Browsing by Author "Fernando, W.S."

Now showing 1 - 15 of 15

Dengue fever in pregnancy- a mamagement dilemma
(College of Anaesthesiologists of Sri Lanka, 2003) de Silva, B.A.; Wijesekera, C.; Fernandopulle, R.C.; Fernando, W.S.; Palihawadana, T.S.
Dengue fever with bleeding manifestations in pregnancy: our experience
(Sri Lanka College of Obstetricians and Gynaecologists, 2004) de Silva, B.A.; Palihawadana, T.S.; Fernando, W.S.; Wijesinghe, P.S.
Dengue fever, a mosquito borne flavivirus infection is endemic in Sri Lanka. An increased number of cases are seen in the recent past. An increase in the number of patients with secondary infection who are prone to develop complications such as bleeding manifestations, are expected due to repeated outbreaks of the disease, We report four cases of serologically confirmed Dengue fever. Different management strategies were adopted in each patient according to the clinical circumstances. Three antenatal mothers presented in 33, 38 and 39 weeks of POA and bleeding manifestations were present in all three of them. One of them died of an intracerebral haemorrhage after Caesarean section to deliver a stillborn following intrauterine death. Post Partum Haemorrhage (PPH) was experienced in another mother following caesarean section. In one patient bleeding manifestation appeared 2 days following normal delivery. She was managed conservatively. Though the clinical presentations may be similar to that of non pregnant patients, there can be many pitfalls in diagnosis and management of dengue fever occurring in pregnancy. Two of the patients described above developed acute dengue viral hepatitis, which needs to be differentiated from HELLP syndrome and acute fatty liver of pregnancy. Serological tests have a special place in diagnosis than in the non pregnant patients. The classical criteria used to identify Dengue Haemorrhagic fever (DHF), such as an increased haemotocrit and postural hypotension were not present in these patients. In management, the administration of intravenous fluids needed to be more closely observed. They seemed to be more prone to develop bleeding manifestations than non pregnant patients and therefore platelet transfusions were required in early stages. Early interventions to deliver the baby, if the other circumstances permit, seem to offer a better outcome in patients presenting in the antenatal period.
Effect of polyherbal formulation DM 13 in the management of Diabetes Mellitus Type 2 (DMT2) patients treated with Glybenclamide and Metformin- A retrospective cohort study
(Sabaragamuwa University of Sri Lanka, 2006) Chandrasiri, W.A.L.; Chandrasekara, H.I.; Fernando, W.S.
Family planning among Medically ill people in a sri lankan setting: a descriptive study
(Sri Lanka College of Obstetricians and Gynaecologists, 2007) Palihawadana, T.S.; Fernando, W.S.; Mallawaarachi, W.P.P.K.; Attanayake, A.M.J.H.; Motha, M.B.C.; Wijesinghe, P.S.
INTRODUCTION: Sri Lanka has a high contraceptive prevalence with a low total fertility rate. In spite of this, unmet need of family planning among medically ill people is observed in day to day clinical practice. Medical illnesses complicating pregnancy are a major cause of maternal morbidity and mortality in Sri Lanka. This is thought to result from non usage as well as use of methods with low efficacy. We studied the contraceptive usage among people suffering from medical illnesses as a preliminary survey of a large scale study. METHOD: The study was carried out at the medical clinics of the Colombo North teaching hospital from March to July, 2007. Those who suffer from medical conditions that could complicate a pregnancy were interviewed to find out the family planning practices and identify the limiting factors for uptake of modern methods. Sixty seven sexually active subjects who are in their reproductive age group were interviewed for the research purpose. RESULTS: Study population comprised of 55% of Buddhists, 38% Catholics and 6% Islamics. Mostly encountered medical conditions were diabetes mellitus (n=18), hypertension (n=15), Valvular heart disease (n=10) and thyroid dysfunction (n=6). Seven subjects were planning for a pregnancy at the time of interview though none of them had been advised that it is safe to do so. Nearly 80% (n-53) of subjects admitted to practicing family planning. However, among them 71% (n=38) were using the traditional methods of family planning, where calendar method was the most commonly used (43.3%) followed by withdrawal (20.8%) and the cervical mucous (75%) methods. Norplant was the most commonly used modern method (13.2%) while other methods used included combined contraceptive pill (9.4%), intrauterine contraceptive device (3.8%) and DMPA (1.9%). None of the study subjects practiced male or female sterilisation. Of the total study population 35.8% (n=24) had received family planning advice from the family health midwife after diagnosis of their condition, while only 6% (n=4) had such advice at the medical clinic. CONCLUSIONS: Though family planning is practiced by a high proportion of medically ill people, only a minority use modern methods. High prevalence of traditional family planning usage make this group vulnerable to unintended pregnancies due to the low efficacy of the methods used by them. Family planning advice does not seem to adequately reach this more deserving population. Possible reasons for this could be either the reluctance of field health workers to dispense modern methods of family planning to these people or the deficiencies in the family planning program to reach such special groups, thus stressing the point that such services should be integrated at the level of the medical clinic.
