Conference Papers

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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine

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Effect of music on blood pressure in healthy young men
(Faculty of Medicine, University of Peradeniya, Sri lanka, 1994) de Silva, A.P.; de Silva, H.J.; Fonseka, C.
It is widely believed that listening (.0 music quietly is relaxing and therefore tends to reduce blood pressure (BP). To test this hypothesis we performed a cress-over study in 30 healthy Sinhalese male volunteers (non-smokers) aged between 23 and 25 years. None ol" them, were on any medication and all were requested not to consume coffee or a similar beverage for at least two hours prior to the test. Each individual rested silting for five minutes before the ex¬periment, and then listened to light classical music of his choice while sitting quietly for 30 minutes. BP was measured before and after listening to music. He was then allowed to engage in normal activities for one hour and the experiment was repeated, this time without music, where the person just sat quietly for 30 minutes in the same room. The systolic and diastolic BP differences were recorded for each person. Subjects were not allowed to fall asleep during the experiment and all experiments were performed between 1 and 4 pm to reduce the possible effect, if any, of diurnal variation in BP. There was no difference in diastolic BP either with or without music. Systolic BP dropped by a mean of 8 rnm (range 4-10) when listening to music and by a mean of 7 mm (range4-10) when sitting quietly without music (P>0.5, Mann-Witney U test). We conclude that listening to light music by itself does not reduce BP signifi¬cantly in normal individuals. Any reduction that occurs is probably a result of the subject sitting quietly while listening to the music.
Hepatitis B virus markers in primary hepatocellular carcinoma
(Faculty of Medicine, University of Peradeniya, Sri lanka, 1994) de Silva, H.J.; Ratnatunga, N.; Ramadasa, S.
Based on serological studies, Sri Lanka has a relatively low Hepatitis B virus (HB V) [hepatitis B surface antigen (HBsAg)] carrier rate of 0.9% and a low prevalence of HBV (5-10%) among patients with primary hepatocellular carcinoma (PHC). To investigate this further we looked for HBV markers in PHC using more sensitive immunoliistochemical methods. Formalin fixed paraffin embedded tissue obtained from 18 PHCs were studied. Only 7 of the specimens contained non-tumour liver tis¬sue around the PHC, and evidence of cirrhosis was seen in 5 of them. Four micron thick sections of tissue were stained, with polyclonai antibod¬ies directed against HBsAg and hepatitis B core antigen (HBcAg) using a three stage immunoperoxidase technique (peroxidase-anti peroxidase). Positive control liver tissue was used in all experiments. HBsAg was detected in6(33.3%)of the 18 specimens (in the tumour tissue only in 3 speci¬mens, tumour tissue and surrounding cirrhotic liver tissue in 1. and surrounding cirrhotic liver tissue only and not in tumour tissue in 2 speci¬mens). The staining was cytoplasrnic. HBcAg was not detected in any of the tissue specimens tested. Nodatareg;irding serum alphafetoprotein levels were available from the patients medical records. From the preliminary results of this on going study, HBsAg markers appear to be more frequently associated with PHC than serological studies from Sri Lanka have indicated. HBV may, therefore, have arnore important aetiologi-cal role in PHC in this country than was previ¬ously believed.
Stroke subtypes in Sri Lanka
(Sri Lanka Medical Association, 1997) Gunatilake, S.B.; Premawardhena, A.
