Duranka Perera - Academia.edu (original) (raw)
Papers by Duranka Perera
BMJ Case Reports, 2021
We present a case of a giant ovarian cyst in a 20-year-old woman who presented atypically at our ... more We present a case of a giant ovarian cyst in a 20-year-old woman who presented atypically at our Emergency Department with left-sided back pain followed by acute left leg swelling. Blood tests showed significantly raised C-Reactive Protein and D-Dimer. CT-Abdomen-Pelvis demonstrated a large mass in the region of the right ovary with suspicious heterogeneous filling defects in the left external iliac vein, confirmed as a left-sided deep-vein thrombosis on ultrasound Doppler. MRI revealed the lesion to be cystic and the deep venous thrombosis was treated with twice-daily Clexane. Prior to removal of the cyst, an Inferior Vena Cava Filter was placed to reduce thromboembolic risk. The cyst was resected without complication and the postoperative period was uneventful. This case occurred while face-to-face services were limited by COVID-19 and illustrates the need for robust systemic measures to safeguard patients against the emergency sequelae of insidious gynaecological pathology.
British Journal of Surgery, 2021
Introduction Gastrointestinal stromal tumours (GISTs) are sarcomas and the most common non-epithe... more Introduction Gastrointestinal stromal tumours (GISTs) are sarcomas and the most common non-epithelial cancers of the GI tract. Patient A 77-year old man with life threatening melaena, drop in haemoglobin from 109 to 71 in 24 hours and hypotension. Co-morbidities included COPD, chronic microcytic anaemia, type 2 Diabetes mellitus and hypertension. Anaemia for 9 years had been investigated with OGD and colonoscopy showing no pathology. Calculated Rockall score was 6. An Urgent Oesophagogastroduodenoscopy showed normal findings with no source of bleeding identified. An urgent CT angiography demonstrated a vascular blush at duodenojejunal (DJ) flexure identified as the source of bleeding. Four units of was blood transfused preoperatively. The bleeding source was not embolisable. He underwent an initial diagnostic laparoscopy to confirm the site of the lesion and ascertaining whether resection and anastomosis would be visible. Findings at laparoscopy included a DJ flexure lesion. A midli...
The Clinical Teacher, 2021
Domestic abuse is defined as ‘controlling, coercive, threatening, degrading and violent behaviour... more Domestic abuse is defined as ‘controlling, coercive, threatening, degrading and violent behaviour’ by an intimate partner, family member or carer.1 Globally, one in three women experience domestic abuse in their lifetime.2 Since the onset of the COVID19 pandemic, the rate of domestic abuse reporting has risen dramatically in the United Kingdom. The United Kingdombased charity, Refuge reported an average 66% increase in the weekly number of calls to the National Domestic Abuse Helpline, and a 950% increase in traffic to its website.2 Early 2020 data warned of a similar trend in countries like Australia, Brazil and Italy,3 where individual complaints of domestic violence in France and the United States rose by 35– 36%, while in China the number of incidents was reported to increase threefold.3 As the crisis continues to evolve, we are overdue a period of reflection on how health care professionals could be better positioned to tackle this hidden pandemic. Clinical guidelines require frontline health care staff to screen and refer suspected cases of domestic abuse to specialist services.1 However, there is limited research appraising the quality and depth of training delivered to medical trainees to enable this. In a 2017 study, 75% of respondents from 25 of the 34 medical schools in the United Kingdom rated their teaching on domestic violence as ‘inadequate’.4 Although 84% responded that domestic violence teaching was present in the curriculum, 52% reported 0– 2 hours of teaching across the whole 5year degree, most often delivered during primary care modules.4 As trainees at three distinct UK medical schools ourselves, we have also received no formal training on screening and management of domestic abuse. Evidently, we are not alone. Such a deficit in the undergraduate curriculum is alarming. When teaching leads were queried over reasons for this, explanations included practical constraints on the curriculum, such as time.4 However, some leads disclosed they believed that domestic violence was not really a clinical issue, with the assumption that the knowledge and skills would be acquired elsewhere. In addition to physical and psychological trauma, domestic abuse often obstructs victims’ ability to seek medical attention. For example, perpetrators are known to monitor or restrict access to health care out of fear of discovery.2 Quarantine measures have also further restricted movement and victims’ access to support.3 However, as the next generation of doctors, without adequate training we are simply not equipped to recognise and manage these situations in the workplace, especially during the pandemic. For these reasons, we argue that formal teaching on domestic abuse should be a priority, as we have a moral and professional duty to safeguard any vulnerable person in our care. As medical students, we firmly believe a proactive approach is required to improve domestic violence training within medical schools, and this starts by addressing barriers to teaching. A significant proportion of medical schools delivers domestic violence training in a more traditional and didactic lecture format.4 We suggest a shift towards simulationbased teaching would help break down psychological barriers preventing students from effectively screening for abuse. The most common barriers reported by US medical
Topics in Spinal Cord Injury Rehabilitation, 2020
Background: Cauda equina syndrome (CES) is rare neurosurgical emergency requiring emergent surgic... more Background: Cauda equina syndrome (CES) is rare neurosurgical emergency requiring emergent surgical decompression to prevent bladder, bowel, and sexual dysfunction that can have significant impact on quality of life. There is a paucity of data relating to the prevalence of these long-term complications. Objective: The aim of this observational study was to evaluate the long-term prevalence of CES-related bladder, bowel, and sexual dysfunction and impact on quality of life to inform service provision. Methods: Participants were selected through coding of operative records of patients who underwent lumbar decompression for CES secondary to a herniated intervertebral disc at two large UK neurosurgical departments between 2011 and 2015 inclusive. A telephone-based survey including both validated and modified tools was used to collect data pertaining to bladder, bowel, and sexual function and impact on quality of life both before development of CES and at the time of the survey, at least...
