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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Hyperglycaemia in pregnancy and cardio metabolic risk parameters in the offspring at 10-11 years(Sri Lanka Medical Association., 2019) Herath, K.K.W.H.P.; Herath, H.M.R.P.; Wickremasinghe, A.R.INTRODUCTION & OBJECTIVES: Studies of developmental origins of health and disease have highlighted the possible role of hyperglycaemic intrauterine environment mediating and accelerating the current epidemic of diabetes and non-communicable diseases through foetal programming and epigenetic changes. While the perinatal and neonatal risks of hyperglycaemia in pregnancy (HIP) are well established, the long-term risks for the offspring are less explored. This study aimed to determine the association between HIP and cardiometabolic risk parameters in the offspring at 10-11 years. METHODS: A community based retrospective cohort study was conducted in the Colombo district. In the first stage, children born in 2005 were identified and the availability of antenatal records were assessed. In the second stage, exposure status of participants was ascertained based on antenatal records. In the third stage, eligible children were examined with blood pressure (BP), fasting blood sugar (FBS) and lipid profile to ascertain outcome status. RESULTS: 159 children of mothers with HIP (exposed) and 253 children of mothers with no HIP (non-exposed) participated. Mean ages (SD) of exposed and non-exposed groups were 10.9(0.3) and 10.8(0.3) years, respectively. Exposed children had a significantly higher risk of developing impaired fasting glycaemia (OR=5.6; 95% CI: 1.2-28.9), elevated total cholesterol (OR=2.1; 95% Cl: 1.3- 3.4), elevated low-density lipoprotein cholesterol (OR=1.9; 95% CI: 1.2-3.3) and elevated triglycerides (OR=2.5; 95% CI: 1.4-4.3). There was no significant difference in the BP and elevated high-density lipoprotein cholesterol between the exposed and non-exposed groups. CONCLUSION: Exposure to HIP increases the cardiometabolic risk in the offspring and these children need long-term follow upItem A Case report of Meningioma with uncal herniation in pregnancy(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Suthakaran, V.; Perera, M.N.I.; Herath, H.M.R.P.; Dias, T.D.; Wijesinghe, P.S.INTRODUCTION: The diagnosis and management of meningioma during pregnancy is a challenge, with growth and regression both reported. The occurrence of meningioma during pregnancy is rare, comparable with that in non-pregnant woman in the same age group. We report a case of meningioma with uncal herniation leading to maternal death during pregnancy. CASE: Thirty-year-old woman was referred to our unit on her 20th weeks of gestation for severe headache and vomiting. This is her third pregnancy with two living children, both delivered by caesarean section. She had early morning headache, lasting for 1 to 2 hours which resolved following vomiting from16th week of gestation. She did not have visual impairment, photophobia or focal neurological ymptoms. She was admitted to base hospital for increased frequency and severity of headache on her 18th week of gestation. Neurological examination was normal. Her blood pressure was normal throughout this pregnancy. She defaulted herneurology appointment. She was readmitted for same symptoms and transferred to our hospital. She complained severe headache, vomiting and blurred vision on day of admission followed by difficulty in breathing. Her SPO was 84 % on air and respiratory rate was 32/minutes. Ophthalmoscopy was normal. She was intubated for impending respiratory arrest and non-contrast CT was performed. CT showed Right sided sphenoidal wing tumour suggestive of a meningioma with midline shift and uncal herniation. She developed repeated episodes of a systole before transfer to neurosurgical unit and did not recover. Postmortem findings and histology confirmed the diagnosis of meningothelial type of meningioma. DISCUSSION: Intracranial tumours in pregnant woman are serious and life threatening conditions. The clinical presentation of intracranial mass mimics the symptoms of hyperemesis gravidarum, eclampsia and puerperal psychosis. MRI of the brain is the investigation of choice for prompt diagnosis of meningioma. Surgery is the key in the management of meningioma depend on the site of tumour. The general recommendation in pregnancy is for caesarean section as first surgery followed by neurosurgical interventions. Urgent neurosurgical linterventions are indicated for patients with malignant tumours, active hydrocephalus or benign tumours with impending herniation or progressive neurological deficits.Item Audit on current practices of induction of labour at a tertiary care hospital(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Kajendran, J.; Jayawardena, G.R.M.U.G.P.; Gunarathna, S.M.S.G.; Herath, H.M.R.P.OBJECTIVE: Induction of labour (IOL) is a common obstetric intervention done for several reasons. Most importantly, induction of labour has a large impact on the health of women and their babies and so needs to be clearly clinically justified. Yet it is also important to perform regular audit of this practice on account of ensuring risk-free