Luther and Vatican II: ‘Liturgical Reform Experiment’ of the Kithu Dana Pubuduwa (renewal movement) in the Sri Lankan Catholic Church.
(The Department of Western Classical Culture & Christian Culture,University of Kelaniya, Sri Lanka., 2017) Fernando, W.S.
Perifartum hysterectomy from 2000 to 2004: Any new lessons?
(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Pathiraja, R.P.; Wijesinghe, P.S.; Fernando, W.S.; Fernandopulle, R.C.
OBJECTIVE: We aimed to identify the risk factors and subsequent maternal and perinatal outcome associated with the procedure of peripartum hysterectomy. MATERIALS AND METHODS: This was a retrospective case review carried out at the Professorial unit, North Colombo Teaching Hospital, Ragama, of all patients who underwent a peripartum hysterectomy from January 2000 to December 2004. RESULTS: Eighteen cases were performed during the study period from a total of 28,038 deliveries (0.064%) mean maternal age was 33 years (24-43), There were five nulliparous patients. Seven patients had previous vaginal deliveries. Six had a history of previous caesarean section, four of whom had more than one caesarean sections. The indications for the hysterectomy were placenta praevia (2), abruptio placenta (1), atonic postpartum haemorrhage (7), placenta accreta (3), traumatic postpartum haemorrhage (5). All Abstracts - Free Papers patients received blood transfusions, 27% receiving more than 10 units. There were five maternal deaths (Maternal mortality rate 17.8 /100,000). There were two stillbirths and one neonatal death secondary to antepartum haemorrhage. CONCLUSION: Even though the maternal mortality was not very high, the associated maternal morbidity and perinatal mortality were high. One third of the cases were associated with previous caesarean section. The caesarean section rate is increasing worldwide for many reasons, including recent emphasis on maternal request. We recommend that caesarean section be performed only for valid clinical indications which should help reduce the problems associated with peripartum hysterectomy.
Physical Barriers Encountered Within Hospitals by an Elderly Population in Accessing Healthcare: A Study Conducted at The North Colombo Teaching Hospital, Ragama, Sri Lanka.
(Access To and Through Education Conference, 2021) Edussuriya, T.N.; Dissanayake, K.D.M.R.H.; Fernando, V.S.T.H.; Fernando, W.S.; Fernando, W.N.N.; Perera, N.
As the population of Sri Lanka rapidly ages, the issue of equity and equality in accessing health care facilities for elderly is important. There are physical barriers for accessibility in healthcare facilities for them which can be corrected effortlessly in local context. Objective- To identify difficulties and physical barriers encountered by an elderly population in accessing healthcare at the North Colombo Teaching Hospital, Ragama, Sri Lanka. Descriptive study was carried out among 341 persons over the age of 60 years visiting the outpatient department and clinics. Interviewer administered questionnaire was administered and data was analysed using SPSS version 22. Demographic data showed mean age as 67 years of which 56% were males. 51% were accompanied by family member and 36% relied on another helper. 51% of them had mobility impairment and 25% had vision impairment. 28% had used assistive devices ranging from glasses (26.8%), crutches (22.3%) to wheel chairs (3.2%). Of persons using mobility assistive equipment, 85% thought that manoeuvrability was limited and could not reach the second floor (41%) without assistance. They complained of not noticing the information desk (33%), poor visibility of boards (25%), difficulties in identifying correct room (20%) and inadequate seating (50%). 1/4th of elderly thought facility to access washrooms was inadequate and were not disabled friendly. (45%) Elderly population has numerous difficulties and physical barriers while accessing health care facilities. Improvements in finding directions, manoeuvrability and physical facilities will help to provide equal and equitable health care services for the neediest people of the society.