Acta Neurochirurgica, 2019
Background Brain biopsies are required to establish a definitive histological diagnosis for brain... more Background Brain biopsies are required to establish a definitive histological diagnosis for brain lesions that have been identified on imaging in order to guide further treatment for patients. Objective Various navigation systems are in use but little up to date evidence is available regarding the safety and accuracy of a frameless, electromagnetic technique to target brain lesions. Methods Data was collected retrospectively on all patients that had brain biopsies at our institution from 01/01/2010 to 31/12/ 2017. Operation notes, neuropathology reports, and clinical notes on electronic patient record were used to determine whether biopsy of adequate identifiable abnormal tissue was achieved, whether a definitive diagnosis was established, any adverse events occurred, and if a repeat biopsy was carried out. Results Three hundred seventy-one AxiEM (Medtronic, Minneapolis, USA)-guided brain tumor biopsies were performed in this 8-year period. Three hundred forty-nine (94.07%) procedures provided definitive tissue diagnosis, 22 (5.93%) were non diagnostic; in 6 cases (1.62%), repeat biopsy was performed and adverse events which caused clinical compromise were observed in 4 patients (1.08%). Conclusions The AxiEM is a fast, effective, and safe frameless and pinless neuronavigational system. It offers a high degree of accuracy required for the establishment of a definitive diagnosis, permitting optimal further treatment, and thus improving patient outcomes.
Clinical Oncology, 2019
time between pre-and post-abiraterone group in our small sample of heavily pre-treated patients. ... more time between pre-and post-abiraterone group in our small sample of heavily pre-treated patients. Further study is required to establish the combined safety profile and guide the best use of the two individually efficacious agents.
World Neurosurgery: X, 2021
BACKGROUND: The increasing shift toward a more generalized medical undergraduate curriculum has l... more BACKGROUND: The increasing shift toward a more generalized medical undergraduate curriculum has led to limited exposure to subspecialties, including neurosurgery. The lack of standardized teaching may result in insufficient coverage of core learning outcomes. Social media (SoMe) in medical education are becoming an increasingly accepted and popular way for students to meet learning objectives outside formal medical school teaching. We delivered a series of case-based discussions (CbDs) over SoMe to attempt to meet core learning needs in neurosurgery and determine whether SoMe-based CbDs were an acceptable method of education.-METHODS: Twitter was used as a medium to host 9 CbDs pertaining to common neurosurgical conditions in practice. A sequence of informative and interactive tweets were formulated before live CbDs and tweeted in progressive order. Demographic data and participant feedback were collected.-RESULTS: A total of 277 participants were recorded across 9 CbDs, with 654,584 impressions generated. Feedback responses were received from 135 participants (48.7%). Participants indicated an increase of 77% in their level of knowledge after participating. Of participants, 57% (n [ 77) had previous CbD experience as part of traditional medical education, with 62% (n [ 84) receiving a form of medical education previously through SoMe. All participants believed that the CbDs objectives were met and would attend future sessions. Of participants, 99% (n [ 134) indicated that their expectations were met.-CONCLUSIONS: SoMe has been shown to be a favorable and feasible medium to host live, text-based interactive CbDs. SoMe is a useful tool for teaching undergraduate neurosurgery and is easily translatable to all domains of medicine and surgery.
