Journal/Magazine Articles
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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
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Item Validation of the international consultation on incontinence questionnaire-vaginal symptoms (ICIQ-VS) in two South- Asian languages(Springer, 2017) Ekanayake, C.D.; Pathmeswaran, A.; Herath, R.P.; Perera, H.S.; Patabendige, M.; Wijesinghe, P.S.INTRODUCTION: The multifaceted nature of pelvic floor disorders means that a systematic evaluation is required for optimal treatment outcome. It is also generally acknowledged that a valid tool is necessary to objectively assess symptoms reported by affected women. METHODS: The International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) questionnaire was translated to Sinhala and Tamil and a validation study carried out among women attending gynecology clinics at North Colombo Teaching Hospital, Ragama, and the district general hospitals Mannar and Vavuniya. RESULTS: Content validity was assessed by the level of missing answers, which was < 4% and 2% for each item in Sinhala and Tamil, respectively. Construct validity was assessed by the ability of the questionnaire to differentiate between patients and controls. Both differentiated patients from controls on vaginal symptoms score (VSS) (p < 0.001), sexual symptoms score (SSS) (p < 0.01), and quality of life (QoL) (p < 0.001). There was a strong positive correlation between Pelvic Organ Prolapse Quantification (POP-Q) scores and VSS (Sinhala r s = 0.64, p < 0.001, Tamil r s = 0.65, p < 0.001), and QoL (Sinhala r s = 0.49, p < 0.001, Tamil r s = 0.60, p < 0.001). Internal consistency as assessed using Cronbach's coefficient alpha: 0.78 (0.76-0.78) and 0.83 (0.80-0.84) in Sinhala and Tamil, respectively. Test-retest reliability was assessed by weighted kappa scores (Sinhala 0.58-0.88 and Tamil 0.76-0.90). Both questionnaires were sensitive to change and showed that VSS and QoL improved following surgery (Wilcoxon matched-pairs signed-rank test p < 0.001). CONCLUSION: The validated Sinhala and Tamil translations of ICIQ-VS will be useful for assessing vaginal and sexual symptoms among women speaking Sinhala and Tamil.Item Diagnostic and therapeutic dilemmas of cervical ectopic pregnancy(Williams and Wilkins, 2014) Hosni, M.M.; Herath, R.P.; Mumtaz, R.IMPORTANCE: Cervical pregnancy is a rare variety of ectopic pregnancy. The etiology is obscure. Its diagnosis may be difficult, and its management has enormously changed during the last 10 years. Unfortunately, the most effective, fertility-sparing treatment is still unclear until now. OBJECTIVES: The aim of this study was to explore the safety and efficacy of different treatment modalities of cervical pregnancy. Evidence Acquisition: A comprehensive systematic review of the literature was performed using the electronic databases MEDLINE and PubMed, using key words cervical, ectopic, and pregnancy, between January 2005 and June 2013. We included all case reports and case series reporting on cervical ectopic pregnancy. RESULTS: A total of 252 cases of cervical ectopic pregnancy were analyzed. Eighty-eight cases (34.9%) had medical treatment, 69 cases (27.5%) had surgical treatment, and 95 cases (37.6%) had combined medical and surgical treatment. Various conservative treatment regimens have been introduced to preserve fertility in young women, with methotrexate being one of the most widely used and effective drugs. CONCLUSIONS and Relevance: A high index of suspicion, combined with meticulous review of clinical and radiological findings, is essential to make an accurate diagnosis of cervical pregnancy. The success of conservative treatment depends mainly on early diagnosis. Such cases would be best managed at specialist tertiary referral centers and preferably, where available, Early Pregnancy Assessment Units, whether medical, surgical, or combined treatment modalities were attempted. Target Audience: Obstetricians, gynecologists, family physicians Learning Objectives: After participating in this activity, physicians should be better able to identify the most likely predisposing factors for cervical ectopic pregnancy, appraise different modalities of treatment, and apply the selection criteria for conservative management of cervical ectopic pregnancy. © 2014 by Lippincott Williams & Wilkins.Item Methylene Blue induced bluish discoloration mimicking cyanosis, at diagnostic laparoscopy(International Publisher of Science, Technology and Medicine, 2014) Herath, R.P.; Warnakulasuriya, T.; de Silva, A.; Wijesinghe, P.S.BACKGROUND: Methylene blue is commonly used to check patency of Fallopian tubes and tracking fistulae. Intraversation of methylene blue is a recognized complication of diagnostic laparoscopy and dye test. Although a case of cyanosis due to methaemoglobinaemia following methylene blue use is a known complication, cyanosis without methaemoglobinaemia is unknown. CASE PRESENTATION: A 31 year old healthy female, being investigated for primary subfertility for 3 years underwent a diagnostic laparoscopy for evaluation of her fallopian tubes under general anaesthesia. Methylene blue 20 ml was injected to see the patency of the tubes. The patient became centrally cyanosed soon after dye ingestion. Her oxygen saturation dropped to 10% whilst her partial pressure of oxygen remained normal. CONCLUSION: Bluish discoloration of the body can occur in the absence of methaemoglobinaemia in patients undergoing laparoscopy following dye ingestion for evaluation of fallopian tubes using methylene blue. Recognizing this complication will help in avoiding unnecessary intervention to the patient. CASE PRESENTATION: A 31 year old healthy female, being investigated for primary subfertility for 3 years underwent a diagnostic laparoscopy for evaluation of her fallopian tubes under general anaesthesia. Methylene blue 20 ml was injected to see the patency of the tubes. The patient became centrally cyanosed soon after dye ingestion. Her oxygen saturation dropped to 10% whilst her partial pressure of oxygen remained normal.Item A Qualitative study on patients' perceptions of expectant management of first trimester incomplete miscarriage(Sri Lanka Medical Association, 2012) Wijesinghe, P.S.; Herath, R.P.; Abeysundara, I.D.H.P.K.INTRODUCTION Efficacy and safety of expectant