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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Outcomes of breast abscesses during lactation: a retrospective study(Sri Lanka college of Obstetricians & Gynaecologists, 2023) Abeysuriya, V.; Dodampahala, S.H.; Chandrasena, L.INTRODUCTION: During breastfeeding one of the most common problems which can encounter is breast abscess. Our retrospective study aimed to assess the outcomes of breast abscesses among a cohort of lactating mothers. METHODS: A single-centre retrospective study was carried out. Randomly selected 2000 medical records of mothers, referred as outpatients and hospitalized from 2002 to 2022 were retrieved. There were 32 breastfeeding mothers with breast abscesses. The diagnosis of lactational breast abscess was made by documented signs of a localized inflammatory, palpable breast lump confirmed with an ultrasound findings. From the retrieved database, data on maternal, perinatal, and breastfeeding features, ultrasound scan reports, methods of interventions and outcomes and microbiological testing reports were evaluated. Ethics Committee Approval was received from Nawaloka Research and Education Unit. No conflict of interest. RESULTS: The mean age of the 32 patients was 28.7 ± 5.7 years. There were 85% primiparous and 15% multiparous. Exclusive breastfeeding at diagnosis was present in 20/32 (63%). Most of the women developed breast abscesses during the initial 40 days (36.3 ± 1.4 days) after delivery. The majority of 26/32 (81.3%) of the breast abscesses were <5cm in diameter in the ultrasound examination. The majority of the patients 28/32 (87%) underwent ultrasound-guided aspiration while on antibiotic coverage according to the standard clinical guidelines. Four patients had repeated ultrasound-guided aspiration. Four patients who had abscesses >5cm, with overlying skin necrosis underwent incising and drainage. None of the patients developed mammary fistulae or sinuses. All of the incision and drainage abscesses were healed within 3 to 5 weeks with repeated wound dressings. Ninety-one percent of the cultures revealed S. aureus positive. None of the patients stops breastfeeding during the acute phase.CONCLUSION: Our retrospective study showed that needle aspiration may be performed, regardless of the size of the breast abscesses in most instances.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 Usefulness of knowledge in anatomy of the internal iliac artery in its ligation during life-threatening pelvic haemorrhages(Sri Lanka College of Obstetricians & Gynaecologists, 2023) Dodampahala, S.H.; Chandrasena, L.; Abeysuriya, V.INTRODUCTION: Post-Partum haemorrhage is a significant cause of maternal mortality. Bilateral internal iliac artery ligation is a life-saving procedure to control massive obstetric and gynaecological haemorrhages. Bilateral internal iliac artery ligation results in toning down the pulsatility making the arterial flow a slow venous flow encouraging the clot formation of the damaged pelvic vessels. This study assesses the retroperitoneal anatomy and regional variations of the internal iliac artery. METHODS: The study was based on examining 45 pelvic halves (23 right sides and 22 left sides), which were dissected during the gross anatomy laboratory at the faculty of medicine, Ragama, University of Kelaniya, from 2020 -2023. There were all adult pelvises. The internal iliac artery and its major branches were carefully dissected and examined. Adachi classification was used to classify the distribution pattern of the internal iliac artery. The study was done on the donated cadavers, and the nature of the study did not warrant any special ethical clearance. No conflict of interest. RESULTS: No anatomical deviation has been noted with regard to the levels of division of aorta, common iliac artery, the division into internal and external iliac arteries and the division of anterior and posterior branches of the internal iliac artery from that of classical anatomical literature. It was also noted that there had been no significant deviation of anatomical relations with regard to the structures as described in the internal lilac artery in our study. In our study, Type Ia was found in 35/45 (78%) of the specimens, Type IIa in 3/45 (6%), Type III in 7 (16%), and no specimens were found with Type IV and. Type V. CONCLUSION: Our study showed no significant anomalies of the pelvic anatomical structural relations to the internal iliac artery. The type Ia branching pattern was found to be the commonest.