Browsing by Author "Pannala, W.S."

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A case of labial adhesions following primary genital herpes infection
(Sri Lanka College of Obstetricians & Gynaecologists, 2018) Casather, D.M.; Herath, R.P.; Ranathunga, R.D.J.; Pannala, W.S.
INTRODUCTION: Genital Herpes is one of the common sexually transmitted diseases in Sri Lanka. Although, the labial adhesions usually associated with hypo-oestrogenism, it may occur as a rare complication of Genital Herpes infection. Here we present a case of almost complete thick band labial adhesions following Genital Herpes infection. Case Report: A 23 year old nulliparous woman presented with vulval pain, dysuria and fever for two days. On vulval examination she had extensive, multiple, painful genital ulcers with some blistering lesions over both labia majora and minora. She had been in a monogamous relationship with the partner, with last sexual exposure about 10 days prior to the development of ulcers. Presumptive diagnosis of primary genital herpes was made on clinical manifestations. She was treated with 7 days course of oral Acyclovir. Ten days later she presented with a complaint of narrowing of the vaginal introitus and dysuria. On examination vulval lesions were in the partial remission and there was thick band of adhesion on the upper two third of labia minora with multiple scars of healing ulcers on either side. Manual separation of adhesions was not attempted due to tense nature of the adhesions. Surgical separation of labial adhesions was done under general anesthesia. After two weeks she made complete remission of Genital herpes ulcers and there were no further labial adhesions. A further follow up appointment was arranged in three months. DISCUSSION: Labial adhesions are not common among women in reproductive age who are having well oestrogenised vulva, in comparison to prepubertal and postmenopausal women with less oestrogenised vulva. Labial adhesions are rare, but severe form of local complication of genital herpes infection. The formation of labial adhesions can be prevented by early treatment with adequate dose of oral acyclovir. Gentle application of local anaesthetic over the labia minora alleviates pain and prevents labial adhesions formation in patients with genital herpes. The usual solution for adult labial adhesion following genital herpes infection is surgical adhesiolysis. Manual separation of the labia under application of local anaesthesia can be considered in patients who have less dense adhesions. This is the first published material in Sri Lanka on this matter. The importance of this report is to maintain the vigilance among health care providers about this rare complication as Genital Herpes infection is a very common sexually transmitted infection in Sri Lanka.
A Case of labial adhesions following primary genital herpes infection
(Kandy Society of Medicine, 2018) Casather, D.M.; Herath, R.P.; Ranathunga, R.D.J.; Pannala, W.S.
Labial adhesions are usually associated with hypo-oestrogenism, but it is also a rare complication of genital herpes infection. We present a case report of a 23-year-old woman presenting with primary genital herpes infection, progressing to labial adhesions.
Clinical characteristics and fate of neonates born before 34 weeks of gestation: a case-controlled study
(Sri Lanka Medical Association, 2008) Mettananda, D.S.G.; Rajindrajith, S.; Adhihetty, D.; Goonewardena, A.R.; Adikari, A.M.C.; Pannala, W.S.; Devanarayana, N.M.; Mettananda, K.C.D.
OBJECTIVES: To describe and compare the socio-de mo graphic and clinical characteristics, problems and outcome of premature neonates born before 34 weeks of gestation. DESIGN, SETTING AND METHODS: A case-controlled study was conducted at the special care baby unit (SCBU) and the university obstetric unit of North Colombo Teaching Hospital from January to December 2006. All neonates born before 34 weeks of gestation were recruited as cases and a randomly selected group of term neonates were recruited as controls into the study after obtaining maternal consent. Data were collected by interviewing mothers and using patient records, RESULTS: Seventy cases and an equal number of controls were recruited. 40(57.1%) cases and 30(42.9%) controls were males. Mean birth weight was 1.44(SD=0.46) kg for cases and 2.94(SD=0.35) kg for controls. Multiple pregnancy [OR-14.3, 95%CI=1.8-113.1] and monthly family income less than Rs.l0, 000/= [OR=2.6, 95%CI:=l.l-5.8] carried a significantly higher risk of deliveries before 34 weeks. Increased risk was also detected in subjects with obstetric [OR=4.2, 95%CI=2.0-8.8)] and fetal [OR=11.0, 95%CI=3.6-33.6] complications. Maternal blood group, maternal education level and social class assessed by father's occupation did not have any association with deliveries before 34 weeks. Mean 1-minute APGAR was significantly lower in neonates born before 34 weeks [7.2(SD=2.9)] than controls [9.7(SD=0.5) J (p<0.001), and the same was true for the score at 5 minutes. All cases were admitted to the SCBU and were kept in incubators. The stay in SCBU ranged from 1 to 110 days (mean 15.1, median 9.0 & mode 1, 0 days). 37(53%) had jaundice whereas 45.7%, 28.6% and 24.3% had sepsis, surfactant deficient lung disease and apnoea respectively. 67(95.7%) neonates needed oxygen, 12.9% were ventilated and 80% were given antibiotics. Twelve (17.1%) died while the rest (82.9%) were discharged. CONCLUSIONS: Multiple pregnancies, presence of maternal or fetal complications and low family income were associated with increased risk of deliveries before 34 weeks of gestation. Jaundice, sepsis, surfactant deficient lung disease and apnoea were the commonest problems in babies born before 34 weeks of gestation. Nearly one fifth of them died during the neonatal period.
