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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Study on age-ralated variation in ovarian volume and proportion of endometrial thickness abnormalities in women of advanced and post-reproductive age(John Wiley & Sons, 2016) Pieris, V.; Dias, T.; Palihawadana, T.S.; de Silva, J.Objectives: To describe the variations in endometrial thickness and the ovarian volume among peri and postmenopausal women. Methods: A cross-sectional analysis was done in a study population of a longitudinal study. This was a community-based study and included 888 women randomly selected from the Ragama, Sri Lanka. This was done as part of a larger ongoing study, the “Ragama Health Study”. All study participants underwent a transvaginal pelvic ultrasound scan and the endometrial thickness and the ovarian size were measured. The ovarian volume was calculated using the formula for a prolate ellipsoid (0.523 h x w x l). Results: The mean age of the study population was 59.45 yrs (SD=7.601) and 85.8% (n = 762) of them had undergone menopause. The prevalence of an endometrial thickness (ET) > 10 mm among premenopausal women was 14.98% while 0.9% (n = 1) had an ET>15 mm. Among postmenopausal women an ET >4 mm was seen in 16.01%. This included 1.3% (n = 10) who had an ET >10 mm. The mean of average ovarian volumes of the study population, according to age is shown in the figure. Conclusions: The study demonsatrated the proportion of asymptomatic women with a thickened endometrium among perimenoausal and poatmenopausal women (>15 mm and >4 mm resepectively) that necessitate evaluation is around 1%. It also described the age related changes in ovarian volume.Item Risk of stillbirth at term and optimum timing of delivery in uncomplicated south Asian singleton pregnancies(Sri Lanka Medical Association, 2014) Dias, T.; Kumarasiri, S.; Wanigasekara, R.; Cooper, D.; Batuwitage, C.; Jayasinghe, L.; Padeniya, T.OBJECTIVES: Aims of this study were to compare the perinatal mortality rate and the prospective risk of stillbirth for each given gestational age and to ascertain whether it is safe to continue the pregnancy beyond 40 weeks of gestational age and induce labour at 41 weeks in low risk singleton pregnancies. METHODS: This was a retrospective study. The perinatal mortality and prospective risk were calculated per 1000 total births and 1000 on going pregnancies respectively in well dated singleton pregnancies. 38+0 to 39+6 gestational age was taken as the reference. RESULTS: A total of 12,595 deliveries after 28 weeks of gestation were included. The risk of stillbirth at 38+0 to 39+6 weeks was 1.43 (95% CI, 0.9 to 2.4) per 1000 on going pregnancies. The perinatal mortality rate at 38+0 to 39+6 weeks was 2.9 (95% CI, 1.9 to 4.5) per 1000 total births. The perinatal mortality rate decreased throughout gestation and it was lowest at 40+0 - 41+6. In contrast, risk of stillbirth increased with advancing gestation and peaked at 40+0 - 41+6 (2.57, 95% CI, 1.4 to 4.7). However, risk of stillbirth at 40+0 - 41+6 was not statistically different from 38+0 to 39+6 (OR 1.79, 95% CI, 0.80 to 3.98). To prevent one stillbirth, 886 pregnancies should be induced at 38+0 to 39+6. CONCLUSIONS: Risk of stillbirth is more informative than perinatal mortality at term. Frequent antenatal fetal surveillance should be adopted towardsterm in order to identify high risk pregnancies. Elective delivery before 40 weeks in low risk pregnancies is not justifiedItem Antenatal uterine rupture in a pregnancy following microwave endometrial ablation(Informa Healthcare, 2011) Herath, R.P.; Singh, N.; Oligbo, N.No abstract availableItem Longterm results of total pelvic floor repair for postobstetric fecal incontinence(Lippincott Williams and Wilkins, 1997) Korsgen, S.; Deen, K.I.; Keighley, M.R.B.PURPOSE:This study was designed to assess the long-term results of total pelvic floor repair for postobstetric neuropathic fecal incontinence. METHOD: Sixty-three of 75 women who had undergone total pelvic floor repair for postobstetric neuropathic fecal incontinence were traced and interviewed a median of 36 (18-78) months after surgery. Thirty-nine patients agreed to repeat anorectal physiology. RESULTS: Six patients required further surgery for persistent incontinence (colostomy, 4; graciloplasty, 2). For the remaining 57 patients, incontinence improved greatly in 28 (49 percent) patients, mildly in 13 (23 percent), and not at all in 16 (28 percent); daily incontinence was present in 41 patients (73 percent) before the operation but persisted in 13 (23 percent). Only eight (14 percent) patients were rendered completely continent; those with marked improvement were socially more active than those with little or no improvement. Resting and maximum squeeze pressures, anal canal sensation, rectal sensation, and pudendal nerve terminal motor latency did not predict outcome. Perineal descent, obesity, and a history of straining before the operation were all associated with a poor outcome. CONCLUSION: Total pelvic floor repair rarely renders patients with postobstetric neuropathic fecal incontinence completely continent but substantially improves continence and lifestyle in approximately one-half of them. The operation is less successful in obese patients and in those with a history of straining or perineal descent.Item Routine use of mebendazole in pregnancy(Sri Lanka Medical Association, 1996) de Silva, N.R.; Kodituwakku, K.K.A.P.; Edirisinghe, S.S.; de Silva, H.J.INTRODUCTION: The Ministry of Health has recommended the routine administration of a broad spectrum anthelmintic to all pregnant women after completion of the first trimester of pregnancy. OBJECTIVE: To estimate prevalence and intensity of geohelminth infections in pregnant women attending an antenatal clinic in Ragama and determine the use of anthelmintics by them. METHODS: Women on their first visit to antenatal clinics of the University Obstetrics Unit, General Hospital Colombo North, Ragama, during July-August 1995, were recruited for the study. Demographic details, duration of pregnancy and a history of using anthelmintics during the current pregnancy were noted. A stool sample was obtained and examined using modified Kato-Katz technique. RESULTS: 309 pregnant women were studied [mean age 26.6 years (SD 5.3)]. 94 (30.4%) had taken an anthelmintic during the current pregnancy. 78 (25.2%) had taken it in the second trimester, 9 (2.9%) in the third, 6 (1.8%) in the first, and one was uncertain of the timing. Stool samples were obtained from 181 women giving a compliance rate of 58.6%. Prevalence of geohelminth infections were: whipworm 10%, hookworm 2.2%, roundworm 1.1%. The intensities of the infections were mild. 157 (86.7%) did not have any geohelminth infection. Of the 181 women whose stools were examined, 52 had taken an anthelmintic. There was no significant difference in the prevalence of geohelminth infections between this group (6/52; 11.2%) and those who had not taken an anthelmintic (18/129; 13.9%) (Chi-square test). CONCLUSION: It may not be necessary to treat all pregnant women in Sri Lanka with anthelmintics, as some areas have a low prevalence of infection. Routine anthelmintic therapy could-be limited to areas where prevalence rates are known to be high.Item Evaluation of effectiveness of iron-folate supplementation and anthelmintic therapy against aneamia in pregnancy - a study in the plantation sector of Sri Lanka(American Society of Clinical Nutrition, 1994) Athukorala, T.M.S.; de Silva, L.D.R.; Dechering, W.H.J.C.; Dissanayake, T.S.Intervention measures against anemia available to plantation workers during pregnancy include fortified food supplements (thriposha) and iron-folate supplements containing 60 mg elemental Fe. The effectiveness of these intervention measures was studied in 195 subjects whose iron and nutritional status were assessed at < 24 and > 32 wk of gestation. Taking thriposha conferred no significant benefit on maternal nutritional status, probably because sufficient amounts were not consumed. An increase in the duration of iron-folate supplementation to > 17 wk caused a significant positive change (P < 0.01) in hemoglobin, whereas an increase in the dose frequency had no significant benefit. Anthelminthic therapy in addition to iron-folate supplements caused a significant positive change in hemoglobin (P < 0.001) and serum ferritin (P < 0.005) compared with no supplementation. Thus, anthelminthic therapy significantly increased the beneficial effects of iron supplementation on hemoglobin concentration and iron status.