Browsing by Author "Wijesinghe, P."

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Challenges of costing a surgical procedure in a lower-middle-income country
(Springer-Verlag, 2019) Ekanayake, C.; Pathmeswaran, A.; Kularatna, S.; Herath, R.; Wijesinghe, P.
BACKGROUND: It is vital to enquire into cost of health care to ensure that maximum value for money is obtained with available resources; however, there is a dearth of information on cost of health care in lower-middle-income countries (LMICs). Our aim was to develop a reproducible costing method for three routes of hysterectomy in benign uterine conditions: total abdominal (TAH), non-descent vaginal (NDVH) and total laparoscopic hysterectomy (TLH). METHODS: A societal perspective with a micro-costing approach was applied to find out direct and indirect costs. A total of 147 patients were recruited from a district general hospital (Mannar) and a tertiary care hospital (Ragama). Costs incurred from preoperative period to convalescence included direct costs of labour, equipment, investigations, medications and utilities, and indirect costs of out-of-pocket expenses, productivity losses, carer costs and travelling. Time-driven activity-based costing was used for labour, and top-down micro-costing was used for utilities. RESULTS: The total cost [(interquartile range), number] of TAH was USD 339 [(308-397), n = 24] versus USD 338 [(312-422), n = 25], NDVH was USD 315 [(316-541), n = 23] versus USD 357 [(282-739), n = 26] and TLH was USD 393 [(338-446), n = 24] versus USD 429 [(390-504), n = 25] at Mannar and Ragama, respectively. The direct cost of TAH, NDVH and TLH was similar between the two centres, whilst indirect cost was related to the setting rather than the route of hysterectomy. CONCLUSIONS: The costing method used in this study overcomes logistical difficulties in a LMIC and can serve as a guide for clinicians and policy makers in similar settings.
Cost evaluation, quality of life and pelvic organ function of three approaches to hysterectomy for benign uterine conditions: study protocol for a randomized controlled trial
(BioMed Central, 2017) Ekanayake, C.; Pathmeswaran, A.; Kularatna, S.; Herath, R.; Wijesinghe, P.
BACKGROUND: Hysterectomy is the commonest major gynaecological surgery. Although there are many approaches to hysterectomy, which depend on clinical criteria, certain patients may be eligible to be operated in any of the several available approaches. However, most comparative studies on hysterectomy are between two approaches. There is also a relative absence of data on long-term outcomes on quality of life and pelvic organ function. There is no single study which has considered quality of life, pelvic organ function and cost-effectiveness for the three main types of hysterectomy. Therefore, the objective of this study is to provide evidence on the optimal route of hysterectomy in terms of cost-effectiveness by way of a three-armed randomized control study between non-descent vaginal hysterectomy, total laparoscopic hysterectomy and total abdominal hysterectomy. METHODS: A multicentre three-armed randomized control trial is being conducted at the professorial gynaecology unit of the North Colombo Teaching Hospital, Ragama, Sri Lanka and gynaecology unit of the District General Hospital, Mannar, Sri Lanka. The study population is women needing hysterectomy for non-malignant uterine causes. Patients with a uterus > 14 weeks, previous pelvic surgery, those requiring incontinence surgery or pelvic floor surgery, any medical illness which caution/contraindicate laparoscopic surgery and who cannot read and write will be excluded. The main exposure variable is non-descent vaginal hysterectomy and total laparoscopic hysterectomy. The control group will be patients undergoing total abdominal hysterectomy. The primary outcome is time to recover following surgery, which is the earliest time to resume all of the usual activities done prior to surgery. In total, 147 patients (49 per arm) are needed to have 80% power at α-0.01 considering a loss to follow-up of 20% to detect a 7-day difference between the three routes; TLH versus TAH versus NDVH. The economic evaluation will take a societal perspective and will include direct costs in relation to allocation of healthcare resources and indirect costs which are borne by the patient. A micro-costing approach will be adopted to calculate direct costs from the time of presentation to the gynaecology clinic up to 6 months after surgery. Incremental cost-effectiveness ratios (ICER) will be obtained by calculating the incremental costs divided by the incremental effects (time to recover and QALYs gained) for the intervention groups (NDVH and TLH) over the standard care (TAH) group. DISCUSSION: The cost of the procedure, quality of life and pelvic organ function following the three main routes of hysterectomy are important to clinicians and healthcare providers, both in developed and developing countries.
