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It is diagnostic speciality which has evolved from neurology. It is mainly focused on recording and clinically interpreting electrical activity from the brain, spinal cord, peripheral nerves and muscles to diagnose disorders of the central and peripheral nerves systems.
Clinical Neurophysiologist is a specialized consultant neurophysician who performs electro diagnostic tests; interpret results in a correct clinical context providing accurate diagnoses
They are diagnostic tests of peripheral nerve system, especially useful in diagnosing diseases in nerve roots, plexuses, peripheral nerves and muscles. These tests also help to localise the lesion site, exclude alternate diagnoses, reveal unsuspected diagnoses, and assess severity, time frame and prognosis of lesions.
Eg: -
Radiculopathies
Nerve Injuries
Entrapment neuropathies – carpal tunnel syndrome
Peripheral neuropathies – axonal, demyelinating neuropathies
Muscle diseases – myopathies
It records the electrical activity of the brain using scalp electrodes. It is mainly useful in diagnosing and evaluation seizures. It is also used to diagnose sleep disorders, coma, encephalitis, encephalopathy and neurodegenerative diseases.
Long term monitoring of EEG with video recording to evaluate undiagnosed seizure like events and screening for epilepsy surgery.
There are electrical potentials produced by nervous system in response to specific stimuli.
Eg:-
They are used for diagnosis of diseases affecting respective sensory pathways.
Evaluation and injection of Botulinum toxin for various movement disorders and spasticity due to stroke, cerebral palsy etc.
Service |
Number of Patients per year |
Special NCS / EMG |
3600 |
Carpal Tunnel Syndrome |
4800 |
Evoked Potential Studies |
720 |
Botulinum Toxin Therapy |
120 to 180 |
Standard EEG Recording |
4800 |
Prolonged Video EEG Monitoring |
120 |
EEG Reporting from NHSL & Other Hospitals |
3000 |
The referral could be made by any consultant through a government hospital. The referral should indicate the patient’s identification details, the clinic or BHT number relevant brief clinical summary, differential diagnosis or clinical question that needs to be answered by the study and the consultant’s signature.
The Clinical Neurophysiology Unit of Institute of Neurology, NHSL is the only such unit in the country. It provides comprehensive neurophysiology services to patients with various neurological as well as non-neurological disorders. Main interactions are with neurology, neurosurgery, ophthalmology, otolaryngology, orthopaedic & paediatric units as well as with intensive care units. It serves other hospitals in the country including the hospitals of three armed forces and the police.
The unit commenced in year 2000 when Dr. Sudath Gunasekera was appointed the first Consultant Neurophysiologist, NHSL. There are grade medical officers, nursing and paramedical staff to provide the services.
These tests are provided for patients with disorders in the peripheral nervous system. Special clinics are conducted daily for complicated cases. A separate clinic is conducted for patients with Carpal Tunnel Syndrome since the number of such patients is high. Urgent tests are arranged when necessary, especially for patients with traumatic and non-traumatic acute weakness.
These are available for visual (VEP), auditory (BSER) as well as somatosensory (SSEP) modalities. These are done according to international standards.
BSER threshold tests are done for hearing screening which is particularly useful in children for early detection of hearing impairment. Clinical Neurophysiology unit of NHSL was the first to introduce this test in Sri Lanka under accurate standards and so far provided this service to a large number of patients.
Standard EEG recording services are provided to patients from NHSL as well as other hospitals which do not have such facilities. All the EEGs are provided with a report by Consultant Neurophysiologist. In addition, EEGs done in other hospitals are also undertaken for reporting by Consultant Neurophysiologist upon requests. Lady Ridgeway Hospital and Mental Hospital in particular receive such services from our unit on a regular basis.
Prolonged video EEG monitoring is also carried out. This is the first ever video EEG monitoring facility with expertise in the procedure and interpretation. The majority of patients who undergo this test are those lined up for epilepsy surgery for which this test is essential. We played a key role in establishment of epilepsy surgery services in Sri Lanka.
In additional short term monitoring is provided for diagnostic purposes. Some studies for sleep disorders (Multiple Sleep Latency Test) is also carried out.
This is provided when necessary for epilepsy surgeries and spinal surgeries. The number is limited due to limitations of staff and equipment.
