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 Ultrasound parameters of pelvic organs and their age-related changes in a cohort of asymptomatic postmenopausal women: A community-based study.(Sage Publishing, 2020) Dias, T.D.; Palihawadana, T.S.; Patabendige, M.; Motha, M.B.; de Silva, H.J.No abstract available.Item Factors associated with nonresponse to ovulation induction using letrozole among women with World Health Organization group II anovulation(Medknow Publications, 2015) Palihawadana, T.S.; Wijesinghe, P.S.; Seneviratne, H.R.CONTEXT: Letrozole, a third generation aromatase inhibitor is gaining importance in ovulation induction. Some prefer to use it as a second line agent in women who fail to respond to clomifene citrate. However, our knowledge about the predictors of response to letrozole is limited. AIMS: The study was aimed at identifying the factors associated with letrozole resistance among women with World Health Organization (WHO) group II anovulation. SUBJECTS AND METHODS: Study was conducted at the infertility clinic at a tertiary care hospital in Sri Lanka. A case–control study design was used and included 50 subjects with WHO group II anovulation (25 clomifene responsive and 25 clomifene resistant). After a treatment cycle of letrozole, the factors were compared between the subjects who responded and those who failed to respond to treatment. RESULTS: Ovulation was achieved in 76% (n = 19) of subjects who had responded to clomifene previously and in 24% (n = 6) with clomifene resistance. The factors associated with letrozole resistance included the presence of hirsutism (odds ratio [OR]: 3.89; 95% confidence interval [CI]: 1.2–12.3) and clomifene resistance (OR: 10.03; 95% CI: 2.81–35.7). The early follicular phase mean (standard deviation) luteinizing hormone level was significantly higher among the nonresponders (9.75 [4.78] – 7.28 [2.3]; P = 0.02). Nonresponders showed significantly lower levels of oestradiol on the 5th and 9th days (28.50 [3.39] pg/mL vs. 7.49 [3.62] pg/mL; P = 0.0007 and 142.04 [76.22] pg/mL vs. 28.10 [12.8] pg/mL; P = 0.0001) of the menstrual cycle, respectively. CONCLUSIONS: The features associated with resistance to Letrozole at a dose of 2.5 mg show some overlap with those associated with clomifene resistance. However, some features do not show similar association. The effectiveness of letrozole at a dose of 2.5 mg in induction of ovulation among women with clomifene resistance is low and it does not seem to be a suitable treatment at a dose of 2.5 mg for this indication.Item Recurrent pregnancy loss and thrombophilia.(Sri Lanka Medical Association, 2014) Motha, M.B.C.; Palihawadana, T.S.; Perry, D.J.No Abstract availableItem Aetiology of infertility among females seeking treatment at a tertiary care hospital in Sri Lanka(Sri Lanka Medical Association, 2012) Palihawadana, T.S.; Wijesinghe, P.S.; Seneviratne, H.R.OBJECTIVES: Aim of this study was to describe the proportion of contributory factors of female infertility in a population that sought fertility treatment. Furthermore, the clinical findings and underlying pathologies associated with ovulatory dysfunction were also sought. METHODS: A cross-sectional study was carried out at the infertility clinic of the North Colombo Teaching Hospital. New clinic attendees were recruited and both partners had a detailed clinical interview. The women underwent a baseline pelvic ultrasound scan, assessment of ovulation and a hormone profile. Tests for tubal patency were carried out when clinically indicated. RESULTS: Ovulatory dysfunction was noted in 53% (n=218). Clinical and investigatory findings associated with ovulatory dysfunction included irregular menstrual cycles, acanthosis nigricans, hirsutism, polycystic ovary syndrome, a LH:FSH ratio of >1, and increased TSH or testosterone levels. Unilateral tubal occlusion was seen in 9.1 % (n=18) while it was bilateral in 1% (n=2). Abnormalities in sexual function were noted in 10.8% (n=56). CONCLUSIONS: Abnormalities in ovulation were common. Clinical findings that could be used to recognise women at risk of ovulatory dysfunction were identified. Abnormalities in sexual function, which are often overlooked in the clinical management of infertility, were seen in over 10% of patients. Tubal factor infertility is rare.Item A Trial of expectant management in incomplete miscarriage(Sri Lanka Medical Association, 2011) Wijesinghe, P.S.; Padumadasa, G.S.; Palihawadana, T.S.; Marleen, F.S.INTRODUCTION Incomplete miscarriage is often treated with surgical evacuation in Sri Lanka. Expectant management, which is an alternative treatment, was assessed for efficacy and safety in a local setting. METHODS