Fate of premature neonates born before 34 Weeks of gestation: experience at a tertiary Care centre in sri lanka
(The Sri Lanka College of Paediatricians, 2008) Mettananda, D.S.G.; Rajindrajith, S.; Adhihetty, D.; Goonewardena, A.R.; Adikari, A.M.C.; Pannala, W.S.; Devanarayana, N.M.; Mettananda, K.C.D.
BACKGROUND: Neonates bom before 34 weeks of gestation are at risk of numerous complications and their management is technologically demanding. Despite advancements in other areas of medicine, neonatal intensive care facilities are still at a primitive stage even in tertiary care hospitals in Sri y Lanka, OBJECTIVE: To describe the clinical characteristics, problems and outcome of premature neonates born before 34 weeks of gestation. DESIGN, SETTING AND METHOD:A descriptive study was conducted in the Special Care Baby Unit (SCBU) of the North Colombo Teaching Hospital. All babies born before 34 weeks of gestation during me year 2006 were recruited, after obtaining maternal consent. Data was collected by interviewing mothers and using patient's records. RESULTS: Seventy neonates were recruited (male 57%). Of them 42 (60%) were delivered vaginally and 10 (14%) were born before 28 weeks of gestation. Mean birth weight was 1.44 (SD = 0.46) kg. All were admitted to the SCBU and were kept in incubators. The stay in SCBU ranged from 1 to 110 days (mean 15 days) and they were kept in incubators for an average of 5,8 days. Thirty seven (53%) had jaundice of whom 25 (36%) needed phototherapy but only one required exchange transfusion. Sepsis, surfactant deficient lung disease and apnoea were seen in 45.7%, 28.6% and 24.3% respectively. Four neonates each developed hypoglycaerma, anaemia and retinopathy of prematurity. Sixty seven (96%) neoaates needed oxygen, 13% were ventilated and 80% were given antibiotics. In 63% blood was taken for investigations more than 5 times. Twelve (17%) died while the rest (83%) were discharged. CONCLUSIONS: Jaundice, sepsis, surfactant deficient lung disease and apnoea were the commonest problems in babies born before 34 weeks of gestation. Nearly one fifth of them died during the neonatal period.
First episode of genital herpes simplex virus infection in the third trimester of Pregnancy; diagnostic limitations and effects on mode of delivery: a case study
(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Pannala, W.S.; Ranatunga, J.D.; Wijesinghe, P.S.
BACKGROUND: Risk of herpes simplex viral (HSV) transmission to the baby during vaginal delivery following maternal primary genital herpes in the third trimester is 41%. Caesarean section is recommended in such instances to minimize the risk of neonatal herpes.DNA-PCR is the gold standard of diagnosis of HSV infection. Crossreactivity of HSV1 and HSV2 IgM, variable IgM response in relation to time make these tests less useful. Furthermore, raised IgM may not always indicate primary infection. DNA-PCR does not differentiate primary infection from a recurrence which has lower risk of neonatal herpes (0- 3%). IgG has a lower positive predictive value in low prevalence settings. CASE: A 19-year-old primigravida at 36 weeks presented with four days’ history of dysuria, multiple painful superficial genital ulcerson both labia with painful bilateral inguinal nodes. Neither she nor her partner had genital or oral lesions before. Syphilis serology, dark ground examination and HIV antibody test were negative whereas Tzanck smear was positive. Clinical diagnosis of primary HSV infection was made and she was treated with acyclovir which was continued until five days after delivery. Two weeks later, she was positive for HSV1+HSV2 IgM antibody ELISA, and negative for type common IgG. Elective LSCS resulted in a healthy baby weighing 3.02kg. Serology four days later had a slightly higher IgG index than previous assay. CONCLUSION: High risk of neonatal herpes following primary genital herpes during third trimester, inability to differentiate primary infection from recurrence by available investigations, and practical difficulties of performing these investigations, necessitate management decisions to be based on clinical diagnosis in resource limited settings.
