Browsing by Author "Palihawadana, T.S."

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Aetiology of infertility among females seeking treatment at a tertiary care hospital in Sri Lanka
(Sri Lanka Medical Association, 2012) Palihawadana, T.S.; Wijesinghe, P.S.; Seneviratne, H.R.
OBJECTIVES: Aim of this study was to describe the proportion of contributory factors of female infertility in a population that sought fertility treatment. Furthermore, the clinical findings and underlying pathologies associated with ovulatory dysfunction were also sought. METHODS: A cross-sectional study was carried out at the infertility clinic of the North Colombo Teaching Hospital. New clinic attendees were recruited and both partners had a detailed clinical interview. The women underwent a baseline pelvic ultrasound scan, assessment of ovulation and a hormone profile. Tests for tubal patency were carried out when clinically indicated. RESULTS: Ovulatory dysfunction was noted in 53% (n=218). Clinical and investigatory findings associated with ovulatory dysfunction included irregular menstrual cycles, acanthosis nigricans, hirsutism, polycystic ovary syndrome, a LH:FSH ratio of >1, and increased TSH or testosterone levels. Unilateral tubal occlusion was seen in 9.1 % (n=18) while it was bilateral in 1% (n=2). Abnormalities in sexual function were noted in 10.8% (n=56). CONCLUSIONS: Abnormalities in ovulation were common. Clinical findings that could be used to recognise women at risk of ovulatory dysfunction were identified. Abnormalities in sexual function, which are often overlooked in the clinical management of infertility, were seen in over 10% of patients. Tubal factor infertility is rare.
Anovulation as cause of infertility and novel methods of ovulation induction
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Palihawadana, T.S.
Infertility is known to affect one in six couples. Ovulatory dysfunction is a common underlying cause and is seen in approximately 38% of couples seeking infertility treatment. Polycystic ovary syndrome was the commonest underlying cause of anovulation and was seen in nearly 60% women. Hypogonadotropic hypogonadism and ovarian failure are uncommon causes of anovulation seen in only about 1-2% of women with anovulation. Clomifene citrate is the commonest medication used for induction of ovulation. It is successful in achieving ovulation in over three quarters of women with WHO group II anovulation. However, factors such as hirsutism, a high antral follicle count and a high LH:FSH ratio are associated with clomifene resistance. Aromatase inhibitor, letrozole, is a novel medication for induction of ovulation. It is successful in achieving ovulation in nearly 75% of women who respond to clomifene and 25% of women with clomifene resistance. Factors associated with resistance to letrozole included a high day2 LH level, hirsuitism and clomifene resistance had the highest association. The use of letrozole for augmentation of ovulation, in comparison to clomifene, resulted in a higher endometrial thickness and a trend towards monofollicle development. Gonadotropin (FSH) is used in induction of ovulation among women with resistance to oral medication. A low-dose step down regimen of rFSH, in comparison to a low-dose step-up regimen, showed a shorter duration of treatment, with no significant reduction in the total drug requirement. These findings have improved our understanding of different modes of induction of ovulation, which helps in further research and clinical practice.
The apt use of symphysio - fundal height chart during antenatal follow up: A multicenter audit
(Sri Lanka College of Obstetricians and Gynaecologists, 2014) Palihawadana, T.S.; Wasalthilaka, C.; Dias, T.
An Audit on Performance of Medical Students of the University of Kelaniya in Completing the Clinical Tasks during their Final
(Sri Lanka College of Obstetricians and Gynaecologists, 2014) Palihawadana, T.S.; Motha, M.B.C.; Dias, T.D.; Wijesinghe, P.S.
An audit on the outcome of Vaginal Birth after Caesarean Section (VBAC) in a Sri Lankan tertiary care setting and factors associated with failure
(Sri Lanka College of Obstetricians and Gynaecologists, 2015) Tilakaratna, T.J.; Palihawadana, T.S.; Fernandopulle, R.C.