AIM: Data on stroke subtypes in Sri Lanka are limited. This is due to the unavailability of brain imaging facilities in most government hospitals in the country. In two leading private hospitals in Colombo, a high proportion of stroke patients are subjected to computerised tomography (CT) scanning. Therefore it was decide to study the stroke patients admitted to these two hospitals to determine the stroke subtypes METHODS: A prospective study of 103 consecutive first -ever stroke patients who were under the eare of the first author during the period 15lhMay 1995 lo30th August 1996 were studied. Diagnosis of stroke was made according to the WI10 definition. Transient ischaemic attacks (TIA) were not included in the study. The pathological subtype was confirmed by CT scan in 99 patients RESULTS: The age of the patients ranged from 37 to 94 years (mean 65y). 87 patients were over the age of 50 years. The proportion of pathological subtypes confirmed by CT scanning was cerebral infarction (CI) 74%, intracerebral haemorrhage (ICH) 19% and subarachnoid haemorrhage (SAII) 6%. Of the 74 infarcts 31 (23%) were cortical, 30 (22%) were lacunar, 12(9%) were cerebellar and brains tern and 1 (0.7%) was a border zone infarct, In-hospilal mortality was 19% for all strokes: 14% for infarcts and 35% for haemorrhages. Mortality was lowest in (he lacunar stroke group (3%). In the cortical infarct group the mortality was 16%, in the ICH group 22% and in the SAM group 50%. CONCLUSION: Direct comparisons with stroke subtypes seen in other countries are not possible due to differences in methodology. In developed countries in the West cerebral infarcs account for about 80% of alI first-ever strokes and of these 13 to 21% are lacunar strokes. Countries in the East like Japan and Hongkong have reported higher proportion of haemorrhages; 27% of first-ever strokes in Hong Kong. In Sri Lanka The proportion of stroke subtypes seem to be intermediate between these countries from die west and east. Lacunar .stroke .seem to be commoner in Sri Lanka than in other countries. These differences may be because of differences in risk factors prevalent in our country.
The Recto-Anal Inhibitory Reflex (RAIR): abnormal response in diabetics suggests an intrinsic neuro-enteropathy
(BMJ Publishing, 1997) Deen, K.I.; Premaratna, R.; Fonseka, M.M.D.; de Silva, H.J.
INTRODUCTION: The recto-anal inhibitory reflex (RAIR) is characterized by reflex relaxation of the anal canal in response to electrical stimulation of the rectal mucosa, and is mediated by nitrergic neural plexuses within the gut wall. Impairment of this reflex may lead to incontinence. AIM: To measure anal canal pressures, anal mucosal electrosensation and RAIR in diabetic patients and correlate these measurements with incontinence for gas or faeces. METHODS: Anal canal pressure, RAIR and continence was evaluated in 30 diabetic patients [Male:Female=13:17, median age 57 years (range 37- 70)], and these data were compared with similar data obatained from 22 age and sex matched 'healthy' controls [Male:Female= 9:13, median age 51 years (range 19 - 65 )]. Median duration of diabetes was 8 years (range 3 -30 ). 12 (40%) of the 30 diabetics had impaired continence for gas (n=12) and liquid faeces (n=3). None ofthe controls had incontinence. RESULTS: Maximum resting anal canal pressure (MRP) was [median (range)]: Patients 30mmHg (20-75) vs. Controls 40mmHg (20-105), P=0.61. Maximum squeeze pressure (MSP) [median (range)]: Patients 65mmHg (30- 150) vs. Controls 84mmHg (35-230), P=0.59. Threshold rectal mucosal eletrosensation (RMES-T) [median (range)]: Patients 27 mA (5-40) vs. Controls l3mA (5-28), P=0.03. Maximum tolerable rectal mucosal electrosensation [median (range)]: Patients 40 mA (20-60) vs. Controls 20 mA (10-30), P=0.042 (all comparisons using Wilcoxon rank test). RAIR was present in 8, abnormal in 5 (1 with incontinence), and absent in 17 (II with incontinence) diabetics while it was present in 18 and abnormal in 4 controls (test of proportion, P=0.03 I). CONCLUSIONS: RAIR was impaired in significantly more patients with diabetes than controls implying impairment of intrinsic neuronal function. All diabetic patients with incontinence had impaired or absent RAIR. Impairment of this reflex may be a useful predictor of incontinence in diabetics.
Psychometric analysis and emotional state in the irritable bowel syndrome (ibs)
(Sri Lanka Medical Association, 1997) Kuruppuarachchi, K.A.L.A.; Deen, K.I.
