Journal/Magazine Articles
Permanent URI for this collectionhttp://repository.kln.ac.lk/handle/123456789/13
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
Browse
11 results
Search Results
Item Clinical practice of vitamin D screening and supplementation in pregnancy in Asia-pacific countries: A cross-sectional study(Elsevier, 2023) Lee, R.W.K.; Chng, A.L.B.; Tan, K.H.; Shub. A.; Tan, T.; Ling, L.S.; Kuma, K.; Siew, C.Y.; Ting, W.; Myint, S.S.; Judistiani, R.T.D.; Shah, M.; Madulid-Sison, L.; Andres-Palencia, B.; Pagilagan-Palma, E.; Banu, L.A.; Boriboonhirunsarn, D.; Dias, T.D.BACKGROUND: Vitamin D deficiency is common in pregnant women. There is scarce information in the Asia-Pacific region on the understanding of vitamin D screening and supplementation in pregnancy among health care professionals. METHODS: We performed a cross-sectional study among health care professionals who are part of the Integrated Platform for Research in Advancing Metabolic Health outcomes of Women and Children (IPRMAHO) international study group on their understanding and perception of Vitamin D screening and supplementation in pregnancy. The cross-sectional survey comprised 4 main sections: demographics, existing policies, nutrient supplementation in pregnancy and various practices on screening, treatment and perceptions, with a total of 22 questions. A total of 15 responses were obtained from attendees from distinct health facilities across eleven participating Asia-Pacific countries. RESULTS: Majority of the surveyed hospitals (11/15, 78.6 %) did not have a national policy or regional guideline regarding Vitamin D screening and supplementation in pregnancy. More than half of respondents were (9/14, 64.3 %) were unsure of the percentage of women seen with Vitamin D deficiencies each year and were unsure of Vitamin D dosage prescribed to pregnant women with (8/15, 53.3 %) or without (6/14, 42.9 %) Vitamin D deficiency. Vitamin D was rarely prescribed in pregnancy when compared to other nutrient supplements such as folic acid and iron. Majority of respondents (9/11, 72.7 %) indicated that their hospital did not screen for Vitamin D deficiencies in pregnancy, even amongst high risk pregnant women. Nevertheless, majority of respondents indicated a need (12/15, 80.0 %) for a guideline or consensus regarding Vitamin D screening and supplementation in pregnancy. CONCLUSION: While majority of the surveyed hospitals did not have a national policy or regional guideline regarding Vitamin D screening and supplementation in pregnancy, majority of respondents indicated a need for the policy or guideline. There were varying clinical knowledge gaps and different perceptions on Vitamin D screening and supplementation in pregnancy among healthcare professionals.Item Upper gastro intestinal endoscopy in pregnancy: A single centre experience(Sri Lanka college of Obstetricians & Gynaecologists, 2023) Abeysuriya, V.; Dodampahala, H.S.; Chandrasena, L.INTRODCTION: Upper gastro intestinal (GI) endoscopy is advisable to perform when strongly indicated during pregnancy. This study was to evaluate the outcomes of upper GI endoscopy during pregnancy. METHODS: A single centre retrospective study was carried out. Randomly selected 500 medical records of the pregnant mothers who were referred as out patients and hospitalized from 2012 to 2022 were retrieved. Inclusion criteria for retrieving data of the patients who underwent upper GI endoscopy were; Major or continued bleeding, severe or refractory nausea and vomiting or abdominal pain, dysphagia or odynophagia. Endoscopic findings were recorded in a computer based database. Ethical approval was obtained from the Ethical Review Committee of Nawaloka Hospitals of Sri Lanka. No conflict of interest. RESULTS: A total of 16 records of patients underwent upper GI endoscopy were retrieved during 2012 to 2022. The mean age of the patients was 25.48 ± 6.5 years. Ten patients (62.5%:10/16) were primigravida. During the first, second and third trimester of pregnancy, number of patients who underwent upper GI endoscopy were 8 (50%), 4 (25%), and 4 (25%) respectively. The major indication was persistence epigastric pain (75%: 12/16) followed by dysphagia (18.7%:3/16) and hematemesis in one patient. All patients had undergone conservative treatment without any therapeutic upper GI endoscopy. There were no records that were found to have ERCP, capsular endoscopy or enteroscopy during pregnancy among our patients. No records were found of having endoscopy related adverse effects on mothers or foetuses. CONCLUSION: The upper GI endoscopy especially oesophago-gastro-dudenoscopy (OGD) may be performed without a major