Decaying Hardwood Associated Fungi Showing Signatures of Polyethylene Degradation
(BioResources, 2021) Perera, P.; Deraniyagala, A.S.; Mahawaththagea, M.P.S.; Herath, H.; Rajapakse, C.S.K.; Wijesinghe, P.; Attanayake, R.N.
The involvement of wood decay fungi and the importance of their enzymes in polyethylene degradation is well documented. Therefore, decay-resistant hardwood associated fungi should be better degraders with their versatile enzymatic systems. In the current study, decaying hardwood associated fungi were isolated and their ability to degrade low-density polyethylene (LDPE) was assessed. Thirty-three isolates were identified by sequencing the internal transcribed spacer region of nuclear ribosomal DNA. Randomly selected isolates were tested for laccase producing abilities. Three species were selected to test their potentials in LDPE sheet degradation. Fungi were incubated in Czapek-Dox broth containing 20-micron LDPE sheets at room temperature for 60 days. The biodegradation signatures were assessed by analyzing the changes in structural characteristics of LDPE using Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), percent reduction of tensile properties, and weight loss. FTIR analysis revealed changes in certain functional groups compared with the control, indicating chemical changes resulting from the treatment. LDPE sheets incubated with fungi showed cracks and holes under SEM analysis, percent reduction in tensile properties, and weight loss, which are the signatures of degradation. This study revealed that the hardwood decaying basidiomycetes, Phlebiopsis flavidoalba, Schizophyllum commune, and Phanerodontia chrysosporium have the potential for in vitro LDPE degradation.
Emergency obstetric hysterectomy
(Taylor and Francis Group, 2021) Padumadasa, S.; Wijesinghe, P.
No abstract available
A Fatal case of dissecting aortic root aneurysm due to undiagnosed Marfan syndrome in the puerperium
(Sri Lanka College of Obstetricians and Gynaecologists, 2012) Nishad, A.A.N.; Herath, R.; Silva, G.R.C.; Mohamed, R.; Wijesinghe, P.; Padumadasa, S.; Premawardhena, A.; Premaratna, R.
Aortic dissection in pregnancy is a lethal cardiovascular complication in women with Marfan syndrome. The course of the treatment would be decided upon by the size of aortic root dilation. We report a case where the unawareness of the diagnosis of Marfan syndrome antenatally led to disastrous post partum consequences even after an uneventful childbirth.
Induction of labor in women over 35 years: How does it affect the outcome?
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Tiran, D.; Janitha, G.; Chaya, H.; Padumadasa, S.; Wijesinghe, P.
OBJECTIVE: Compare fetal and labor outcomes following induction of labor in singleton pregnant women over 35 years (>35) with women between 20 to 30 years (20-30) METHOD: This was a retrospective study carried out at North Colombo Teaching Hospital using North Colombo Obstetric Database (NORCOD) between March 2014 and May 2016. Two hundred and ninety six singleton pregnancies that underwent induction of labor were included. Women had been categorized into two groups based on their age. They were 20-30 years (2030) and above 35 years (>35). Two groups were matched against their booking visit body mass index. Labor and fetal outcomes of each group were assessed. RESULT: Lower segment Caesarean section (LSCS) rates observed in 20-30 and >35 groups were 16.2% (N=24) and 17.6% (N=26) respectively (P>0.05). Newborns of induced pregnancies of 20-30 mothers had an APGAR <7 at 5min in 1.4% (N=2) and 2.7% (N=4) babies of women >35 had an APGAR <7 at 5 min (P>0.05). Induced pregnancies of 20-30 mothers reported 16.2% (N=24) NICU admissions and >35 years group had 20.3% (N=30) NICU admissions (P>0.05). CONCLUSION: There is no significant difference between the two groups in terms of LSCS rates, low 5 min APGAR and NICU admissions.
Induction of labor in women over 35 years: How does it affect the outcome?
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Dias, T.D.; Janitha, G.; Chaya, H.; Padumadasa, S.; Wijesinghe, P.
