Sivasuriya Sivaganesh - Academia.edu (original) (raw)

Papers by Sivasuriya Sivaganesh

SAGE open medical case reports, 2024

Scientific Reports, Nov 22, 2023

The treatment modality of gastric adenocarcinoma (GCA) depends on the stage of the disease at the... more The treatment modality of gastric adenocarcinoma (GCA) depends on the stage of the disease at the clinical presentation. Long delays are probably an unfavorable factor for the patient's prognosis. A prospective longitudinal, study involving 145 consecutive GCA was conducted at the National Hospital of Sri Lanka (NHSL). The overall delay (in weeks) was recorded for each patient and divided into four periods-patient, endoscopy, pathology and treatment. The median and Interquartile Range (IQR) duration of delays were calculated and differences were explored with chi square test and Mann Whitney U test Survival analysis was done with Kaplan Meier technique and Cox regression. The median duration of delays for patient, endoscopy, histology reporting delay, other histology delay (specimen transfer delay and report receipt delay) and treatment were 18 (IQR 14-27), 2 (IQR 2-3), 3 (IQR 2-3), 2 (IQR 1-2) and 6 (IQR 4-8) weeks respectively. Delayed patient presentation to hospital was associated with significant adverse median survival 16 (IQR 11.5-22.5) weeks versus 20 (IQR 16-27.5) weeks, p = 0.004. Delay in initiating treatment was associated with significantly lower median survival 04 (IQR 4-6) weeks versus 06 (IQR 4-8) weeks, p = 0.003. Over 60% of both proximal and distal GCA presented at an advanced radiological stage (stage III/IV). The Kaplan Meier analysis showed that the higher hazard function was associated with a higher tumour stage and undergoing chemotherapy. Age of the patient and the treatment modality were significant predictors of the survival. Patient delay and delay in initiation of definitive treatment are the most important factors that adversely affect the outcomes of GCA. Public health interventions aiming to shorten the patient delay time with proper referral for specialist care would play an important role. Also, it is important to minimize these preventable delays and there should be time limits in producing the histopathology report and to establish online portals of hospital and laboratory information systems for easy access of histology reports in future. Gastric adenocarcinoma (GCA) is one of most common neoplasms in the world with a significant impact to the patient and to the health system. It is the third leading cause of death due to cancer worldwide 1. Eastern and central Asian regions are associated with the highest estimated mortality rates 2,3. According to the National Cancer Registry data of 2020, the age standardized incidence rate per 100,000 males was 4.4 and for females was 1.7 4 The National Cancer Registry 2020 represents a total number of 726 cases (male = 497, females = 229) 4. This might not reflect the true incidence of the disease due to potential under-reporting of cases to the national government statistic processes from the private medical care and from patients opting for alternative or traditional forms of treatment. The treatment modality of GCA depends on the stage of the disease at the clinical presentation. Prognosis of GCA remains dismal with a 5-year survival being around 5-20%, despite advancement of endoscopic, surgical and oncological modalities 5,6. Therefore; it remains a poorly resolved oncological problem. The main reason behind this is the advanced stage of tumours at presentation. Hence, long delays are probably an unfavorable

SAGE open medical case reports, 2022

Klebsiella pneumoniae, found in the gastrointestinal flora is a causative agent of hospital-acqui... more Klebsiella pneumoniae, found in the gastrointestinal flora is a causative agent of hospital-acquired infections. Although isolated organ infections are common, reports of multi-system involvement are rare. We report on a susceptible patient presenting with disseminated Klebsiella infection with concurrent multi-organ disease involving the lung, liver, prostate and eye. He recovered after prolonged therapy but suffered from permanent sequalae. Early diagnosis and aggressive therapy is facilitated by awareness and a high degree of suspicion in at-risk patient groups.

Southern African Journal of Hiv Medicine, May 26, 2011

A 49-year-old male security supervisor was admitted to hospital with recurrent chest infections. ... more A 49-year-old male security supervisor was admitted to hospital with recurrent chest infections. He was found to be HIV positive with a CD4 count of 60 cells/µl, and was started on an antiretroviral treatment regimen comprising zidovudine, lamivudine and efavirenz. Six months later the absolute CD4 count had increased to 249 cells/µl and the viral load was undetectable.

Sri Lanka Journal of Surgery, Dec 29, 2017

Sri Lanka Journal of Surgery, Jan 24, 2014

Conclusion This data suggests that unwarranted cross-matching of blood is done in most procedures... more Conclusion This data suggests that unwarranted cross-matching of blood is done in most procedures, especially c h o l e c y s t e c t o m i e s , f u n d o p l i c a t i o n s a n d thyroidectomies where a group and screen is adequate. We recommend further study of this issue and the development of evidence based blood ordering schedules in each hospital.