medical practice. Thus, current practice of IOL was examined to assess the indications and outcomes of IOL. METHOD: This audit was carried out from January 2016 to April 2016 in obstetric professorial unit of Colombo north teaching hospital Ragama. Data on all women admitted for IOL was collected using data collection sheet. The processes of IOL were tested against the WHO clinical guideline. It was aimed to determine the IOL rate, reasons, and outcomes. RESULTS: Out of the1423 deliveries during those periods 377 were induced (26.49%). Mean maternal age was 28.08-years and mean gestation was 39-weeks. Number of successful induction was 286.The most common indications for IOL were: prolonged rupture of membranes (29.4%), prolonged pregnancy (20.7%) diabetes complicating pregnancy (12.2%), hypertensive disorders (9.8%), and small for gestational age (5.1%). Reason for IOL was not documented in 20% and rests of the IOL were due to social, IUD and other medical disorders. The most common indications at <37 weeks were prolonged rupture of membranes (52%) and small for gestational age (17%). Emergency caesarean section was 19.3% for lack of progress and fetal distress. Seventeen percentages of neonates were admitted for NICU and 96% had APGAR more than 7 at 7 minutes. CONCLUSION: Our unit IOL proportion is lower than national figure (35.5%).One fifth of the IOL indications were not documented and this highlights the deficiency in the documentation. Checklist for IOL has been decided in the unit meeting to enhance proper documentation.Item Audit on current practices of induction of labour at a tertiary care hospital(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Kajendran, J.; Jayawardena, G.R.M.U.G.P.; Gunarathna, S.M.S.G.; Herath, H.M.R.P.OBJECTIVE: Induction of labour (IOL) is a common obstetric intervention done for several reasons. Most importantly, induction of labour has a large impact on the health of women and their babies and so needs to be clearly clinically justified. Yet it is also important to perform regular audit of this practice on account of ensuring risk-free medical practice. Thus, current practice of IOL was examined to assess the indications and outcomes of IOL. METHOD: This audit was carried out from January 2016 to April 2016 in obstetric professorial unit of Colombo north teaching hospital Ragama. Data on all women admitted for IOL was collected using data collection sheet. The processes of IOL were tested against the WHO clinical guideline. It was aimed to determine the IOL rate, reasons, and outcomes. RESULTS: Out of the1423 deliveries during those periods 377 were induced (26.49%). Mean maternal age was 28.08-years and mean gestation was 39-weeks. Number of successful induction was 286.The most common indications for IOL were: prolonged rupture of membranes (29.4%), prolonged pregnancy (20.7%) diabetes complicating pregnancy (12.2%), hypertensive disorders (9.8%), and small for gestational age (5.1%). Reason for IOL was not documented in 20% and rests of the IOL were due to social, IUD and other medical disorders. The most common indications at <37 weeks were prolonged rupture of membranes (52%) and small for gestational age (17%). Emergency caesarean section was 19.3% for lack of progress and fetal distress. Seventeen percentages of neonates were admitted for NICU and 96% had APGAR more than 7 at 7 minutes. CONCLUSION: Our unit IOL proportion is lower than national figure (35.5%).One fifth of the IOL indications were not documented and this highlights the deficiency in the documentation. Checklist for IOL has been decided in the unit meeting to enhance proper documentation.Item A case report of Meningioma with uncal herniation in pregnancy(Sri Lanka College of Obstetricians & Gynaecologists, 2017) Suthakaran, V.; Perera, M.N.I.; Herath, H.M.R.P.; Dias, T.D.; Wijesinghe, P.S.INTRODUCTION: The diagnosis and management of meningioma during pregnancy is a challenge, with growth and regression both reported. The occurrence of meningioma during pregnancy is rare, comparable with that in non-pregnant woman in the same age group. We report a case of meningioma with uncal herniation leading to maternal death during pregnancy. CASE: Thirty-year-old woman was referred to our unit on her 20th weeks of gestation for severe headache and vomiting. This is her third pregnancy with two living children, both delivered by caesarean section. She had early morning headache, lasting for 1 to 2 hours which resolved following vomiting from16th week of gestation. She did not have visual impairment, photophobia or focal neurological ymptoms. She was admitted to base hospital for increased frequency and severity of headache on her 18th week of gestation. Neurological examination was normal. Her blood pressure was normal throughout this pregnancy. She defaulted herneurology appointment. She was readmitted for same symptoms and transferred to our hospital. She complained severe headache, vomiting and blurred vision on day of admission followed by difficulty in breathing. Her SPO was 84 % on air and respiratory rate was 32/minutes. Ophthalmoscopy was normal. She was intubated for impending respiratory arrest and non-contrast CT was performed. CT showed Right