Medicine
Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12
This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
Browse
7 results
Search Results
Item Spontaneous ovarian hyperstimulation syndrome as a presenting manifestation of acquired hypothyroidism(Sri Lanka College of Paediatricians, 2024) Kaluarachchi, D.P.; Casather, D.M.; Rathnayaka, R.M.A.N.; Ramachandran, R.; Herath, R.; Mettananda, S.No abstract availableItem 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 Osteitis pubis following laparoscopic Burch colposuspension: A case report(Elsevier B.V., 2021) Jayasundara, S.; Herath, R.Osteitis pubis is a condition which predominantly affects young athletes. However, it may also occur following uro-gynecological interventions. We report a case of osteitis pubis following laparoscopic Burch colposuspension. There are several theories on the pathogenesis of postoperative osteitis pubis and a wide variety of treatment options have shown inconsistent outcomes. In our case, the condition was diagnosed radiologically and was managed with antibiotics and analgesics, which resulted in complete recovery.Item Vaginal, sexual and urinary symptoms following Hysterectomy: A Multi-centre randomized controlled trial.(BioMed Central, 2020) Ekanayake, C.; Pathmeswaran, A.; Herath, R.; Wijesinghe, P.BACKGROUND: Hysterectomy is the most common major gynaecological procedure. The aim of this study was to study vaginal, sexual and urinary symptoms following total abdominal hysterectomy (TAH), non-descent vaginal hysterectomy (NDVH) and total laparoscopic hysterectomy (TLH) in a low resource setting. METHODS: A multi-centre randomized controlled trial (RCT) was conducted in two public sector hospitals in Sri Lanka. Participants were patients requiring hysterectomy for non-malignant uterine causes. Exclusion criteria were uterus> 14 weeks, previous pelvic surgery, medical illnesses which contraindicated laparoscopic surgery, and those requiring incontinence surgery or pelvic floor surgery.Vaginal, sexual function and urinary symptoms were assessed by the validated translations of ICIQ-VS and ICIQ-FLUTS questionnaires. Post-operative improvement (pre-operative - post-operative) was assessed. RESULTS: There was an improvement (median (IQ1-IQ3) in vaginal symptoms [TAH 6(2-8) vs 4(0-8), p < 0.001; NDVH 6(4-8.5) vs 5(0-8), p < 0.001; TLH 4(2-10.5) vs 4(0-10), p < 0.001], urinary flow symptoms [TAH 2(1-4) vs 1 (0-3), p < 0.001; NDVH 3 (2-5) vs 2 (0.5-4), p < 0.001; TLH 1(1-4) vs 1(0-3), p < 0.05], urinary voiding symptoms [TAH 0(0-0) vs 0(0-0), p = 0.20; NDVH 0(0-1) vs 0(0-0.8), p < 0.05; TLH 0(0-0) vs 0(0-0), p < 0.05] and urinary incontinence symptoms [TAH 0(0-2) vs 0(0-2), p = 0.06; NDVH 0(0-3) vs 0(0-3), p < 0.001; TLH 0(0-3) vs 0(0-2), p < 0.05] at 1-year (TAH n = 47, NDVH n = 45, TLH n = 47). There was an improvement in sexual symptoms only in the TLH group [TAH 0(0-11.5) vs 0(0-14), p = 0.08); NDVH 0(0-0) vs 0(0-0), p = 0.46; TLH 0(0-0) vs 0(0-4), p < 0.05].There was no significant difference among the three different routes in terms of vaginal symptoms score [TAH 2 (0-2), NDVH 0 (0-2), TLH 0 (0-2), p = 0.33], sexual symptoms [TAH 0 (0-0), NDVH 0 (0-0), TLH 0 (0-0), p = 0.52], urinary flow symptoms [TAH 0 (0-1), NDVH 0 (0-1), TLH 0 (0-2), p = 0.56], urinary voiding symptoms [TAH 0 (0-0), NDVH 0 (0-0), TLH 0 (0-0), p = 0.64] and urinary incontinence symptoms [TAH 0 (0-0), NDVH 0 (0-1), TLH 0 (0-1), p = 0.35] at 1-year. CONCLUSIONS: There was a post-operative improvement in vaginal symptoms and urinary symptoms in all three groups. There was no significant difference in pelvic organ symptoms between the three routes; TAH, NDVH and TLH. TRIAL REGISTRATION: Sri Lanka clinical trials registry, SLCTR/2016/020 and the International Clinical Trials Registry Platform, U1111-1194-8422, on 26 July 2016. Available from: http://slctr.lk/trials/515. KEYWORDS: Non-descent vaginal hysterectomy; Randomized controlled trial; Sexual symptoms; Total abdominal hysterectomy; Total laparoscopic hysterectomy; Urinary symptoms; Vaginal symptoms.Item Cost evaluation, quality of life and pelvic organ function of three approaches to hysterectomy for benign uterine conditions: study protocol for a randomized controlled trial(BioMed Central, 2017) Ekanayake, C.; Pathmeswaran, A.; Kularatna, S.; Herath, R.; Wijesinghe, P.BACKGROUND: