspected subcontinental origin. The major porin genes ompK35 and ompK36 from these isolates had insertions, deletions and substitutions. Some of these were exclusive to strains within single pulsotypes. We detected one ompK36 variant, ins AA134- 135GD, in six ST-14- and six ST-147, blaOXA-181-positive isolates. This porin mutation was an independent predictor of high-level meropenem resistance in our entire Sri Lankan isolate collection (P=0.0030). Analysis of the Sri Lankan ST-14 and ST-147 ins AA134-135GDpositive isolates found ST-14 was more resistant to meropenem than other isolates (mean MIC: 32±0 μg ml-1 and 20±9.47 μg ml-1, respectively, P=0.0277). The likely international transmission of these carbapenem resistance determinants highlights the need for regional collaboration and prospective surveillance of carbapenem-resistant Enterobacteriaceae. © 2014 The Authors.

Chandrasinghe P.C.,North Colombo Teaching Hospital | Ediriweera D.S.,North Colombo Teaching Hospital | Kumarage S.K.,North Colombo Teaching Hospital | Deen K.I.,North Colombo Teaching Hospital
BMC Clinical Pathology | Year: 2013

Background: 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 <35 g/L vs. >35 g/L. We sought for significant associations of survival with age, sex, stage, tumour site, use of neoadjuvant chemoradiation, microscopic positive resection margins, 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 < 35 g/L and was associated with a poor overall survival (P = 0.02). Mean survival in months for <35 g/L vs. >35 g/L was 64.7 (SE - 9.3) vs. 95.8 (SE - 7.0) and 5 year overall survival rates were 49% and 69%. Individual variable analysis revealed age, circumferential margin, stage, perineural, lympho-vascular and angio invasion to be also significant. With multifactorial analysis hypoalbuminaemia (HR = 0.58; 95% CI: 0.35 - 0.95, P = 0.03), advanced stage (HR = 2.0; 95% CI: 1.26 - 3.23, P < 0.01) and positive circumferential margin (HR = 2.2; 95% CI: 1.26 - 3.89, P < 0.01) remained significant. Conclusion: Preoperative hypoalbuminaemia is an independent risk factor for poor overall survival in rectal cancer. Advanced tumour stage and circumferential margin positivity were the other associations with poor survival. © 2013 Chandrasinghe et al.; licensee BioMed Central Ltd.

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