BMJ Case Reports, 2021
We present a case of a giant ovarian cyst in a 20-year-old woman who presented atypically at our ... more We present a case of a giant ovarian cyst in a 20-year-old woman who presented atypically at our Emergency Department with left-sided back pain followed by acute left leg swelling. Blood tests showed significantly raised C-Reactive Protein and D-Dimer. CT-Abdomen-Pelvis demonstrated a large mass in the region of the right ovary with suspicious heterogeneous filling defects in the left external iliac vein, confirmed as a left-sided deep-vein thrombosis on ultrasound Doppler. MRI revealed the lesion to be cystic and the deep venous thrombosis was treated with twice-daily Clexane. Prior to removal of the cyst, an Inferior Vena Cava Filter was placed to reduce thromboembolic risk. The cyst was resected without complication and the postoperative period was uneventful. This case occurred while face-to-face services were limited by COVID-19 and illustrates the need for robust systemic measures to safeguard patients against the emergency sequelae of insidious gynaecological pathology.
British Journal of Surgery, 2021
Introduction Gastrointestinal stromal tumours (GISTs) are sarcomas and the most common non-epithe... more Introduction Gastrointestinal stromal tumours (GISTs) are sarcomas and the most common non-epithelial cancers of the GI tract. Patient A 77-year old man with life threatening melaena, drop in haemoglobin from 109 to 71 in 24 hours and hypotension. Co-morbidities included COPD, chronic microcytic anaemia, type 2 Diabetes mellitus and hypertension. Anaemia for 9 years had been investigated with OGD and colonoscopy showing no pathology. Calculated Rockall score was 6. An Urgent Oesophagogastroduodenoscopy showed normal findings with no source of bleeding identified. An urgent CT angiography demonstrated a vascular blush at duodenojejunal (DJ) flexure identified as the source of bleeding. Four units of was blood transfused preoperatively. The bleeding source was not embolisable. He underwent an initial diagnostic laparoscopy to confirm the site of the lesion and ascertaining whether resection and anastomosis would be visible. Findings at laparoscopy included a DJ flexure lesion. A midli...
The Clinical Teacher, 2021
Domestic abuse is defined as ‘controlling, coercive, threatening, degrading and violent behaviour... more Domestic abuse is defined as ‘controlling, coercive, threatening, degrading and violent behaviour’ by an intimate partner, family member or carer.1 Globally, one in three women experience domestic abuse in their lifetime.2 Since the onset of the COVID19 pandemic, the rate of domestic abuse reporting has risen dramatically in the United Kingdom. The United Kingdombased charity, Refuge reported an average 66% increase in the weekly number of calls to the National Domestic Abuse Helpline, and a 950% increase in traffic to its website.2 Early 2020 data warned of a similar trend in countries like Australia, Brazil and Italy,3 where individual complaints of domestic violence in France and the United States rose by 35– 36%, while in China the number of incidents was reported to increase threefold.3 As the crisis continues to evolve, we are overdue a period of reflection on how health care professionals could be better positioned to tackle this hidden pandemic. Clinical guidelines require frontline health care staff to screen and refer suspected cases of domestic abuse to specialist services.1 However, there is limited research appraising the quality and depth of training delivered to medical trainees to enable this. In a 2017 study, 75% of respondents from 25 of the 34 medical schools in the United Kingdom rated their teaching on domestic violence as ‘inadequate’.4 Although 84% responded that domestic violence teaching was present in the curriculum, 52% reported 0– 2 hours of teaching across the whole 5year degree, most often delivered during primary care modules.4 As trainees at three distinct UK medical schools ourselves, we have also received no formal training on screening and management of domestic abuse. Evidently, we are not alone. Such a deficit in the undergraduate curriculum is alarming. When teaching leads were queried over reasons for this, explanations included practical constraints on the curriculum, such as time.4 However, some leads disclosed they believed that domestic violence was not really a clinical issue, with the assumption that the knowledge and skills would be acquired elsewhere. In addition to physical and psychological trauma, domestic abuse often obstructs victims’ ability to seek medical attention. For example, perpetrators are known to monitor or restrict access to health care out of fear of discovery.2 Quarantine measures have also further restricted movement and victims’ access to support.3 However, as the next generation of doctors, without adequate training we are simply not equipped to recognise and manage these situations in the workplace, especially during the pandemic. For these reasons, we argue that formal teaching on domestic abuse should be a priority, as we have a moral and professional duty to safeguard any vulnerable person in our care. As medical students, we firmly believe a proactive approach is required to improve domestic violence training within medical schools, and this starts by addressing barriers to teaching. A significant proportion of medical schools delivers domestic violence training in a more traditional and didactic lecture format.4 We suggest a shift towards simulationbased teaching would help break down psychological barriers preventing students from effectively screening for abuse. The most common barriers reported by US medical
Topics in Spinal Cord Injury Rehabilitation, 2020
Background: Cauda equina syndrome (CES) is rare neurosurgical emergency requiring emergent surgic... more Background: Cauda equina syndrome (CES) is rare neurosurgical emergency requiring emergent surgical decompression to prevent bladder, bowel, and sexual dysfunction that can have significant impact on quality of life. There is a paucity of data relating to the prevalence of these long-term complications. Objective: The aim of this observational study was to evaluate the long-term prevalence of CES-related bladder, bowel, and sexual dysfunction and impact on quality of life to inform service provision. Methods: Participants were selected through coding of operative records of patients who underwent lumbar decompression for CES secondary to a herniated intervertebral disc at two large UK neurosurgical departments between 2011 and 2015 inclusive. A telephone-based survey including both validated and modified tools was used to collect data pertaining to bladder, bowel, and sexual function and impact on quality of life both before development of CES and at the time of the survey, at least...
