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 Ultrastructure of endothelial cells of fetal capillaries of placentae of women with pregnancy induced hypertention(University of Colombo, 2006) Salgado, S. S.; Angunawela, P.; de Tissera, A.; Sirisena, J.The present study aimed to compare the ultra structural features of endothelial cells of fetal terminal capillaries of placentae from hypertensive (n=10) and non-hypertensive (n=10) pregnancies. The ultrastructural features of endothelial cells of terminal capillaries from the fetal surface of each placenta were examined under the electron microscope. Micrographs of 8 different endothelial cells from each placenta were prepared for evaluation by stereological analysis using a coherent double lattice test system. The volume fractions of different organelles and cytosol in endothelial cells of placental fetal capillaries of both hypertensive and non-hypertensive pregnancies were deter¬mined by counting the number of grid intersection points falling on the endothelial cell cytoplasm, mitochondria, rough endoplasmic reticulum and glycogen deposits. Ultrastructural changes were noted in endothelial cells of capillaries of placentae of mothers with pregnancy induced hypertension. Statistical analysis showed that the volume fractions of the organelles and the amount of cytoplasm of endothelial cells of placentae from hypertensive pregnancies were significantly higher than those from non-hypertensive pregnanciesThere was a significant increase in some of the organelles and the capacity of cytoplasm of endothelial cells of placentae from hypertensive pregnancies when compared to normotensive pregnancies. These findings may be attributed to compensatory mechanisms operating as a response to hypoxia caused by reduced maternal blood flow to the placenta.Item Villous syncytial knots in hypertensive placenta(Sri Lanka College of Obstetricians and Gynaecologists, 2004) Salgado, S. S.; Angunawela, P.; de Tissera, A.; Sirisena, J.Syncytial knots are seen on many terminal villi of all mature placentae. Syncytial knots in more than 30 percent of mature terminal villi, is considered as an indication of postmaturity. The aim of this study was to find out whether there is significant increase in syncytial knot formation in pre-eclampsia and to assess the relationship between syncytial knot formation and maternal age, parity, and period of gestation and effects of syncytial knots on the birthweight, and apgar score of the newborn. The study sample consisted of 150 normal and 200 hypertensive mothers. Light microscopic studies were done on sections taken from fetal surface of their placentae. Hundred terminal villi in fetal subdivisions of each placenta were counted and the number of villi with syncytial knots was recorded. Multivariate analysis was done to find out the difference between the number of placentae with high syncytial knot counts in normal and hypertensive groups and the relationship between high syncytial knot counts and the maternal age, parity, period of gestation and birthweight, head circumference and apgar score of the newborn. Statistically significant increase of syncytial knot counts was seen in hypertensive group than the normal group. There was no relationship between syncytial knot formation and maternal age and parity. In normal and hypertensive groups, an increase in the number of placentae with high syncytial counts was observed with increasing maturity. Although the number of placentae with high syncytial knot counts were higher in relation to low apgar score than the normal counts, difference was not statistically significant. A significant difference in the birth weight and the head circumference of newborns in relation to normal and high syncytial knot counts was observed in hypertensive group.Item How accurate is the postnatal estimation of gestational age?(Oxford University Press, 2002) Karunasekera, K.A.W.; Sirisena, J.; Jayasinghe, J.A.C.T.; Perera, G.U.I.The aim of the present study was to determine the accuracy of postnatal gestational age assessment of babies using three different methods. Two hundred women attending the university obstetric unit of North Colombo Teaching Hospital, Ragama, Sri Lanka whose expected date of delivery (EDD) by early ultrasonography fell within a week of EDD by dates were included in the study. Postnatal assessment was performed within 24 h of birth. Two co-researchers performed Dubowitz and Parkin methods separately without prior knowledge of menstrual gestation. Data was analysed using EpiInfo 6 and SPSS packages. The mean difference between menstrual gestation and Dubowitz physical criteria was -0.45 weeks; between menstrual gestation and classical Dubowitz method, +2.18 weeks; and between menstrual gestation and Parkin's method, +0.34 weeks. It was concluded that postnatal assessment of gestational age by the Parkin's method is much closer to menstrual gestation than the classical Dubowitz method and is also easier and quicker to perform.Item Efficiency of Pipelle device in sampling endometrium(Wiley, 2000) Wagaarachchi, P. T.; Sirisena, J.No