Dr Anuruddha Padeniya - Academia.edu (original) (raw)

Papers by Dr Anuruddha Padeniya

Research paper thumbnail of Six Novel ATM Gene Variants in Sri Lankan Patients with Ataxia Telangiectasia

Case Reports in Genetics, 2020

Introduction. Ataxia telangiectasia is a rare genetic condition with an estimated prevalence of 1... more Introduction. Ataxia telangiectasia is a rare genetic condition with an estimated prevalence of 1 in 40,000–100,000 live births. This condition predominantly affects the nervous and immune systems. It is characterized by progressive ataxia beginning from early childhood. The neurological deficit associated with this condition affects one’s balance, coordination, walking, and speech and can be accompanied by chorea, myoclonus, and neuropathy. They may also have ocular telangiectasias and high levels of blood alpha-fetoprotein (AFP). The ataxia telangiectasia mutated gene (ATM) is associated with this condition and codes for the ATM protein which is a phosphatidylinositol 3-kinase. This gene occupies 150 kb on chromosome 11q22–23 and contains 66 exons encoding a 13 kb transcript. ATM is a relatively large protein with a molecular weight of 350 kDa and 3,056 amino acids. Methods. Four patients of Sri Lankan origin presenting with features suggestive of ataxia telangiectasia were referr...

Research paper thumbnail of A rare case of congenital fibre type disproportion causing delayed motor milestones

Ceylon Medical Journal, 2015

Research paper thumbnail of The mismatch between canteen guidelines and their implementation at canteens in medical institutions in Anuradhapura District

Ceylon Medical Journal, 2021

Introduction: The 'Guidelines for a healthy canteen in workplaces' (guidelines) was published in ... more Introduction: The 'Guidelines for a healthy canteen in workplaces' (guidelines) was published in 2013 by the Ministry of Health to improve food choices and healthy eating of working community. Objectives: To determine the extent of implementation of guidelines in canteens at medical institutions in Anuradhapura District. Methods: A descriptive cross-sectional study was conducted on random working days in canteens providing all three main meals in medical institutions in Anuradhapura District in August and September 2018. Data were collected by observing the canteen and interviewing the canteen owners according to guidelines. Scoring was done according to a scoring system to obtain a percentage. Results: Ten canteens were included in the study. The median number of customers per canteen was 200 (IQR 100-625). The highest and lowest scores by canteens for overall implementation were 41.8% and 14.1%, while the mean among all canteens was 29.2%. Average percentages for healthy carbohydrate, fruit, snacks, and oil options were 15.2%, 20.0%, 8.8%, and 28.2% respectively. Availability of healthy dairy and use of standard coconut oil was 0.0%. Safe drinking water and hand-washing with soap were available only in 6 and 4 canteens respectively. Implementation of food safety measures was 32.5%. None of the canteens had any posters/guides regarding healthy eating and none of the owners were aware of the guidelines. Conclusions: The level of implementation of the canteen guidelines was highly unsatisfactory among the canteens in medical institutions in Anuradhapura District.

Research paper thumbnail of A Novel Mutation in the EIF2B4 Gene Associated with Leukoencephalopathy with Vanishing White Matter

Case Reports in Pediatrics, 2018

Research paper thumbnail of Validity and reliability of Adolescent Headache Attributed Restriction, Disability Social Handicap and Impaired Participation (Adolescent HARDSHIP) Questionnaire -Sinhala

Journal of the College of Community Physicians of Sri Lanka, 2021

Research paper thumbnail of Knowledge on Epilepsy and its Associated Factors among Parents of Children Attending Epilepsy Clinics at the Premier Paediatric Hospital in Sri Lanka

