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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Incisional herniae following lower segment caesarean section: A 20-year chart review(Sri Lanka College of Obstetricians & Gynaecologists, 2023) Dodampahala, S.H.; Chandrasena, L.; Abeysuriya, V.INTRODUCTION: The rates of caesarean delivery is increasing worldwide as well as in Sri Lanka. Incisional hernia is a known complication of abdominal surgery. To our knowledge there has been no study to assess the incidence of incisional hernia following caesarean section in Sri Lanka. This study was to assess the incidence of incisional hernia requiring surgical repair after lower segment caesarean section (LSCS) in a cohort during a 20-year period. METHODS: This was a chart review based on tertiary care private sector hospital in Sri Lanka. Hernia repairs performed during 2002 to 2022 were identified. The data was retrieved from computer based data base and previous bed head tickets. The main inclusion criterion was a caesarean delivery from the 01st of January 2002 to 31st of December 2022 in women with no history of previous abdominal surgery. The cohort was assessed from their first caesarean delivery until 20 years in the inclusion period for an event of hernia repair. The following exclusion criteria for the hernia repairs were used: Diastasis rectiwithout hernia, hernia not in the caesarean incision, and no hernia. The study was approved by the Research and Ethical Committee of Nawaloka Hospital Sri Lanka. The patient records and the data-set were anonymized before analysis. No conflict of interest. RESULTS: There were 2675 records retrieved. The mean age of the patients was 28±7.5 years. There were 10/2675 (0.37%) patients were found to incisional herniae following LSCS. The majority (7/10) of patients with incisional hernia had lower midline incisions for their LSCS. The average time duration of the occurrence of incisional hernia following a single LSCS was 19.5±2.3 months and it was 14.3±1.6 and 12.3±1.5 months for following second and third LSCS respectively. Majority of the incisional herniae were done as routine cases. Following the incisional hernia repair one patient had a recurrence after year. CONCLUSION: The overall incidence of having an incisional hernia requiring repair of a caesarean delivery was 0.37%. Most herniae appeared within the first two years and associated with the lower midline incisions.Item Idiopathic pancreatitis: Is it a consequence of an altering spectrum of bile nucleation time?.(BMJ Publishing Group, 2009) Abeysuriya, V.; Deen, K.I.; Navaratne, N.M.M.; Kumarage, S.K.INTRODUCTION: The pathogenesis of idiopathic pancreatitis (IP) remains poorly understood. Our hypothesis is that IP is a sequel of the microcrystallisation of hepatic bile. AIMS AND METHODS: A prospective case-control study compared 55 patients (symptomatic cholelithiasis, 30: 14 men, 16 women, median age 36 years, body mass index (BMI) 25.1 +/- 0.33 kg/m2; gallstone pancreatitis, nine: six women, three men, median age 35 years, BMI 24.86 +/- 0.23 kg/m2; and idiopathic pancreatitis, 16: seven women, nine men, median age 34 years, BMI 23.34 +/- 0.2 kg/m2) with 30 controls (15 men, 15 women, median age 38 years, BMI 24.5 +/- 0.23 kg/m2, undergoing laparotomy and who had normal gallbladder and no demonstrable stones on ultrasonography). Ultrafiltered bile from the common hepatic duct in patients and controls was anaerobically incubated and examined by polarised light microscopy, for nucleation time (NT). Ethical approval was obtained. RESULT(S): Patients were similar to controls. Mean NT in all groups of patients was significantly shorter than controls (established gallstones cumulative mean NT, 1.73 +/- 0.2 vs controls, 12.74 +/- 0.4 days vs, p = 0.001, t test and IP patients mean NT, 3.1 +/- 0.24 days vs controls, 12.74 +/- 0.4 days, p = 0.001, t test). However, NT in those with IP was significantly longer compared with those with established gallstones (mean NT in IP, 3.1 +/- 0.24 SEM days, vs cumulative mean in patients with established symptomatic gallstones, 1.73 +/- 0.2 days, p = 0.002, t test). CONCLUSION(S): NT in bile in patients with IP is abnormal and is intermediate in NT of lithogenic and non-lithogenic bile.Item Variation of segment specific carotid artery intima-media thickness in a selected Sri Lankan population.