Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Fetal echocardiographic assessment: impact of gestational age and maternal obesity.(Jaypee Brothers Medical Publishers, 2023) Patabendige, M.; Kodithuwakku, S.U.; Perera, M.N.I.; Dias, T.AIM: To identify the ability to acquire various fetal cardiac views using two-dimensional ultrasound at different gestational age and body mass index (BMI) categories. MATERIALS AND METHODS: We performed a prospective observational study among low-risk women with singleton pregnancies attending the University Obstetrics Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka. The ability to obtain satisfactory views of the situs, four chambers, right and left outflow tracts, three vessels, aortic arch, ductal arch, and superior and inferior vena cava of fetal heart was studied. RESULTS: A total of 314 eligible pregnant women underwent fetal echocardiography and 288 had complete data. All eight cardiac views were obtained with 100% success at the gestational age of 18 – 21 + 6 weeks and days. All eight cardiac views were satisfactory in more than 97% at the gestational age of 22 – 25 + 6 weeks and days. Body mass index was not significantly associated with acquisition of cardiac views at all gestations (p = 0.62). All eight cardiac views were obtained with 50% success at 14 – 17 + 6 weeks and 5.4% success at 11 – 13 + 6 weeks and days. CONCLUSIONS: Acquisition of all fetal cardiac views was best at 18 – 21 + 6 weeks and days of gestation, but reasonably successful till 26 weeks. Acquisition was sub-optimal in first trimester, below 18 weeks and for some cardiac views after 26 weeks. BMI does not hamper the ability to obtain cardiac views during fetal echocardiography. CLINICAL SIGNIFICANCE: This could be used as a guide for the timing of echocardiography when a particular cardiac defect is suspected in the fetus, where specific cardiac view(s) are used to confirm the particular diagnosis as well as the most appropriate gestational age period.Item Does emigration by itself improve birth weight? Study in European newborns of Indo-Pakistan origin(Elsevier Ltd, 2023) Morales-Roselló, J.; Buongiorno, S.; Loscalzo, G.; Scarinci, E.; Dias, T.; Rosati, P.; Lanzone, A.; Marín, A.P.OBJECTIVE: Our aim was to evaluate the effect of emigration on fetal birth weight (BW) in a group of pregnant women coming from the Indian subcontinent. METHODS: This was a retrospective study in a mixed population of pregnant women from the Indian subcontinent that either moved to Europe or stayed in their original countries. The influence of emigration along with several pregnancy characteristics: GA at delivery, fetal gender, maternal age, height, weight, body mass index (BMI) and parity on BW was evaluated by means of multivariable linear regression analysis. RESULTS: According to European standards, babies born to Indo-Pakistan emigrants and babies born to women staying in the Indian subcontinent were similarly small (BW centile 30± 29 and 30.1 ± 28, p<0.68). Multivariable regression demonstrated that emigration by itself did not exert a direct influence on BW (p = 0.27), being BMI and gestational age at delivery the true determinants of BW (p<0.0001). Conclusions: Maternal BMI is the most relevant parameter affecting fetal growth regardless of the place of residence. © 2023Item Fetal Doppler reference values in women with a normal body mass index(Sri Lanka Medical Association, 2019) Dias, T.; Abeykoon, S.; Mendis, P.; Gunawardena, C.; Pragasan, G.; Padeniya, T.; Pathmeswaran, A.; Kumarasiri, S.OBJECTIVES:To construct gestation specific reference limits for fetal umbilical (UA), middle cerebral artery (MCA) pulsatility indices (PI) and the cerebroplacental ratio (CPR) in singleton pregnancies with normal BMI between 16 and 40 weeks of gestation.METHODS:We ultrasonographically examined 596 fetuses from women with normal nutritional and health status and minimal environmental constraints on fetal growth. Each mother was considered only once for measurement of fetal Doppler indices, at gestations between 16 and 40 weeks in a prospective cross-sectional study. Gestational age was confirmed by fetal crown-rump length measurement between 11 and 14 weeks. Pulsatility indices of umbilical and middle cerebral arteries were measured by real time and Doppler ultrasonography. CPR ratio was calculated by dividing MCA PI by UA PI. The fetal Doppler measurements obtained from the current study were compared with commonly used reference charts. For each parameter separate polynomial regression models were fitted to estimate the gestation specific means and standard deviations, assuming that the measurements have a normal distribution at each gestational age.RESULTS:A significant difference of fetal Doppler indices was observed between our study and previously published reference charts for most gestational weeks. The fitted 10th, 50th and 90th centiles at 40 weeks of gestation were 0.65, 0.87 and 1.08 for UA PI; 0.93, 1.32 and 1.71 MCA PI; 1.02, 1.58 and 2.13 for CPR.CONCLUSIONS: These charts can be used for better defining the normal range of fetal arterial Doppler indices. This will be useful in the diagnosis and management of fetuses with abnormal fetal growthItem Minimizing the risks of twin pregnancy(Sri Lanka College of Obstetricians and Gynaecologists, 2018) Dias, T.no abstract availableItem Anaemia among females in child-bearing age: Relative contributions, effects and interactions of α- and β-thalassaemia.