Research paper thumbnail of Neurocutaneous Syndromes

Atlas of Dermatoses in Pigmented Skin, 2020

NF 1 is the most common single-gene genetic disorder to affect the human nervous system and the e... more NF 1 is the most common single-gene genetic disorder to affect the human nervous system and the estimated prevalence of 2 to 3 cases per 10,000 population (North 2000). It is inherited as a complex autosomal dominant manner due to mutations in germline NF1 tumour suppressor gene (Gutmann et al. 2017). The clinical manifestation varies and almost all develops pigmentary lesions, such as café-aulait macules, skinfold freckling and Lish nodules. Other systemic involvements are skeletal abnormalities (scoliosis, tibial pseudarthrosis and orbital dysplasia), brain tumours (optic pathway gliomas and glioblastoma), peripheral nerve tumours (spinal neurofibromas, plexiform neurofibromas and malignant peripheral nerve sheath tumours), learning disabilities, attention deficits and social and behavioural problems. These will negatively impact quality of life (Ferner et al. 2007). The clinical manifestations according to three major studies are as follows (North 2000). Dermatological Manifestations of NF1 (Friedman 1993) (Table 4.1) 4.1.1 Café-au-lait Spots This is the first clinical manifestation. These macules are varied in sizes, but the typical spot is between 10 and 30 mm in size, ovoid in shape and uniform in colour, although the variations are not uncommon to this. They normally do not appear in the scalp, eyebrow, palms and soles. Its melanocytes are histologically characterised with the presence of giant melanosomes; however, this finding is not unique to NF1 (Figs. 4.1, 4.2 and 4.3).

Research paper thumbnail of 39.3 Sleeping Patterns of School Children Aged Between 9 and 11 Years of Colombo 8 Region, Sri Lanka

Journal of the American Academy of Child & Adolescent Psychiatry, 2021

Research paper thumbnail of Innovations to combat COVID-19

Journal of the College of Community Physicians of Sri Lanka, 2020

COVID-19 pandemic has at present seized the world and caused humankind to focus on survival and p... more COVID-19 pandemic has at present seized the world and caused humankind to focus on survival and progression. It has caused individuals to step forward beyond their comfort zone and develop and nurture abilities and innovations to combat this novel virus. This innovation culture was evidenced in China, the epicentre of the pandemic, where multiple technological innovations helped to combat the Corona outbreak (1). In addition, scientists are also involved in biological innovations aiming to discover treatment modalities for the virus (2). Furthermore, these innovations are crucial for the sustainable development of the globe (3). Sri Lanka, which is a lower-middle income country (LMIC) requires facilities and equipment to overcome the COVID-19 pandemic as well as to face the post-pandemic era. Innovations and interventions were produced by the scientists, innovators, software engineers, medical professionals and others interested in the vast field of innovation. The lack of a platform for these inventors to develop their inventions to a globally accepted and commercially producible level was noted. This narrative report highlights the need for new innovations to uplift the health sector and fulfilment of this requirement.

Research paper thumbnail of Government Medical Officers' Association's proposed COVID-19 Exit Strategy for Sri Lanka

Journal of the College of Community Physicians of Sri Lanka, 2020

Containment strategies for COVID-19 have varied across the globe. Sri Lanka made swift decisions ... more Containment strategies for COVID-19 have varied across the globe. Sri Lanka made swift decisions and early interventions which were widely commended on a global platform. The Government Medical Officers' Association (GMOA) Sri Lanka proposed a strategy based on the World Health Organization's (WHO) four phases of the pandemic. This was a novel strategy based on real-time data and best available evidence. It facilitated three pillars: development of health and social capital via inter-sectoral collaboration, public engagement and government support. Advocacy by the GMOA was needed in terms of political leadership, health sector staff and the corporate sector to ensure smooth functioning at different levels.

Research paper thumbnail of Preparing medical graduates in Sri Lanka for a productive internship and beyond: The "Good Intern Program

Allied Journal of Medical Research, 2017

Introduction: The transition from undergraduate student to independent practitioner for medical g... more Introduction: The transition from undergraduate student to independent practitioner for medical graduates is a challenging one. This paper describes a multi-faceted training model-the "Good Intern Programme (GIP)"-that aims to provide such training for newly qualified doctors (pre-interns, PI) in Sri Lanka. Methods: The development and implementation of the GIP included the following: focus group discussions to understand the requirements; a needs assessment including identification of the main stressors; a 10-day practical Tamil language-training programme; a 4-day acute care skills training (ACST) program; and a 4-day Good Medical Practice (GMP) workshop based on the system building blocks of the WHO. Results: 980 PIs participated in the needs assessment; 383 (39.1%) stated that the first half of their internship was more stressful than the second (p<0.003). Amongst the 866 PI who registered for the GIP, 783 (90.4%) considered knowledge of medical administrative matters to be of importance to doctors. Hospital based clinical training, conducted in 28 hospitals island-wide, was attended by 278 PI; a statistically significant increase for all surveyed skills was demonstrated. The feedback for the GMP workshop, attended by 796 PI, was broadly positive with the session on "essential skills for interns" receiving the highest positive rating for relevance. Conclusion: The GIP provides a comprehensive opportunity to facilitate the transition of medical graduates in Sri Lanka using a multimodal, integrated and sustainable platform. This national program may have applicability beyond Sri Lanka.