INTRODUCTION: Caesarean section is a major surgical operation and its rate is on the rise in Sri Lanka as well as in the world. It is recommended to lower the Caesarean section rate due to the risk of potential complications and burden on the health care system. Previous Caesarean is a common indication for planned Caesarean section and vaginal birth after Caesarean section (VBAC) is considered a safe alternative for many women. This audit study was aimed at determining the success rate of VBAC in a local setting and to identify the factors that are associated with failure in this study population. METHOD: An audit study was carried out in two obstetric units if South Colombo Teaching hospital, Kalubowila and De Soysa hospital for women, Colombo 8 to assess the success rate among women who underwent VBAC. The unit policies included patient choice for decision to undergo VBAC and non-usage of medication either for induction or augmentation of labour. The audit standards were set as a VBAC success rate of 72% (RCOG Green-top guidelines) and a low APGAR (<7) in less than 2% of neonates (set by clinical experience). The demographic and past obstetric factors were compared between groups to determine significant associations. RESULTS: A total of 161 women (37.8% of those with a previous one Caesarean) had opted to undergo VBAC during the study period. It was successful in 69.6% of the total study sample and 84.6% who has had a previous vaginal delivery. Low APGAR scores at 5 minutes was observed in two neonates (1.2%) and both these were in the group with a successful VBAC. The factors associated with failed VBAC in this study population included not having had a previous vaginal delivery (Odds ratio 2.99), poor progress of labour being the indication for previous section (OR 2.32), a cervical dilatation of <2cm at onset of labour (OR 4.43), malpositions in early labour (OR 12.24), and a birth weight of more than 3000g (OR 2.11). Other preciously described factors such as a high BMI and inter-delivery interval failed to show a significant association in this study group. DISCUSSION AND RECOMMENDATIONS: The take up rate of VBAC in our study population seems to be low. However, the study did not study the reasons contributing to this low rate hence no recommendations can be made. The success rate of VBAC on our group (69%) was very close to the set standards (72%) and the rate of low APGAR at 5 minutes was 1.2% and was achieving the set standard. These figures along with the factors identified to be associated with the failure at VBAC should be used for patient counseling in our local setting. Other units also should carry out such audit projects to find out the success rate of VBAC in their respective units. More in-depth studies should be carried out to find causes for low rate of undergoing VBAC and to determine effective ways to improve it
Caring for women in their post reproductive life: current recommendations on hormone replacement therapy
(Sri Lanka Medical Association, 2015) Palihawadana, T.S.; Morris, E.P.
Childbirth Experience Questionnaire (CEQ) in the Sri Lankan setting: translation, cultural adaptation and validation into the Sinhala language
(BioMed Central, 2020) Patabendige, M.; Palihawadana, T.S.; Herath, R.P.; Wijesinghe, P.S.
OBJECTIVE: To adapt the CEQ into Sri Lankan Sinhala cultural context and to determine the psychometric properties of CEQ. This would yield an opportunity to evaluate childbirth experience among Lankan population. RESULTS: Out of 390, 226 (57.9%) postnatal mothers completed the CEQ after 1 month postpartum. Face validity and content validity were demonstrated with all participants stating that CEQ was easy to understand and complete. For reliability, internal consistency was acceptable for the overall score (0.85) and for all four domains in CEQ (0.65, 0.80, 0.70, 0.83 for "own capacity", "professional support", "perceived safety" and "participation", respectively). A weighted kappa of 0.61-0.80 for all 22 items in CEQ demonstrated a good test-retest reliability. This Sri Lankan version showed fit statistics in line with standard recommendations in exploratory factor analysis. Women with spontaneous onset of labour (except for "professional support" in women with spontaneous onset of labour) and women with a normal birth showed significantly higher CEQ scores. However, oxytocin augmentation could not yield a difference in CEQ scores. KEYWORDS: Birth satisfaction; Childbirth experience questionnaire; Low-resource settings.
Chlamidia trachomatis infection in an infertile population, a cross sectional study
(Sri Lanka College of Obstetricians and Gynaecologists, 2010) Palihawadana, T.S.; Dissanayake, D.M.A.B.; Harshanie, A.; Wijesinghe, P.S.
