Briefing Paper on Taking stock of the Tsunami recovery process

Promoting positive action towards disaster risk reduction and advising future recovery policies and practices when communities face the aftermath of a major disaster, a briefing paper has been launched on Taking stock of the Tsunami recovery process in Sri Lanka: 2004 to 2014. A conference taking stock of the Tsunami recovery in Sri Lanka was held in Colombo in December 2014 organized by GDRC at Hudderfield, UK, University of Colombo and University of Moratuwa in Sri Lanka to coincide with the tenth anniversary of the unprecedented disaster. A number of papers dealing with diverse aspects of the disaster and its aftermath were presented, followed by a panel discussion that examined the policy implications of research findings presented by various authors and the discussions that followed. While some of the papers looked at broader issues of disaster risk reduction, others embodied analyses of data collected through recent field research in different parts of the country affected by the Tsunami. This brief policy statement is based on the deliberations throughout the conference involving researchers, public officials and other participants

Cephalometric evaluation of soft tissue profile changes following double jaw surgery : (Le Fort I and vertical subsigmoid osteotomy)

A retrospective cephalometric study was undertaken to evaluate the soft tissue changes following orthodontic decompensation, Le Fort I osteotomy and surgical setback of the mandible using the technique of intraoral vertical subsigmoid osteotomy. No genioplasty was performed. The investigation involved a detailed analysis of 23 sets of serial cephalometric records consisting of 10 males and 13 females, in the Oral and Maxillofacial Surgery Unit of the University of Adelaide. The female sample ages ranged from 16 years, 2 months to 35 years, 5 months with a mean age of 20 years. The male sample ages ranged from 16 years, 5 months to 59 years, 5 months with a mean age of 20 years. Of the 23 sets of patient records, 23 had cephalograms available within three months prior to surgery and within six months after surgery. 20 subjects (87%) also had cephalograms taken within one year following surgery. 10 subjects (43%) had cephalograms taken within two years after surgery. 9 subjects (21%) had cephalograms taken within three years after surgery. This series was studied for short and long term soft tissue changes. START WITHIN three months PRIOR TO SURGERY WITHIN six months POST SURGERY WITHIN one year POST SURGERY WITHIN two years POST SURGERY WITHIN three years POST SURGERY 23 sets 23 sets 23 sets 20 sets 10 sets 9 sets Standard procedures were used to reduce the effect of random error on the results. These included selection of cases according to radiographic quality, the use of accepted landmark definitions, a standardised method of landmark location, an electronic digitiser to record landmark coordinates and computer plots to identify "wild" recordings. Replicated measurements were made in order to quantify the error component. The error of the method involved in landmark location, superimposition and digitisation was low. For some variables, the differences between the two sets of determinations were found to be significant at the 5% level. In these instances, they were found to require careful interpretation. The error of digitisation alone was not significant. The superimposition method of Björk (1968) and Björk and Skieller (1983) was used in this study. This method, which utilised stable structures of the anterior cranial base, had a sound biological rationale and was of acceptable accuracy. The sample size was small but generally larger than those of previously reported soft tissue studies of a similar nature. Therefore, the results need to be interpreted with some degree of caution. The data was normally distributed allowing the application of routine statistical procedures. Some statistically significant differences were found between the mean value of the male and female groups calculated from the presurgical data. The changes following surgery were generally not statistically significant between males and females. The present study is unique in that it is the first known cephalometric evaluation of soft tissue profile changes following Le Fort I advancement and vertical subsigmoid setback. However, the soft and hard tissue changes appear comparable with other studies using different techniques. Horizontal soft tissue changes of the upper lip were positively correlated to horizontal hard tissue changes of the maxilla: A:SUN 1:0.81 (r=0.80, p<0.05); A:SLS 1:0.74 (r=0.59, p<0.01); A:LS 1:0.53 (r=0.68, p<0.01). soft tissues generally lagged behind the hard tissues. Vertical soft tissue changes of the upper lip were positively correlated to vertical hard tissue changes of the maxilla: A:SUN 1:0.79 (r=0.43, p<0.05); A:SLS 1:0.64 (r=0.18); A:LS 1:0.66(r=0.33). Horizontal and vertical soft tissue changes of the lower lip were positively correlated with horizontal and vertical changes at B-point: Horizontal: B:Ll 1:0.50 (r=0.69,p<0.01); B:lLS 1:0.69 (r=0.93, p<0.01). Vertical: B:lLS 1:0.80 (r=0.56, p<0.01). Changes of the soft tissue chin were positively correlated with changes at pogonion: 1:0.94 (r=0.94, p<0.01). These correlations need to be interpreted cautiously as the sample size is small. The upper lip thinned following maxillary advancement. For every 1 mm of maxillary advancement (at A-point), the upper lip thickness reduces by 0.61 mm (r=0.71, p<0.01). The upper lip lengthened following surgery but this was not statistically significant. The lower lip length reduced following surgery by a minimal amount but this was not statistically significant. This may be due to the lower lip coming under the influence of the upper lip following surgery. Lip competency is established following surgery. During the period six months to twelve months postsurgery, the maxilla moved 43% superiorly and 28"/o backwards. The mandible moved 11% forwards and 34"/" superiorly. Upper incisors proclined during this period. The upper incisor proclination may be due to forward movement of the mandibular arch and postero-superior movement of the maxilla. The lower incisors also proclined during this period but the change was minimal. This may be due to alteration in the position of gonion at surgery since this point was often close to the site of surgery and could have influenced the lower incisor to mandibular plane angle. Ching (1995) reported proclination of lower incisors during this period. The nasolabial angle increased in the presurgery to postsurgery six months period. Labiomental fold deepened in the presurgery to postsurgery six months period. Lip form established at surgery appears to be maintained in the longer term. Thick and thin upper lips responded similarly to surgery. Thick and thin lower lips also responded similarly to surgery. Lip thickness did not seem to influence the surgical response. The magnitude of surgical advancement of the maxilla did not affect the upper lip response. The magnitude of surgical setback did not affect the lower lip response. The soft tissue response is consistent and proportional to the skeletal change. Age and sex do not appear to have a bearing on the soft tissue response of lips following surgery. Minimal skeletal, dental and soft tissue changes were noted 12 months postsurgically indicating stability of the Le Fort I and vertical subsigmoid osteotomy procedure. Most of the correction was maintained at 12 months postsurgery. However, some degree of caution is required when interpreting the data at 24 months and 36 months postsurgery as sample size becomes extremely small.Thesis (M.D.S.)--University of Adelaide, Dept. of Dentistry, 199

