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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Upper gastro intestinal endoscopy in pregnancy: A single centre experience(Sri Lanka college of Obstetricians & Gynaecologists, 2023) Abeysuriya, V.; Dodampahala, H.S.; Chandrasena, L.INTRODCTION: Upper gastro intestinal (GI) endoscopy is advisable to perform when strongly indicated during pregnancy. This study was to evaluate the outcomes of upper GI endoscopy during pregnancy. METHODS: A single centre retrospective study was carried out. Randomly selected 500 medical records of the pregnant mothers who were referred as out patients and hospitalized from 2012 to 2022 were retrieved. Inclusion criteria for retrieving data of the patients who underwent upper GI endoscopy were; Major or continued bleeding, severe or refractory nausea and vomiting or abdominal pain, dysphagia or odynophagia. Endoscopic findings were recorded in a computer based database. Ethical approval was obtained from the Ethical Review Committee of Nawaloka Hospitals of Sri Lanka. No conflict of interest. RESULTS: A total of 16 records of patients underwent upper GI endoscopy were retrieved during 2012 to 2022. The mean age of the patients was 25.48 ± 6.5 years. Ten patients (62.5%:10/16) were primigravida. During the first, second and third trimester of pregnancy, number of patients who underwent upper GI endoscopy were 8 (50%), 4 (25%), and 4 (25%) respectively. The major indication was persistence epigastric pain (75%: 12/16) followed by dysphagia (18.7%:3/16) and hematemesis in one patient. All patients had undergone conservative treatment without any therapeutic upper GI endoscopy. There were no records that were found to have ERCP, capsular endoscopy or enteroscopy during pregnancy among our patients. No records were found of having endoscopy related adverse effects on mothers or foetuses. CONCLUSION: The upper GI endoscopy especially oesophago-gastro-dudenoscopy (OGD) may be performed without a major risk to the mother and the baby. However, further prospective multicentre research studies are strongly recommended.Item The usefulness of flexible sigmoidoscopy in bleeding per rectum during pregnancy: an observational study(Sri Lanka College of Obstetricians & Gynaecologists, 2023) Abeysuriya, V.; Dodampahala, S.H.; Chandrasena, L.INTRODUCTION: Bleeding per rectum is not an infrequent complaint during pregnancy, which may require endoscopic evaluation and treatment. Flexible sigmoidoscopy is a relatively simple, quick procedure. The current study was aimed to assess the usefulness of flexible sigmoidoscopy in bleeding per rectum during pregnancy from a single tertiary care centre. METHODS: A single centre retrospective study was carried out. Randomly selected 1000 medical records of the pregnant mothers who were referred as out patients and hospitalized from 2012 to 2022 were retrieved. All patients had the passage of fresh blood as their chief complaint. All of them had not undergone any prior diagnostic workup for their presentation. All had undergone flexible sigmoidoscopies and patients with significant additional bowel symptoms underwent colonoscopy following sigmoidoscopy. Endoscopic findings were recorded in a computer based database. Ethical approval was obtained from the Ethical Review Committee of Nawaloka Hospitals of Sri Lanka. No conflict of interest. RESULTS: A total of 48 pregnant women had undergone lower GI endoscopies. The mean age of the patients was 25.3 ± 6.5 years. Twenty-four patients (50%) were primigravida. Majority was in the second trimester of pregnancy 89.5% (43/48). The mean (±SD) gestational age at the time of procedure was 18(±2) weeks. All had undergone sigmoidoscopy, and an additional colonoscopy were done in 2 patients. Bleeding per rectum was the main indication. All flexible sigmoidoscopies were done without sedation. Wiliest, the colonoscopies were performed under conscious sedation. Majority of the pregnant mothers found to have haemorrhoids followed by anal fissures (46/48; 95.8%). Ulcerative colitis and a sigmoidal cancer were found in two patients (4.2%). None had an immediate post procedure-related complication. CONCLUSION: Flexible sigmoidoscopy is useful and safe to be performed in pregnancy with clinically significant bleeding per rectum. It has a good diagnostic yield. Further prospective multicentre research studies are strongly recommended.Item Acute appendicitis in pregnancy(Sri Lanka College of Obstetricians & Gynaecologists, 2023) Abeysuriya, V.; Dodampahala, H.S.; Chandrasena, L.INTRODUCTION: The early diagnosis and management of appendicitis in pregnancy are essential in maternal and fetal morbidity and mortality. In this 20-year retrospective study, we aimed to assess the outcomes of pregnant patients diagnosed with acute appendicitis. METHODS: A single-center retrospective study was carried out. Randomly selected 2000 medical records of pregnant mothers referred as outpatients and hospitalized from 2002 to 2022 were retrieved. Six pregnant patients who were diagnosed and treated in Nawaloka Hospital with the diagnosis of acute appendicitis during 2002-2022 were examined retrospectively. Ethics Committee approval was received. No conflicting interest. RESULTS: The age range of our patients was 22 to 31 years, mean of 26± 3.4. The mean gestational week was 20±5.3 weeks, and most were in the second trimester 4 (68%). All patients were admitted with the complaint of abdominal pain, the majority of them had the right iliac fossa pain (RIF). All had elevated inflammatory markers. No computed tomography (CT) was performed. One patient was diagnosed clinically of having acute appendicitis without any imaging. Acute appendicitis was diagnosed in 3/5 patients who underwent ultrasound scan examination. The other two patients (one from 2nd trimester and one in the third trimester) were diagnosed with acute appendicitis on MRI examination. All patients underwent open appendectomy under general anaesthesia. No maternal or foetal morbidity or mortality was noted during pre or post-surgical and anaesthesia procedures. The mean hospital stay was 3.9±0.9 days. All appendixes were pathologically proven to have acute appendicitis. Except for minor superficial surgical site infection rest of the mothers and foetus had no morbidity or mortality recorded in the follow-up. CONCLUSION: Although appendicitis is not frequent during pregnancy, it is a disease that requires urgent surgical and obstetrics care for timely diagnosis and treatment.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 Prevalence and some selected characteristics of asymptomatic gallstones among pregnant women. A retrospective chart review(Sri Lanka College of Obstetricians & Gynaecologists, 2022) Abeysuriya, V.; Dodampahala, S.H.; Chandrasena, L.Introduction During pregnancy, it is often associated with gallstones and biliary sludge. Gallstone disease is the second most common indication for non-obstetric surgical intervention in pregnancy. Methods A retrospective chart review was carried out to determine the prevalence and characteristics of asymptomatic gallstones among selected sample of pregnant women in a private hospital in Colombo, Sri Lanka. Data was retrieved form the available records at hospitals from 2016 to 2022.There were 329 patients recode during the study period. An exclusion criteria was applied to select the subjects. Data pertains to demographic, haematological, bio-chemical and hepatobiliary sonography was retrieved. The study data were analysed using STATA (StataCorp LLC Texas, USA) software version 16 for Windows. Normality was determined using the Kolmogorov-Smirnov’s test. Categorical variables like gallbladder status and blood group were presented using frequency tables. The mean values of age, gestational age, and gravidity were compared t-test and ANOVA. Gallbladder status was compared to age group, gravidity, trimester, and blood group using Chi-squared test. P values of <0.05 were considered significant. Results The study sample consists of 300 pregnant women records. The means age of pregnant mother with gall stone and sludge was statistically higher than the normal gallbladder. Multigravida was higher among the study sample (63%).The most of the study subject were in third trimester (68%). Majority (97%) had normal gallbladder, 2% had gallstones and 1% had sludge. A higher proportion of gallstones were identified among mothers age more than 30 years. Muliti-gravid had higher proportion of gallstones and sludge. The third trimester was identified as higher proportion of gallstones and sludge. All the cases who had gallstone and sludge were Blood group type “O”. Conclusion This sample shows that a higher proportion of gallstones and sludge were identified among mothers whose age more than 30 years, muliti-gravid, in their third trimester and blood group of type “O”. Further studies are needed to generalized this study finds to Sri Lankan setting.