INTRODUCTION: Chlamydia trachomatis is sexually transmitted and causes infection of the genital tract that leads to many long term complications. Invasive procedures in infected infertile females increase the risk of ascending infection and long term consequences. Though infertile individuals are considered a high risk population prevalence data for our population is not available. Furthermore, the use of risk factor identification in diagnosis is not well established. This study was planned to determine the prevalence of Chlamydia infection and to describe the socio-economic clinical characteristics that are associated with the presence of infection among a patient population who sought treatment for infertility at a tertiary care facility. METHOD: A cross sectional study was carried out among patients who sought infertility treatment at the infertility clinic of Colombo North Teaching Hospital, Ragama. Two hundred married couples were included in the study. The socio-economic data and any symptoms suggestive of genital infections were collected and Chlamydia trachoma tis infection was diagnosed with a rapid antigen test using a commercial test kit. Intracervical swabs of the female and first void urine samples of the male were used. Data analysis was done to describe the prevalence of Chlamydia infection in each partner as well as to identify the number of couples where either partner was affected. Associations with recognized risk factors were identified. RESULTS: Presence of symptoms was low in the males while one third of female subjects had one or more symptoms. The Chlamydia test revealed 12(6%) female and 6(3%) male study participants to be positive for current disease. These study participants were from 15 couples giving a prevalence rate of either partner being positive in 7.5% of couples. Of the risk factors identified the duration of marriage or infertility, education level, household income, alcohol use and smoking by the male, and presence of symptoms did not demonstrate a significant association with the presence of the disease. Partners staying away from each other were significantly associated with a positive result. CONCLUSION: There is 7.5% disease prevalence among infertile couples seeking treatment. Risk assessment and clinical symptoms have a limited value in identification of affected couples. Couples living separately have a high risk of Chlamydia infection. The high disease prevalence warrants either screening or empirical treatment of all infertile female patients undergoing invasive procedures.
A Comparison of endometrial thickness following augmentation of ovulation with clomifene citrate or letrozole in women with ovulatory infertility
(Sri Lanka Medical Association, 2015) Palihawadana, T.S.; Wijesinghe, P.S.; Seneviratne, H.R.
OBJECTIVES: To compare endometrial thickness following augmentation of ovulation with clomifene (CC) and letrozole and to assess the rate of multi-follicle development and the FSH fluctuations during the stimulated cycles. METHODS: A comparative study was carried out at the infertility clinic of Faculty of Medicine, University of Kelaniya, Sri Lanka. Each arm included 25 participants. They received either 100mg of CC or 2.5mg of letrozole per day for 5 days starting from 2nd day of the cycle. The fluctuation of FSH in the follicular phase of the cycle, the endometrial thickness and the number of pre-ovulatory follicles on the day of detecting a mature follicle, were measured. RESULTS: Treatment with letrozole resulted in a smaller rise in the follicular phase FSH, which was shorter in duration than with CC. Also it resulted in a higher mean endometrial thickness at the time of detecting a mature follicle [9.89 (SD=2.02) mm vs. 8.58 (SD=1.32) mm; p=0.021]. Augmentation of ovulation with CC showed a trend towards multi-follicle development compared to letrozole. CONCLUSIONS: This study suggests that letrozole is superior to CC in augmentation of ovulation in terms of endometrial growth and mono-follicle development. However more studies are needed to assess how these differences affect the treatment outcome before it is recommended for clinical use.
Dengue fever in pregnancy- a mamagement dilemma
(College of Anaesthesiologists of Sri Lanka, 2003) de Silva, B.A.; Wijesekera, C.; Fernandopulle, R.C.; Fernando, W.S.; Palihawadana, T.S.
Dengue fever with bleeding manifestations in pregnancy: our experience
(Sri Lanka College of Obstetricians and Gynaecologists, 2004) de Silva, B.A.; Palihawadana, T.S.; Fernando, W.S.; Wijesinghe, P.S.