(Public Library of Science, 2018) Mettananda, S.; Suranjan, M.; Fernando, R.; Dias, T.; Mettananda, C.; Rodrigo, R.; Perera, L.; Gibbons, R.; Premawardhena, A.; Higgs, D.INTRODUCTION: Anaemia in women during pregnancy and child bearing age is one of the most common global health problems. Reasons are numerous, but in many cases only minimal attempts are made to elucidate the underlying causes. In this study we aim to identify aetiology of anaemia in women of child bearing age and to determine the relative contributions, effects and interactions of α- and β-thalassaemia in a region of the world where thalassaemia is endemic. METHODS: A cross sectional study was conducted at the Colombo North Teaching Hospital of Sri Lanka. The patient database of deliveries between January 2015 and September 2016 at University Obstetrics Unit was screened to identify women with anaemia during pregnancy and 253 anaemic females were randomly re-called for the study. Data were collected using an interviewer-administered questionnaire and haematological investigations were done to identify aetiologies. RESULTS: Out of the 253 females who were anaemic during pregnancy and were re-called, 8 were excluded due to being currently pregnant. Of the remaining 245 females, 117(47.8%) remained anaemic and another 22(9.0%) had non-anaemic microcytosis. Of anaemic females, 28(24.8%) were iron deficient, 40(35.4%) had low-normal serum ferritin without fulfilling the criteria for iron deficiency,18(15.3%) had β-haemoglobinopathy trait and 20(17.0%) had α-thalassaemia trait. Of females who had non-anaemic microcytosis, 14(66.0%) had α-thalassaemia trait. In 4 females, both α- and β-thalassaemia trait coexist. These females had higher levels of haemoglobin (p = 0.06), MCV (p<0.05) and MCH (p<0.01) compared to individuals with only β-thalassaemia trait. A significantly higher proportion of premature births (p<0.01) and lower mean birth weights (p<0.05) were observed in patients with α-thalassaemia trait. CONCLUSIONS: Nearly one third of anaemic females in child bearing age had thalassaemia trait of which α-thalassemia contributes to a majority. Both α- and β-thalassaemia trait can co-exist and have ameliorating effects on red cell indices in heterozygous states. α-Thalassaemia trait was significantly associated with premature births and low birth weight. It is of paramount importance to investigate the causes of anaemia in women of child bearing age and during pregnancy in addition to providing universal iron supplementation.Item Birth weight differences at term are explained by placental dysfunction, but not by maternal ethnicity(John Wiley & Sons, 2018) Morales-Roselló, J.; Dias, T.; Khalil, A.; Fornes-Ferrer, V.; Ciammella, R.; Gimenez Roca, L.; Perales-Marín, A.; Thilaganathan, B.OBJECTIVE: The main aim of this study was to investigate the influence of ethnicity, fetal gender and placental dysfunction on birth weight (BW) in term fetuses of South Asian and Caucasian origin. METHODS: This was a retrospective study of 627 term pregnancies assessed in two public tertiary hospitals in Spain and Sri Lanka. All fetuses underwent a scan and Doppler examination within two weeks of delivery. The influences of fetal gender, ethnicity, gestational age (GA) at delivery, cerebroplacental ratio (CPR), maternal age, height, weight and parity on BW were evaluated by multivariable regression analysis. RESULTS: Fetuses born in Sri Lanka were smaller than those born in Spain (mean BW= 3026g±449g versus 3295g±444g, p<0.001). Multivariable regression analysis demonstrated that GA at delivery, maternal weight, CPR, maternal height and fetal gender (estimates=0.168, p<0.001; 0.006, p<0.001; 0.092, p=0.003; 0.009, p=0.002; 0.081, p=0.01) were significantly associated with BW. Conversely, no significant association was noted with maternal ethnicity, age and parity (estimates= -0.010, p=0.831; 0.005, p=0.127; 0.035, p=0.086). The findings were unchanged when the analysis was repeated using IG21 EFW instead of BW centile (-0.175, p=0.170; 0.321, p<0.001). CONCLUSIONS: Fetal BW variation at term is less dependent on ethnic origin and better explained by placental dysfunction.Item Metabolic syndrome and risk of endometrial carcinoma among asymptomatic, postmenopausal, urban Sri Lankan females: a community cohort follow-up study(Wiley Publishing, 2017) Dias, T.; Niriella, M.; de Silva, S.; Motha, C.; Palihawadana, T.S.; Ediriweera, D.; de Silva, J.OBJECTIVES: Metabolic syndrome (MetS) has been recognised as a risk factor for malignancies. The aim of this study was to evaluate the association of MetS and risk of endometrial carcinoma (EC), by measuring endometrial thickness (ET). METHODS: The Ragama Health Study (RHS) recruited 35-64-year-old female cohort by age-stratified random sampling in 2007 and re-evaluated them in 2014, using a structured interview, anthropometric measurements and biochemical tests. Liver ultrasound to detect fatty liver was performed in 2007. Pelvic ultrasound to detect ET was performed in 2014 among consenting participants. MetS was diagnosed on established International Diabetes Federation (IDF 2012) criteria. Increased ET was defined as >5mm. Simple logistic regression was used to screen variables and multiple logistic regression was used to obtain adjusted effects of risk factors for increased ET. RESULTS: 813/1636(49.7%) of the original female cohort attended follow-up; ET was measured in 567(69.7%). Median (IQR) age of females was 61 (56-66) years. 