Sri Lanka Journal of Surgery, Apr 30, 2017

Sri Lanka Journal of Surgery, Jan 27, 2013

American Journal of Clinical Pathology, Oct 1, 2014

A 49-year-old man was diagnosed as HIV infected, with a CD4 count of 60 cells/μl. He was started ... more A 49-year-old man was diagnosed as HIV infected, with a CD4 count of 60 cells/μl. He was started on an antiretroviral treatment regimen comprising zidovudine, lamivudine and efavirenz. Following treatment, his CD4 count improved and the viral load was undetectable. He was subsequently found to have a moderately differentiated adenocarcinoma of the lower oesophagus.

Sri Lanka Journal of Surgery, Dec 31, 2018

Guidelines to manage liver metastases were developed at a meeting jointly organized by the Sri La... more Guidelines to manage liver metastases were developed at a meeting jointly organized by the Sri Lanka Hepato Pancreato Biliary Association (SLHPBA) and the International Hepato Pancreato Biliary Association (IHPBA). Existing evidence was used in the development of guidelines, as recommended by the AGREE II consortium. Guidelines are provided for diagnosis, pre-operative workup, multidisciplinary team review, surgery, anaesthesia, post-operative care and follow up. Consideration was given to the limitations of facilities available in the country.

SAGE open medical case reports, 2023

Gallbladder duplication is a rare anomaly of the biliary tree. Implications of misdiagnosis inclu... more Gallbladder duplication is a rare anomaly of the biliary tree. Implications of misdiagnosis include unwarranted surgery and morbidity such as when liver resections are done suspecting cystic intraductal papillary neoplasm of the bile duct. The use of appropriate imaging, when suspected, facilitates diagnosis and avoids adverse surgical outcomes. We describe a case of an intrahepatic duplicate gallbladder containing calculi detected incidentally during a Focused Assessment Sonography for Trauma after a blunt trauma.

Journal of Antimicrobial Chemotherapy, Jun 23, 2023

Quantification of antibiotic usage is an important component of antimicrobial stewardship program... more Quantification of antibiotic usage is an important component of antimicrobial stewardship programmes. We aimed to estimate institutional antibiotic usage and costs using methodology and metrics applicable to low-income settings without electronic health records. Methods: The DDD per 100 patient-days (DDDs/100 PDs) of antibiotics used in a calendar year was calculated retrospectively from ward registers and inpatient drug records in general surgical wards of a tertiary hospital. The antibiotics were categorized using the Access, Watch, Reserve classification. The annual expenditure on antibiotics was estimated from price lists of the state medication procurer. Results: Annual usage of IV co-amoxiclav, cefuroxime and metronidazole was significantly higher than other antibiotics and certain wards showed outlier use of the same. The IV formulations of co-amoxiclav (5-fold), metronidazole (3-fold) and ciprofloxacin (2-fold) were used in excess of the oral formulation. Proportionate antibiotic usage based on the AWaRe category did not vary significantly between wards. Two wards were outliers for annual expenditure/100 PDs. IV clindamycin and meropenem combined accounted for 43.8% of expenditure on antibiotics. Conclusions: This study demonstrated intra-institutional variations of annual antibiotic usage and related costs. The metric DDD/100 PDs and the methodology used here are suitable for intra-and inter-institutional analyses of antibiotic usage, particularly in low-income settings.

The Journal of Diagnostic Pathology, Dec 21, 2016

Journal of liver cancer, Mar 31, 2023

Parenchymal-sparing hepatectomy (PSH), though technically challenging, is emerging as a choice of... more Parenchymal-sparing hepatectomy (PSH), though technically challenging, is emerging as a choice of treatment for colorectal liver metastases (CRLM). PSH in Jehovah's witness (JW) patients, for whom transfusion is not an option, involves complex surgical and medicolegal issues. A 52-year-old JW male with synchronous, multiple, bilobar liver metastases from a rectal adenocarcinoma was referred following neoadjuvant chemotherapy. At surgery, 10 metastatic deposits were observed and confirmed by intraoperative ultrasonography. Parenchymal-sparing non-anatomical resections were performed using a cavitron ultrasonic aspirator with the application of intermittent Pringle maneuvres. Histology confirmed multiple CRLMs with tumor-free resection margins. PSH is increasingly employed for CRLMs to preserve residual liver volume and minimize morbidity without compromising oncological outcomes. It is technically challenging, especially in the presence of bilobar, multi-segmental disease. This case illustrates the feasibility of performing complex hepatic surgery in special patient groups by meticulous planning and preparation involving multiple specialties and the patient. (2023 Feb 15 [online ahead of print])