Dengue fever, a mosquito borne flavivirus infection is endemic in Sri Lanka. An increased number of cases are seen in the recent past. An increase in the number of patients with secondary infection who are prone to develop complications such as bleeding manifestations, are expected due to repeated outbreaks of the disease, We report four cases of serologically confirmed Dengue fever. Different management strategies were adopted in each patient according to the clinical circumstances. Three antenatal mothers presented in 33, 38 and 39 weeks of POA and bleeding manifestations were present in all three of them. One of them died of an intracerebral haemorrhage after Caesarean section to deliver a stillborn following intrauterine death. Post Partum Haemorrhage (PPH) was experienced in another mother following caesarean section. In one patient bleeding manifestation appeared 2 days following normal delivery. She was managed conservatively. Though the clinical presentations may be similar to that of non pregnant patients, there can be many pitfalls in diagnosis and management of dengue fever occurring in pregnancy. Two of the patients described above developed acute dengue viral hepatitis, which needs to be differentiated from HELLP syndrome and acute fatty liver of pregnancy. Serological tests have a special place in diagnosis than in the non pregnant patients. The classical criteria used to identify Dengue Haemorrhagic fever (DHF), such as an increased haemotocrit and postural hypotension were not present in these patients. In management, the administration of intravenous fluids needed to be more closely observed. They seemed to be more prone to develop bleeding manifestations than non pregnant patients and therefore platelet transfusions were required in early stages. Early interventions to deliver the baby, if the other circumstances permit, seem to offer a better outcome in patients presenting in the antenatal period.
Effects of different Zinc levels in the sperm culture medium on sperm recovery and quality of sperms in the swims up procedure for sperm processing
(University of Colombo, 2006) Dissanayake, D.M.A.B.; Wijesinghe, P.S.; Rathnasooriya, W.D.; Wimalasena, S.; Palihawadana, T.S.
A controlled in vitro study was carried out to observe the effect of different Zinc (Zn) levels on sperm recovery rate, chromosome integrity, cell membrane integrity and motility in the swim up procedure. Semen samples were obtained from males who underwent seminal fluid analysis at the Infertility Laboratory, Department of Obstetrics and Gynaecology, Faculty of Medicine, Ragama. Twenty normozoospermicm samples were randomly selected for the study and each sample was processed with supplemented Earl's Balanced Salt Solution (EBSS) containing different concentrations of Zn [0.5ml of supplemented EBSS with 25μ1 of solution containing 0.6μmol (group 1) and 1.2 μmol (group 2) of Zn respectively]. One aliquot processed with 25 μl of physiological saline with added EBSS served as the control. Pre and post wash sperm counts and motility were recorded immediately after processing. Post wash sperms from the three groups were observed for chromosome integrity, cell membrane integrity, and motility. Motility changes after four hours of incubation were also observed. The mean sperm concentration showed an increase in group 1 compared to the control sample l21.87 ± 21.61 (SD) millions/ml compared to 18.34 ± 19.73 millions/ml, P<0.05] whereas a reduction was observed in group 2 [16.25 ± 17.73 (SD) millions/ml compared to 18.34 ± 19.73 millions/ml, P>0.05]. The mean differences in sperm concentration compared to the control showed statistically significant differences in both groups where an increase was observed in group 1 [3.52 ± 4.96 (SD) millions/ml] and a reduction in group 2 (- 2.08 ±6.59 millions/ml). The mean differences in sperm recovery rate showed significant differences in group 1 [8.97 ± 14.04 (SD) millions/ml] and group 2 (-4.85 ± 17.92 millions/ml) compared to the control. It was an increase in group 1 and a reduction in the sperm recovery rate in group 2. A significant reduction in mean sperm motility was observed in group 2 [67.33% ± 18.52 (SD) vs. 91.00% ± 9.60, P<0.05] after four hours of incubation. Though a reduction was observed in group 1 it was not statistically significant (83.33% ± 8.72 vs. 93.60% ± 5.01, P>0.05). The motility reduction was significantly greater in group 2 compared to group 1 (26.01% ± 20.24 vs. 10.97% ± -8.35, P<0.05). Chromosome integrity and cell membrane integrity of sperms were not affected by different Zn levels. In conclusion, low levels of Zn in the sperm processing medium (EBSS) have a beneficial effect on sperm recovery in the swim up procedure.