Unusual intraparenchymal pontomedullary epidermoid cyst in a 2 year-old: case report and literature review.

BACKGROUND: Intrinsic brainstem epidermoid cysts are rare, benign, slow growing lesions. Their eloquence preclude complete excision, however subtotal resection will often result in prolonged or sometimes permanent relief of presenting symptoms and signs. We describe an unusual case and review the literature of this pathology in the paediatric population. CASE DESCRIPTION: We report an intra-axial pontine epidermoid cyst in a 2-year-old girl who presented with developmental delay, multiple cranial nerve palsies and pneumonia. Magnetic resonance imaging (MRI) demonstrated an intrinsic pontine lesion with partial restricted diffusion and an enhancing plaque, the latter not typically seen in congenital lesions like epidermoid. However, gross surgical inspection and histopathology confirmed an epidermoid. CONCLUSION: Our case, supported by the literature, shows that brain stem epidermoid cysts may have atypical radiological characteristics, and that near total resection remains safe and can improve outcome

Oesophageal pleural fistula presenting with Parvimonas micra infection causing cervical and brain abscesses.

Parvimonas micra (P. micra) infections causing spinal cord compression are extremely rare. We report an occult oesophageal pleural fistula presenting with spinal epidural and brain abscesses resulting in severe neurological deficits caused by P. micra. Molecular detection proved to be instrumental in identifying the causative pathogen. Essential management with decompression, drainage, antibiotics and fistula repair lead to a good outcome

Challenges in multi-agency collaboration in disaster management : a Sri Lankan perspective

This study was aimed at investigating the current challenges prevailing in relation to multi-agency collaboration during disaster management and at the strategies that should be implemented in order to overcome such challenges. The study was based on a qualitative approach under which 32 semi-structured interviews were carried out among agencies engaged in disaster management. The collected data were analysed using content analysis. The study identified seven challenges that hinder multi-agency collaboration (communication, environmental, social, political, inter-organisational, intra-organisational and infrastructure challenges) and corresponding strategies that can be used to overcome them. Communication was considered as the dominant challenge due to the lack of a technology platform and well-defined guidelines for sharing data among the agencies to establish a common view of the disaster context. Furthermore, the interoperability challenges that exist among the agencies seems to hinders the effective collaboration among agencies

Paraganglioma of the cauda equina: a tertiary centre experience and scoping review of the current literature.