Randomised clinical trial of two treatment groups of expectant and surgical management with 71 and 69 participants, respectively, was done at the University Gynaecology Unit of the Colombo North Teaching Hospital, Ragama, from December 2007 to July 2009. Women with incomplete miscarriage at a period of amenorrhoea of <14 weeks and retained products of conception of <50mm were included. Expectant management involved in-ward treatment till resolution of heavy bleeding and pain and follow up for two weeks. In surgical treatment, evacuation was undertaken and the patient sent home from hospital after bleeding settled with follow up. The maximum anteroposterior diameter of the endometrial cavity was measured with transvaginal ultrasonography and a diameter <15mm was considered as complete miscarriage. RESULTS Expectant management had a treatment success of 90.1% at one week and 94.4% at two weeks. For surgical treatment this was 95.7%. Infection was noted in one subject from the surgical group and none in the expectant group. Fall in the haemoglobin concentration in the two groups was clinically not significant. The expectantly managed group had a shorter hospital stay than the surgically managed group (1.58 vs 2.57 days, p=0.008). CONCLUSIONS Expectant management is an effective and safe alternative to surgical evacuation in management of incomplete miscarriage in the local setting. It relieves the burden on the healthcare provider by shortening the hospital stay and avoiding the need for evacuation of retained products of conception under anaesthesia.Item Chlamidia trachomatis infection in an infertile population, a cross sectional study(Sri Lanka College of Obstetricians and Gynaecologists, 2010) Palihawadana, T.S.; Dissanayake, D.M.A.B.; Harshanie, A.; Wijesinghe, P.S.INTRODUCTION: Chlamydia trachomatis is sexually transmitted and causes infection of the genital tract that leads to many long term complications. Invasive procedures in infected infertile females increase the risk of ascending infection and long term consequences. Though infertile individuals are considered a high risk population prevalence data for our population is not available. Furthermore, the use of risk factor identification in diagnosis is not well established. This study was planned to determine the prevalence of Chlamydia infection and to describe the socio-economic clinical characteristics that are associated with the presence of infection among a patient population who sought treatment for infertility at a tertiary care facility. METHOD: A cross sectional study was carried out among patients who sought infertility treatment at the infertility clinic of Colombo North Teaching Hospital, Ragama. Two hundred married couples were included in the study. The socio-economic data and any symptoms suggestive of genital infections were collected and Chlamydia trachoma tis infection was diagnosed with a rapid antigen test using a commercial test kit. Intracervical swabs of the female and first void urine samples of the male were used. Data analysis was done to describe the prevalence of Chlamydia infection in each partner as well as to identify the number of couples where either partner was affected. Associations with recognized risk factors were identified. RESULTS: Presence of symptoms was low in the males while one third of female subjects had one or more symptoms. The Chlamydia test revealed 12(6%) female and 6(3%) male study participants to be positive for current disease. These study participants were from 15 couples giving a prevalence rate of either partner being positive in 7.5% of couples. Of the risk factors identified the duration of marriage or infertility, education level, household income, alcohol use and smoking by the male, and presence of symptoms did not demonstrate a significant association with the presence of the disease. Partners staying away from each other were significantly associated with a positive result. CONCLUSION: There is 7.5% disease prevalence among infertile couples seeking treatment. Risk assessment and clinical symptoms have a limited value in identification of affected couples. Couples living separately have a high risk of Chlamydia infection. The high disease prevalence warrants either screening or empirical treatment of all infertile female patients undergoing invasive procedures.Item A Study to access the prevalence of zinc abnormalities and the effect of zinc on semen parameters in subfertile population(Faculty of Allied Health Sciences, University of Peradeniya, 2009) Dissanayake, D.M.A.B.; Palihawadana, T.S.; Herath, H.M.R.P.; Wimalasena, S.; Ratnasooriya, W.D.; Wijesinghe, P.S.OBJECTIVE: To study the relationship between