A specialized clinic for botulinum toxin therapy is conducted every fortnight. This serves to provide botulinum toxin injection for patients with various movement disorders ranging from hemi facial spams and Writer’s cramps to laryngeal spasmodic dysphonia. Some of these patients are given the injection under EMG guidance.
Neurophysiological evaluation of majority of such cases is done in the neurophysiology unit. Consultant Neurophysiologist also takes part in the committee meeting as a member.
We take part in the process of postgraduate medical education by training pre-MD postgraduate students in medicine and paediatrics. We have also taken part in training post MD Senior Registrars in Clinical Neurophysiology, Neurology and Paediatric Neurology.
This unit houses the EEG Technologist Training School of the Ministry of Health. Coordination of their programme including conducting practical hands on training as well as lectures are done by this unit.
Examinations for trainee EEG technologists and efficiency bar examinations for EEG technologists are conducted in this unit under the supervision of Ministry of Health.
Service |
Number of Patients per month |
Special NCS / EMG |
300 |
Carpal Tunnel Syndrome |
400 |
Evoked Potential Studies |
60 |
Botulinum Toxin Therapy |
10 to 15 |
Standard EEG Recording |
400 |
Prolonged Video EEG Monitoring |
10 |
EEG Reporting from NHSL & Other Hospitals |
250 |
A large number of patients are referred from armed forces and police for various nerve injuries sustained at the battle front. They are given priority. Presently about 50% of special NCS / EMG tests done are for these patients. These tests cannot be done at those hospitals since necessary equipment or expertise is not available.
The number of patients seen is very large, similar to other clinics in Sri Lanka. This is several times more than that of a clinic in a developed country.
Botulinum Toxin injection | Tuesday [ Once in 02 Week ] | 8.00 a.m | Neuro Building E.M.G Room |
Special Nerve Conduction Clinic & E.M.G Clinic | Monday |Tuesday| Wednesday| Thursday | Friday| Saturday | 8.00 a.m. | Neuro Building |
B.S.E.R.(Brain Stem Auditary Evoke potential Clinic) S.E.P.(Somato Sensary ) & V.E.P.(Visual Evoke Potential ) |
Monday| Tuesday | Wednesday| Thursday |Friday | 12.30 p.m | Neuro Building E.M.G Room |
C.T.S (Carpal Tunnel Syndrome ) | Monday|Tuesday|Wednesday|Thursday | 11.30 a.m | Neuro Building E.M.G Room |
Department of microbiology at NHSL was established in 1970s by two Consultant Pathologists Dr. Doris Peiris and Dr. H.R. Wickramasinghe. In 1981 Dr. S.D. Athukorala was appointed as the first permanent Consultant Clinical Bacteriologist to the department of microbiology. On his retirement in mid 2005 Dr. Mrs. Philomina Chandrasiri was appointed as the second Consultant Microbiologist and she served till early 2013.
The infection control unit was established in 1987 under the leadership of Dr. S.D. Athukorala, Consultant Clinical Bacteriologist and Mrs. Chandra Gunawathie was the first Infection Control Nursing Officer appointed to the infection control unit.
The department of microbiology and infection control is a well recognized unit in Sri Lanka
It is well equipped to provide microbiology culture, direct microscopy and antibiotic susceptibility testing in microbiological samples namely blood and all sterile fluids namely cerbro-spinal fluid, peritoneal fluid, pleural fluid, aspirates from sterile sites, heart valves, pus aspirates, respiratory samples, urine, faeces, throat swabs, wound cultures, tissue biopsy samples, screening and surveillance cultures as appropriate according to standardized and quality controlled methodology.
The department participates in the External Quality Assessment (EQA) programmes conducted by the Medical Research Institute and the NPTCCD (National Programme for Tuberculosis and Chest Diseases)
Department is an approved training centre for both undergraduates from the faculty of medicine and post graduate trainee medical officers in different disciplines including clinical microbiology. It is an approved training centre for medical laboratory technologists too.
Department conducts research in relation to medical microbiology and infection control aspects as a single centre and also in collaboration with other institutes and some of them have been published and presented in local and international gatherings.
Department of microbiology works closely with the infection control unit of the hospital which too is headed by the Consultant Clinical Microbiologist as the technical head of the unit.
The team included dedicated group of staff members from medical, technical and support staff who give tireless service in order to issue timely and quality microbiology reports for better patient care.
They provide a vital service in clinical care for the battle against infections.