Research paper thumbnail of Practices and Perspectives in Cardiopulmonary Resuscitation Attempts and the Use of Do Not Attempt Resuscitation Orders: A Cross-sectional Survey in Sri Lanka

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2017

The objective of this study is to describe the characteristics of in-hospital cardiopulmonary res... more The objective of this study is to describe the characteristics of in-hospital cardiopulmonary resuscitation (CPR) attempts, the perspectives of junior doctors involved in those attempts and the use of do not attempt resuscitation (DNAR) orders. A cross-sectional telephone survey aimed at intern doctors working in all medical/surgical wards in government hospitals. Interns were interviewed based on the above objective. A total of 42 CPR attempts from 82 hospitals (338 wards) were reported, 3 of which were excluded as the participating doctor was unavailable for interview. 16 (4.7%) wards had at least 1 patient with an informal DNAR order. 42 deaths were reported. 8 deaths occurred without a known resuscitation attempt, of which 6 occurred on wards with an informal DNAR order in place. 39 resuscitations were attempted. Survival at 24 h was 2 (5.1%). In 5 (13%) attempts, CPR was the only intervention reported. On 25 (64%) occasions, doctors were "not at all" or "only a l...

Research paper thumbnail of Critical Care Junior Doctors' Profile in a Lower Middle-income Country: A National Cross-sectional Survey

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2017

Retention of junior doctors in specialties such as critical care is difficult, especially in reso... more Retention of junior doctors in specialties such as critical care is difficult, especially in resource-limited settings. This study describes the profile of junior doctors in adult state intensive care units in Sri Lanka, a lower middle-income country. This was a national cross-sectional survey using an anonymous self-administered electronic questionnaire. Five hundred and thirty-nine doctors in 93 Intensive Care Units (ICUs) were contacted, generating 207 responses. Just under half of the respondents (93, 47%) work exclusively in ICUs. Most junior doctors (150, 75.8%) had no previous exposure to anesthesia and 134 (67.7%) had no previous ICU experience while 116 (60.7%) ICU doctors wished to specialize in critical care. However, only a few (12, 6.3%) doctors had completed a critical care diploma course. There was a statistically significant difference (P < 0.05) between the self-assessed confidence of anesthetic background junior doctors and non-anesthetists. The overall median c...

Research paper thumbnail of Closing the theory to practice gap for newly qualified doctors: evaluation of a peer-delivered practical skills training course for newly qualified doctors in preparation for clinical practice

Postgraduate medical journal, Jan 12, 2017

The Good Intern Programme (GIP) in Sri Lanka has been implemented to bridge the 'theory to pr... more The Good Intern Programme (GIP) in Sri Lanka has been implemented to bridge the 'theory to practice gap' of doctors preparing for their internship. This paper evaluates the impact of a 2-day peer-delivered Acute Care Skills Training (ACST) course as part of the GIP. The ACST course was developed by an interprofessional faculty, including newly graduated doctors awaiting internship (pre-intern), focusing on the recognition and management of common medical and surgical emergencies. Course delivery was entirely by pre-intern doctors to their peers. Knowledge was evaluated by a pre- and post-course multiple choice test. Participants' confidence (post-course) and 12 acute care skills (pre- and post-course) were assessed using Likert scale-based questions. A subset of participants provided feedback on the peer learning experience. Seventeen courses were delivered by a faculty consisting of eight peer trainers over 4 months, training 320 participants. The mean (SD) multiple cho...