Positive peritoneal fluid cytology in ovarian malignancies with metastasis:a descriptive study
(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Hewavisenthi, S.J.de S.; Palihawadana, T.S.; Fernando, W.S.; Wijesinghe, P.S.
Detection of malignant cells in peritoneal fluid and peritoneal washings obtained at laparotomy is useful in predicting the presence of peritoneal metastasis in ovarian cancer. It will help in tumour staging, planning of further management as well as predicting the prognosis. The accuracy of such predictions will depend on the diagnostic accuracy of cytology in detecting metastasis, which is expressed by sensitivity, specificity and positive and negative predictive values. We tried to determine the said parameters in a series of patients with ovarian cancer who underwent laparotomy at a tertiary care teaching hospital. Forty two consecutive patients with malignant ovarian tumours were studied with respect to differentiation, grade and size of tumour. The peritoneal fluid obtained was assessed for the presence of malignant cells and the nature (serous or blood stained) of the fluid. The accompanying omentectomy specimens were examined for histological evidence of metastasis. Nineteen out of 42 patients had histologically proven omental tumour deposits. Of these only 11 yielded positive cytology. One specimen was cytology positive in the absence of histological evidence of peritoneal deposits. The sensitivity of peritoneal fluid cytology was 57.9%, specificity was 95.7%, positive predictive value was 91.7% and negative predictive value was 76.7% in our series. Any of the characteristics in the tumour or the peritoneal fluid failed to demonstrate a significant association with positive cytology. The sensitivity of peritoneal fluid cytology in detection of peritoneal spread was low (measured against histologically proven omental deposits), which highlights the need of other adjunct methods such as biochemical markers and fluorescence in situ hybridisation to improve the diagnostic accuracy.
A Possible progression of an atypical leiomyoma to a leiomyosarcoma
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Ekanayake, C.D.; Liyanage, A K.; Herath, R.P.; Fernando, W.S.; Mahendra, B.A.G.G.
BACKGROUND: The spectrum of uterine smooth muscle cell tumours can range from leiomyoma to leiomyosarcoma. Atypical leiomyomasare a group of tumours with cellular atypia and a mitotic indexof up to 5/HPF that are classified between the innocuous leiomyoma and leiomyosarcomas. The absence of coagulative necrosis helps to differentiate it from leiomyosarcomas.Traditionally atypical leiomyomas are thought to have a low recurrence rate. CASE DETAILS: A 41-year-old woman underwent a myomectomy for ananteriorcervical fibroid.Histology revealed a smooth muscle tumour (SMT) withdiffusely scattered hyperchromatic large cells. The maximum mitotic count was 5/10 HPF.There was no coagulative necrosis or atypical mitotic figures. It was classified as an atypical leiomyomas and had close follow up. However, 30 months later she developed heavy menstrual bleeding. The ultrasound scan revealed an anterior fibroid. She underwent a total abdominal hysterectomy with ovarian conservation. The specimen showed a well-defined myometrial nodule of 7cm with haemorrhagic areas,compressing the cervix. It was a SMT with high a mitotic activity (11-12/HPF), atypical cells with bizarre nuclei and focal coagulative necrosis confirming a leiomyosarcoma (FIGO 1B). CONCLUSION: As atypical leiomyomashave a low risk profile and are mostly found in younger women,it invariably leads to treatment that offers fertility preservation. This case challenges the generalisability of this currently held viewpoint and recommends more extensive surgery or further heightened surveillance
A possible progression of an atypical leiomyoma to a leiomyosarcoma
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Ekanayake, C.D.; Liyanage, A.K.; Herath, R.P.; Fernando, W.S.; Mahendra, B.A.G.G.
BACKGROUND: The spectrum of uterine smooth muscle cell tumours can range from leiomyoma to leiomyosarcoma. Atypical leiomyomasare a group of tumours with cellular atypia and a mitotic indexof up to 5/HPF that are classified between the innocuous leiomyoma and leiomyosarcomas. The absence of coagulative necrosis helps to differentiate it from leiomyosarcomas.Traditionally atypical leiomyomas are thought to have a low recurrence rate. CASE DETAILS: A 41-year-old woman underwent a myomectomy for ananteriorcervical fibroid.Histology revealed a smooth muscle tumour (SMT) withdiffusely scattered hyperchromatic large cells. The maximum mitotic count was 5/10 HPF.There was no coagulative necrosis or atypical mitotic figures. It was classified as an atypical leiomyomas and had close follow up. However, 30 months later she developed heavy menstrual bleeding. The ultrasound scan revealed an anterior fibroid. She underwent a total abdominal hysterectomy with ovarian conservation. The specimen showed a well-defined myometrial nodule of 7cm with haemorrhagic areas,compressing the cervix. It was a SMT with high a mitotic activity (11-12/HPF), atypical cells with bizarre nuclei and focal coagulative necrosis confirming a leiomyosarcoma (FIGO 1B). CONCLUSION: As atypical leiomyomashave a low risk profile and are mostly found in younger women,it invariably leads to treatment that offers fertility preservation. This case challenges the generalisability of this currently held viewpoint and recommends more extensive surgery or further heightened surveillance.