INTRODUCTION: Data are lacking on psychometric scores and the emotional state in Sri Lankan patients with the irritable bowel syndrome. AIM: To evaluate patients with IBS using a Hospital Anxiety Depression (I IAD) scale and to assess the accuracy of clinical prediction of the emotional state by a non psychia¬trist clinician. METHODS: Data from 30 patients (20 male, median age - 27 years, range 20 - 50) with IBS titling me manning criteria were compared with 44 age and sex matched controls without IBS. Anxiety rating (median, range) was : Patients 11 (5-17) versus Controls 6 (1-17); P<0.05. Depression rating was : Palients 7 (2 -14 ) versus Controls 5 (0-16) P>0.05, Wilcoxon lest. Prediction of emotional state in patients with IBS correlated well with HAD scores in 17 (56%), was inaccurate in 6 (20%) and equivocal in 7 (24%). All patients in whom clinical prediction of emotional state was inaccurate had combined high anxiety and depression scores. CONCLUSION: Sri Lankan patients with IBS have greater prevalence of anxiety state disorders compared with controls. Clinical prediction of the emotional state by an untrained physician was inaccurate. The HAD scale may be of value in clinical decision making for patients with the irritable bowel syndrome associated with emotional state disorders.
New bone formation in fractured head of the femur. A study using the scanning electron microscope
(Sri Lanka Medical Association, 1997) Jayasinghe, J.A.P.
INTRODUCTION: In senile osteoporosis, thinning and loss of irabeculae in tlie proximal end of ilie lemur leads to hip fractures. New bone formation in ihe form of thickening of remaining irabeculae and microcallus formation around stressed and cracked trabeculae has been demonstrated to occur both before and after fractures. I lowever, formation of an effective trabecular architecture to compensate for lost bone lias not been demonstrated to date. OBJECTIVE: To assess new bone formation in head of Jhe femur associated with hip fracture. METHOD: Femoral heads removed from 22 patients (15 fe¬males 8 males aged from 58 to 82 years) were fro/en and cut into 4 mm thick sections. Macerated specimens were made superficially anorganic by treating them with 1 lydro-gen Peroxide; coated with Platinum and examined under a Scanning Electron M icroscope. RESULTS: Microcallus formation on irabeculae showing different morphological appearance was evident in most specimens. Evidence of bone remodelling was observed on surfaces of these calluses. Irregular deposition of mineral nodules was seen on the fracture face of five specimens indicating that they may have been deposited after the fracture has occurred. The presence of growing trabecular patterns made up of woven bone from ihe remaining irabeculae was observed in six specimens; a phenomenon hitherto not described. Their morphology suggested dial they have been growing before the fracture has occurred. CONCLUSION: The findings suggest a reparalory mechanism resulting in growth of new interconnected trabcculae occurring prior to tlie fracture in a femoral head consequent to bone thinning in senile osteoporosis
Altered pelvic floor physiology in women with uterovaginal prolapse (UVP)
(Sri Lanka Medical Association, 1997) Deen, K.I.; Gunasekara, P.C.