Research paper thumbnail of Milder phenotypes of glucose transporter type 1 deficiency syndrome

Developmental Medicine & Child Neurology, 2011

ABBREVIATION GLUT1DS Glucose transporter type 1 deficiency syndrome Glucose transporter type 1 de... more ABBREVIATION GLUT1DS Glucose transporter type 1 deficiency syndrome Glucose transporter type 1 deficiency syndrome (GLUT1DS) is a treatable condition resulting from impaired glucose transport into the brain. The classical presentation is with infantile-onset epilepsy and severe developmental delay. Non-classical phenotypes with movement disorders and early-onset absence epilepsy are increasingly recognized and the clinical spectrum is expanding. The hallmark is hypoglycorrhachia (cerebrospinal fluid [CSF] glucose<2.2mmol ⁄ l) in the presence of normoglycaemia with a CSF ⁄ blood glucose ratio of less than 0.4. GLUT1DS is due to a mutation in the solute carrier family 2, member 1 gene (SLC2A1). We present five individuals (four males, one female), all of whom had a mild phenotype, highlighting the importance of considering this diagnosis in unexplained neurological disorders associated with mild learning difficulties, subtle motor delay, early-onset absence epilepsy, fluctuating gait disorders, and ⁄ or dystonia. The mean age at diagnosis was 8 years 8 months. This paper also shows phenotypical parallels between GLUT1DS and paroxysmal exertion-induced dyskinesia.

Research paper thumbnail of X-linked hereditary motor sensory neuropathy (type 1) presenting with a stroke-like episode

Developmental Medicine & Child Neurology, 2010

Research paper thumbnail of Electroclinical outcome of children referred with suspected absence seizures

Archives of Disease in Childhood, 2011

Approximately 10% of children with epilepsy have absence epilepsy syndromes.1 The diagnosis is co... more Approximately 10% of children with epilepsy have absence epilepsy syndromes.1 The diagnosis is confirmed by recording events during a standard EEG recording synchronised with video.2 However, non-epileptic absence-like behaviour is common in children, and although there may be clinical pointers to non-epileptic behaviours, an EEG is often requested.3 To describe the EEG (synchronised with video) results in children …

Research paper thumbnail of Video EEG outcome on children referred following a single unprovoked afebrile seizure

Archives of Disease in Childhood, 2011

To look at the outcome of the routine video EEG (vEEG) wake and sleep records on children referre... more To look at the outcome of the routine video EEG (vEEG) wake and sleep records on children referred following a single unprovoked afebrile seizure. METHODS We examined all the vEEGs that were undertaken in a regional paediatric neurophysiology department in Oxford, following a single unprovoked seizure over a 1-year period (2008-2009), several years after National Institute for Health and Clinical Excellence (NICE) 1 guidelines for the management of epilepsy in children became available.

Research paper thumbnail of Six Novel ATM Gene Variants in Sri Lankan Patients with Ataxia Telangiectasia

Case Reports in Genetics, 2020

Introduction. Ataxia telangiectasia is a rare genetic condition with an estimated prevalence of 1... more Introduction. Ataxia telangiectasia is a rare genetic condition with an estimated prevalence of 1 in 40,000–100,000 live births. This condition predominantly affects the nervous and immune systems. It is characterized by progressive ataxia beginning from early childhood. The neurological deficit associated with this condition affects one’s balance, coordination, walking, and speech and can be accompanied by chorea, myoclonus, and neuropathy. They may also have ocular telangiectasias and high levels of blood alpha-fetoprotein (AFP). The ataxia telangiectasia mutated gene (ATM) is associated with this condition and codes for the ATM protein which is a phosphatidylinositol 3-kinase. This gene occupies 150 kb on chromosome 11q22–23 and contains 66 exons encoding a 13 kb transcript. ATM is a relatively large protein with a molecular weight of 350 kDa and 3,056 amino acids. Methods. Four patients of Sri Lankan origin presenting with features suggestive of ataxia telangiectasia were referr...

Research paper thumbnail of A rare case of congenital fibre type disproportion causing delayed motor milestones

Ceylon Medical Journal, 2015

Research paper thumbnail of The mismatch between canteen guidelines and their implementation at canteens in medical institutions in Anuradhapura District