risk to the mother and the baby. However, further prospective multicentre research studies are strongly recommended.Item The usefulness of flexible sigmoidoscopy in bleeding per rectum during pregnancy: an observational study(Sri Lanka College of Obstetricians & Gynaecologists, 2023) Abeysuriya, V.; Dodampahala, S.H.; Chandrasena, L.INTRODUCTION: Bleeding per rectum is not an infrequent complaint during pregnancy, which may require endoscopic evaluation and treatment. Flexible sigmoidoscopy is a relatively simple, quick procedure. The current study was aimed to assess the usefulness of flexible sigmoidoscopy in bleeding per rectum during pregnancy from a single tertiary care centre. METHODS: A single centre retrospective study was carried out. Randomly selected 1000 medical records of the pregnant mothers who were referred as out patients and hospitalized from 2012 to 2022 were retrieved. All patients had the passage of fresh blood as their chief complaint. All of them had not undergone any prior diagnostic workup for their presentation. All had undergone flexible sigmoidoscopies and patients with significant additional bowel symptoms underwent colonoscopy following sigmoidoscopy. Endoscopic findings were recorded in a computer based database. Ethical approval was obtained from the Ethical Review Committee of Nawaloka Hospitals of Sri Lanka. No conflict of interest. RESULTS: A total of 48 pregnant women had undergone lower GI endoscopies. The mean age of the patients was 25.3 ± 6.5 years. Twenty-four patients (50%) were primigravida. Majority was in the second trimester of pregnancy 89.5% (43/48). The mean (±SD) gestational age at the time of procedure was 18(±2) weeks. All had undergone sigmoidoscopy, and an additional colonoscopy were done in 2 patients. Bleeding per rectum was the main indication. All flexible sigmoidoscopies were done without sedation. Wiliest, the colonoscopies were performed under conscious sedation. Majority of the pregnant mothers found to have haemorrhoids followed by anal fissures (46/48; 95.8%). Ulcerative colitis and a sigmoidal cancer were found in two patients (4.2%). None had an immediate post procedure-related complication. CONCLUSION: Flexible sigmoidoscopy is useful and safe to be performed in pregnancy with clinically significant bleeding per rectum. It has a good diagnostic yield. Further prospective multicentre research studies are strongly recommended.Item Acute appendicitis in pregnancy(Sri Lanka College of Obstetricians & Gynaecologists, 2023) Abeysuriya, V.; Dodampahala, H.S.; Chandrasena, L.INTRODUCTION: The early diagnosis and management of appendicitis in pregnancy are essential in maternal and fetal morbidity and mortality. In this 20-year retrospective study, we aimed to assess the outcomes of pregnant patients diagnosed with acute appendicitis. METHODS: A single-center retrospective study was carried out. Randomly selected 2000 medical records of pregnant mothers referred as outpatients and hospitalized from 2002 to 2022 were retrieved. Six pregnant patients who were diagnosed and treated in Nawaloka Hospital with the diagnosis of acute appendicitis during 2002-2022 were examined retrospectively. Ethics Committee approval was received. No conflicting interest. RESULTS: The age range of our patients was 22 to 31 years, mean of 26± 3.4. The mean gestational week was 20±5.3 weeks, and most were in the second trimester 4 (68%). All patients were admitted with the complaint of abdominal pain, the majority of them had the right iliac fossa pain (RIF). All had elevated inflammatory markers. No computed tomography (CT) was performed. One patient was diagnosed clinically of having acute appendicitis without any imaging. Acute appendicitis was diagnosed in 3/5 patients who underwent ultrasound scan examination. The other two patients (one from 2nd trimester and one in the third trimester) were diagnosed with acute appendicitis on MRI examination. All patients underwent open appendectomy under general anaesthesia. No maternal or foetal morbidity or mortality was noted during pre or post-surgical and anaesthesia procedures. The mean hospital stay was 3.9±0.9 days. All appendixes were pathologically proven to have acute appendicitis. Except for minor superficial surgical site infection rest of the mothers and foetus had no morbidity or mortality recorded in the follow-up. CONCLUSION: Although appendicitis is not frequent during pregnancy, it is a disease that requires urgent surgical and obstetrics care for timely diagnosis and treatment.Item Whole-body hypothermia, cerebral magnetic resonance biomarkers, and outcomes in neonates with moderate or severe hypoxic-ischemic