INTRODUCTION: Although an association between Uterovaginal prolapse (UVP) and urinary incontinence is known, the prevalence of anoreetal dysfunction in UVP remains largely unexplored. AIM: To evaluate the prevalence of u re ih roves Seal and anorectal dysfunction in UVP. METHODS: 27 women (median age - 52 years, range 31 - 68 years) with UVP were evaluated by functional and anoreetal physiologic assessment. Data were compared with 20 age matched controls without UVP. Urethrovesical fimcfion was assessed by a 5 point functional score (micturitition frequency, nociuria, urgency, stress incontinence and residual sensation of urine), where 0- no dysfunction, 1,2-minimal, 3,4 - moderate and 5 implied severe dysfunction. Anoredal function was evaluated by clinical assessment and anoreetal physiology. Anal canal pressures were measured by microballoon manomelry. RESULTS : Moderate to severe urethrovesical dysfunction was seen in 33% of patients compared with none of (lie control group (P = 0.052, test of proportions). Anorectal mucosal prolapse was seen in 63% of patients compared with 13% of controls (p = 0.045, test of proportions). Maximum resting (MRP) and squeeze anal pressures (MSP) did not differ significantly between patients and controls. MRP [median, (range)] - Patients; 51 mm Hg (20 - 87) vs. Controls; 60mm 1 Ig (25 - 80), P>0.05; MSP [median, (range)] - Patients; 82 mm Hg (39 - 165) vs. Controls; 100mm Ilg (60 - 185, p>0.05, Wiieoxon test. However, the length of Hie high pressure zone (I IPZ) was significantly less in patients compared with controls (111*2 I cm - Patients = 56% vs. IIPZ 1cm - Controls = 10%, P=0.038, test of proportions). Abnormal anal electroscnsilivity (> 14 inAmps) was seen in 52% of patients compared with none in the control group (P=0.024) and abnormal vaginal electrosensation (> 12mAmps) in 55% of patients vs. 10% Of controls (P = 0.031), test of proportions. CONCLUSION: A greater proportion of women with UVP exhibited either urethrovcssical or anoreetal dysfunction or both compared with controls indicating a pan-pelvic floor weakness. Theses abnormalities should be considered in overall management of women with UVP
The recto-anal inhibitory reflex (rair): abnormal response in diabetics suggests an intrinsic neuro-enteropathy
(Sri Lanka Medical Association, 1997) Deen, K.I.; Premaratna, R.; Fonseka, M.M.D.; de Silva, H.J.
INTRODUCTION: The recto-anal inhihilory reflex (RAIR) is characterized by reflex relaxation of die anal canal in response to electrical stimulation of the rectaJ mucosa, and is mediated by nitrergic neural plexuses within the wall. Im-painnent of this reflex may lead lo incontinence. AIM: To measure anal canal pressures, anal mueosal electrosensation and RAIR in diabetic patients and corre¬late these measurements with incontinence for gas or faeces. METHODS: Anal canal pressure, RAIR and continence was evaluated in 30 diabetic patients [Male : Female = 13:17, median age 57 years (range 37 - 70) ], and these data were compared with similar data obtained from 22 age and sex matched 'healthy' controls [Male:Female = 9:13,age51 years (range 19-65)]. Median duration of diabetes was 8 years(rangc 3-30). 12 (40%) of Uic 30 diabetes had impaired continence for gas (n = 12) and liquid faeces (n =3). None oi'the controls had incontinence. RESULTS : Maximum resting anal canal pressure (MRP) was [median (range)]: Patients 30 mml Ig (20 -75) vs. Controls 40mmHg (20-105). P=0.61. Maximum squeeze pressure (MSP) [median (range)] : Patients 65 mmllg (30-150) vs. Controls 84mmHg (35 -230), P = 0.59. Threshold rectal mueosal elec(rosensation (RMES-T) [median(range)]: Patients 27 mA (5-40) vs. Controls 13mA (5-28), P = 0.03. Maximum tolerable rectal mueosal electrosensation [median(rangc)]: Patients 40mA (20-60) vs. Controls 20mA (10-30), P=0.042 (all comparisons using Wiicoxon rank test). RAIR was present in 8, abnormal in 5 (1 with inconti¬nence), and absent in 17 (11 with incontinence) diabetics while it was present in 18 and abnormal in 4 controls (testof proportion, P = 0.031). CONCLUSIONS: RAIR was impaired in significantly more patients with diabetes than controls implying impairment of intrinsic neuronal function. All diabetic patients with incontinence had impaired or absent RAIR. Impairment of this reflex may be a useful predictor of incontinence in diabetics.