323 fulfilled criteria for MetS (prevalence 57.1%) in 2007. 57(10.1%) had increased ET in 2014. Increasing plasma triglycerides [OR=1.004 per mg/dl, 95%CI:1.001-1.007, p<0.05] and being hypertensive [OR=2.16, 95%CI:1.11–4.08, p<0.05] were associated with increased ET, while advancing age [OR=0.93 per year, 95%CI:0.89–0.98, p<0.01] and being diabetic [OR= 0.34, 95%CI:0.10–0.89, p<0.05] were protective. CONCLUSIONS: Hypertension and increased plasma triglyceride levels, in the pre-menopausal period, were risk factors for future asymptomatic increased ET.Item Study on age-ralated variation in ovarian volume and proportion of endometrial thickness abnormalities in women of advanced and post-reproductive age(Wiley Publishing, 2016) Pieris, V.; Dias, T.; Palihawadana, T.S.; de Silva, J.OBJECTIVES : To describe the variations in endometrial thickness and the ovarian volume among peri and postmenopausal women. METHODS : A cross-sectional analysis was done in a study population of a longitudinal study. This was a community-based study and included 888 women randomly selected from the Ragama, Sri Lanka. This was done as part of a larger ongoing study, the “Ragama Health Study”. All study participants underwent a transvaginal pelvic ultrasound scan and the endometrial thickness and the ovarian size were measured. The ovarian volume was calculated using the formula for a prolate ellipsoid (0.523 h x w x l). RESULTS: The mean age of the study population was 59.45 yrs (SD=7.601) and 85.8% (n = 762) of them had undergone menopause. The prevalence of an endometrial thickness (ET) > 10 mm among premenopausal women was 14.98% while 0.9% (n = 1) had an ET>15 mm. Among postmenopausal women an ET >4 mm was seen in 16.01%. This included 1.3% (n = 10) who had an ET >10 mm. The mean of average ovarian volumes of the study population, according to age is shown in the figure. CONCLUSIONS : The study demonsatrated the proportion of asymptomatic women with a thickened endometrium among perimenoausal and poatmenopausal women (>15 mm and >4 mm resepectively) that necessitate evaluation is around 1%. It also described the age related changes in ovarian volume.Item Blood flow changes in pelvic vessels associated with the application of an abdominal compression belt in healthy postpartum women(Sri Lanka Medical Association, 2017) Dias, T.; Patabendige, M.; Herath, R.P.; Garvik, T.I.; Liland, F.; Arulkumaran, S.INTRODUCTION: Postpartum haemorrhage (PPH) accounts for a high proportion of maternal mortality and morbidity throughout the world. A uterine compression belt which has been developed recently represents a very low tech, low cost solution in managing postpartum haemorrhage. OBJECTIVES :To evaluate the blood flow changes in pelvic vessels following application of the postpartum haemorrhage compression belt (Laerdal Global Health, Stavanger, Norway). METHODS: The sample included healthy postpartum women within 6 hours of vaginal delivery. The study was performed at Teaching Hospital, Ragama, Sri Lanka. PPH compression belt was applied on the lower abdomen in a supine position with a slight lateral tilt. Patient’s pulse, blood pressure and Doppler indices (RI, PI and PFV) of the uterine, internal iliac and femoral arteries were measured using transabdominal Doppler ultrasonography. Lower limb oxygen saturation was also measured. Measurements were obtained by connecting the subjects to a multimonitor throughout the study period of 20 minutes. Median RI, PI and PFV was calculated and comparisons were made between the baseline and after belt application at 10 and 20 minutes. RESULTS: A total of 20 healthy women were included and the mean time from delivery to study inclusion was 2.5 (range 0.5–5.0) hours. There were no adverse outcomes or altered vital signs noted among participants. Overall there were no significant changes in the internal iliac, uterine and femoral artery blood flow after application of the compression belt. CONCLUSIONS: There were no significant changes in the internal iliac, uterine and femoral artery blood flow after application of the compression belt. This preliminary study only shows that the application of the PPH compression belt has no apparent adverse changes in the iliac, uterine and femoral artery blood flow in postpartum mothers.Item Jk3 antibodies complicated with severe fetal anaemia requiring intrauterine transfusion: a case report(Blackwell Scientific Publications,, 2019) Dias, T.; Patabendige, M.; Kajendran, J.; Kularathna, M.