management of first trimester miscarriage are well known, though the patients’ perceptions and attitudes are less clear. This study was designed to understand the women’s perception of symptoms, acceptability, fertility wishes and care received. METHODS A qualitative study among 25 women who were allocated to the expectant management arm of a randomised control trial, which compared expectant versus surgical management of incomplete miscarriage, was carried out. Interviews were recorded at the end of two weeks from the initial diagnosis based on five themes, which were transcribed and analysed. RESULTS Out of the 25 interviewed, two had to undergo surgical evacuation due to failed expectant management. Excessive bleeding was the main concern especially for employed women. Ideas and beliefs of family members influenced the women’s experience. Majority preferred expectant management in a possible future event. Many expected to conceive again but preferred to delay a pregnancy even in the absence of any contraindications. Inadequate knowledge of expectant management led to dissatisfaction regarding the care received. CONCLUSIONS Better understanding on the natural course of events in spontaneous miscarriage will help not only the patient but also the relatives in accepting expectant management of first trimester miscarriage and influence their ideas, beliefs and feelings. Improved health education, counselling, and symptomatic relief are important aspects in improving the overall quality of care.Item Hyperemesis gravidarum and fetal gender: a retrospective study(Informa Healthcare, 2012) Rashid, M.; Rashid, M.H.; Malik, F.; Herath, R.P.This retrospective study of 9,980 women who delivered at the James Paget Hospital, Norfolk, UK, over 5 years, aimed to primarily determine whether the incidence of hyperemesis gravidarum (HG) is higher in the presence of a female fetus. The results showed that more women with HG had a femalefetus compared with women without HG. Also found was that heavy ketonuria was more prevalent in women with a female fetus compared with women with a male fetus, and the mean number of admissions per woman was also higher in women with a female fetus compared with women with a male fetus. It can be concluded that women presenting with HG are more likely to have a female fetus and that women with HG and a female fetustend to a higher level of ketonuria and an increased number of hospital admissions.Item Chronic nonpuerperal uterine inversion: laparotomy assisted vaginal hysterectomy(Alkim Basin Yayin Ltd. Sti, 2011) Herath, R.P.; Hosni M.M.; Rashid, M.; Hassanaien, M.Chronic nonpuerperal uterine inversion is an extremely rare clinical situation. We report a 36 year-old woman with chronic nonpuerperal uterine inversion due to a fundal leiomyoma. She was treated with laparotomy assisted vaginal hysterectomy. We emphasized the importance of abdominal access at the time of vaginal hysterectomy for complete inversion of uterus. After excluding possible bowel loops in the inverted uterus through abdominal incision, vaginal subtotal hysterectomy was performed followed by total hysterectomy. In addition to better surgical exposure, abdominal approach also helped management hemorrhage as in our caseItem How can we reduce negative laparoscopies for pelvic pain?(Informa Healthcare, 2011) Singh, N.; Rashid, M.; Herath, R.P.Chronic pelvic pain is a common condition and the RCOG guideline provides an evidence-based framework for the initial assessment. This study investigated the adequacy and relevance of the initial assessment in patients who underwent elective laparoscopic procedure for pelvic pain. History-taking was found to be deficient and was unable to identify factors which may be related to the cause or perception of the pain. Only a small percentage benefitted from a therapeutic trial of hormonal and non-hormonal agents and referral to other specialities. Ultrasound and bimanual examination were both found to be of little value. Laparoscopy assisted in diagnosis in 45% of patients. A structured initial assessment and targeted selection of patients for laparoscopy would reduce the number of patients with normal findings and thus, it would reduce the number of women who suffer pain and isolation after a negative laparoscopy.Item Laparoscopic management of genital prolapse(Springer International, 2011) Mahran, M.A.; Herath, R.P.; Sayed, A.T.; Oligbo, N.INTRODUCTION: Genital prolapse is one of the most common indications for gynaecological surgery. Surgery is performed traditionally via abdominal, vaginal and laparoscopic approaches. METHODS: A MEDLINE computer search was performed to explore the recent evidence behind laparoscopic surgery for female pelvic organ prolapse. RESULTS: Advances in minimal access surgery have led to an increase in adoption of laparoscopic techniques. Current evidence supports the use of laparoscopy for sacrocolpopexy and colposuspension as an alternative to open surgery. However, the introduction of less invasive midurethral sling procedures for stress incontinence has reserved laparoscopic colposuspension for special indications. The scientific evidence regarding uterosacral suspension procedures and paravaginal and vaginal prolapse repairs are sparse. CONCLUSION: The current evidence supports the outcome of laparoscopic sacrocolpopexy as an alternative to open surgery. Further studies are required on the long-term efficiency in laparoscopic paravaginal repair and vaginal wall prolapse.Item Management of morbidly adherent placenta(Sri Lanka College of Obstetricians and Gynaecologists, 2011) Herath, R.P.; Wijesinghe, P.S.Morbidly adherent placenta is a rare complication of human placentation that may threaten maternal life due to massive haemorrhage. Its incidence is increasing due to the rising caesarean section rates worldwide. A high degree of clinical suspicion coupled with ultrasonography, magnetic resonance imaging, and cystoscopy helps in antenatal diagnosis. Elective caesarean hysterectomy with a multidisciplinary approach is the conventional treatment for confirmed cases of morbidly adherent placenta. However more conservative fertility saving approaches are also used successfully.Item Antenatal uterine rupture in a pregnancy following microwave endometrial ablation(Informa Healthcare, 2011) Herath, R.P.; Singh, N.; Oligbo, N.No abstract available