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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Ultrasound parameters of pelvic organs and their age-related changes in a cohort of asymptomatic postmenopausal women: A community-based study.(Sage Publishing, 2020) Dias, T.D.; Palihawadana, T.S.; Patabendige, M.; Motha, M.B.; de Silva, H.J.No abstract available.Item Neglected symptoms of heart failure presented as peripartum cardiomyopathy: a case of maternal near-miss(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Patabendige, M.; Perera, M. N. I.; Suthakaran, V.; Kajendran, J.; Padumadasa, S. P.INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a rare obstetric emergency affecting women in late pregnancy or up to five months of postpartum period. It occurs in the absence of an identifiable cause or recognizable heart disease prior to the last month of pregnancy. The aetiology of PPCM is unknown. It has potentially devastating effects on mother and fetus if not treated early. The signs, symptoms and treatment of PPCM are similar to that of heart failure. Early diagnosis and proper management is the corner stone for better outcome of these patients. CASE REPORT: A 41 year old woman in her fourth pregnancy with two vaginal deliveries followed by a first trimester miscarriage presented with cough and exertional dyspnoea for two weeks duration at 31 weeks of gestation. History also revealed features of orthopnoea and paroxysmal nocturnal dyspnea. Her pregnancy was uncomplicated up to this. On admission, she was dyspnoec with clinical signs of acute heart failure and pulmonary oedema and blood pressure of 170/122 mmHg. Arterial blood gas showed metabolic acidosis and 64% of oxygen saturation. She was transferred to ICUand intubated with continuous positive airway pressure followed by synchronized intermittent mechanical ventilation and multi-disciplinary care. Echocardiography revealed dilated cardiomyopathy with ejection fraction of 20% and improved only upto 35%-40%favouring diagnosis of PPCM over pre-eclampsia. With initial resuscitation, intravenous antibiotics and heart failure therapy hercondition improved. Ultrasonography revealed an intrauterine death.Since she was receiving ICU care with sepsis and also cesarean section does not confer any benefit over vaginal delivery, induction was done with prostaglandin E2followed by misoprostol. She was discharged with a plan of sterilization.DISCUSSION: Third trimester is the most vulnerable period for most of the maternal and foetal lethal events. Proper education regrinding earlier medical advice for uncommon symptoms in late pregnancy may help to reduce the occurrence of these maternal near-misses. Although PPCM has a higher chance of mortality, rational and evidenced-based management can save these mothers. Since it carries a higher risk of recurrence in subsequent pregnancies, sterilization is required.Item Validation of the Sinhala translation of the International Consultation on Incontinence modular Questionnaire on Vaginal Symptoms (ICIQ-VS)(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Ekanayake, C.D.; Patabendige, M.; Wijesinghe, P.S.; Pathmeswaran, A.; Herath, R.P.; Weerasinghe, N.OBJECTIVE: To translate and validate the International Consultation on Incontinence Modular Questionnaire on vaginal symptoms (ICIQ VS) from English to Sinhala.METHODS: ICIQ-VS questionnaire was translated to Sinhala and a validation study was carried out among women attending the gynaecology clinic at North Colombo teaching hospital, Ragama. RESULTS: Basic demographic characteristics of women with prolapse (n=64) versus women without prolapse (n=135) were as follows; Age 55.8 (SD 13.1) years, median parity 2.5 (IQ1IQ3=2-4), BMI 23.8 kg/m2 (SD 3.2) versus age 42.6 (SD 13.1), median parity 2 (IQ1-IQ3=1-3), BMI 23.2 kg/m2 (SD 2.9) respectively. Content validity was assessed by the level of missing data which was less than 1% for each item. Internal consistency was assessed using Cronbach’s coefficient alpha scores which ranged from 0.75 to 0.78. Test–retest reliability as assessed by kappa values ranged from 0.54 to 0.80, except for item, ‘vagina too tight’ which demonstrated moderate reliability (kappa 0.41). Construct validity was assessed by the ability of the questionnaire to differentiate between patients and controls. The questionnaire differentiated between patients and controls on vaginal symptoms score (VSS) (p<0.001), sexual symptoms score (SSS) (p<0.05) and quality of life (p<0.001). There was a positive correlation between pelvic organ prolapse quantification system (POP-Q) scores and VSS (rs= 0.61, p<0.001), SSS (rs = 0.22, p<0.01) and quality of life (rs = 0.52, p<0.001). CONCLUSIONS: The preliminary results for ICIQ VS (Sinhala) validation are satisfactory and once completed it will be invaluable to objectively assess vaginal and sexual symptoms in Sinhala speaking population in Sri LankaItem Neglected symptoms of heart failure presented as peripartum cardiomyopathy: a case of maternal near-miss(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Patabendige, M.; Perera, M.N.I.; Suthakaran, V.; Kajendran, J.; Padumadasa, S.P.INTRODUCTION: Peripartum cardiomyopathy (PPCM) is a rare obstetric emergency affecting women in late pregnancy or up to five months of postpartum period. It occurs in the absence of an identifiable cause or recognizable heart disease prior to the last month of pregnancy. The aetiology of PPCM is unknown. It has potentially devastating effects on mother and fetus if not treated early. The signs, symptoms and treatment of PPCM are similar to that of heart failure. Early diagnosis and proper management is the corner stone for better outcome of these patients. CASE REPORT: A 41 year old woman in