OBJECTIVE: Compare fetal and labor outcomes following induction of labor in singleton pregnant women over 35 years (>35) with women between 20 to 30 years (20-30) METHOD: This was a retrospective study carried out at North Colombo Teaching Hospital using North Colombo Obstetric Database (NORCOD) between March 2014 and May 2016. Two hundred and ninety six singleton pregnancies that underwent induction of labor were included. Women had been categorized into two groups based on their age. They were 20-30 years (20- 30) and above 35 years (>35). Two groups were matched against their booking visit body mass index. Labor and fetal outcomes of each group were assessed. RESULTS: Lower segment Caesarean section (LSCS) rates observed in 20-30 and >35 groups were 16.2% (N=24) and 17.6% (N=26) respectively (P>0.05). Newborns of induced pregnancies of 20-30 mothers had an APGAR <7 at 5min in 1.4% (N=2) and 2.7% (N=4) babies of women >35 had an APGAR <7 at 5 min (P>0.05). Induced pregnancies of 20-30 mothers reported 16.2% (N=24) NICU admissions and >35 years group had 20.3% (N=30) NICU admissions (P>0.05). CONCLUSION: There is no significant difference between the two groups in terms of LSCS rates, low 5 min APGAR and NICU admissions.
Leiomyomatosis peritonealis disseminata presenting as an acute abdomen
(Sri Lanka Medical Association, 1997) Wijesinghe, P.
No abstract available
Presence of very small embryonic like stem cells (VSEL) in human semen; A novel finding
(Wijebandara N. R. Y.; Dissanayake D. M. A. B.; Wijesinghe P. (2022), Presence of very small embryonic like stem cells (VSEL) in human semen; A novel finding, 22nd International Postgraduate Research Conference, Faculty of Graduate Studies, University of Kelaniya Sri Lanka. 21., 2022) Wijebandara, N. R. Y.; Dissanayake, D. M. A. B.; Wijesinghe, P.
The presence of a very small, quiescent, and pluripotent population of stem cells termed as VSELs was first reported in 2006. Those cells are observed in various organs in the body including bone marrow, peripheral blood, endometrium, ovary, and testis so on. But their existence in seminal plasma has not been reported so far. To find out whether VSELs are present in human semen samples and, if so, study their characteristics and relationship with semen parameters. Semen samples were collected from sub fertile men and analyzed according to WHO guidelines. VSELs in seminal plasma were detected using Giemsa stain. The presence of cells with primitive germ cell properties was confirmed by GPR 125 expression and alkaline phosphatase activity. Very small (2-6 μm) and round cells population with a large nucleus and narrow rim of cytoplasm was observed in all semen samples. The mean (SEM) concentration of VSELs was 17.21 (4.42) m/ml. Two distinct populations of cells were identified according to their color intensity; VSEL dark and pale, 53% and 47% respectively. VSEL count was significantly high in oligozoospermic samples compared to samples with normal sperm count, 22.71 (5.89) vs 6.22 (1.81), p < 0.05. There was a positive correlation between VSEL and immature germ cells (r = 0.759, p < 0.001). Minor percentage of sub-populations positive for alkaline phosphatase activity (6.06 %) and expressing GPR 125 (5.56 %) were also observed. To the best of our knowledge this is the first report on the presence of VSELs in semen samples. Sub-population of cells with primitive germ cell properties would be a good source of stem cells for future studies on in vitro spermatogenesis.
The relationship between university library usage and educational performance in University of Kelaniya
(Department of Economics, University of Kelaniya, 2015) Wijesinghe, P.; Dilanga, N.; Samudrika, H.; Lasanthi, C.; Medya, N.
University libraries all over the world provide an excellent service for their users. Therefore it’s important to find out the relationship between the library usage and educational performance. Several studies have claimed that usage of library affects educational performance in a positive way. A questionnaire based survey was conducted to measure the relationship between university library usage and educational performance. Hence this study was mainly undertaken to explore the impact of library usage on undergraduate’s GPA. The questionnaires were distributed among 160 undergraduates using cluster sampling method. Responses received from the survey were turned into data that could be analyzed. The result of the study reveals that there is a positive relationship between university library usage and educational performance.
Should male doctors in Sri Lanka wear a necktie to be recognized and respected?
(Open Learning on Enteric Pathogens, 2019) Abeysundara, P.K.; Nishad, N.; Balendran, K.; Pabasara, M.; Bandara, P.K.; Perera, N.M.; de Silva, H.; de Silva, S.; Umakanth, M.; Wijesinghe, P.