(Sri Lanka Medical Association, 2021) Abeysuriya, V.; Wijesinha, A.N.I.; Priyadharshan, A.; Wickremasinghe, A.R.Introduction and objective Carotid artery intima-media thickness (CIMT) is a strong predictor of coronary heart disease (CHD). The literature debates considering segment-specific CIMT variation while constructing country-specific risk prediction models to screen at-risk populations. We evaluated segment-and site-specific variation in CIMT to derive a composite score for Sri Lankans. Methods The study was conducted from November 2019 to October 2020 in a private hospital in Colombo. Based on predefined inclusion-exclusion criteria, cases (having a CHD diagnosis, n=338) and controls (n=356) were recruited. People without any suggestive medical history of having angina type chest pain , no significant ECG changes suggestive of acute coronary syndrome, negative treadmill test, normal echocardiographic evidence and negative test results of Troponin I and T were considered as controls. Ultrasound examination of the common-carotid-(CCA), the carotid-bulb-(CB) and the internalcarotid segments-(ICA) of the carotid vessel were conducted by a radiologist, and CIMTs were measured. A composite-CIMT score defined as the average value of all six segments of both the left and right sides was derived. Results 694 participants were enrolled. The mean-(+SD) age of the study sample was 60.2(±9.86) years. The highest mean-(+SD) CIMT value was in the CB-(0.89 (±0.09mm)) in the CHD group and in the CCA-(0.72 (±0.11mm)) in the non-CHD group. The lowest mean-(+SD) CIMT was in the ICA in both the CHD group-(0.86 (±0.08mm)) and in the non-CHD-(0.69 (±0.11mm)). There was a significant difference in the mean CIMT values between the right and left sides (p<0.05 for all) in both the two groups. The composite value for CHD and non-CHD groups was 0.88(±0.07) mm and 0.71(±0.09) mm (P<0.001). Conclusion Carotid artery segment-specific-CIMT variations are present in this population. Further analyses should be carried out to determine if a composite-CIMT value is a better predictor of CHD.Item Anatomical variations of the musculocutaneous nerve - A cadaveric study(College of Surgeons of Sri Lanka, 2015) Padeniya, A.G.P.M.; Salgado, L.S.S.; Hasan, R.; Fernando, E.D.P.S.; Ranaweera, R.M.S.L.; Abeysuriya, V.; Karunanayake, A.L.; Salvin, K.A.; Siriwardana, S.A.S.R.; Balasooriya, B.M.C.M.; Alahakoon, A.M.D.K.INTRODUCTION: The musculocutaneous (MC) nerve commences from the lateral cord of the brachial plexus, passes inferolaterally and pierces the coracobrachialis while innervating it. It then descends between biceps and brachialis muscles, innervating both and continues as the lateral cutaneous nerve of the forearm. Few studies have been done with regard to variations in origin, course, branching pattern, termination and communications of the MC nerve. These variations are important for anatomists, clinicians, anesthetists and surgeons to avoid unexpected complication as these variations have clinical significance during the surgical procedures and in diagnostic clinical neurophysiology. Therefore the aim of this paper was to study the anatomical variations of the MC nerve. MATERIAL AND METHODS: This descriptive cross sectional study was carried out in the Department of Anatomy, Faculty of Medicine, University of Kelaniya. Dissections were carried out on 50 upper limbs of 25 cadavers to record anatomical variations of the MC nerve. RESULTS: MC nerve was present only in 46(92%) upper limbs. Of the 46 upper limbs where the MC was present, one (2%) did not pierce the coracobrachialis. Communications were seen between MC and median nerve in 06(13%) samples of which 1(17%) was proximal and 5(83%) were distal to the point of entry of the MC into the coracobrachialis and in 4(9%) upper limbs MC nerve rejoins with the median nerve. CONCLUSIONS: It is evident that significant anatomical variations of the MC nerve exist in our study. These variations emphasize the complexities and irregularities of this anatomical structure with regard to surgical approaches.Item The distribution of the anal glands and the variable regional occurrence of fistula-in-ano: is there a relationship?(Springer Nature, 2010) Abeysuriya, V.; Salgado, L.S.S.; Samarasekera, D.N.BACKGROUND: Fistula in ano is a rather common condition, but the disease process is not yet fully understood. The aim of our study was to determine how the distribution of anal glands contributes to the variable occurrence of fistula-in-ano in the perineum. METHODS: we conducted a blinded two-phase prospective study. In the first phase, the perineum of the patients with primary fistulae was anatomically divided into right upper and lower and left upper and lower quadrants in the lithotomy position. The fistulae were classified according to what quadrant the external and internal openings and the tract pathway were in. In the second phase, using 10 human cadaver specimens, full thickness tissue samples were taken from each quadrant of the anus. Samples were histologically evaluated for the volume fractions of the anal