Evaluation of reproductive hormone profile in relation to semen quality in male partners of subfertile couples
(Sri Lanka Association for the Advancement of Science, 2007) Dissanayake, D.M.A.B.; Palihawadana, T.S.; Wijesinghe, P.S.; Ratnasooriya, W.D.; Wimalasena, S.
The objective of the study was to assess the reproductive hormone profile of a Sri Lankan subfertile male population and to relate it to their semen parameters. Male partners of 152 subfertile couples who sought treatment at the subfertility unit of the department of Obstetrics and Gynaecology at the Faculty of Medicine, Ragama were included in the study. Serum samples were assayed for follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL), Estradiol (E2) and testosterone (T) levels, using electrochemiluminescence immunoassay (ECLIA). A semen sample was obtained from each participant on the same day. Seminal fluid analysis was done according to the WHO guidelines. The mean (SEM) of FSH, LH, PRL, E2 and T levels of the males were 5.35 (0.53) mIU/mL, 6.20 (0.33) mIU/mL, 17.53 (0.60) ng/mL, 30.48 (1.80) pg/mL and 523.80 (14.74) ng/dL and the prevalence of abnormalities of these hormones were 9.8% (n=15), 5.9% (n=9), 13.15% (n=20), 0.6% (n=1) and 2.6% (n=4) respectively. Of the study population 20.3% (n=31) men had either single or combination of hormone abnormalities. When the mean hormone levels of the men with normal semen parameters were compared with those of men with abnormal semen parameters, none showed a statistically significant difference; FSH - 4.18 (2. 78) Vs 4.58 (3.15), LH - 5.90 (2.78) Vs 5.70 (2.36), PRL - 28.63 (14.96) Vs 17.59 (7.63) and T -551.39ñ208.17 Vs 515.73 (158.25). Mean (SD), FSH and LH levels were significantly higher among azoospermic participants compared with normozoospermics; 19.69 (9.93) Vs 4.18 (2.78) for FSH, 12.82 (11.82) Vs 5.90 (2.78) for LH, p<0.01). Similarly FSH and LH levels were significantly higher in severe oligospermic participants compared with the normozoospermics; 7.58 (4.34) Vs 4.18 (2.78) for FSH, and 6.96 (2.65) Vs 5.90 (2.78) for LH, p<0.05). The serum FSH level showed an inverse correlation with sperm concentration (r= -0.203, p<0.05) and total sperm count (r= -0.206, p<0.05). In conclusion, an endocrinopathy was present in up to 20% of this population. Abnormalities in Gonadotrophin levels were related with azoospermia and severe oligozoospermia. Serum FSH showed a negative correlation with the sperm concentration and the total sperm count. Other hormones failed to show a significant relationship with the semen parameters in this population. Acknowledgement: National Science Foundation research grant No. RG/2004/M/14
Factors associated with nonresponse to ovulation induction using letrozole among women with World Health Organization group II anovulation
(Medknow Publications, 2015) Palihawadana, T.S.; Wijesinghe, P.S.; Seneviratne, H.R.