Semen ph in infertile males and its association with semen parameters
(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Dissanayake, D.M.A.B.; Palihawadana, T.S.; Amarasena, J.M.T.; Fernando, W.S.
INTRODUCTION: Assessment of pH of the ejaculate is part of the basic seminal fluid analysis. The WHO defines the reference range for seminal fluid pH to be 7.2 or more. In practise we have observed that the pH is commonly in the alkaline range in patients with normal as well as abnormal seminal parameters. Furthermore, there are many others who question the reference range defined by the WHO, and claim it to be too low. Objective: To define the range of pH in seminal fluid in a infertile male population and to assess the association it shows to seminal fluid parameters. METHOD: Seminal fluid analysis including pH assessment was done on 168 males who sought infertility treatment at the university infertility clinic, at teaching hospital, Ragama. The pH was assessed within 30 minutes from collecting the sample using a pH meter. The seminal fluid analysis was done according to the WHO criteria. Log inversion of pH was done prior to calculation ofmeans. Results: The mean (±SD) pH of the sample population was 7.70 (±0.25) with a minimum of 6.78 and a maximum of 8.52. Only five patients (3%) had a pH less than 7.2. The distribution of the pH showed a 5" percentile value of 7.37 and a 95 'percentile of8.21.Thirty four percent (n=57) of subjects had a normal Seminal fluid analysis with regard to volume, concentration, motility and viability. Mean pH value showed a significant difference between the groups with a normal vs. abnormal volume of ejaculate, 7.75 vs. 7.59, P<0.05. Similar differences were not seen with any other semen parameter. Conclusion: The pH of ejaculate in this study sample is towards an alkaline range. Associations between semen pH and seminal parameters needs further study.
Sexual practices, knowledge and usage of contraceptives among adolescents and young adults
(Sri Lanka College of Obstetricians and Gynaecologists, 2008) Herath, H.M.R.P.; Dissanayake, D.M.A.B.; Hilmi, M.A.M.; Pathmeswaran, S.; Fernando, W.S.; Wijesinghe, P.S.
INTRODUCTION: Adolescence is a critical period of development, as important behaviour patterns are learnt during this period. The sexual debut in Sri Lankan schooling adolescents has been reported as 15.3 years for males and 14.4 for females. Furthermore a significant difference in the prevalence of heterosexual experience among the two sexes have been reported(14% among boys Vs 2% among girls). In 2001, of the pregnant women who received antenatal care from public health midwives, 7.8% were teenagers. Interestingly 22.2% of maternal deaths due to illegal abortions were in this age group during 1996. Thus the situation demands research into sexual practices and strategies to increase the contraceptive uptake by teenagers. OBJECTIVES: To describe and compare the sexual practices. knowledge and usage of contraceptives by the adolescents and young adults with different educational backgrounds. METHOD: Study was a cross sectional descriptive study done involving subjects of three different educational levels i.e. students of universities and technical colleges and employees of garment factories. Data were collected with a pretested self administered questionnaire. RESULTS: Data of 1258 subjects were analyzed. Of them 23% were garment factory workers, 38.2% were technical college students and 38.8% were university students. Females consisted 58.9% of the population. The mean age for males and females were 20.5 years and 20.7 years respectively. The mean age of first sexual relationship of males and females were at 17.65 and 19.44 years respectively (p<.001). Out of the total population 17% of females and 33.5% of males were sexually active. Sexual relationships were reported by 51.7% of garment factory employees, 19.4% technical college students and 12.3% of university students. Majority of male garment factory workers ("90 %) were sexually active. Of the 166 sexually active males 19.3% had sexual relationship with commercial sex workers. Out of the 172 people who have not used modern contraceptives during heterosexual relationships, 32% has used natural family planning. Significantly larger proportion (21.7%) of garment factory workers compared to other settings believed that IUCD would protect them from HIV infection. Of the study population 24.9% of females and 71.2% of males knew barrier methods would minimize the risk of development of HIV. With regard to primary source of information regarding contraceptive methods, 24.2 % and 23.4% of subjects reported school and news papers, while 28.4% felt that information from parents as the least important source. Of the people who selected school as their main source of information, only 41.4% knew barrier methods could protect them from HIV. Majority preferred instructions from school and special health clinics on contraceptive usage. CONCLUSIONS: Teenage and young adult males have their first sexual relationship at an earlier age than female counterparts. A larger proportion of garment factory employees are sexually active compared to students of technical colleges and universities. Significant proportion of males of the age group had their first relationship with commercial sex workers. The knowledge about different contraceptive methods among this population is inadequate. More emphasis should be given to the preferred media by the adolescents and young adults in educating them on contraceptive methods.