glands in each quadrant. RESULTS: The new classification system we propose revealed that the largest number of fistulae 43% (17/39) were in the right lower quadrant, and 22% (9/39), 12% (5/39) and 8% (3/39) were in the left lower, right upper and left upper quadrants, respectively. It was also observed that 14% (5/39) of fistulae were in more than one quadrant. The volume fractions of each quadrant showed that the largest volume fraction of the anal glands was in the right lower quadrant (right lower quadrant: 0.64, left lower quadrant: 0.35, right upper quadrant: 0.26 and left upper quadrant: 0.22, P = 0.001). CONCLUSIONS: To the best of our knowledge, this is the first study that has objectively shown that the distribution of the anal glands is variable, and the highest density of anal glands is in the right lower quadrant of the anus. This variable distribution may be associated with the variable occurrence in fistula in ano.Item The socio-demographic and economic profile of patients attending emergency services in a private hospital(Sri Lanka Medical Association, 2018) Abeysuriya, V.; Chandrasena, L.G.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVES: Studies have highlighted that the private sector contributes a major share in outpatient healthcare and a small proportion in inpatient care in Sri Lanka. There is little or no information on the contribution of the private health sector in emergency care. METHODS: A descriptive cross sectional study was carried out on patients admitted to an emergencytreatment unit of a private hospital in Colombo from October 15th to December 15th 2016. Data were abstracted from medical records, verbal interviews, and the computerized database maintained by the hospital. Data were analyzed using the SPSS 16. RESULTS: 2395 patients (1426 men; 59.2%) were admitted during the study period. The majority of patients were 61 to 70 years (30.4%) and 80.3% were employed. 61.6% of patients had a health insurance policy; 67.3% of these were private insurance policies. 38.4% of insurance policies were self-financed. The monthly income ranged between Rs.15, 000 and Rs.150, 000 (mean Rs.41, 800±26,180). Persons less than 60 years were more likely to have insurance cover (1.58 times in state policies and 1.34 times in private insurance) as compared to patients 60 years and over. Persons with an education less than A-Levels were more likely (OR=l.78) to have private insurance cover as compared to a person with a higher education.CONCLUSION: Persons with varying economic backgrounds seek emergency health care in private hospitals. A large percentage of patients seeking emergency health care in private hospitals have to bear out-of-pocket expenditure. The older the person, the less likely that (s)he has health insurance cover.Item Idiopathic pancreatitis: is it a consequence of an altering spectrum of bile nucleation time?(BMJ Publishing, 2009) Abeysuriya, V.; Deen, K.I.; Navarathne, N.M.M; Kumarage, S.K.INTRODUCTION: The pathogenesis of idiopathic pancreatitis (IP) remains poorly understood. Our hypothesis is that IP is a sequel of the microcrystallisation of hepatic bile. AIMS AND METHODS: A prospective case–control study compared 55 patients (symptomatic cholelithiasis, 30: 14 men, 16 women, median age 36 years, body mass index (BMI) 25.1 ¡ 0.33 kg/m2 ; gallstone pancreatitis, nine: six women, three men, median age 35 years, BMI 24.86 ¡ 0.23 kg/m2 ; and idiopathic pancreatitis, 16: seven women, nine men, median age 34 years, BMI 23.34 ¡ 0.2 kg/m2 ) with 30 controls (15 men, 15 women, median age 38 years, BMI 24.5 ¡ 0.23 kg/m2 , undergoing laparotomy and who had normal gallbladder and no demonstrable stones on ultrasonography). Ultrafiltered bile from the common hepatic duct in patients and controls was anaerobically incubated and examined by polarised light microscopy, for nucleation time (NT). Ethical approval was obtained. RESULTS: Patients were similar to controls. Mean NT in all groups of patients was significantly shorter than controls (established gallstones cumulative mean NT, 1.73 ¡ 0.2 vs controls, 12.74 ¡ 0.4 days vs, p = 0.001, t test and IP patients mean NT, 3.1 ¡ 0.24 days vs controls, 12.74 ¡ 0.4 days, p = 0.001, t test). However, NT in those with IP was significantly longer compared with those with established gallstones (mean NT in IP, 3.1 ¡ 0.24 SEM days, vs cumulative mean in patients with established symptomatic gallstones, 1.73 ¡ 0.2 days, p = 0.002, t test). CONCLUSION: NT in bile in patients with IP is abnormal and is intermediate in NT of lithogenic and non-lithogenic bile.Item Characteristics of patients admitted to an emergency treatment unit of a private sector