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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Dietaryadviceongdmmothers-an audit(Sri Lanka College of Obstetricians and Gynaecologists, 2006) Jayasundar, C.; Ellepola, U.K.; Herath, H.M.R.P.; Perera, A.; Wijesundere, A.BACKGROUND: Gestational Diabetes Mellitus (GDM) is considered a global problem and in Sri Lanka. It is emerging as a common complication in pregnancy. Hence, an audit was undertaken to evaluate dietary advice given to GDM mothers as it is the primary modality of treatment. OBJECTIVE: To ascertain the standard of dietary advice given to GDM mothers attending a tertiary care ,. ater.STUDY TYPE: Retrospective study. STUDY SETTING: Tertiary care center. STUDY SAMPLE: 49 consecutive GDM mothers, who was diagnosed in the ANC and ward. METHOD: Study was carried out from 1st of June to 1st of August 2006. A questionnaire was developed to evaluate the standard of the dietary advice in accordance with the unit policy. RESULTS: Out of the population 39% were in the age group of 21-30 and 61% in the 31-40 age category. Out of the total sample 96% of mothers received advice on a diabetic diet but out of which, only 4% had been supplemented with written format. The SHO, registrar, and senior registrar contributed dietary advice to 37% of the mothers while nursing officers have advised to 22%. The intern medical officers have advised 19% of mothers, while public health rnidwives, MOH have accounted for advising 15% and 5% respectively. The dietician advised only 2% of the mothers. Out of the mothers who were interviewed following the dietary advice, 69% understood the advice satisfactorily. Furthermore 24% stated that they understood the advice partially and 7 % reported poor understanding. In addition 16% of the mothers had requested repeated dietary advice. Finally, 56% reported satisfaction with the overall dietary management of the above medical complication. CONCLUSIONS AND RECOMMENDATIONS: The dietary advice given in our study population is unsatisfactory, considering the fact that the diet control is the primary modality of treatment in GDM. We recommend that advising on diet is a joint responsibility of medical officers, nursing officers, midwives and dieticians. Such advice should be solid and tailored to follow the Sri Lankan dietary habits and expectations. In addition the explanations should be done in a simple manner with use of a dietary advice leaflet according to a common protocol and each hospital should have a specialized supplemented with written format. The SHO, registrar, and senior registrar contributed dietary advice to 37% of the mothers while nursing officers have advised to 22%. The intern medical officers have advised 19% of mothers, while public health rnidwives, MOH have accounted for advising 15% and 5% respectively. The dietician advised only 2% of the mothers. Out of the mothers who were interviewed following the dietary advice, 69% understood the advice satisfactorily. Furthermore 24% stated that they understood the advice partially and 7 % reported poor understanding. In addition 16% of the mothers had requested repeated dietary advice. Finally, 56% reported satisfaction with the overall dietary management of the above medical complication. CONCLUSIONS AND RECOMMENDATIONS: The dietary advice given in our study population is unsatisfactory, considering the fact that the diet control is the primary modality of treatment in GDM. We recommend that advising on diet is a joint responsibility of medical officers, nursing officers, midwives and dieticians. Such advice should be solid and tailored to follow the Sri Lankan dietary habits and expectations. In addition the explanations should be done in a simple manner with use of a dietary advice leaflet according to a common protocol and each hospital should have a specialized dietician.Item Vault prolapse in a patient with rokitansky syndrome(Sri Lanka College of Obstetricians and Gynaecologists, 2007) Herath, H.M.R.P.; Palihawadana, T.H.; Wijewardana, A.H.M.A.; Wijesinghe, P.S.INTRODUCTION: The Mayer—Rokitansky—Kuster-Hauser syndrome (MRKHS) is a rare congenital cause of primary amenorrhoea, due to agenesis of the uterus and the upper two thirds of the vagina. Since the vaginal vault is not suspended to the bony pelvis it is predisposed to prolapse. We report a case of MRKH syndrome with vaginal vault prolapse successfully treated with surgery. CASE REPORT: A 30 year old female married for two years, who was diagnosed to have MRKHS, presented with vaginal vault prolapse. This prevented her from having satisfactory sexual intercourse. She did not have symptoms of pelvic floor weakness such as urinary or faecal incontinence. An intravenous urograrn did not reveal any anomaly. At laparotomy normal ovaries with follicular activity and a rudimentary uterus were noted. A tape of proline mesh was fixed to the posterior surface of the rudimentary uterus and was brought forward to the rectus sheath through the broad ligament along the round ligament, to support the vaginal vault. The peritoneal cavity was opened through an incision in the vault of the blind vagina. Vaginal vault was anchored to the previously placed proline tape. A fibreglass mould was introduced and kept in place for seven days to keep the integrity of the dilated vaginal lumen. Two months after surgery the patient was asymptomatic with normal sexual activity. DISCUSSION: MRKHS occurs in one in 4000-5000 women. It may be associated with renal and skeletal anomalies. The blind ended vagina is usually