Utrastructural changes of foetal surface of the placenta in hypertensive disorders of pregnancy
(Sri Lanka Medical Association, 1997) Salgado, S.; Angunawala, P.; de Tissera, A.
OBJECTIVES : The pathogenesis of pregnancy induced hypertension and its relationship to pathological and ullrastructural changes of the placenta has not been adequately understood We studied placenta! (issue from foetal side to show whether there are any significant ullrastructural changes. This area of the placenta has not been studied previously. METHODS: Placenial tissue from 15 pregnant mothers with a persistent blixxi pressure of 140/90 or more, and 10 normal mothers who had normal full term deliveries were studied. Fresh placentae were examined macroscopically. 2mm sized section were taken from (lie central, foetal surface and fixed in 2% gluteraldehyde lor electron microscopic studies. RESULTS: 9 months had pregnancy induced hypertension without proteinuria, 3 had hypertension and proteinuria and oilier 3 had essential hypertension. All hypertensive placenta showed increased number of cytotrophoblast cells. Syncytiotrophoblast cells of the hypertensive placenta showed Jess number of lipoid droplets, compared to the controls. Syncliotrophoblast cells of the test group also showed short, blunt and swollen microvilli. All hypertensive placentae except one, showed thickened, laminated and irregular subirophoblasu'c basement membranes and increased amount of interestitial collagen in the villous stroma CONCLUSIONS: In electron microscopic study of normal and hypertensive placentae revealed that the placentas of hypertensive disoalers pregnancy is associated with increased number of cytotrophoblast cells, thickening of subtrophoblastic basement membrane, abnormal microvilli, and increased amunt on interestitial collagen
Anatomy of the gall bladder in Sri Lankan population : a warning to the laparoscopic surgeon.
(Sri Lanka Medical Association, 1998) Samarasekera, D.N.; Welgama, U.
INTRODUCTION : Minimally invasive surgery has advanced rapidly to involve resection of almost all abdominal organs. Out of all these procedures, laparoscopic cholccystectomy has become the operation of choice for the removel of gall bladder and has stood the test of time. AIM : Since we started laparoscopic cholecystectomy procedure in our unit, this study was designed to document the possible variations that we may encounter in the Sri Lankan population. MATERIAL AND METHODS : Seventy five fresh non selected adult cadavers (within 24 hours of death) were dissected, Exclusion criteria were those with crush injuries to the liver and previous hcpato-biliary surgery. Findings were documented according to a standard proforma. FINDINGS : Normal anatomy was seen in 22 ( 29.3%) bodies. Documented abnormalities given in the text books were seen in 45 (60% ). Eight (10.6%) new abnormalities were detected in our study GB - 0, cystic duct - 5, cystic artery - 7). CONCLUSIONS : Altogether nearly seventy percent of the cadavers showed developmental anomalies. Therefore a thorough knowledge of all these anomalies is essential for the surgeon performing laparoscopic cholecystectomy to avoid iatrogenic injury.
Prolapsed haemorrhoids and anorectal manometry - do haemorrhoids prolapse due to reduction in the anorectal pressures ?
(Sri Lanka Medical Association, 1998) Samarasekera, D.N.; Suraweera, P.H.R.
Abstract Available
Sapheno-peritoneal shunting for treatment of resistant ascites
(Sri Lanka Medical Association, 1998) Deen, K.I.; Jayakody, M.; de Silva, A.P.; Bodhipakse, S.; de Silva, H.J.