Ceylon Medical Journal, 2021

Introduction: The 'Guidelines for a healthy canteen in workplaces' (guidelines) was published in ... more Introduction: The 'Guidelines for a healthy canteen in workplaces' (guidelines) was published in 2013 by the Ministry of Health to improve food choices and healthy eating of working community. Objectives: To determine the extent of implementation of guidelines in canteens at medical institutions in Anuradhapura District. Methods: A descriptive cross-sectional study was conducted on random working days in canteens providing all three main meals in medical institutions in Anuradhapura District in August and September 2018. Data were collected by observing the canteen and interviewing the canteen owners according to guidelines. Scoring was done according to a scoring system to obtain a percentage. Results: Ten canteens were included in the study. The median number of customers per canteen was 200 (IQR 100-625). The highest and lowest scores by canteens for overall implementation were 41.8% and 14.1%, while the mean among all canteens was 29.2%. Average percentages for healthy carbohydrate, fruit, snacks, and oil options were 15.2%, 20.0%, 8.8%, and 28.2% respectively. Availability of healthy dairy and use of standard coconut oil was 0.0%. Safe drinking water and hand-washing with soap were available only in 6 and 4 canteens respectively. Implementation of food safety measures was 32.5%. None of the canteens had any posters/guides regarding healthy eating and none of the owners were aware of the guidelines. Conclusions: The level of implementation of the canteen guidelines was highly unsatisfactory among the canteens in medical institutions in Anuradhapura District.

Research paper thumbnail of A Novel Mutation in the EIF2B4 Gene Associated with Leukoencephalopathy with Vanishing White Matter

Case Reports in Pediatrics, 2018

Research paper thumbnail of Validity and reliability of Adolescent Headache Attributed Restriction, Disability Social Handicap and Impaired Participation (Adolescent HARDSHIP) Questionnaire -Sinhala

Journal of the College of Community Physicians of Sri Lanka, 2021

Research paper thumbnail of Knowledge on Epilepsy and its Associated Factors among Parents of Children Attending Epilepsy Clinics at the Premier Paediatric Hospital in Sri Lanka

Research paper thumbnail of Neurocutaneous Syndromes

Atlas of Dermatoses in Pigmented Skin, 2020

NF 1 is the most common single-gene genetic disorder to affect the human nervous system and the e... more NF 1 is the most common single-gene genetic disorder to affect the human nervous system and the estimated prevalence of 2 to 3 cases per 10,000 population (North 2000). It is inherited as a complex autosomal dominant manner due to mutations in germline NF1 tumour suppressor gene (Gutmann et al. 2017). The clinical manifestation varies and almost all develops pigmentary lesions, such as café-aulait macules, skinfold freckling and Lish nodules. Other systemic involvements are skeletal abnormalities (scoliosis, tibial pseudarthrosis and orbital dysplasia), brain tumours (optic pathway gliomas and glioblastoma), peripheral nerve tumours (spinal neurofibromas, plexiform neurofibromas and malignant peripheral nerve sheath tumours), learning disabilities, attention deficits and social and behavioural problems. These will negatively impact quality of life (Ferner et al. 2007). The clinical manifestations according to three major studies are as follows (North 2000). Dermatological Manifestations of NF1 (Friedman 1993) (Table 4.1) 4.1.1 Café-au-lait Spots This is the first clinical manifestation. These macules are varied in sizes, but the typical spot is between 10 and 30 mm in size, ovoid in shape and uniform in colour, although the variations are not uncommon to this. They normally do not appear in the scalp, eyebrow, palms and soles. Its melanocytes are histologically characterised with the presence of giant melanosomes; however, this finding is not unique to NF1 (Figs. 4.1, 4.2 and 4.3).

Research paper thumbnail of 39.3 Sleeping Patterns of School Children Aged Between 9 and 11 Years of Colombo 8 Region, Sri Lanka

Journal of the American Academy of Child & Adolescent Psychiatry, 2021

Research paper thumbnail of Innovations to combat COVID-19

Journal of the College of Community Physicians of Sri Lanka, 2020

COVID-19 pandemic has at present seized the world and caused humankind to focus on survival and p... more COVID-19 pandemic has at present seized the world and caused humankind to focus on survival and progression. It has caused individuals to step forward beyond their comfort zone and develop and nurture abilities and innovations to combat this novel virus. This innovation culture was evidenced in China, the epicentre of the pandemic, where multiple technological innovations helped to combat the Corona outbreak (1). In addition, scientists are also involved in biological innovations aiming to discover treatment modalities for the virus (2). Furthermore, these innovations are crucial for the sustainable development of the globe (3). Sri Lanka, which is a lower-middle income country (LMIC) requires facilities and equipment to overcome the COVID-19 pandemic as well as to face the post-pandemic era. Innovations and interventions were produced by the scientists, innovators, software engineers, medical professionals and others interested in the vast field of innovation. The lack of a platform for these inventors to develop their inventions to a globally accepted and commercially producible level was noted. This narrative report highlights the need for new innovations to uplift the health sector and fulfilment of this requirement.