First episode of genital herpes simplex virus infection in the third trimester of Pregnancy; diagnostic limitations and effects on mode of delivery: a case study
(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Pannala, W.S.; Ranatunga, J.D.; Wijesinghe, P.S.
BACKGROUND: Risk of herpes simplex viral (HSV) transmission to the baby during vaginal delivery following maternal primary genital herpes in the third trimester is 41%. Caesarean section is recommended in such instances to minimize the risk of neonatal herpes.DNA-PCR is the gold standard of diagnosis of HSV infection. Crossreactivity of HSV1 and HSV2 IgM, variable IgM response in relation to time make these tests less useful. Furthermore, raised IgM may not always indicate primary infection. DNA-PCR does not differentiate primary infection from a recurrence which has lower risk of neonatal herpes (0- 3%). IgG has a lower positive predictive value in low prevalence settings. CASE: A 19-year-old primigravida at 36 weeks presented with four days’ history of dysuria, multiple painful superficial genital ulcerson both labia with painful bilateral inguinal nodes. Neither she nor her partner had genital or oral lesions before. Syphilis serology, dark ground examination and HIV antibody test were negative whereas Tzanck smear was positive. Clinical diagnosis of primary HSV infection was made and she was treated with acyclovir which was continued until five days after delivery. Two weeks later, she was positive for HSV1+HSV2 IgM antibody ELISA, and negative for type common IgG. Elective LSCS resulted in a healthy baby weighing 3.02kg. Serology four days later had a slightly higher IgG index than previous assay. CONCLUSION: High risk of neonatal herpes following primary genital herpes during third trimester, inability to differentiate primary infection from recurrence by available investigations, and practical difficulties of performing these investigations, necessitate management decisions to be based on clinical diagnosis in resource limited settings.
Neonatal deaths in a tertiary care hospital in sri lanka
(The Sri Lanka College of Paediatricians, 2008) Pannala, W.S.; Adikari, A.M.C.; Mettananda, D.S.G.; Rajindrajith, S.; Devanarayana, N.M.
BACKGROUND: Neonatal mortality rate reliably assesses the level of perinatal care in a country. Lethal congenital malformations and extreme prematurity are the main causes of neonatal mortality in developed countries. Developing countries continue to lose neonates due to infections, malnutrition and birth asphyxia. OBJECTIVE: To describe the clinical characteristics, timing and causes of neonatal deaths Jn a tertiary care hospital in Sri Lanka, DESIGN, SETTING AND METHOD: A descriptive study was conducted at the Special Care Baby Unit of the University Paediatric Unit of North Colombo Teaching Hospital, Ragama. Data on all neonatal deaths which occurred from January 2006 to June 2007 were extracted from hospital records using a data collection form. RESULTS: Fifty-nine neonatal deaths were studied. All babies were born at hospitals and there were no home deliveries. Thirty (51%) were males and 42% were first born. Sixty six percent were deliveredpreterm including 13% delivered before 28 weeks. Mean birth weight was 1.81 (SD^O.87) kg. Twenty eight (47%) were delivered following an' uncomplicated antenatal period while 9 (15%) mothers had pre-labour rupture of membranes, 8 (14%) had pregnancy induced hypertension and 6 (10%) had antepartum haemorrhages. Fifty four percent were delivered vaginally and 41% by emergency caesarean section. Forty five (76%) needed resuscitation at birth. Eight (14%) newborns did not survive more than an hour and a further 16 (27%) died within the first 24 hours. Forty four (75%) died within one week. Twenty six (44%) died of complications of prematurity of which half had surfactant deficient lung disease. Other causes of death were sepsis (20%), congenital abnormalities (14%), meconium aspiration syndrome (12%) and birth asphyxia (10%). Pathological postmortems were done on 17 (29%). CONCLUSIONS: Seventy five percent of deaths occurred in the first week of life, 41% occurring within the first 24 hours. Forty four percent died of complications of prematurity. Birth asphyxia accounted for only 10% of deaths.