sided sphenoidal wing tumour suggestive of a meningioma with midline shift and uncal herniation. She developed repeated episodes of a systole before transfer to neurosurgical unit and did not recover. Postmortem findings and histology confirmed the diagnosis of meningothelial type of meningioma. DISCUSSION: Intracranial tumours in pregnant woman are serious and life threatening conditions. The clinical presentation of intracranial mass mimics the symptoms of hyperemesis gravidarum, eclampsia and puerperal psychosis. MRI of the brain is the investigation of choice for prompt diagnosis of meningioma. Surgery is the key in the management of meningioma depend on the site of tumour. The general recommendation in pregnancy is for caesarean section as first surgery followed by neurosurgical interventions. Urgent neurosurgical linterventions are indicated for patients with malignant tumours, active hydrocephalus or benign tumours with impending herniation or progressive neurological deficits.Item Gestational diabetes mellitus and risk of type 2 diabetes 10 years after the index pregnancy in Sri Lankan women: a community based retrospective cohort study(Sri Lanka Medical Association, 2017) Herath, K.K.W.H.P.; Herath, H.M.R.P.; Wickremasinghe, A.R.INTRODUCTION & OBJECTIVES: Women with a history of gestational diabetes mellitus (GDM) have an increased risk of type 2 diabetes mellitus (T2DM) later in life. This study aimed to determine the risk of developing T2DM 10 years after GDM in Sri Lankan women. METHODS: A retrospective cohort study was conducted in the Colombo district. 7205 women who delivered a child in 2005 were identified through the PHM in the field. Women with antenatal records were interviewed and relevant data were extracted from medical records to identify potential participants. 119 women who had GDM and 240 women who did not have GDM were recruited. Current diagnosis of diabetes was based on the history and relevant medical records within the past 1 year. RESULTS: The mean duration of follow up was 10.9 (SD= 0.35) years in the GDM group and 10.8 (SD=0.31) years in the non-GDM group. The incidence density of diabetes in the GDM group was 56.3 per 1000 person years compared to 5.4 per 1000 person years in the non GDM group giving a rate ratio of 10.42 (95% CI 6.01-19.12). A woman with GDM was 10.6 times more likely to develop diabetes compared to women with no GDM after controlling for confounding variables. Delivering a child after 30 years, being treated with insulin during pregnancy and birth weight ≥ 3.5 Kg were significant predictors of development of T2DM. CONCLUSION: Women with GDM had a 10 fold higher risk of developing T2DM during a 10 year follow up period as compared to women with no GDM.Item Histological types of Gynaecological tumours in the teaching hospital, Ragama over a 9 year period(Sri Lanka College of Obstetricians and Gynaecologists, 2008) Nishad, A.A.N.; Herath, H.M.R.P.; Padumadasa, S.G.J.; Wijesinghe, P.S.; Feranando, W.S.; Rathayake, R.M.U.S.; Hewavisenthi, S.J.de S.INTRODUCTION: Gynaecological malignancies contribute significantly to the mortality of women. The pathological spectrum of ovarian and uterine malignancies is wide and diverse. Differences in incidence of histological types and stages at presentation have been reported. OBJECTIVE: To describe the histological types of ovarian, uterine and fallopian tube malignancies diagnosed at Professorial unit Ragama during the period of 1st January 1999 to 1st May 2008. METHODOLOGY: A descriptive, retrospective study was done using the histopathological reports during the study period. RESULTS: There were 96 ovarian, 44 uterine and 1 fallopian tube malignancies detected during the study period. Out of the 96 ovarian malignancies, 94 (97.9%) were primary ovarian tumours while 2 (2.1%) were secondary tumours. Epithelial tumours were the commonest accounting for 80.9% of primary ovarian malignancies while stromal and germ cell tumours contributed to 9.6% and 5.3% respectively. There were 39 (51.3%) serous tumours, 18 (23.7%) endometrioid tumours and 9(11.9%) mucinous tumours among the epithelial tumours. Immature teratomas were the commonest (60%) germ cell tumour. At presentation 22 (23.4%) were bilateral tumours. Majority 29 (31%) of ovarian malignancies were FIGO stage T11C at diagnosis. Among the uterine malignancies there were 33(75%) endometrial carcinoma, 3(7%) Endometrial stromal sarcoma, 2 (4.5%) leiomyosarcomas, ,and 6 (13.5%) other sarcomas. Most (67%) of the patients who had endometrial carcinomas were FIGO stage 1 at the time of diagnosis. DISCUSSION: Though the proportion of the epithelial tumours were similar to the standard figures, germ cell tumours seems to be less in number. Secondary ovarian tumours seem to be less in our study population. The fact that the ovarian malignancies are diagnosed late is evident by the study.Item Sexual practices, knowledge and usage of contraceptives among adolescents and young adults(Sri Lanka College of Obstetricians and Gynaecologists, 2008) Herath, H.M.R.P.; Dissanayake, D.M.A.B.; Hilmi, M.A.M.; Pathmeswaran, S.; Fernando, W.S.; Wijesinghe, P.S.INTRODUCTION: Adolescence is a critical period of development, as important behaviour