encephalopathy born at tertiary care centers vs other facilities: A nested study within a randomized clinical trial(American Medical Association, 2023) Thayyil, S.; Montaldo, P.; Krishnan, V.; Ivain, P.; Pant, S.; Lally, P.J.; Bandiya, P.; Benkappa, N.; Kamalaratnam, C.N.; Chandramohan, R.; Manerkar, S.; Mondkar, J.; Jahan, I.; Moni, S.C.; Shahidullah, M.; Rodrigo, R.; Sumanasena, S.; Sujatha, R.; Burgod, C.; Garegrat, R.; Mazlan, M.; Chettri, I.; Babu, S.P.; Joshi, A.R.; Swamy, R.; Chong, K.; Pressler, R.R.; Bassett, P.; Shankaran, S.IMPORTANCE: The association between place of birth and hypothermic neuroprotection after hypoxic-ischemic encephalopathy (HIE) in low- and middle-income countries (LMICs) is unknown. OBJECTIVE: To ascertain the association between place of birth and the efficacy of whole-body hypothermia for protection against brain injury measured by magnetic resonance (MR) biomarkers among neonates born at a tertiary care center (inborn) or other facilities (outborn). DESIGN, SETTING, AND PARTICIPANTS: This nested cohort study within a randomized clinical trial involved neonates at 7 tertiary neonatal intensive care units in India, Sri Lanka, and Bangladesh between August 15, 2015, and February 15, 2019. A total of 408 neonates born at or after 36 weeks' gestation with moderate or severe HIE were randomized to receive whole-body hypothermia (reduction of rectal temperatures to between 33.0 °C and 34.0 °C; hypothermia group) for 72 hours or no whole-body hypothermia (rectal temperatures maintained between 36.0 °C and 37.0 °C; control group) within 6 hours of birth, with follow-up until September 27, 2020. EXPOSURE: 3T MR imaging, MR spectroscopy, and diffusion tensor imaging. MAIN OUTCOMES AND MEASURES: Thalamic N-acetyl aspartate (NAA) mmol/kg wet weight, thalamic lactate to NAA peak area ratios, brain injury scores, and white matter fractional anisotropy at 1 to 2 weeks and death or moderate or severe disability at 18 to 22 months. RESULTS: Among 408 neonates, the mean (SD) gestational age was 38.7 (1.3) weeks; 267 (65.4%) were male. A total of 123 neonates were inborn and 285 were outborn. Inborn neonates were smaller (mean [SD], 2.8 [0.5] kg vs 2.9 [0.4] kg; P = .02), more likely to have instrumental or cesarean deliveries (43.1% vs 24.7%; P = .01), and more likely to be intubated at birth (78.9% vs 29.1%; P = .001) than outborn neonates, although the rate of severe HIE was not different (23.6% vs 17.9%; P = .22). Magnetic resonance data from 267 neonates (80 inborn and 187 outborn) were analyzed. In the hypothermia vs control groups, the mean (SD) thalamic NAA levels were 8.04 (1.98) vs 8.31 (1.13) among inborn neonates (odds ratio [OR], -0.28; 95% CI, -1.62 to 1.07; P = .68) and 8.03 (1.89) vs 7.99 (1.72) among outborn neonates (OR, 0.05; 95% CI, -0.62 to 0.71; P = .89); the median (IQR) thalamic lactate to NAA peak area ratios were 0.13 (0.10-0.20) vs 0.12 (0.09-0.18) among inborn neonates (OR, 1.02; 95% CI, 0.96-1.08; P = .59) and 0.14 (0.11-0.20) vs 0.14 (0.10-0.17) among outborn neonates (OR, 1.03; 95% CI, 0.98-1.09; P = .18). There was no difference in brain injury scores or white matter fractional anisotropy between the hypothermia and control groups among inborn or outborn neonates. Whole-body hypothermia was not associated with reductions in death or disability, either among 123 inborn neonates (hypothermia vs control group: 34 neonates [58.6%] vs 34 [56.7%]; risk ratio, 1.03; 95% CI, 0.76-1.41), or 285 outborn neonates (hypothermia vs control group: 64 neonates [46.7%] vs 60 [43.2%]; risk ratio, 1.08; 95% CI, 0.83-1.41). CONCLUSIONS AND RELEVANCE: In this nested cohort study, whole-body hypothermia was not associated with reductions in brain injury after HIE among neonates in South Asia, irrespective of place of birth. These findings do not support the use of whole-body hypothermia for HIE among neonates in LMICs.Item Prevalence and some selected characteristics of asymptomatic gallstones among pregnant women. A retrospective chart review(Sri Lanka College of Obstetricians & Gynaecologists, 2022) Abeysuriya, V.; Dodampahala, S.H.; Chandrasena, L.Introduction During pregnancy, it is often associated with gallstones and biliary sludge. Gallstone disease is the second most common indication for non-obstetric surgical intervention in pregnancy. Methods A retrospective chart review was carried out to determine the prevalence and characteristics of asymptomatic gallstones among selected sample of pregnant women in a private hospital in Colombo, Sri Lanka. Data was retrieved form the available records at hospitals from 2016 to 2022.There were 329 patients recode during the study