serum zinc levels and semen quality in a subfertile population. STUDY DESIGN: Study was carried out as a cross sectional prospective study at the Infertility unit, Department of Obstetrics and Gynaecology, Faculty of medicine, Ragama. SUBJECTS AND METHODS: One hundred and fifty two male partners of couples who were seeking fertility treatment were recruited after excluding possible confounding factors. A semen sample and a blood sample were obtained from each subject. Semen samples were analyzed according to WHO guidelines and serum level of zinc was estimated using flame atomic absorption spectrometry. Mean daily intake of zinc was assessed by 24 hour dietary recall method. RESULTS: There were twenty one males (13.8 %) with serum zinc deficiency and seven (4.6 %) with serum zinc levels above the normal reference value. The mean serum zinc levels were not significantly different between normal and abnormal groups of individual seminal parameters There was no significant difference of zinc levels between normozoospermics and pathozoospermics, 0.92 Ilg/ml (SD 0.37) vs. 1.01 Ilg/ml (SD 0.35), P = 0.136. There was a weak positive correlation between serum zinc levels and seminal pH (r = 0.167, P < 0.039), but not between zinc levels and other semen parameters. The mean daily zinc intake in the study population was 13.67 mg (SD 1.55). There were no correlations between zinc intake and social aspects (income or educational level) or serum zinc levels. CONCLUSION: Prevalence of serum zinc abnormalities in this population was 18.4 %. There was no significant effect of serum zinc on the quality of semen. Assessment of serum zinc levels may have no advantage in evaluating male fertility.Item Effects of different Zinc levels in the sperm culture medium on sperm recovery and quality of sperms in the swims up procedure for sperm processing(University of Colombo, 2006) Dissanayake, D.M.A.B.; Wijesinghe, P.S.; Rathnasooriya, W.D.; Wimalasena, S.; Palihawadana, T.S.A controlled in vitro study was carried out to observe the effect of different Zinc (Zn) levels on sperm recovery rate, chromosome integrity, cell membrane integrity and motility in the swim up procedure. Semen samples were obtained from males who underwent seminal fluid analysis at the Infertility Laboratory, Department of Obstetrics and Gynaecology, Faculty of Medicine, Ragama. Twenty normozoospermicm samples were randomly selected for the study and each sample was processed with supplemented Earl's Balanced Salt Solution (EBSS) containing different concentrations of Zn [0.5ml of supplemented EBSS with 25μ1 of solution containing 0.6μmol (group 1) and 1.2 μmol (group 2) of Zn respectively]. One aliquot processed with 25 μl of physiological saline with added EBSS served as the control. Pre and post wash sperm counts and motility were recorded immediately after processing. Post wash sperms from the three groups were observed for chromosome integrity, cell membrane integrity, and motility. Motility changes after four hours of incubation were also observed. The mean sperm concentration showed an increase in group 1 compared to the control sample l21.87 ± 21.61 (SD) millions/ml compared to 18.34 ± 19.73 millions/ml, P<0.05] whereas a reduction was observed in group 2 [16.25 ± 17.73 (SD) millions/ml compared to 18.34 ± 19.73 millions/ml, P>0.05]. The mean differences in sperm concentration compared to the control showed statistically significant differences in both groups where an increase was observed in group 1 [3.52 ± 4.96 (SD) millions/ml] and a reduction in group 2 (- 2.08 ±6.59 millions/ml). The mean differences in sperm recovery rate showed significant differences in group 1 [8.97 ± 14.04 (SD) millions/ml] and group 2 (-4.85 ± 17.92 millions/ml) compared to the control. It was an increase in group 1 and a reduction in the sperm recovery rate in group 2. A significant reduction in mean sperm motility was observed in group 2 [67.33% ± 18.52 (SD) vs. 91.00% ± 9.60, P<0.05] after four hours of incubation. Though a reduction was observed in group 1 it was not statistically significant (83.33% ± 8.72 vs. 93.60% ± 5.01, P>0.05). The motility reduction was significantly greater in group 2 compared to group 1 (26.01% ± 20.24 vs. 10.97% ± -8.35, P<0.05). Chromosome integrity and cell membrane integrity of sperms were not affected by different Zn levels. In conclusion, low levels of Zn in the sperm processing medium (EBSS) have a beneficial effect on sperm recovery in the swim up procedure.Item 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.Item Peritoneal tuberculosis mimicking malignancy(Sri Lanka College of Obstetricians and Gynaecologists, 2004) Rodrigo, S.N.K.; Palihawadana, T.S.