INTRODUCTION: Prosthetic peritoneovenous shunts are useful to manage resistant ascites due to portal hypertension. However, they are expensive and not widely available. AIM : To assess the efficacy to direct sapheno-peritoneal shunting (SPS) in the treatment of resistant ascites due to portal hypertension. SETTING : University Medical and Surgical Units, Colombo North General Hospital. METHODS : Six male alcoholic cirrhotics (age range 39-68 years) with ascites resistant to diuretics and paracentesis were offered this procedure. Two had evidence of early encephalopathy. SPS was performed under general anaesthesia in 5 and spinal anaesthesia in one. Procedure consisted of division of the saphenous vein 5-6 cms distal to the saphenofemoral junction and connecting the proximal cut end to the peritoneal reflexion above the inguinal ligament. RESULTS : There was no surgical mortality. Control of ascites was considered satisfactory in 5 of the 6 patients (reduction in discomfort, abdominal girth, diuretic requirement and no further paracentesis necessary). The Childs grade improved in 3 of the 6 patients and remained unchanged in 3. One patient required repeated paracentesis, developed severe hepatic encephalopathy and died three months after surgery. Wound infection was seen in 3 patients and a temporary peritoneal fluid leak was seen in another 3. At the time of discharge from hospital Doppler ultrasound showed that the shunt was patent and EEC showed no evidence of encephalopathy in any-patient. CONCLUSION : Although our numbers are small, in the short-term, SPS appears to be useful and relatively safe for control of resistant ascites. It is appropriate for poor countries as an alternative to prosthetic shunts.
Interaction between pericytes and endothelial cell of foetal capillaries in hypertensive placentae
(Sri Lanka Medical Association, 1998) Salgado, S.; Angunawela, P.; Sirisena, J.; de Tissera, A.
INTRODUCTION : Pericytes and endothelial cells are known to possess direct contacts in many parts of the vascular tree. Pericytes are known to have modulating effects on endothelial cell growth and differentiation. It is possible that some pericytes are a source of new endothelial cell. OBJECTIVES : Information regarding the ultrastructural changes of foetal capillaries of hypertensive placentae is lacking. Therefore we studied the foetal capillaries of hypertensive placentae to ascertain any significant ultrastructural interaction between pericytes. endothelial cells and basement membrane. METHOD : Placental tissue from 15 pregnant mothers with a blood pressure of 140/90 or more and 10 normal mothers who had normal full term deliveries were studied. Fresh placentae were examined and 2mm sized pieces were taken from central foetal and fixed in 2% gluteraldehyde for eletron microscopic studies. RESULTS : All hypertensive placentae showed a number of pericytic processes, which was significantly higher than in normal placentae. (P<0.001). Both frequency and complexity of direct connections between endothelial cells and pericytes appear to be increased in foetal capi 1 laries of hypertensive placentae . Basement membranes of foetal capillaries in 9 hypertensive placentae showed marked thickening. CONCLUSIONS : There was complexed interaction between endothelial cells and pericytes of foetal capillaries of hypertensive placentae.
Electrogastrographic observations in healthy adults
(Sri Lanka Medical Association, 1998) Ferdinandis, T.G.H.C.; Dissanayake, A.S.; de Silva, H.J.
INTRODUCTION : Electrogastrography (EGG) is a recently developed non invasive technique of recording gastric myoelectrical activity. Normal values of EGG parameters are yet to be clearly defined. There are suggestions that the values may vary due to factors such as gender and ethnicity. AIM : To determine normal values for several EGG parameters in healthy Sri - Lankan volunteers in the fasting and fed state, and we also hypothesized that, there are significant differences in these between the two sexes. METHOD : EGG was performed in 17 healthy volunteers, 8 males(age 21 -60 yr.) and 9 females(age 24 - 46 yr.) in the follicular phase for one hour each in the fasting and the fed states. Result were analyzed using the statistical package Epilnfo. RESULTS : The mean gastric electrical frequency was 2.65 + 0.67 cpm in the fasting and 2.69 + 0.75 in the fed state. The dominant frequency was in the 2 -4 cpm range in 15 (88.2%) subjects in the fasting and in 14(87.5%) in the fed state respectively. These differences were not statistically significant. Feeding caused an increase in the power of the dominant frequency by 19 - 4600 uV2 in 12(75%) subjects. The above results did not differ significantly between the two sexes. CONCLUSIONS : The dominant gastric electrical frequency in Sri Lankans was consistent with previously reported data from other countries. Increase in EGG power after a solid meal was confirmed by the study. Although a gender difference in EGG parameters has been reported previously, our reports failed to demonstrate such a difference.