Research paper thumbnail of Government Medical Officers' Association's proposed COVID-19 Exit Strategy for Sri Lanka

Journal of the College of Community Physicians of Sri Lanka, 2020

Containment strategies for COVID-19 have varied across the globe. Sri Lanka made swift decisions ... more Containment strategies for COVID-19 have varied across the globe. Sri Lanka made swift decisions and early interventions which were widely commended on a global platform. The Government Medical Officers' Association (GMOA) Sri Lanka proposed a strategy based on the World Health Organization's (WHO) four phases of the pandemic. This was a novel strategy based on real-time data and best available evidence. It facilitated three pillars: development of health and social capital via inter-sectoral collaboration, public engagement and government support. Advocacy by the GMOA was needed in terms of political leadership, health sector staff and the corporate sector to ensure smooth functioning at different levels.

Research paper thumbnail of Preparing medical graduates in Sri Lanka for a productive internship and beyond: The "Good Intern Program

Allied Journal of Medical Research, 2017

Introduction: The transition from undergraduate student to independent practitioner for medical g... more Introduction: The transition from undergraduate student to independent practitioner for medical graduates is a challenging one. This paper describes a multi-faceted training model-the "Good Intern Programme (GIP)"-that aims to provide such training for newly qualified doctors (pre-interns, PI) in Sri Lanka. Methods: The development and implementation of the GIP included the following: focus group discussions to understand the requirements; a needs assessment including identification of the main stressors; a 10-day practical Tamil language-training programme; a 4-day acute care skills training (ACST) program; and a 4-day Good Medical Practice (GMP) workshop based on the system building blocks of the WHO. Results: 980 PIs participated in the needs assessment; 383 (39.1%) stated that the first half of their internship was more stressful than the second (p<0.003). Amongst the 866 PI who registered for the GIP, 783 (90.4%) considered knowledge of medical administrative matters to be of importance to doctors. Hospital based clinical training, conducted in 28 hospitals island-wide, was attended by 278 PI; a statistically significant increase for all surveyed skills was demonstrated. The feedback for the GMP workshop, attended by 796 PI, was broadly positive with the session on "essential skills for interns" receiving the highest positive rating for relevance. Conclusion: The GIP provides a comprehensive opportunity to facilitate the transition of medical graduates in Sri Lanka using a multimodal, integrated and sustainable platform. This national program may have applicability beyond Sri Lanka.

Research paper thumbnail of Practices and Perspectives in Cardiopulmonary Resuscitation Attempts and the Use of Do Not Attempt Resuscitation Orders: A Cross-sectional Survey in Sri Lanka

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2017

The objective of this study is to describe the characteristics of in-hospital cardiopulmonary res... more The objective of this study is to describe the characteristics of in-hospital cardiopulmonary resuscitation (CPR) attempts, the perspectives of junior doctors involved in those attempts and the use of do not attempt resuscitation (DNAR) orders. A cross-sectional telephone survey aimed at intern doctors working in all medical/surgical wards in government hospitals. Interns were interviewed based on the above objective. A total of 42 CPR attempts from 82 hospitals (338 wards) were reported, 3 of which were excluded as the participating doctor was unavailable for interview. 16 (4.7%) wards had at least 1 patient with an informal DNAR order. 42 deaths were reported. 8 deaths occurred without a known resuscitation attempt, of which 6 occurred on wards with an informal DNAR order in place. 39 resuscitations were attempted. Survival at 24 h was 2 (5.1%). In 5 (13%) attempts, CPR was the only intervention reported. On 25 (64%) occasions, doctors were "not at all" or "only a l...

Research paper thumbnail of Critical Care Junior Doctors' Profile in a Lower Middle-income Country: A National Cross-sectional Survey

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine, 2017

Retention of junior doctors in specialties such as critical care is difficult, especially in reso... more Retention of junior doctors in specialties such as critical care is difficult, especially in resource-limited settings. This study describes the profile of junior doctors in adult state intensive care units in Sri Lanka, a lower middle-income country. This was a national cross-sectional survey using an anonymous self-administered electronic questionnaire. Five hundred and thirty-nine doctors in 93 Intensive Care Units (ICUs) were contacted, generating 207 responses. Just under half of the respondents (93, 47%) work exclusively in ICUs. Most junior doctors (150, 75.8%) had no previous exposure to anesthesia and 134 (67.7%) had no previous ICU experience while 116 (60.7%) ICU doctors wished to specialize in critical care. However, only a few (12, 6.3%) doctors had completed a critical care diploma course. There was a statistically significant difference (P < 0.05) between the self-assessed confidence of anesthetic background junior doctors and non-anesthetists. The overall median c...