CONTEXT: Letrozole, a third generation aromatase inhibitor is gaining importance in ovulation induction. Some prefer to use it as a second line agent in women who fail to respond to clomifene citrate. However, our knowledge about the predictors of response to letrozole is limited. AIMS: The study was aimed at identifying the factors associated with letrozole resistance among women with World Health Organization (WHO) group II anovulation. SUBJECTS AND METHODS: Study was conducted at the infertility clinic at a tertiary care hospital in Sri Lanka. A case–control study design was used and included 50 subjects with WHO group II anovulation (25 clomifene responsive and 25 clomifene resistant). After a treatment cycle of letrozole, the factors were compared between the subjects who responded and those who failed to respond to treatment. RESULTS: Ovulation was achieved in 76% (n = 19) of subjects who had responded to clomifene previously and in 24% (n = 6) with clomifene resistance. The factors associated with letrozole resistance included the presence of hirsutism (odds ratio [OR]: 3.89; 95% confidence interval [CI]: 1.2–12.3) and clomifene resistance (OR: 10.03; 95% CI: 2.81–35.7). The early follicular phase mean (standard deviation) luteinizing hormone level was significantly higher among the nonresponders (9.75 [4.78] – 7.28 [2.3]; P = 0.02). Nonresponders showed significantly lower levels of oestradiol on the 5th and 9th days (28.50 [3.39] pg/mL vs. 7.49 [3.62] pg/mL; P = 0.0007 and 142.04 [76.22] pg/mL vs. 28.10 [12.8] pg/mL; P = 0.0001) of the menstrual cycle, respectively. CONCLUSIONS: The features associated with resistance to Letrozole at a dose of 2.5 mg show some overlap with those associated with clomifene resistance. However, some features do not show similar association. The effectiveness of letrozole at a dose of 2.5 mg in induction of ovulation among women with clomifene resistance is low and it does not seem to be a suitable treatment at a dose of 2.5 mg for this indication.
Family planning among Medically ill people in a sri lankan setting: a descriptive study
(Sri Lanka College of Obstetricians and Gynaecologists, 2007) Palihawadana, T.S.; Fernando, W.S.; Mallawaarachi, W.P.P.K.; Attanayake, A.M.J.H.; Motha, M.B.C.; Wijesinghe, P.S.
INTRODUCTION: Sri Lanka has a high contraceptive prevalence with a low total fertility rate. In spite of this, unmet need of family planning among medically ill people is observed in day to day clinical practice. Medical illnesses complicating pregnancy are a major cause of maternal morbidity and mortality in Sri Lanka. This is thought to result from non usage as well as use of methods with low efficacy. We studied the contraceptive usage among people suffering from medical illnesses as a preliminary survey of a large scale study. METHOD: The study was carried out at the medical clinics of the Colombo North teaching hospital from March to July, 2007. Those who suffer from medical conditions that could complicate a pregnancy were interviewed to find out the family planning practices and identify the limiting factors for uptake of modern methods. Sixty seven sexually active subjects who are in their reproductive age group were interviewed for the research purpose. RESULTS: Study population comprised of 55% of Buddhists, 38% Catholics and 6% Islamics. Mostly encountered medical conditions were diabetes mellitus (n=18), hypertension (n=15), Valvular heart disease (n=10) and thyroid dysfunction (n=6). Seven subjects were planning for a pregnancy at the time of interview though none of them had been advised that it is safe to do so. Nearly 80% (n-53) of subjects admitted to practicing family planning. However, among them 71% (n=38) were using the traditional methods of family planning, where calendar method was the most commonly used (43.3%) followed by withdrawal (20.8%) and the cervical mucous (75%) methods. Norplant was the most commonly used modern method (13.2%) while other methods used included combined contraceptive pill (9.4%), intrauterine contraceptive device (3.8%) and DMPA (1.9%). None of the study subjects practiced male or female sterilisation. Of the total study population 35.8% (n=24) had received family planning advice from the family health midwife after diagnosis of their condition, while only 6% (n=4) had such advice at the medical clinic. CONCLUSIONS: Though family planning is practiced by a high proportion of medically ill people, only a minority use modern methods. High prevalence of traditional family planning usage make this group vulnerable to unintended pregnancies due to the low efficacy of the methods used by them. Family planning advice does not seem to adequately reach this more deserving population. Possible reasons for this could be either the reluctance of field health workers to dispense modern methods of family planning to these people or the deficiencies in the family planning program to reach such special groups, thus stressing the point that such services should be integrated at the level of the medical clinic.
Iron deficiency anaemia in pregnancy: diagnosis, prevention and treatment
(Sri Lanka College of Obstetricians and Gynaecologists, 2014) Palihawadana, T.S.; Goonewardene, I.M.R.; Motha, M.B.C.; Williams, H.S.A.