hospital(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Abeysuriya, V.; Chandrasena, L.G.; Kasturiratne, A.; Senanayake, M.G.B.; Wickremasinghe, A.R.BACKGROUND: Studies have highlighted that the private sector contributes a major share in outpatient healthcare and a small proportion in in-patient care in Sri Lanka. There is little or no information on private health sector emergency care. OBJECTIVES: To determine the socio-economic characteristics of patients admitted to an emergency treatment unit (ETU) in a private hospital in Colombo. METHODS: A descriptive cross sectional study was carried out on patients admitted to the ETU of a private hospital in Colombo from October 16th to December 15th 2015. Data were abstracted from medical records, verbal interviews, and the computerized data base maintained by the hospital. RESULTS: 2395 patients (1426 men; 59.2%) were admitted during the study period. The majority of patients were 61 to 70 years (30.4%). 80.3% were employed. 61.6% of patients had an insurance policy of which, 41.5% were private insurance policies. The monthly income ranged between Rs.15, 000 and Rs.150, 000 (mean Rs.43, 700±19,020). The commonest admissions were due to diseases of the digestive system (27.4%). Persons with an educational level ofItem Cut off value of TSH for early prediction of poor neurodevelopment of 5 to 9 year old children in Sri Lanka(Sri Lanka Medical Association, 2012) Abeysuriya, V.; Perera, K.P.J.; Kasturiratne, A.; Wickremasinghe, A.R.INTRODUCTION AND AIMS: To assess the relationship between TSH and neuro-development of children between 5- 9 years of age and to identify the cutoff value of TSH for early prediction of poor neuro developmental outcome. METHODS: A descriptive cross sectional study was carried out in 20 randomly selected estates in the Ratnapura district of Sri Lanka from August to December 2010. A validated neurodevelopment assessment tool was used to assess the neuro-development of 1683 randomly selected children. Neuro¬development was expressed as a General Quotient (GQ) score and a score <100 was identified as evidence of poor neuro-development Of 1683 children screened, 519 were randomly selected with consent from the parents; blood was assayed for TSH using the 3rd generation TSH Chemiluminescent immunometric assay. ROC curve analysis was used to find out the cut off value of TSH that best predicts poor neuro¬development in children. RESULTS: Of 519 children whose TSH levels were assayed, 494 had TSH levels within the normal range between 0.60 to 5.40 ulU/ml, of whom 16% had a GQ score <100. There was a significant association between TSH levels and neuro-development [p=0.0001). The best cutoff value of TSH to predict a GQ score <100 was 1.5 p.IU/ml. [Area under cure=73.4%, sensitivity= 97.0% and specificity =70.6%). CONCLUSIONS: The best cutoff value of TSH for prediction of poor neuro-development in children 5 to 9 years of age is 1.50 p.IU/ml.Item Survival of patients treated with Percutaneous Transluminal Coronary Angioplasty following ST segment elevation myocardial infarction(Sri Lanka Medical Association, 2013) Abeysuriya, V.; Kasturiratne, A.; Chandrasena, L.G.; Hettiarachchi, V.S.; Wickremasinghe, A.R.INTRODUCTION AND OBJECTIVE: Objective was to determine the survival of patients treated with Percutaneous Transluminal Coronary Angioplasty (PTCA) following ST segment elevation myocardial infarction (STEMI) and factors affecting survival. METHOD: A retrospective study was conducted among patients diagnosed with STEMI and treated with PTCA in a private hospital in Colombo from 1st January 2009 to 1st November 2012. Details of patients were collected from the medical records and survival status, cause and date of death where relevant, were obtained from medical records, patients or next of kin. RESULTS: Data of 197 patients were obtained. Of them 153 (77.7%) were males. The mean age of males was 55.30 ± 9 30 years and of females 58.80 ±7.10 years. Twenty three pat (11.7%) had died due to all causes and 13 (6.6%) due to cardiovascular diseases. Of the sample 82.7 % (95% CI 77.9-90.5) survived for 3 years. Survival was associated with (unadjusted) history of smoking, diabetes, dyslipidemia, hF ABP positivity, not being on regular medication, occlusion site of LAD and regular follow up. Based on Cox proportional hazards model (adjusted), site of arterial occlusion (proximal vs distal segment of left anterior descending artery [HR 10.98; 95% CI 1.096- 110.205] was significantly associated with survival of patients after ontrolling for other risk factors. CONCLUSION: The three year survival of patients with STEMI who underwent PTCA was 83%. Patients with proxM LAD occlusion were 11 times more likely t< years of PTCA as compared to those who had a distal LAD occlusion.