http://ir.lib.ruh.ac.lk/handle/iruor/7412 2026-05-01T21:15:04Z http://ir.lib.ruh.ac.lk/handle/iruor/18932 Reducing the Environmental Impact of Surgery on a Global Scale: Systematic Review and Co-prioritization with Healthcare Workers in 132 Countries National Institute for Health and Care Research Global Health Research Unit on Global Surgery Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co- prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results: In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion: This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries. 2023-04-20T00:00:00Z http://ir.lib.ruh.ac.lk/handle/iruor/18931 Niemann Pick Disease as a Cause of Recurrent Non-immune Hydrops .Fetalis Causing Neonatal Death Dasanayake, D.L.W.; Gamage, U.R.; Fernandopulle, R.C. Introduction Fetal hydrops is defined as the accumulation of fluid in the interstitial tissues (skin) and two serous cavitiesl'2. It is further subdivided into 'imrnune' or 'non-immune', a distinction made on the presence of maternal alloimmunization. In general terms, it carries a high perinatal mortality but the variability of outcome is reflected in its many possible underlying aetiologiesl'2 Historically, Rh alloimmunization accounted for the majority of fetal hydrops cases. The true incidence of non-immune hydrops (NIH) in a population is variable and is probably subiect to regional variation- For example homologous cr-Thalassemia is the commonest cause of hydrops fetalis in South East Asia and arguably the leading cause of NIH worldwide2s. Other causes include cardiac disorders, chromosomal abnormalities, infections, fetal structural anomalies, metabolic disorders and a few maternal conditions suctf as, severe diabetes, severe anemia and severe hypoproteinaemiaa. Metabolic disorders are a recognized cause of NIH but, are relatively rare, examples include; Hurler's syndrome, Gaucher's disease, G6PD deficiency, Niemann pick disease, mucolipidosis and mucopolysacharidosis. Niemann Pick disease is a metabolic disorder that causes the accumulation of Sphingomyelin due to acid Sphingomyelinase deficiency6. It is inherited in an autosomal recessive manner. It is a recognized cause of either fetal hydrops or early and late neonatal death' There are two variants of the disease. Type-A, the acute neuropathic variant, Type-B is the non-neuropathic variant of the disease. 2006-01-01T00:00:00Z http://ir.lib.ruh.ac.lk/handle/iruor/18930 A Rare Case of Type III Von Willebrand Disease in a Woman of Reproductive Age Ranaweera, U.D.H.; Dasanayake, D.L.W.; Epitawela, D.; Dissanayaka, T.B. Von Willebrand disease (vWD) is the most comman inherited bleeding disorderr. Von Willebrand's factor (vWF) is a glycoprotein produced by' vascular endothelium with a molecular weight about 200000. It froms multimers in the circrtlation2. Von Willebrand's factor has two main functions. It stabilizes factor VIII in circulation and promotes adhesion of platelets to damaged vasctdar endothelium. The' gene for vWF is located in chromosome 12 and genetic mutation of this gene calrses vWD. There are 3 different types of vWD Type I and II has autosomal dominant inheri- tance pattern and type III the most severe form has an antosomal recessive inheritance3. Type I is the most common mildest form present in approdmately 75o/" of patients. It is associated with a quantitative deficiency of vWF. In type II the defect is qualitative. In these cases often a family history of mucocutaneous bleeding and perscnal history of mucocutaneous bleeding tendency and menorrhagia often occur.,Major haemorrhages are rare. Type III disease is associated with a negligible amount of vWF {both qrlantity and fttnction affected) and therefore a significant reduction in factorVlll activity. In these cases tire bleeding history is severe and can cause life threatening haemorrhagesa. 2007-01-01T00:00:00Z http://ir.lib.ruh.ac.lk/handle/iruor/13708 Management of Thrombocytopaenia in Pregnancy Dasanayake, D.L.W.; Costa, Y.; Weerawardana, A. 2021-11-25T00:00:00Z