Team is headed by the Consultant Clinical Microbiologist, Dr (Mrs) Geethika Patabendige.
Medical staff in the department of microbiology includes Senior Registrars, Registrars undergoing clinical training in medical microbiology and other disciplines on rotational basis and four Medical Officers in microbiology.
The technical team includes Senior Medical Laboratory Technologist and eleven Medical Laboratory Technologists.
Support staff includes two orderlies and five assistant staff members.
The team included dedicated group of staff members from medical, nursing and support staff who play a vital role in providing the patients and staff members with safer healthcare.
Infection control unit team includes Dr. Geethika Patabendige, Consultant Clinical Microbiologist as the head of the department, two infection control medical officers, Infection Control Nursing Sister and thirteen Infection Control Nursing Officers and one support staff member.
Timely issuing of technically and clinically validated microbiology reports
The department of microbiology processes around 16,000 to 20,000 blood cultures, 6,400 sterile fluid cultures, 30,000 urine cultures, 21,000 pus cultures, 12,000 respiratory sample cultures, 3,000 surveillance cultures, 50,000 antibiotic susceptibility testing and 10,000 smears for Acid Fast Bacilli ( AFB) annually. To carry out the above tasks microscopy, plating on culture media, broth inoculations and biochemical testing have to be carried out. Twenty four thousand Gram stains, 90,000 plating on culture media, 20,000 broth inoculations and 30,000 biochemical testings’ including rapid manual identifications are done annually at the department of microbiology.
Providing advice on collection and transport of microbiological specimens and suggesting further testing when required
Providing antimicrobial ad infection control advice to all ICUs, HDUs, wards and units
Authorization of antimicrobial agents as required
Attending to referrals for antimicrobial and infection control advice from all specialized areas namely general medicine and surgery, orthopaedic surgery, cardiology, urology, GU surgery, cardiothoracic surgery, emergency care and accident service, neurosurgery, neurology, dialysis and transplantation.
Sending appropriate samples and isolates for reference testing to Medical Research Institute and NPTCCD reference laboratory for Tuberculosis culture and automated PCR (GeneXpert)
Undergraduate and post graduate training and other training as required
Evaluation of consumables and equipment for registration and for tenders which are submitted by the CDDA and SPC
Being resource persons in educational workshops
Representing committees related to microbiology at the Ministry of Health
General infection control activities at NHSL and outside whenever necessary
Specialized infection control activities such as theatre commissioning, recommissioning and designing and expert microbiological advice on designing specialized and other units at NHSL and outside whenever necessary
Healthcare associated infections (HAI) surveillance
Training staff and patients
Conducting infection control audits and related research
Accidental exposure reporting and management
Vaccination of patients and staff members
Epidemiological services – notification, dengue e. surveillance, dengue sentinel site surveillance, ILI surveillance, AFP surveillance
Outbreak detection and management
Representing National advisory committee on infection control at the Ministry of Health
In order to obtain services from the department of microbiology and infection control contact over the telephone on 0112691111 extension 2473. 2474, 2923 and 2647
Expanding the microbiological services to include mycological and molecular biological services with the provision of necessary resources through the ministry of health and other funding institutes.
Establishing a better laboratory information system and networking so that the units would be able to access the results with minimum delay
Obtaining laboratory accreditation to the microbiology laboratory
Further improving the infection control services to safeguard the lives of patients and staff members
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The National Hospital of Sri Lanka (NHSL), situated in Colombo on a 32-acre block of land, is the largest teaching hospital in Sri Lanka and the final referral centre in the country, consisting of 3000 beds. it is the training centre for undergraduates and postgraduate trainees of the Faculty of Medicine. The nursing training school, Colombo, PBS, and Schools of Radiography, Pharmacy, Cardiograph, physiotherapy and occupational therapy are also affiliated with the National Hospital.
The U.S. Ambassador to Sri Lanka, Julie Chung paid a visit to the National Hospital of Sri Lanka, Colombo on 14 June 2022 to officially handed over much-needed medical consumables to the hospital donated by SLMANA Inc. The donation was accepted by Dr W.K. Wickremasinghe, DDG-NHSL and Dr Indika de Lanerolle, Consultant Emergency Physician. The United States, being an ally of Sri Lanka has always assisted the Sri Lankan public in times of crisis and the donated items shall facilitate the provision of continuous healthcare through NHSL-Colombo.