Abstract AvailableItem A Cautionary tale: intra amniotic injection of methylene blue(Sri Lanka Medical Association, 2000) Sirisena, J.; Lanerolle, S. D.No Abstract AvailableItem Effect of mebendazole therapy in pregnancy on birth outcome(Lancet Publishing Group, 1999) de Silva, N.R.; Sirisena, J.; Gunasekera, D.P.S.; Ismail, M.M.; de Silva, H.J.BACKGROUND: In areas endemic for hookworm, routine antenatal mebendazole therapy could greatly reduce the prevalence of anaemia in pregnancy. At present, however, this is not a widely accepted control strategy because of a lack of data on the safety of the drug. We assessed the effect of mebendazole therapy during pregnancy on birth outcome. METHODS: A cross-sectional study was done in Sri Lanka, where prescription of mebendazole to women in the second trimester of pregnancy is recommended. Two hospitals were chosen for the study, and women who gave birth there between May, 1996, and March, 1997, were recruited. We compared the rates of major congenital defects, stillbirth, perinatal death, and low birthweight (less or equal 1500 g) among babies of mothers who had taken mebendazole during pregnancy with those whose mothers had not taken an anthelmintic (controls). FINDINGS: The rate of major congenital defects was not significantly higher in the mebendazole group than in the control group (97 [1.8 percent] of 5275 vs 26 [1.5 percent] of 1737; odds ratio 1.24 [95 percent CI 0.8-1.91], p equal 0.39). Among 407 women who had taken mebendazole in the first trimester (contrary to medical advice), 10 (2.5 percent) had major congenital defects (odds ratio vs controls 1.66 [0.81-3.56], p equal 0.23). The proportions of stillbirths and perinatal deaths were significantly lower in the mebendazole group (1.9 vs 3.3 percent, 0.55 [95 percent CI 0.4-0.77]), as was the proportion of low-birthweight babies (1.1 vs 2.3 percent 0.47 [95 percent CI 0.32-0.71]). INTERPRETATION: Mebendazole therapy during pregnancy is not associated with a significant increase in major congenital defects, but our results indicate that it should be avoided during the first trimester. This therapy could offer beneficial effects to pregnant women in developing countries, where intestinal helminthiases are endemic.Item Spontaneous hepatic rupture in pregnancy(Sri Lanka Medical Association, 1998) Wijesinghe, P.S.; Gunasekera, P.C.; Sirisena, J.Spontaneous hepatic rupture in pregnancy is rare and associated with significant maternal morbidity and mortality. It has been reported in association with severe pregnancy-induced hypertension and HELP (haemolysis elevated liver enzymes low platelets) syndrome. New imaging techniques enable early diagnosis, and in those with subcapsular haematomas, conservative management. Surgical intervention is necessary in capsular rupture with haemodynamic instability. We here report three fatal cases and discuss the diagnosis and managementItem Time we increased folic acid consumption in Sri Lanka(Sri Lanka Medical Association, 1997) Gunasekera, P.C.; Chandrasena, L.G.; Gunasekera, D.P.; Sirisena, J.No Abstract AvailableItem Viral hepatitis during pregnancy(The Kandy Society of Medicine, 1995) de Silva, H.J.; Sirisena, J.Item Use of medicine as abortifacients(The Kandy Society of Medicine, 1994) Sirisena, J.SUMMARY: In Sri Lanka, abortion is illegal except in cases where the mothers life is in danger. Therefore, many women resort to illegal methods of abortion, including over-the-counter purchase of drugs to use as abortifacients. The objectives of this study were to determine the prevalence of use of medicines as abortifacients and to evaluate some aspects of this practice. All women who consulted the author at a private clinic requesting abortion between 1st September 1992 and 1st September 1993 were studied. Patients were interviewed using a questionnaire. Management consisted of counselling only and an abortion was not offered. Out of 201 women who requested abortion, 79(39.3%) had taken some from of drug as an abortifacient Of the women who had exposure to drugs four (5.1%) were notpregnant. Most (78.4%) of the prescriptions were given by qualified practitioners. Sixty eight(86.1%) were unaware or unable to name the drug they had been given. Sixty six (83.5%) belived that the drugs prescribed could act as abortifacients. The drugs were used at all stages of pregnancy, even upto 26 weeks of gestation, but most (84.8%) had used them before 12 weeks of gestation and only 7.6% used them at 16 weeks or later. The majority (64.6%) of women did not use any type of contraception at the cycle in which they got pregnant. Only 6 (7.6%) had used a reliable method of contraception. The hasty prescription of drugs to use as abortifacients will not allow time for counselling and jeopardise any chance of the women deciding to continue with the pregnancy. The use of drugs as abortifacients and their health consequences need further study in this country. But the only long-term solution to the problem of illegal abortion would be to introduce a safe, effective and inexpensive method of legal abortion.