Acta Neurochirurgica, 2019
Background Brain biopsies are required to establish a definitive histological diagnosis for brain... more Background Brain biopsies are required to establish a definitive histological diagnosis for brain lesions that have been identified on imaging in order to guide further treatment for patients. Objective Various navigation systems are in use but little up to date evidence is available regarding the safety and accuracy of a frameless, electromagnetic technique to target brain lesions. Methods Data was collected retrospectively on all patients that had brain biopsies at our institution from 01/01/2010 to 31/12/ 2017. Operation notes, neuropathology reports, and clinical notes on electronic patient record were used to determine whether biopsy of adequate identifiable abnormal tissue was achieved, whether a definitive diagnosis was established, any adverse events occurred, and if a repeat biopsy was carried out. Results Three hundred seventy-one AxiEM (Medtronic, Minneapolis, USA)-guided brain tumor biopsies were performed in this 8-year period. Three hundred forty-nine (94.07%) procedures provided definitive tissue diagnosis, 22 (5.93%) were non diagnostic; in 6 cases (1.62%), repeat biopsy was performed and adverse events which caused clinical compromise were observed in 4 patients (1.08%). Conclusions The AxiEM is a fast, effective, and safe frameless and pinless neuronavigational system. It offers a high degree of accuracy required for the establishment of a definitive diagnosis, permitting optimal further treatment, and thus improving patient outcomes.
Clinical Oncology, 2019
time between pre-and post-abiraterone group in our small sample of heavily pre-treated patients. ... more time between pre-and post-abiraterone group in our small sample of heavily pre-treated patients. Further study is required to establish the combined safety profile and guide the best use of the two individually efficacious agents.
World Neurosurgery: X, 2021
BACKGROUND: The increasing shift toward a more generalized medical undergraduate curriculum has l... more BACKGROUND: The increasing shift toward a more generalized medical undergraduate curriculum has led to limited exposure to subspecialties, including neurosurgery. The lack of standardized teaching may result in insufficient coverage of core learning outcomes. Social media (SoMe) in medical education are becoming an increasingly accepted and popular way for students to meet learning objectives outside formal medical school teaching. We delivered a series of case-based discussions (CbDs) over SoMe to attempt to meet core learning needs in neurosurgery and determine whether SoMe-based CbDs were an acceptable method of education.-METHODS: Twitter was used as a medium to host 9 CbDs pertaining to common neurosurgical conditions in practice. A sequence of informative and interactive tweets were formulated before live CbDs and tweeted in progressive order. Demographic data and participant feedback were collected.-RESULTS: A total of 277 participants were recorded across 9 CbDs, with 654,584 impressions generated. Feedback responses were received from 135 participants (48.7%). Participants indicated an increase of 77% in their level of knowledge after participating. Of participants, 57% (n [ 77) had previous CbD experience as part of traditional medical education, with 62% (n [ 84) receiving a form of medical education previously through SoMe. All participants believed that the CbDs objectives were met and would attend future sessions. Of participants, 99% (n [ 134) indicated that their expectations were met.-CONCLUSIONS: SoMe has been shown to be a favorable and feasible medium to host live, text-based interactive CbDs. SoMe is a useful tool for teaching undergraduate neurosurgery and is easily translatable to all domains of medicine and surgery.