Neonatal deaths in a tertiary care hospital in Sri Lanka: a clinical audit
(Sri Lanka Medical Association, 2008) Pannala, W.S.; Adikari, A.M.C.; Mettananda, D.S.G.; Rajindrajith, S.; Devanarayana, N.M.
OBJECTIVE: To describe the clinical characteristics, timing and causes of neonatal deaths in a tertiary can centre in Sri Lanka. DESIGN, SETTING AND METHODS: A clinical audit was conducted on all neonatal deaths occurred at specia care baby unit of the university pediatric unit of North Colombo Teaching Hospital from January 2006 tc June 2007. Data were extracted from hospital records using a data collection form. RESULTS: Fifty-nine neonatal deaths were audited. All baies were born in hospitals and there were no home deliveries. Thirty (51%) were males and 42% were first borns. Sixty-six percent were delivered preterm while 13% were delivered even before 28 weeks. Mean birth weight was 1.81(SD=0.87) kg. Twenty-eight (47%) were delivered following an uncomplicated antenatal period while 9(15%) mothers had pre-labour rupture of membranes, 8( 14%) had pregnancy induced hypertension and 6( 10%) had antepartum haemorrhages. 54% were delivered vaginally and 41% were delivered by emergency caesarian section. Forty-five (76%) needed resuscitation at birth. Eight (14%) newborns did not survive more than an hour and 16 more (27%) died within the first 24-hours; 44(75%) died within one week. Twenty-six (44%) died of complications of prematurity of which half had surfactant deficient lung disease. Other causes of death were sepsis (20%), congenital abnormalities (14%), meconium aspiration syndrome (12%) and birth asphyxia (10%). Pathological postmortems were done on 17(29%). CONCLUSIONS: Three-quarters of deaths were early neonatal deaths and over 40% occurred within the first 24 hours. Nearly half died of complications of prematurity and asphyxia accounted only for 10% of deaths.
Socio-demograpfflc and clinical Characteristics of neonates born before 34 Weeks of gestation: a case control study
(The Sri Lanka College of Paediatricians, 2008) Mettananda, D.S.G.; Rajindrajith, S.; Adhihetty, D.; Goonewardena, A.R.; Adikari, A.M.C.; Pannala, W.S.; Devanarayana, N.M.; Mettananda, K.C.D.
BACKGROUND: Management of neonates born before 34 weeks of gestation demands special resources and'' facilities which are limited in Sri Lanka. Identification of pregnancies at risk of preterm deliveries will enhance the optimal use of these neonatal facilities by appropriate and timely referrals. Objective: To compare th'e socio-demographic and clinical characteristics of neonates born before 34 weeks of gestation with those of term neonates. DESIGN, SETTING AND METHOD: A case-control study was conducted at the university obstetric unit of the North Colombo Teaching Hospital in the year 2006. All neonates born before 34-weeks of gestation were recruited as cases and a randomly selected group of term neonates was recruited as controls into the study after obtaining maternal consent. Data was collected by interviewing mothers and using patient records. RESULTS: Seventy cases and an equal number of controls were recruited. Forty (57%) cases and 30 (43%) controls were males. Mean birth weight was 1.44 (SD=0.46) kg for cases and 2.94 (SD=0.35) kg for controls. Previous history of preterm deliveries was found in 06 (8.6%) cases and. 01 (1.4%) control. Multiple pregnancy [OR=14.3,95% 01=1.8-113] and monthly family income less than Rs.lO,000/= [OR=2.6, 95% Cr^Ll-5.8] carried a significantly higher risk of_deliveries before 34 weeks. Increased risk was also detected in subjects with obstetric [OR=4.2, 95% CI=2.0-8.8)] and fetal [OR=11.0, 95% CI=3.6-33.6] complications. Maternal blood group, maternal education level and social class assessed by father's occupation did not have any association with deliveries before 34 weeks. Mean 1-minute APGAR was significantly lower in neonates born before 34 weeks [7.2 (SD=2.9)] than controls [9.7 (SD=0.5)], (pO.OOl) and the same was true for the score at 5 minutes. CONCLUSIONS: Multiple pregnancies, presence of maternal or fetal complications and low family income were associated with increased risk of deliveries before 34 weeks of gestation. Apgar scores at 1 and 5 minute were lower in neonates born before 34 weeks of gestation.