A study on the incidence and the outcome of teenage pregnancies and the associated socio-economic factors: an interim analysis
(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Palihawadana, T.S.; Motha, M.B.C.; Fernando, W.S.; Wijesinghe, P.S.
INTRODUCTION: Teenage pregnancy is known to be associated with adverse pregnancy outcomes for both the mother and her offspring. Knowledge on the socio-economic conditions associated with teenage pregnancy and the short term and intermediate outcomes would provide information useful in prevention and management of teenage pregnancy. OBJECTIVE: To describe the prevalence of teenage pregnancy in a low risk population and two identified high risk populations and to identify the associated socio-economic characteristics as well as to assess the incidence of short term and intermediate adverse outcomes in the mother and the offspring. METHODS: The study will be conducted in three phase. The prevalence of teenage pregnancy and associated socio-economic factors would be assessed at three study settings of Ragama, Nuwara Eliya and Puttalam. Second phase would be at Ragama and the pregnancy outcome of the teenage mothers would be compared against a parity matched sample of controls while in phase three a community based follow up study would be done in teenage mothers who delivered at Ragama Hospital two years ago to assess the intermediate outcome of mothers and their offspring. Here we report the results of the Ragama component of Phase I and a part of the data accumulated for Phase II. RESULTS: Review of records of 5249 deliveries yielded a teenage pregnancy rate of 4.74% (n=249). Results pertaining to 25 subjects and 50 parity matched controls in phase I and 102 subjects with 179 controls are described here. The distribution according to religion and ethnicity was not different between the subjects and the controls. The occupations and marital status as well as alcohol consumption of fathers did not demonstrate a difference between the teenage mothers and the controls. Five percent of subjects were not married while all were married in the control group (p<0.05). There was a significant difference in the educational level between subjects and controls (p<0.001); education beyond Ordinary level was 14% in subjects as compared to 33% among
Uterine artery embolisation (uae) for symptomatic uterine fibroids
(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Rannulu, P.; de Silva, P.; Fernando, W.S.
INTRODUCTION: Uterine Artery Embolisation is a modern treatment modality used in the treatment of symptomatic uterine fibroids. Though common in the developed world it is still not routinely done in Sri Lanka. We report four patients with symptomatic uterine fibroids who were treated with bilateral UAE. SETTING: North Colombo Teaching Hospital, Ragama. METHOD: Four patients with symptomatic leiomyomas were selected from Gynaecology out patient clinics. Sizes of the fibroids were assessed by ultrasound imaging. Bilateral UAE was performed via retrograde femoral artery catheterization of the uterine arteries under local anaesthesia using absorbable soft Gelatine (USP). Imaging of the myomas were performed three months after the procedure. Results: Size of the fibroids were reduced in three patients when compared with the pre- procedure imaging. No major complications were noted. The severity of menorrhagia was reduced in three Patients. One patient failed to respond to the therapy with regard to the reduction of size of the fibroid and improvement of symptom severity. CONCLUSIONS: UAE is a non-surgical alternative in the management of symptomatic fibroids, which could be carried out in the local setting.
Vulvitis granulomatosa, Melkersson-Rosenthal syndrome, and Crohn's disease: dramatic response to infliximab therapy
(Wiley-Blackwell, 2012) Wickramasinghe, N.; Gunasekara, C.N.; Fernando, W.S.; Hewavisenthi, J.; de Silva, H.J.
No Abstract Available