Established, emerging and potential parasitic zoonoses in Sri Lanka
(Elsevier, 1998) Abeyewickreme, W.; Wijesundara, M.; Weerasooriya, M.M.V.; Naotunna, T. de S.; de Silva, N.R.; Ismail, M.M.; Dissanaike, A.S.
Microbiology of hand towels on surgical wards.
(Sri Lanka Medical Association, 1998) Deen, K.I.; Welgama, V.; Perera, C.
INTRODUCTION : Frequent ablution followed by hand drying is recommended in surgical wards as prophylaxis against cross infection. It is recommended that hands are dried using " clean" towels. Aim : This study was designed to evaluate the microbiological flora of towels routinely used for hand drying in surgical wards at General Hospital Ragama. METHODS : Fifteen towels which were in use from 15 wards visited on a single occasion were sampled using a sterile microbiological swab (one swab per towel). Each towel was sampled on both sides and at 20-24 randomly chosen sites. Four laundered towels were also sampled in a similar manner prior to use in the wards. Specimens were transported in brain heart infusion and plated on culture media within 2 hours. RESULTS : All towels used in the wards compared with none of the laundered towels revealed either mild or moderate growth of micro-organisms, (test of proportions P -0.00025 Organisms isolated number of towels were Acinetobacter species (10 ). Enterococcus species (14), Bacillus species (5) , Klcbsiella species (2), Staphylococcus aureus (2) and Escherichia coli species in one towel. Only one towel appeared clean. Fourteen appeared stained and visibly dirty to the naked eye. All 15 towels were damp. All control towels appeared clean and dry. CONCLUSION : All towels sampled in this study were found to harbour micro-organisms. This may contribute to cross infections on surgical wards. We believe, hand wiping using towels is unsafe-and suitable alternative methods should be sought.
Extrathymic T cells in human malaria patients
(Elsevier, 1998) Watanabe, W.; Weerasinghe, A.; Miyaji, C.; Sekikawa, H.; de Silva, N.R.; Gunawardena, S.; Ratnayake, H.; Kobayashi, J.; Thoma, H.; Sato, Y.; Abo, T.
Effect of mebendazole threapy in pregnancy on birth outcome
(Sri Lanka Medical Association, 1998) de Silva, N.; Sirisena, J.; Gunasekera, D.; de Silva, J.
OBJECTIVES : A prospective, unmatched, case-control study was done to assess the safety of mebendazole threapy in pregnancy, a hitherto uninvestigated factor. DESIGN : All women delivering in the University Obstetrics Unit of the Ragama Teaching Hospital between May 1996 and, March 1997 were administered a questionnaire soon after delivery. Details of the birth and the baby were recorded; suspected defects were confirmed by a paediatrician. The incidence of congenital defects in babies of mothers who had taken mebendazole during the pregnancy was compared with the incidence among those who had not taken an anthelmintic (controls). Data analysis was done using Epi Info 6.03. RESULTS : Of 3688 women, 73.5% had taken mebendazole, 24.8% had not taken any any anthelmintic , 1.1% had taken an anthelmintic but could not identify it and 0.6% had taken pyrantel or albedazole. The incidence of birth defects was 2.36% {64/2711) in the mebendazole group compared with 2.3% (21/913) in the controls (odds ratio 1.03, 95% confidence limits 0.61 - 1.75). This difference was not statistically significant even when corrected for other known risk factors by stratified analysis . Data regarding timing of mebendazole threapy was available for 2660 women; 6.9% in the first trimester, 83.8% in the second, and 9.2% in the third. The incidence of birth defects among women who had taken mebendazole in the first trimester was 3.24% (6/185). giving an odds ratio of 1.42 against the controls; this was also not statistically significant.CONCLUSIONS : The use of mebendazole in pregnancy does not lead to a significant increase in the risk of congenital defects.