INTRODUCTION: European cultural norms have influenced physicians' attire in Sri Lanka. The necktie is one such item of clothing which is worn to be recognized and respected as professionals. This study was carried out to assess the perceptions of doctors and patients towards male doctors wearing neckties while providing patient care. METHODOLOGY: A descriptive cross-sectional study was carried out at the National Hospital of Sri Lanka. An interviewer-administered questionnaire was used to collect data from doctors and patients. RESULTS: The study included 105 doctors (57% males) and 333 patients (54% males). Mean ages of the doctors and patients were 37 years (95% C.I. 36-39) and 47 years (95% C.I. 45-49) respectively. Sixty-nine percent of the patients had completed secondary education or above. None of the patients were aware of the risk of spreading infections by wearing a necktie. Of the 41% of doctors who thought it was unnecessary to wear a necktie, 95% believed the necktie can spread infections. Ninety-five percent of patients believed doctors should wear neckties to be identified and respected and to maintain trustworthiness.CONCLUSIONS: None of the patients were aware of the possible risk of spreading infections by wearing a necktie, while most of the doctors who thought neckties were unnecessary also believed neckties can spread infections. Almost all patients thought that doctors should wear a necktie to be recognized and respected. Therefore, implementing a change in dress policy for doctors is a challenging task in Sri Lanka. KEYWORDS: doctors; hospital infections; neckties.
Term versus preterm induction of labor: Does it change the outcome?
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Dias, T.; Gunasena, J.; Herath, R.; Pieris, V.; Wijesinghe, P.
ABSTRACT: Induction of labour is important to timely deliver the fetus and minimize adverse perinatal outcomes to both the mother and the neonate. Therefore, comparison of the outcomes following induction of labour at term and preterm is invaluable to assess its benefits and detriments. OBJECTIVE: Compare fetal and labour outcomes following induction of preterm and term singleton pregnancies. METHOD:This was a retrospective studycarried out at North Colombo Teaching Hospital using North Colombo Obstetric Database (NORCOD) between March 2014 and May 2016. Six hundred and one singleton pregnancies that underwent induction of labour were included. Timing of induction of labor was categorized intopreterm labor induction (<38 weeks) and term labour induction (38-42 weeks). Vaginal delivery rate and neonatal outcomes were compared.RESULTS: Out of 601 cases 18.5% (N=111) were induced preterm and 81.5% (N=490) were induced at term. Vaginal delivery rates between the two groups were 71.2% (N=79) and 78.6% (N=385) (P>0.05). Preterm induced deliveries had an APGAR <7 at 5 minutes in 3 babies (2.7%) and six term babies(1.2%) had an APGAR <7 at 5 minutes (P>0.05). Preterm induced pregnancies reported 28.8% (N=32) NICU admissions and term induced pregnancies had 14.9% (N=73) NICU admissions (P<0.05). CONCLUSION: There’s no significant difference in LSCS rates and low 5 min APGAR among two groups. However preterm induction significantly increases NICU admission of the newborn, which is expected due to the complications associated with prematurity of the newborn.
Term versus preterm induction of labor: Does it change the outcome?
(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Dias, T.; Gunasena, J.; Pieris, V.; Herath, R.; Wijesinghe, P.
ABSTRACT: Induction of labour is important to timely deliver the fetus and minimize adverse perinatal outcomes to both the mother and the neonate. Therefore, comparison of the outcomes following induction of labour at term and preterm is invaluable to assess its benefits and detriments. OBJECTIVE: Compare fetal and labour outcomes following induction of preterm and term singleton pregnancies. METHOD: This was a retrospective studycarried out at North Colombo Teaching Hospital using North Colombo Obstetric Database (NORCOD) between March 2014 and May 2016. Six hundred and one singleton pregnancies that underwent induction of labour were included. Timing of induction of labor was categorized intopreterm labor induction (<38 weeks) and term labour induction (38-42 weeks). Vaginal delivery rate and neonatal outcomes were compared. RESULTS: Out of 601 cases 18.5% (N=111) were induced preterm and 81.5% (N=490) were induced at term. Vaginal delivery rates between the two groups were 71.2% (N=79) and 78.6% (N=385) (P>0.05). Preterm induced deliveries had an APGAR <7 at 5 minutes in 3 babies (2.7%) and six term babies(1.2%) had an APGAR <7 at 5 minutes (P>0.05). Preterm induced pregnancies reported 28.8% (N=32) NICU admissions and term induced pregnancies had 14.9% (N=73) NICU admissions (P<0.05). CONCLUSION: There’s no significant difference in LSCS rates and low 5 min APGAR among two groups. However preterm induction significantly increases NICU admission of the newborn, which is expected due to the complications associated with prematurity of the newborn.