Metabolic syndrome and risk of endometrial carcinoma among asymptomatic, postmenopausal, urban Sri Lankan females: a community cohort follow-up study
(Wiley Publishing, 2017) Dias, T.; Niriella, M.; de Silva, S.; Motha, C.; Palihawadana, T.S.; Ediriweera, D.; de Silva, J.
OBJECTIVES: Metabolic syndrome (MetS) has been recognised as a risk factor for malignancies. The aim of this study was to evaluate the association of MetS and risk of endometrial carcinoma (EC), by measuring endometrial thickness (ET). METHODS: The Ragama Health Study (RHS) recruited 35-64-year-old female cohort by age-stratified random sampling in 2007 and re-evaluated them in 2014, using a structured interview, anthropometric measurements and biochemical tests. Liver ultrasound to detect fatty liver was performed in 2007. Pelvic ultrasound to detect ET was performed in 2014 among consenting participants. MetS was diagnosed on established International Diabetes Federation (IDF 2012) criteria. Increased ET was defined as >5mm. Simple logistic regression was used to screen variables and multiple logistic regression was used to obtain adjusted effects of risk factors for increased ET. RESULTS: 813/1636(49.7%) of the original female cohort attended follow-up; ET was measured in 567(69.7%). Median (IQR) age of females was 61 (56-66) years. 323 fulfilled criteria for MetS (prevalence 57.1%) in 2007. 57(10.1%) had increased ET in 2014. Increasing plasma triglycerides [OR=1.004 per mg/dl, 95%CI:1.001-1.007, p<0.05] and being hypertensive [OR=2.16, 95%CI:1.11–4.08, p<0.05] were associated with increased ET, while advancing age [OR=0.93 per year, 95%CI:0.89–0.98, p<0.01] and being diabetic [OR= 0.34, 95%CI:0.10–0.89, p<0.05] were protective. CONCLUSIONS: Hypertension and increased plasma triglyceride levels, in the pre-menopausal period, were risk factors for future asymptomatic increased ET.
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.
Needle stick and sharp injuries during surgical procedures: an ignored danger?
(Sri Lanka College of Obstetricians and Gynaecologists, 2006) Palihawadana, T.S.; Sitbodhini, M.A.; Fernando, S.; Wijesinghe, P.S.
Handling of needles and sharp instruments expose the surgeons to sharp injuries, which can transmit blood borne pathogens such as HIV, Hepatitis B and C. Obstetrics and Gynaecology has been shown to carry the highest risk on this regard for medical students during their training. Universal precautions have been described to prevent such disease transmission, but their effectiveness during surgical training has not been evaluated. In this study we assessed the frequency of such injuries among undergraduates, surgical and gynaecology post graduate trainees (PG trainees) and the theatre nursing staff at Teaching Hospital, Ragama. The procedures that exposed them to injury and the measures taken following the injury were also evaluated. Study was carried out from January to March, 2006 and the participants were asked to recall such injuries during their career and in the preceding year. Data were collected using a self administered questionnaire. Eighty medical students, 33 post graduate trainee medical officers, and 29 nursing officers were included in the study. The proportion suffered from such injuries during their carrier among medical students, PG trainees and nurses were 66%, 94%, and 82%. Within the preceding year it was 53%, 82% and 52% respectively. The mean frequency of injuries in the last year among PG trainees was significantly higher than medical students and nurses (3.1 vs. 1.67, 1.64; P<0.001). Assisting at major surgery caused the highest number of injuries to both PG trainees and nurses while repairing of episiotomy was the commonest procedure among medical students. A high proportion of members in all categories had received Hepatitis B vaccination. The actions taken following these injuries were inappropriate in a vast majority of participants. We conclude that needle stick and sharp injuries among surgical trainees is very common. Steps need to be taken to protect the individuals from serious blood borne pathogens.
Nutcracker syndrome in pregnancy: a worrying presentation of a benign condition
(Sri Lanka Medical Association, 2017) Motha, M.B.; Palihawadana, T.S.; Dias, T.D.; Wijesinghe, P.S.