A prospective study on deliberate self harm
(Sri Lanka Medical Association, 1998) Kuruppuarachchi, K.A.L.A.; Rajakaruna, R.R.; Dassanayake, H.; Ratnayake, J.A.W.S.; Gunawardana, W.P.M.; Fernando, P.L.N.
INTRODUCTION : Suicide and deliberate self harm [DSH) in Sri Lanka have caused considerable concern due to its dramatic increase over the past few iecades. In global terms Sri Lanka has the highest -ate of suicide amongst females while its second lighest in males. The research work done with regard ,o DSH still appears to be inadequate. OBJECTIVES : To identify the demographical pattern )f DSH; nature of the attempt & methods used, mderlying psychopathology, awareness of helping igencies amongst the patients. METHOD : All patients (91) with DSH refered to the 'sychiatric Unit G.H Ragama within a period of one 'ear from October 1996 were included. ICD 10 riteria was used in the assessment. RESULTS : 53/91 were females. Age distribution 20yrs -21/91; 20-3Oyrs 38/91; 31-40yrs 17/91, 41-Oyrs 10/91; 51-60yrs 2/91; 61-70yrs 3/91. 47/91 /ere single; 42/91 married; 2/91 divorced. 18/91 grochemical poisoning ; 26/91 overdosing, 25/91 ther methods (kerosine oil, oleander etc.) 22/91 sed violent methods. Amongst impulsive acts 19/91) 6 were under the influence of alcohol. 42/91 ad mental illness; 19 affective disodcrs; 12 :hizophrenia; 2 Delusional disorder ; 4 :hizoaffective disorder; 1 mental retardation; 1 bsessive compulsive disorder; 3 psychoactive jbstance abuse. 59/91 wished to be alive; 17/91 'ished to be dead; 15/91 indifferent, 34/91 were ware of helping agencies. CONCLUSIONS : Females outnumbered the males and le commonest age distribution was between 21-)yrs. Overdosing was the commonest method used hile affective disorder was the main sychopathology amongst the mentally ill. An iteresting observation was that only a minority were rare of helping agencies and its worthwhile iproving the awareness of helping agencies nongst the people.
Closure of the peritoneum during vaginal hysterectomy and repair (VH & R)
(Sri Lanka Medical Association, 1998) Wijesinghe, P.S.; Gunasekera, P.C.
INTRODUCTION : Standard VH & R involves closure of the peritoneum with a purse string suture. Potential benefits are prevention of Fallopian tube prolapse, prolapse of intestines, vault prolapse and recurrence of the cntcrocoele. However, damage to the ureters, blood vessels and intestines is possible with this method. OBJECTIVES : To assess the usefulness of a technique which does not involve closure of the peritoneum with a purse string suture. DESIGN :Case control study. Setting : The Professorial Gynaecology Unit of the North Colombo General Hospital, Ragama. MAIN OUTCOME MEASURES :Post operative febrile morbidity, vault haematoma and abscess formation, and prolapse of viscera. Follow up for recurrence of components of prolapse. RESULTS : Over a period of 15 months from June 1995, 115 women awaiting VH & R were randomly allocated to two groups viz. A and B. conventional VH & R was carried out in group A. In group B the peritoneum was not closed separately but the pedicles except the vascular one were tied together in the midline. In spite of prophylactic antibiotics 3 out of 56 in group A and 4 out of 59 in group B developed post operative fever which lasted more than 48 hours. The incidence of postoperative haematoma and abscess formation was not different between the two groups and there were no cases of fallopian tube prolapse or intestinal prolapse. Apart from two cases each of recurrent cystocoele in the two groups, there were no other relevant morbidity during the follow up of upto two years. CONCLUSION : In this series closure of the peritoneum during VH & R with a purse string suture does not appear to be of any extra benefit. This step can be safely omitted during this procedure without adding to morbidity.