her fourth pregnancy with two vaginal deliveries followed by a first trimester miscarriage presented with cough and exertional dyspnoea for two weeks duration at 31 weeks of gestation. History also revealed features of orthopnoea and paroxysmal nocturnal dyspnea. Her pregnancy was uncomplicated up to this. On admission, she was dyspnoec with clinical signs of acute heart failure and pulmonary oedema and blood pressure of 170/122 mmHg. Arterial blood gas showed metabolic acidosis and 64% of oxygen saturation. She was transferred to ICUand intubated with continuous positive airway pressure followed by synchronized intermittent mechanical ventilation and multi-disciplinary care. Echocardiography revealed dilated cardiomyopathy with ejection fraction of 20% and improved only upto 35%-40%favouring diagnosis of PPCM over pre-eclampsia. With initial resuscitation, intravenous antibiotics and heart failure therapy hercondition improved. Ultrasonography revealed an intrauterine death.Since she was receiving ICU care with sepsis and also cesarean section does not confer any benefit over vaginal delivery, induction was done with prostaglandin E2followed by misoprostol. She was discharged with a plan of sterilization. DISCUSSION: Third trimester is the most vulnerable period for most of the maternal and foetal lethal events. Proper education regrinding earlier medical advice for uncommon symptoms in late pregnancy may help to reduce the occurrence of these maternal near-misses. Although PPCM has a higher chance of mortality, rational and evidenced-based management can save these mothers. Since it carries a higher risk of recurrence in subsequent pregnancies, sterilization is required.Item Validation of the Sinhala translation of the International Consultation on Incontinence modular Questionnaire on Vaginal Symptoms (ICIQ-VS)(Sri Lanka College of Obstetricians & Gynaecologists, 2016) Ekanayake, C.D.; Patabendige, M.; Wijesinghe, P.S.; Pathmeswaran, A.; Herath, R.P.; Weerasinghe, N.OBJECTIVE: To translate and validate the International Consultation on Incontinence Modular Questionnaire on vaginal symptoms (ICIQ VS) from English to Sinhala. METHOD: ICIQ-VS questionnaire was translated to Sinhala and a validation study was carried out among women attending the gynaecology clinic at North Colombo teaching hospital, Ragama. RESULTS: Basic demographic characteristics of women with prolapse (n=64) versus women without prolapse (n=135) were as follows; Age 55.8 (SD 13.1) years, median parity 2.5 (IQ1- IQ3=2-4), BMI 23.8 kg/m2 (SD 3.2) versus age 42.6 (SD 13.1), median parity 2 (IQ1-IQ3=1-3), BMI 23.2 kg/m2 (SD 2.9) respectively. Content validity was assessed by the level of missing data which was less than 1% for each item. Internal consistency was assessed using Cronbach’s coefficient alpha scores which ranged from 0.75 to 0.78. Test–retest reliability as assessed by kappa values ranged from 0.54 to 0.80, except for item, ‘vagina too tight’ which demonstrated moderate reliability (kappa 0.41). Construct validity was assessed by the ability of the questionnaire to differentiate between patients and controls. The questionnaire differentiated between patients and controls on vaginal symptoms score (VSS) (p<0.001), sexual symptoms score (SSS) (p<0.05) and quality of life (p<0.001). There was a positive correlation between pelvic organ prolapse quantification system (POP-Q) scores and VSS (rs= 0.61, p<0.001), SSS (rs = 0.22, p<0.01) and quality of life (rs = 0.52, p<0.001). CONCLUSION: The preliminary results for ICI Q VS (Sinhala) validation are satisfactory and once completed it will be invaluable to objectively assess vaginal and sexual symptoms in Sinhala speaking population in Sri Lanka.Item Validation of the international consultation on incontinence questionnaire-vaginal symptoms (ICIQ-VS) in two South- Asian languages(Springer, 2017) Ekanayake, C.D.; Pathmeswaran, A.; Herath, R.P.; Perera, H.S.; Patabendige, M.; Wijesinghe, P.S.INTRODUCTION: The multifaceted nature of pelvic floor disorders means that a systematic evaluation is required for optimal treatment outcome. It is also generally acknowledged that a valid tool is necessary to objectively assess symptoms reported by affected women. METHODS: The International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS) questionnaire was translated to Sinhala and Tamil and a validation study carried out among women attending gynecology clinics at North Colombo Teaching Hospital, Ragama, and the district general hospitals Mannar and Vavuniya. RESULTS: Content validity was assessed by the level of missing answers, which was < 4% and 2% for each item in Sinhala and Tamil, respectively. Construct validity was assessed by the ability of the questionnaire to differentiate between patients and controls. Both differentiated patients from controls on vaginal symptoms score (VSS) (p < 0.001), sexual symptoms score (SSS) (p < 0.01), and quality of life (QoL) (p < 0.001). There was a strong positive correlation between Pelvic Organ Prolapse Quantification (POP-Q) scores and VSS (Sinhala r s = 0.64, p < 0.001, Tamil r s = 0.65, p < 0.001), and QoL (Sinhala r s = 0.49, p < 0.001, Tamil r s = 0.60, p < 0.001). Internal consistency as assessed using Cronbach's coefficient alpha: 0.78 (0.76-0.78) and 0.83 (0.80-0.84) in Sinhala and Tamil, respectively. Test-retest reliability was assessed by weighted kappa scores (Sinhala 0.58-0.88 and Tamil 0.76-0.90). Both questionnaires were sensitive to change and showed that VSS and QoL improved following surgery (Wilcoxon matched-pairs signed-rank test p < 0.001). CONCLUSION: The validated Sinhala and Tamil translations of ICIQ-VS will be useful for assessing vaginal and sexual symptoms among women speaking Sinhala and Tamil.