Umbilical cord prolapse
(Taylor and Francis Group, 2021) Padumadasa, S.; Wijesinghe, P.
No abstract available
Uterine devascularization
(Taylor and Francis Group, 2021) Padumadasa, S.; Wijesinghe, P.
No abstract available
Vaginal, sexual and urinary symptoms following Hysterectomy: A Multi-centre randomized controlled trial.
(BioMed Central, 2020) Ekanayake, C.; Pathmeswaran, A.; Herath, R.; Wijesinghe, P.
BACKGROUND: Hysterectomy is the most common major gynaecological procedure. The aim of this study was to study vaginal, sexual and urinary symptoms following total abdominal hysterectomy (TAH), non-descent vaginal hysterectomy (NDVH) and total laparoscopic hysterectomy (TLH) in a low resource setting. METHODS: A multi-centre randomized controlled trial (RCT) was conducted in two public sector hospitals in Sri Lanka. Participants were patients requiring hysterectomy for non-malignant uterine causes. Exclusion criteria were uterus> 14 weeks, previous pelvic surgery, medical illnesses which contraindicated laparoscopic surgery, and those requiring incontinence surgery or pelvic floor surgery.Vaginal, sexual function and urinary symptoms were assessed by the validated translations of ICIQ-VS and ICIQ-FLUTS questionnaires. Post-operative improvement (pre-operative - post-operative) was assessed. RESULTS: There was an improvement (median (IQ1-IQ3) in vaginal symptoms [TAH 6(2-8) vs 4(0-8), p < 0.001; NDVH 6(4-8.5) vs 5(0-8), p < 0.001; TLH 4(2-10.5) vs 4(0-10), p < 0.001], urinary flow symptoms [TAH 2(1-4) vs 1 (0-3), p < 0.001; NDVH 3 (2-5) vs 2 (0.5-4), p < 0.001; TLH 1(1-4) vs 1(0-3), p < 0.05], urinary voiding symptoms [TAH 0(0-0) vs 0(0-0), p = 0.20; NDVH 0(0-1) vs 0(0-0.8), p < 0.05; TLH 0(0-0) vs 0(0-0), p < 0.05] and urinary incontinence symptoms [TAH 0(0-2) vs 0(0-2), p = 0.06; NDVH 0(0-3) vs 0(0-3), p < 0.001; TLH 0(0-3) vs 0(0-2), p < 0.05] at 1-year (TAH n = 47, NDVH n = 45, TLH n = 47). There was an improvement in sexual symptoms only in the TLH group [TAH 0(0-11.5) vs 0(0-14), p = 0.08); NDVH 0(0-0) vs 0(0-0), p = 0.46; TLH 0(0-0) vs 0(0-4), p < 0.05].There was no significant difference among the three different routes in terms of vaginal symptoms score [TAH 2 (0-2), NDVH 0 (0-2), TLH 0 (0-2), p = 0.33], sexual symptoms [TAH 0 (0-0), NDVH 0 (0-0), TLH 0 (0-0), p = 0.52], urinary flow symptoms [TAH 0 (0-1), NDVH 0 (0-1), TLH 0 (0-2), p = 0.56], urinary voiding symptoms [TAH 0 (0-0), NDVH 0 (0-0), TLH 0 (0-0), p = 0.64] and urinary incontinence symptoms [TAH 0 (0-0), NDVH 0 (0-1), TLH 0 (0-1), p = 0.35] at 1-year. CONCLUSIONS: There was a post-operative improvement in vaginal symptoms and urinary symptoms in all three groups. There was no significant difference in pelvic organ symptoms between the three routes; TAH, NDVH and TLH. TRIAL REGISTRATION: Sri Lanka clinical trials registry, SLCTR/2016/020 and the International Clinical Trials Registry Platform, U1111-1194-8422, on 26 July 2016. Available from: http://slctr.lk/trials/515. KEYWORDS: Non-descent vaginal hysterectomy; Randomized controlled trial; Sexual symptoms; Total abdominal hysterectomy; Total laparoscopic hysterectomy; Urinary symptoms; Vaginal symptoms.