Research paper thumbnail of Closing the theory to practice gap for newly qualified doctors: evaluation of a peer-delivered practical skills training course for newly qualified doctors in preparation for clinical practice

Postgraduate medical journal, Jan 12, 2017

The Good Intern Programme (GIP) in Sri Lanka has been implemented to bridge the 'theory to pr... more The Good Intern Programme (GIP) in Sri Lanka has been implemented to bridge the 'theory to practice gap' of doctors preparing for their internship. This paper evaluates the impact of a 2-day peer-delivered Acute Care Skills Training (ACST) course as part of the GIP. The ACST course was developed by an interprofessional faculty, including newly graduated doctors awaiting internship (pre-intern), focusing on the recognition and management of common medical and surgical emergencies. Course delivery was entirely by pre-intern doctors to their peers. Knowledge was evaluated by a pre- and post-course multiple choice test. Participants' confidence (post-course) and 12 acute care skills (pre- and post-course) were assessed using Likert scale-based questions. A subset of participants provided feedback on the peer learning experience. Seventeen courses were delivered by a faculty consisting of eight peer trainers over 4 months, training 320 participants. The mean (SD) multiple cho...

Research paper thumbnail of Milder phenotypes of glucose transporter type 1 deficiency syndrome

Developmental Medicine & Child Neurology, 2011

ABBREVIATION GLUT1DS Glucose transporter type 1 deficiency syndrome Glucose transporter type 1 de... more ABBREVIATION GLUT1DS Glucose transporter type 1 deficiency syndrome Glucose transporter type 1 deficiency syndrome (GLUT1DS) is a treatable condition resulting from impaired glucose transport into the brain. The classical presentation is with infantile-onset epilepsy and severe developmental delay. Non-classical phenotypes with movement disorders and early-onset absence epilepsy are increasingly recognized and the clinical spectrum is expanding. The hallmark is hypoglycorrhachia (cerebrospinal fluid [CSF] glucose<2.2mmol ⁄ l) in the presence of normoglycaemia with a CSF ⁄ blood glucose ratio of less than 0.4. GLUT1DS is due to a mutation in the solute carrier family 2, member 1 gene (SLC2A1). We present five individuals (four males, one female), all of whom had a mild phenotype, highlighting the importance of considering this diagnosis in unexplained neurological disorders associated with mild learning difficulties, subtle motor delay, early-onset absence epilepsy, fluctuating gait disorders, and ⁄ or dystonia. The mean age at diagnosis was 8 years 8 months. This paper also shows phenotypical parallels between GLUT1DS and paroxysmal exertion-induced dyskinesia.

Research paper thumbnail of X-linked hereditary motor sensory neuropathy (type 1) presenting with a stroke-like episode

Developmental Medicine & Child Neurology, 2010

Research paper thumbnail of Electroclinical outcome of children referred with suspected absence seizures

Archives of Disease in Childhood, 2011

Approximately 10% of children with epilepsy have absence epilepsy syndromes.1 The diagnosis is co... more Approximately 10% of children with epilepsy have absence epilepsy syndromes.1 The diagnosis is confirmed by recording events during a standard EEG recording synchronised with video.2 However, non-epileptic absence-like behaviour is common in children, and although there may be clinical pointers to non-epileptic behaviours, an EEG is often requested.3 To describe the EEG (synchronised with video) results in children …

Research paper thumbnail of Video EEG outcome on children referred following a single unprovoked afebrile seizure

Archives of Disease in Childhood, 2011

To look at the outcome of the routine video EEG (vEEG) wake and sleep records on children referre... more To look at the outcome of the routine video EEG (vEEG) wake and sleep records on children referred following a single unprovoked afebrile seizure. METHODS We examined all the vEEGs that were undertaken in a regional paediatric neurophysiology department in Oxford, following a single unprovoked seizure over a 1-year period (2008-2009), several years after National Institute for Health and Clinical Excellence (NICE) 1 guidelines for the management of epilepsy in children became available.