Hysterectomy is the commonest major gynaecological surgery. Although there are many approaches to hysterectomy, which depend on clinical criteria, certain patients may be eligible to be operated in any of the several available approaches. However, most comparative studies on hysterectomy are between two approaches. There is also a relative absence of data on long-term outcomes on quality of life and pelvic organ function. There is no single study which has considered quality of life, pelvic organ function and cost-effectiveness for the three main types of hysterectomy. Therefore, the objective of this study is to provide evidence on the optimal route of hysterectomy in terms of cost-effectiveness by way of a three-armed randomized control study between non-descent vaginal hysterectomy, total laparoscopic hysterectomy and total abdominal hysterectomy. METHODS: A multicentre three-armed randomized control trial is being conducted at the professorial gynaecology unit of the North Colombo Teaching Hospital, Ragama, Sri Lanka and gynaecology unit of the District General Hospital, Mannar, Sri Lanka. The study population is women needing hysterectomy for non-malignant uterine causes. Patients with a uterus > 14 weeks, previous pelvic surgery, those requiring incontinence surgery or pelvic floor surgery, any medical illness which caution/contraindicate laparoscopic surgery and who cannot read and write will be excluded. The main exposure variable is non-descent vaginal hysterectomy and total laparoscopic hysterectomy. The control group will be patients undergoing total abdominal hysterectomy. The primary outcome is time to recover following surgery, which is the earliest time to resume all of the usual activities done prior to surgery. In total, 147 patients (49 per arm) are needed to have 80% power at α-0.01 considering a loss to follow-up of 20% to detect a 7-day difference between the three routes; TLH versus TAH versus NDVH. The economic evaluation will take a societal perspective and will include direct costs in relation to allocation of healthcare resources and indirect costs which are borne by the patient. A micro-costing approach will be adopted to calculate direct costs from the time of presentation to the gynaecology clinic up to 6 months after surgery. Incremental cost-effectiveness ratios (ICER) will be obtained by calculating the incremental costs divided by the incremental effects (time to recover and QALYs gained) for the intervention groups (NDVH and TLH) over the standard care (TAH) group. DISCUSSION: The cost of the procedure, quality of life and pelvic organ function following the three main routes of hysterectomy are important to clinicians and healthcare providers, both in developed and developing countries.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(Public Library of Science, 2017) Herath, H.; Herath, R.; Wickremasinghe, R.BACKGROUND: Women with a history of gestational diabetes mellitus (GDM) have an increased risk of type 2 diabetes mellitus (T2DM) later in life compared to women with no GDM. This study was 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, Sri Lanka. 7205 women who delivered a child in 2005 were identified through Public Health Midwives in the field. Women with antenatal records were interviewed and relevant data were extracted from medical records to identify potential participants. One hundred and nineteen women who had GDM and 240 women who did not have GDM were recruited. Current diagnosis of diabetes was based on history, relevant medical records and blood reports 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 non GDM group giving a rate ratio of 10.42 (95% CI: 6.01-19.12). A woman having GDM in the index pregnancy was 10.6 times more likely to develop diabetes within 10 years compared to women with no GDM after controlling for other confounding variables. Delivering a child after 30 years, being treated with insulin during the pregnancy and delivering a baby weighing more than 3.5 Kg were significant predictors of development of T2DM after controlling for family history of diabetes mellitus (DM), GDM in previous pregnancies, parity and gestational age at delivery. CONCLUSIONS: 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 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.