Cauda equina paragangliomas are rare benign extra-adrenal neuroendocrine tumours arising from the neural crest cells associated with autonomic ganglia. These tumours are often mistaken preoperatively for ependymomas or schwannomas. Patients present with axial or radicular pain with or without neurological deficits. Recurrence, secretory features and length of follow-up are controversial. We conducted a retrospective cohort study of paraganglioma through searching a prospectively maintained histopathology database. Patient demographics, presentation, surgery, complications, recurrence, follow-up and outcome between 2004 and 2016 were studied. The primary aim was to collate and describe the current evidence base for recurrence and secretory features of the tumour. The secondary objective was to report outcome and follow-up strategy. A scoping review was performed in accordance with the PRISMA-ScR Checklist. Ten patients were diagnosed (M:F 7:3) with a mean age of 53.6 ± 5.1 (range 34-71 years). MRI scans revealed intradural lumbar enhancing lesions. All patients had complete microsurgical excisions without adjuvant therapy with no recurrence with a mean follow-up of 5.1 ± 1.4 years. Tumours were attached to the filum terminale. Electron microscopic images demonstrated abundant neurosecretory granules with no evidence of catecholamine production. A total of 620 articles were screened and 65 papers (including ours) combining 121 patients (mean age 48.8 and M:F 71:50) were included. The mean follow-up was 3.48 ± 0.46 (range 0.15-23 years). Back pain was the most common symptom (94%). Cure following surgery was achieved in 93% of the patients whilst 7% had recurrence. Total resection likely results in cure without the need for adjuvant therapy or prolonged follow-up. However, in certain situations, the length of follow-up should be determined by the treating surgeon

Prior exposure of graphic editing, video editing and animation software among new medical entrants at Faculty of Medicine, University of Kelaniya

Introduction: The use of graphic related educational materials is common in modern medicaleducation.Objectives: This study assesses the familiarity of graphic editing software (GES), video editingsoftware (VES) and animation software (AS) among new medical entrants.Methods: Moodle based self-administered questionnaire was given to new medical students who joinedthe Faculty of Medicine, University of Kelaniya in 2017.Results: There were 155 students in the batch where 66 (43%) were males. Thirty-nine percent (n=60)had used GES before entering to the faculty, among them 20% used GES at least once a month and55% reported to have at least an average skill level. Twenty-one percent (n=32) had used VES, amongthem 20% used it at least once and 24 % reported to have at least an average skill level. Ten percent(n=15) had used AS, among them 13% used it at least once and 11% reported to have at least an averageskill level. Students had used GES more than VES (P<0.01) and AS (P<0.01), and VES more than AS(P=0.01) before entering to the faculty.Conclusions: The majority of students had not used GES, VES and AS before entering to the facultyand it would be beneficial to teach this software to medical students. Self-assessment of skill level canunderestimate or overestimate the actual skill level of the student and can be identified as a limitationof the study

Post-operative paediatric cerebellar mutism syndrome: time to move beyond structural MRI

PURPOSE: To determine the value of structural magnetic resonance imaging (MRI) in predicting post-operative paediatric cerebellar mutism syndrome (pCMS) in children undergoing surgical treatment for medulloblastoma. METHODS: Retrospective cohort study design. Electronic/paper case note review of all children with medulloblastoma presenting to Great Ormond Street Hospital between 2003 and 2013. The diagnosis of pCMS was established through a scoring system incorporating mutism, ataxia, behavioural disturbance and cranial nerve deficits. MRI scans performed at three time points were assessed by neuroradiologists blinded to the diagnosis of pCMS. RESULTS: Of 56 children included, 12 (21.4%) developed pCMS as judged by a core symptom of mutism. pCMS was more common in those aged 5 or younger. There was no statistically significant difference in pre-operative distortion or signal change of the dentate or red nuclei or superior cerebellar peduncles (SCPs) between those who did and did not develop pCMS. In both early (median 5 days) and late (median 31 months) post-operative scans, T2-weighted signal change in SCPs was more common in the pCMS group (p = 0.040 and 0.046 respectively). Late scans also showed statistically significant signal change in the dentate nuclei (p = 0.024). CONCLUSIONS: The development of pCMS could not be linked to any observable changes on pre-operative structural MRI scans. Post-operative T2-weighted signal change in the SCPs and dentate nuclei underlines the role of cerebellar efferent injury in pCMS. Further research using advanced quantitative MRI sequences is warranted given the inability of conventional pre-surgical MRI to predict pCMS