patterns are learnt during this period. The sexual debut in Sri Lankan schooling adolescents has been reported as 15.3 years for males and 14.4 for females. Furthermore a significant difference in the prevalence of heterosexual experience among the two sexes have been reported(14% among boys Vs 2% among girls). In 2001, of the pregnant women who received antenatal care from public health midwives, 7.8% were teenagers. Interestingly 22.2% of maternal deaths due to illegal abortions were in this age group during 1996. Thus the situation demands research into sexual practices and strategies to increase the contraceptive uptake by teenagers. OBJECTIVES: To describe and compare the sexual practices. knowledge and usage of contraceptives by the adolescents and young adults with different educational backgrounds. METHOD: Study was a cross sectional descriptive study done involving subjects of three different educational levels i.e. students of universities and technical colleges and employees of garment factories. Data were collected with a pretested self administered questionnaire. RESULTS: Data of 1258 subjects were analyzed. Of them 23% were garment factory workers, 38.2% were technical college students and 38.8% were university students. Females consisted 58.9% of the population. The mean age for males and females were 20.5 years and 20.7 years respectively. The mean age of first sexual relationship of males and females were at 17.65 and 19.44 years respectively (p<.001). Out of the total population 17% of females and 33.5% of males were sexually active. Sexual relationships were reported by 51.7% of garment factory employees, 19.4% technical college students and 12.3% of university students. Majority of male garment factory workers ("90 %) were sexually active. Of the 166 sexually active males 19.3% had sexual relationship with commercial sex workers. Out of the 172 people who have not used modern contraceptives during heterosexual relationships, 32% has used natural family planning. Significantly larger proportion (21.7%) of garment factory workers compared to other settings believed that IUCD would protect them from HIV infection. Of the study population 24.9% of females and 71.2% of males knew barrier methods would minimize the risk of development of HIV. With regard to primary source of information regarding contraceptive methods, 24.2 % and 23.4% of subjects reported school and news papers, while 28.4% felt that information from parents as the least important source. Of the people who selected school as their main source of information, only 41.4% knew barrier methods could protect them from HIV. Majority preferred instructions from school and special health clinics on contraceptive usage. CONCLUSIONS: Teenage and young adult males have their first sexual relationship at an earlier age than female counterparts. A larger proportion of garment factory employees are sexually active compared to students of technical colleges and universities. Significant proportion of males of the age group had their first relationship with commercial sex workers. The knowledge about different contraceptive methods among this population is inadequate. More emphasis should be given to the preferred media by the adolescents and young adults in educating them on contraceptive methods.Item Teenage pregnancy outcome(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. Controversy exists \vhether poor obstetric performance of teenagers is related to age or quality of care received.. The study was conducted to assess the antenatal care received and to assess the pregnancy outcome in teenage mothers. OBJECTIVES: To describe the reception of antenatal care provided, pregnancy complications and out corne in teenage pregnant mothers delivering at teaching hospital Peradeniya. METHOD: A prospective descriptive study, using interviewer administered questionnaire was done on teenage mothers who delivered at teaching hospital Peradeniya from 1st of April 2005 to 31st of March, 2006. Data was collected with regard to the demographic characteristics, booking antenatal visits, pregnancy complications and pregnancy outcomes. RESULTS: There were 190 teenage mothers delivered during the study period. Data were collected from 186 of them. Only 5.2% of the population was booked at any antenatal clinic before 12 weeks of period of amenorrhoea (POA), while the mean POA of booking was 24 weeks. Ninety five (51.1%) has had 5 or more antenatal clinic visits. Number of clinic visits and folk acid intake during first trimester was not related to the age of teenage mother. Anaemia was the commonest complication noted, accounting to 19.4%, while PIH was seen in 5.45 % of cases. LSCS was the mode of delivery in 16.7% of cases while instrumental deliveries contributed to 8.6%. In 26.9% of babies, birth weight was less than 2500grams, while 17.7 % of babies needed to be admitted to SBU. DISCUSSION: Teenage pregnant mothers are less likely to have received early and adequate antenatal care. More attention is needed to identify teenage pregnancies at early stage with subsequent referral to an antenatal clinic.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.
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