period. An exclusion criteria was applied to select the subjects. Data pertains to demographic, haematological, bio-chemical and hepatobiliary sonography was retrieved. The study data were analysed using STATA (StataCorp LLC Texas, USA) software version 16 for Windows. Normality was determined using the Kolmogorov-Smirnov’s test. Categorical variables like gallbladder status and blood group were presented using frequency tables. The mean values of age, gestational age, and gravidity were compared t-test and ANOVA. Gallbladder status was compared to age group, gravidity, trimester, and blood group using Chi-squared test. P values of <0.05 were considered significant. Results The study sample consists of 300 pregnant women records. The means age of pregnant mother with gall stone and sludge was statistically higher than the normal gallbladder. Multigravida was higher among the study sample (63%).The most of the study subject were in third trimester (68%). Majority (97%) had normal gallbladder, 2% had gallstones and 1% had sludge. A higher proportion of gallstones were identified among mothers age more than 30 years. Muliti-gravid had higher proportion of gallstones and sludge. The third trimester was identified as higher proportion of gallstones and sludge. All the cases who had gallstone and sludge were Blood group type “O”. Conclusion This sample shows that a higher proportion of gallstones and sludge were identified among mothers whose age more than 30 years, muliti-gravid, in their third trimester and blood group of type “O”. Further studies are needed to generalized this study finds to Sri Lankan setting.Item Gallstone-related complications and evidence base treatments. A scoop review(Sri Lanka College of Obstetricians & Gynaecologists, 2022) Abeysuriya, V.; Dodampahala, S.H.The incidence of gallstones is 10-15%, making it one of the most common causes of surgical admissions. The number of admissions and operations for gallstone disease is increasing. Commonly gallstones are formed in the gallbladder but can also develop in the biliary tree. Commonly, gallstones are made of cholesterol. Even though the exact cause of supersaturation of bile is not known, there are multiple associate factors for gallstone formation. Most patients with gallstones never experience any symptoms, but the risk of presenting with complications related to gallstones is 1%-4% a year. Patients with gallstones can present with pain or other more severe complications that demand surgical treatment and follow-up. This article looks into epidemiology, basic pathophysiology, complications, pregnancy and gallstones, diagnosis and recent evidence base treatment of gallstone disease.Item Hyperglycaemia in pregnancy and anthropometric parameters in the offspring at 10 Years: A community-based retrospective cohort study in Sri Lanka(Hindawi Publishing Corporation., 2020) Herath, H.P.; Herath, R.P.; Wickremasinghe, R.BACKGROUND: Studies of developmental origins of health and disease have highlighted the possible role of intrauterine hyperglycaemia, increasing the future risk of obesity, diabetes, and cardiovascular diseases in the offspring. There is limited evidence from South Asian populations for risk estimates for childhood obesity that are attributable to maternal diabetes in utero. OBJECTIVE: The aim of this study was to determine the association between hyperglycaemia in pregnancy (HIP) and anthropometric parameters in the offspring at 10-11 years of age. METHODS: A community-based retrospective cohort study was conducted in Colombo district, Sri Lanka. In the first stage, children born in 2005 were identified, and the availability of antenatal records was assessed. In the second stage, the exposure status of participants was ascertained based on antenatal records and predefined criteria. In the third stage, height, weight, waist circumference, and triceps skinfold thickness (TSFT) of eligible participants were measured to ascertain the outcome status. Background characteristics were collected by interviewing mothers. A 24-hour dietary recall and a 3-day diet diary were recorded. RESULTS: 159 children of mothers with HIP (exposed) and 253 children of mothers with no HIP (nonexposed) participated. Mean ages (SD) of exposed and unexposed groups were 10.9 (0.3) and 10.8 (0.3) years, respectively. The median BMI (17.6 vs 16.1, p < 0.001), waist circumference (63 cm vs 59.3 cm, p < 0.001), and triceps skinfold thickness (13.7 mm vs 11.2 mm, p < 0.001) were significantly higher in the exposed group. Offspring of women with HIP were more likely to be overweight (aOR = 2.6, 95% CI 1.4-4.9) and have abdominal obesity (aOR = 2.7, 95% CI 1.1-6.5) and high TSFT (aOR = 2.2, 95% CI 1.06-4.7) at 10-11 years than children who were not exposed after adjusting for maternal BMI, maternal age at delivery, and birth order. CONCLUSIONS: Intrauterine exposure to HIP is a significant determinant of overweight, high TSFT, and abdominal obesity in the offspring.Item Non-alcoholic fatty liver disease and pregnancy complications among Sri Lankan women: A cross sectional analytical study.