short and originates from the urogenital sinus. The vaginal vault is susceptible to prolapse as it is not anchored to the bony pelvis. The incidence of vault prolapse in MRKHS is unknown and thought to be very rare. Many surgical methods have been described including abdominal sacrocolpopexy and sacrospinous fixation.Item Do we handle fetal heart Traces correctly? A completed audit cycle(Sri Lanka College of Obstetricians and Gynaecologists, 2007) Herath, H.M.R.P.; Attanayake, A.M.J.H.; Mohomad, H.Z.; Wijesinghe, P.S.INTRODUCTION: Electronic fetal monitoring has become an integral part of modern obstetric practice. Appropriate use and interpretation of CTG is necessary to achieve the expected benefits of electronic fetal monitoring. On the other hand incorrect usage of it can lead to unnecessary interventions. OBJECTIVE: To audit the standards of interpretation of and documentation on intrapartum CTGs. METHOD: An audit was conducted to assess the standard of documentation on the CTG, accuracy of interpretationand the appropriateness of subsequent action taken. Ninety six CTGs taken in July and August 2007 were audited according to standards given in NICE guidelines. The findings of the audit were presented to the team members and a discussion was conducted to improve awareness. A re -audit was conducted during the subsequent week and another 69 CTGs were studied. RESULTS: There were 96 CTGs audited during the first cycle. Patients name, date and time of taking the CTG were mentioned in 79(82.3%), 78(81.3%) and 79(82.3%) of CTGs respectively. Though 78(81.3%) CTGs were signed, the time of seeing the CTG was mentioned only in 19 (19.8%). Although an opinion about the CTG was given in 59 (61.5%), the fetal heart tracing was described only in 13 (13.5%) cases. Most of the interpretations were correct and the subsequent action taken was appropriate. Sixty nine CTGs were audited during the second cycle. Documentation showed a significant improvement with patients name date and time being documented on 64(92.8%), 65(94.2%), 67(97.1%) of CTGs respectively. Majority 56(81.2%) was signed and the time of seeing was noted in 47(68.7%) of CTGs. Comparatively higher proportion (72.5%) of CTGs was described. Second cycle also showed most of the opinions given to be accurate. DISCUSSION: Interpretation of CTGs is fairly satisfactory. Documentation on CTGs is not up to the expected standards. Regular auditing will help to achieve better standards with regard to documentation.Item Do teenager prefer contraception or termination?(Sri Lanka College of Obstetricians and Gynaecologists, 2007) Herath, H.M.R.P.; Dias, T.D.; Amarasinghe, W.L.INTRODUCTION: Teenage pregnancy is universal in all known societies past and present. One in four girls in the world becomes a mother before the age of 19 years. In Sri Lanka, 22.2% of maternal deaths due to illegal abortions were in this age group during 1996. Lack of knowledge regarding contraceptive methods is thought to be the main reason for not practicing proper contraception. On the other hand information about domestic violence in families with teenage mother is scares. OBJECTIVES: To describe the use of contraception, attempted pregnancy terminations and violence against women during the pregnancy among teenage mothers delivered at Teaching Hospital Peradeniya. METHOD: A prospective descriptive study was done on teenage mothers who delivered at teaching hospital Peradeniya from 1st of April 2005 to 31st of March, 2006, using interviewer administered questionnaire. RESULTS: There were 190 teenage mothers delivered during the study period. Data was collected from 186 of them. Among these teenage mothers Only 3(1.6%) has studied above GCE ordinary level. Only 28% ofwomen of the group have used any form of contraception, and of which 64% has used barrier methods of contraception. 80 (43%) of teenage mothers had thought of future contraception before they were discharged from the hospital. Termination of the pregnancy has been attempted by 9.1% of the study population. Of those who had'attempted termination 82.4% had not used any form of contraception. Male partners have assaulted 16.1% of teenage mothers during the pregnancy. CONCLUSION: The teenage pregnant mothers have poor educational background. The contraceptive use in the population was very low leading to unnecessary pregnancies and termination of pregnancies. Domestic violence in this population is fairly common.Item Adolescent sexual practices and contraceptive usage(Faculty of Medicine, University of Kelaniya & Plan International, 2008) Herath, H.M.R.P.; Dissanayake, D.M.A.B.; Hilmi, M.A.M.; Pathmeswaran, A.; Wijesinghe, P.S.INTRODUCTION: Adolescence is a critical period of development, as adoption of unhealthy risk behaviours such as unprotected sex, smoking and drug abuse, avoiding contraceptive methods will lead to long standing health and socioeconomic consequences. Therefore information is needed about the sexual practices and contraceptive usage of adolescents and young adults to develop interventions in the community. This study was undertaken to describe and compare the sexual practices, knowledge and usage of contraceptives by adolescents and young adults in selected urban and rural settings.METHOD: This cross sectional descriptive study was conducted among young adults aged less than 21 years at the time of interview in three settings in both rural and urban areas. The study subjects were students from universities, technical colleges and garment factory workers representing both rural and urban areas. The data