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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Possible progression of an atypical leiomyoma to a leiomyosarcoma: a case report(Menopause Society of Sri Lanka, 2021) Ekanayake, C.D.; Herath, R.; Fernando, S.; Mahendra, G.; Balawardene, J.; de Silva, A.The spectrum of uterine smooth muscle cell tumours (SMT) ranges from leiomyomas to leiomyosarcomas (LMS). Atypical leiomyomas (AL) are a uterine SMT of a contentious nature due to its indeterminate malignant potential. Although the risk of recurrence is low there is limited experience on management. On the other hand, it is generally believed that the uterine LMS arises de novo, rather than from a precursor lesion.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 Comparison of metformin versus other treatment modalities in gestational diabetes mellitus(Society for Advance Healthcare Research, Maharashtra, India, 2016) Ekanayake, C.D.; Wijesinghe, P.S.; Herath, R.; Puliyadda, N.; Nishad, N.INTRODUCTION: Despite evidence to prove both its efficacy and safety, use of metformin is at most restricted to only as an adjunct to insulin preparations. We compared the maternal, fetal and neonatal outcomes associated with GDM in women treated with metformin versus those treated with diet alone and diet plus insulin. Method: An observational study was carried out over a period of six months in 104 GDM patients. Study groups were 43 patients on diet alone (group A), 42 on metformin plus diet (group B), and 19 on diet plus insulin (group C). Maternal, fetal and neonatal outcomes were compared. Results: Fourteen patients in group B subsequently required supplemental insulin. Gestational hypertension 5(12%), 4(10%), 5(26%) (p=0.8) and wound infection among 2(5%), 1(2%), 0(0%) (p=0.6) were seen in groups A, B and C respectively. Four patients with polyhydramnios were seen in group B. Mean birth weights were A=3.07kg, B=3.07kg, C=3.1kg (p=0.96). Macrosomia 5 (12%), 3 (7%), 3 (16%) (p=0.2), neonatal hypoglycemia 2 (5%), 2 (5%), 2 (11%) (p=0.4), five minute Apgar scores 9.9, 9.7, 9.9, and neonatal jaundice 5(12%), 4(10%), 3(16%) (p=0.04) were noted in in groups A, B and C respectively. Single case of respiratory distress was seen in the insulin group. Shoulder dystocia and perinatal deaths were not observed. Conclusion: Maternal and perinatal outcomes were similar among diet alone, diet plus metformin, and diet plus insulin groups. Cost-effectiveness, easy administration, safety profile and convenience of storage would make metformin an attractive option in the management of gestational diabetes mellitus.Item Outcome of Non-Descent Vaginal Hysterectomy at a Single Centre in Sri Lanka: an Observational Study(Sri Lanka College of Obstetricians and Gynaecologists, 2015) Chaminda, S.H.H.; Ekanayake, C.D.; Sriskanthan, R.S.; Perera, B.; Palihawadana, T.S.INTRODUCTION: Hysterectomy is the commonest major gynaecological surgery performed worldwide. Though many routes of hysterectomy are described, open abdominal approach remains the commonest route to date for indications other than genital prolapse. There is evidence of advantages of non-descent vaginal hysterectomy (NDVH) over abdominal hysterectomy in such indications. However, the acceptance rate for vaginal approach by the gynaecologists remains low. We describe the outcome data of a series of non-descent vaginal hysterectomies performed in a single centre in Sri Lanka. OBJECTIVES: To describe the post-operative outcome and complications of NDVH for benign indications of uteri less than 14 weeks size. METHOD: An observational study was undertaken at the ward 14 of The De Soysa Maternity Hospital, Colombo over a period of one year from May 2007 to April 2008 among women who underwent NDVH for benign conditions. Those with co-existing genital prolapse requiring surgical correction, uteri larger than 14 weeks, a history of previous abdominal surgery and medical co-morbidities were excluded from the study. RESULTS: The study included 53 patients who underwent NDVH. The majority had a normal sized uterus 39 (73.6%). There was a statistically significant improvement in post-operative urinary index compared to pre-operative urinary index [Kruskal-Wallis test-6.155, degrees of freedom = 2, p < 0.05 (0.046)]. There was no difference in pre-operative and post-operative bowel function. The frequency of coitus and patient satisfaction appear to have improved post-surgery. Most patients [n=45 (85%)] had a faster than expected recovery. There were no visceral injuries and only one patient required blood transfusion following surgery. One patient developed a urinary tract infection. The mean post-operative hospital stay was 4.11 days (95% CI=3.48-4.74 days). CONCLUSIONS: The outcome and complication rates of non-descent vaginal hysterectomy this series were comparable with evidence from literature. Therefore, we conclude that NDVH is a feasible option for benign gynaecological conditions with a uterus less than 14 weeks in size in the current gynaecological practice of Sri Lanka.Item Choriocarcinoma of the ovary: a case report(Sri Lanka College of Obstetricians and Gynaecologists, 2015) Ekanayake, C.D.; Wijesinghe, P.S.; Herath, R.P.; Puliyadda, T.M.N.K.; Hewavisenthi, S.J.de S.Ovarian choriocarcinoma whether gestational or non-gestational, is an extremely rare malignant germ cell tumour. We report a young patient with an ovarian choriocarcinoma who was successfully treated with fertility sparing conservative surgery and adjuvant chemotherapy. Sri LankaItem Transplacental transfer of dengue(Sri Lanka Medical Association, 2014) Ekanayake, C.D.; Padumadasa, S.; Premaratna, R.; Rajindrajith, S.; Samaranayake, W. W.