(Public Library of Science, 2019) Herath, R.P.; Siriwardana, S.R.; Ekanayake, C.D.; Abeysekara, V.; Kodithuwakku, S.U.A.; Herath, H.P.BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the commonest cause of liver disease worldwide and is the hepatic manifestation of metabolic syndrome. Effects of NAFLD on pregnancy is still unclear with few studies showing an association to gestational diabetes and pre-eclampsia. We aimed to describe the association between the NAFLD and pregnancy complications. This is the first study, to our knowledge, in a South Asian population. METHOD: A cross sectional analytical study was done in Teaching Hospital, Ragama, Sri Lanka. Women carrying a singleton pregnancy, admitted for delivery were assessed for NAFLD with liver ultrasound scan. Data were extracted from interviewer administered questionnaire and antenatal and inpatient records. Pregnancy complications and labour outcomes were compared between the women with NAFLD and women without NAFLD (non-NAFLD). RESULTS: Out of the 573 women who participated, 18.2% (n = 104) were found to have NAFLD. Out of them, 58 (55.8%), 32(30.8%), and 14(13.5%) had fatty liver grade 1,2 and 3 respectively. Women with NAFLD were 2 times more likely to develop gestational hypertension and pre-eclampsia compared to the women in the non-NAFLD group, after adjusting for BMI, age and Hyperglycaemia in pregnancy [Adjusted OR 2.09, (95% CI 1.07-4.10)]. There was no association between the grade of steatosis and a composite outcome of gestational hypertension and pre-eclampsia, within the NAFLD group. Composite outcome of gestational diabetes mellitus and diabetes in pregnancy diagnosed during pregnancy was a significant complication in the NAFLD group compared to non-NAFLD group in the bivariate analysis (27.2% vs 17.7%; p<0.05), but the significance disappeared after adjusting for confounders. The current study did not demonstrate a significant association between NAFLD with preterm labour, caesarean section rate, low birth weight, and Apgar score of the baby. CONCLUSION: Women with NAFLD had a 2-fold higher risk of developing gestational hypertension and pre-eclampsia during pregnancy compared to women without NAFLD, after controlling for other confounding variables.Item Determinants of timely pregnancy dating scan in a Sri Lankan antenatal clinic setup(Sri Lanka College of Obstetricians and Gynaecologists, 2015) Dias, T.; Fernando, A.; Kumarasiri, S.; Padeniya, T.Background: Early accurate estimation of gestational age is the most important intervention in pregnancy. Ultrasound between 11 and 13 weeks is most reliable in dating. There is no uniform policy in timing of dating scan in Sri Lanka. Objective: Aim of this study was to find out factors that determine the timely dating scan before 14 weeks in a district general hospital in Sri Lanka. Methods: This was a prospective observational study carried out at District General Hospital in Sri Lanka. A detail history was taken in order to ascertain age, parity, menstrual history, time taken to reach the hospital, distance to the hospital, level of education and gestation at the first booking visit with public health midwife (PMH). We offered dating scans for every pregnant mother before 14 weeks. Logistic regression analyses were performed to evaluate the association of socio-demographic factors and receiving timely dating scan before 14 Weeks. Results:A total 199 women were included for the analysis with a mean age of 26.98 years (SD 5.58). A 190 out of total recruitments (95.5%) were booked with PHM before 14 weeks. A total of 171 (86%) pregnant women received their first scan before 14 weeks. Logistic regression analysis demonstrated that only booking before 14 weeks with PMH (Odds ratio 12.272 (95% CI, 4.563-33.000) p<0.000) contributed significantly to receive dating scan before 14 weeks, while maternal age, parity, time taken to reach the hospital, distance to the hospital and mother’s level of education did not. Conclusion: Our study showed it is entirely possible to offer dating scan before 14 weeks even in a peripheral District General Hospital. Moreover, we demonstrated that none other than booking before 14 weeks was determined the dating scan prior to 14 weeks.