was collected using a pretested self administered questionnaire during June 2007 to August 2007. Information collected included marital status, gender and the level of education, first sexual relationship (age, partner, contraception used), current contraceptive practices and knowledge about contraceptive methods. The data was analysed using SPSS 10.1 statistical package. Informed consent was obtained from all participants. RESULTS : There were a total of 1258 subjects who had returned the completed questionnaires. Out of them there were 290 garment factory employees, 480 technical college students, and 488 university students. The percentage of females was 58.9%. The mean ages of the males and the females of the total population were 20.75(50 1.13) years and 20.55(SD 1.63) and it was similar in the three settings. The level of education was highest among the undergraduates lowest among garment factory workers. Out of the population 303 (24.1%) were sexually active. It was significantly higher among males {33.5%0 than females (17.0%). Both among male and females this trend was significantly more common among garment factory workers. Sexual activity of the unmarried and the premarital sexual practices of married subjects are shown in the table. 6. 17% of females and 33.5% of males were sexually active before marriage. 90% male garment factory workers were sexually active. In contrast the proportionItem Precision of predicting expected date of delivery by ultrasound scan in comparison to last menstrual period(Sri Lanka College of Obstetricians & Gynaecologists, 2014) Wasalathilaka, C.; Kumari, S.D.T.L.; Palihawadana, T.S.; Herath, H.M.R.P.; Padumadasa, S.; Pathmeswaran, A.; Dias, T.D.INTRODUCTION: Estimation of the expected date of delivery (EDD)is important in management of pregnancy, as many clinical decisions would rely on the estimated gestation of the fetus. In routine clinical practice, this is done by either adding the duration of a pregnancy to the last menstrual period (LMP) or by assessment of fetal biometry by an early pregnancy ultrasound scan (USS). The accuracy of these methods can be assessed either by correlating the dates with people with a know date of conception, such as following IVF, or by study of the correlation with the date of delivery in a cohort of women who goes in to spontaneous labour. In this study we have assessed the accuracy of the two methods by the latter approach. The aim of this study was to assess the agreement of EDD calculated by LMP or USS, to the date of delivery in spontaneous labour. METHODS: This was a retrospective cohort study. 675 patients who had a spontaneous onset of labour were included in the analysis. USS fetal crown rump length was considered for gestational age assessment between 8 and 14 weeks and fetal head circumference considered thereafter. Their agreement of the date of delivery with the estimated expected date of delivery by LMP or USS was assessed. RESULTS: Spontaneous delivery was seen with 6 days of the USS EDD and 7 days of the LMP EDD in 50% of women and within 11days of USS EDD and 15days of LMP EDD among 75% of women. A delivery within 14 date of the EDD was observed in 93.7% when USS EDD was considered and it was only in 86.2% with the LMP EDD (OR 2.40, 95%CI 1.64-3.52). CONCLUSION: This study demonstrate that the USS EDD is more in agreement with the date of spontaneous delivery than the EDD estimated from LMP. This highlights the importance of dating USS in all pregnancies which would be helpful in management of pregnancy in late stages.Item Prevalence of osteoporosis in a sample of Sri Lankan urban population(Sri Lanka Medical Association, 2008) Karunanayake, A.L.; Salgado, L.S.S.; Abeysuriya, V.; Fernando, S.; Herath, H.M.R.P.; Kumarendran, B.; Premaratna, B.A.H.R.; Mahawithanage, S.T.C.BACKGROUND: Osteoporosis is characterized by low bone mineral density and deterioration in the micro architecture of bone. It predisposes individuals to increased risk of fractures of the hip, spine and other skeletal sites. Peripheral DEXA (P-DEXA) scans are ideal for mass screening of bone mineral density (BMD). OBJECTIVE: To determine the prevalence of osteoporosis and osteopenia in a sample of urban Sri Lankans. DESIGN, SETTING AND METHODS: A descriptive cross sectional study was conducted at the Faculty of Medicine, University ofKelaniya from July 2007 to October 2007. The study subjects were selected from 22 Gramasevaka Niladhari Divisions of the Ragama MOH area. From each division, people aged 35 to 65 years were randomly selected from the voters list and invited to participate in the study. A P-DEXA scan was used to measure the BMD of the left middle finger. A T score of <-2.5 was considered as osteoporosis, -1 to -2.5 as osteopenia. These two categories together were considered low BMD. A T score of > -1 was considered normal. RESULTS: There were 731 subjects with a mean age (SD) of 52.5 (7.5) comprising 60% females. The prevalences of osteoporosis and osteopenia were 14% and 29% respectively. 20% of females and 6% of males were affected with osteoporosis. The prevalence of osteoporosis was 7% among those <50 years and 20% among those >50 years. CONCLUSION: There was a high prevalence of low BMD in this urban population. Prevalence of low BMD was higher among females and those over fifty years.Item Mirror syndrome: a rare presentation with a trisomy 21 fetus(Sri Lanka College of Obstetricians and Gynaecologists, 2014) Prasanga, D.P.G.G.M.; Dias, T.D.; Palihawadana, T.S.; Gunathilaka, S.N.M.P.K.; Herath, H.M.R.P.; Wasalathilaka, C.D.