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.Item Postdischarge outcomes of COVID-19 patients from South Asia: a prospective study(Royal Society of Tropical Medicine and Hygiene, 2022) Abeysuriya, V.; Seneviratne, S.L.; de Silva, A.P.; Mowjood, R.; Mowjood, S.; de Silva, T.; de Mel, P.; de Mel, C.; Wijesinha, R.S.; Fernando, A.; de Mel, S.; Chandrasena, L.Background: Coronavirus disease 2019 (COVID-19) may cause clinical manifestations that last for weeks or months after hospital discharge. The manifestations are heterogeneous and vary in their frequency. Their multisystem nature requires a holistic approach to management. There are sparse data from the South Asian region on the outcomes of hospital-discharged COVID-19 patients. We assessed the posthospital discharge outcomes of a cohort of Sri Lankan COVID-19 patients and explored the factors that influenced these outcomes. Methods: Data were prospectively collected from patients who were discharged following an admission to the Nawaloka Hospital, Sri Lanka with COVID-19 from March to June 2021. At discharge, their demographic, clinical and laboratory findings were recorded. The patients were categorised as having mild, moderate and severe COVID-19, based on the Sri Lanka Ministry of Health COVID-19 guidelines. Following discharge, information on health status, complications and outcomes was collected through clinic visits and preplanned telephone interviews. A validated (in Sri Lanka) version of the Short Form 36 health survey questionnaire (SF-36) was used to assess multi-item dimensions health status of the patients at 1, 2 and 3 mo postdischarge. Results: We collected data on 203 patients (male, n=111 [54.7%]). The level of vaccination was significantly associated with disease severity (p<0.001). Early recovery was seen in the mild group compared with the moderate and severe groups. At 3 mo, on average 98% of mild and 90% of moderate/severe patients had recovered. Based on the SF-36, physical functioning dimensions, role limitation due to physical and emotional health, energy/ fatigue, emotional well-being, social functioning, pain and general health were significantly different in the moderate/severe vs mild COVID-19 groups at 1, 2 and 3 mo postdischarge (p<0.05). Twenty-three patients developed complications, of which the most common were myocardial infarction with heart failure (n=6/23; 26.1%), cerebrovascular accident (n=6/23; 26.1%) and respiratory tract infections (n=3/23; 13.01%) and there were six deaths. Conclusions: In our cohort, receiving two doses of the COVID-19 vaccine was associated with reduced disease severity. Those with mild disease recovered faster than those with moderate/severe disease. At 3 mo posthospital discharge, >90% had recovered.Item Combination of cycle threshold time, absolute lymphocyte count and neutrophil:lymphocyte ratio is predictive of hypoxia in patients with SARS-CoV-2 infection(Royal Society of Tropical Medicine and Hygiene, 2022) Abeysuriya, V.; Seneviratne, S.L.; de Silva, A.P.; Mowjood, R.; Mowjood, S.; de Silva, T.; de Mel, P.; de Mel, C.; Chandrasena, L.; Wijesinha, R.S.; Fernando, A.; de Mel, S.Background: There is currently no clinically validated biomarker to predict respiratory compromise in sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Cycle threshold time (Ct), absolute lymphocyte count (AL) and neutrophil:lymphocyte ratio (NLR) have been previously evaluated for this purpose. We hypothesized that the combination of these parameters at presentation may be predictive of hypoxia (oxygen saturation <92%). Methods: Data were collected on 118 patients with SARS-CoV-2 infection between May 2020 and April 2021. Demographics, clinical parameters and laboratory and radiological investigation results were recorded. Respiratory compromise (RC) was defined based on symptoms and signs, hypoxia and chest X-ray abnormalities. Results: RC occurred in 61 (51.7%) of patients. The Ct, AL and NLR at median day 3 of illness were significantly different between patients with and without RC (Ct, RC vs not: 19.46±2.64 vs 22.62±3.37, p=0.0001; AL, RC vs not: 531.49±289.09 vs 764.69±481.79, p=0.0001; NLR, RC vs not: 3.42±0.75 vs 2.59±0.55, p=0.0001). Receiver operating characteristics analysis showed that a Ct <19.9, AL <630.8×103/μL and NLR >3.12 at median day 3 of symptoms was predictive of hypoxia on day 7 of illness (area under the curve 0.805, sensitivity 96.7%, specificity 69.1%). The predictive value for the parameters combined was significantly superior to their individual predictive power. Conclusions: Ct, AL and NLR used in combination on day 3 of symptoms are predictive of hypoxia on day 7 of SARS-CoV-2 illness.Item The Impact of empirical hydrocortisone therapy on clinical outcomes in dengue fever: A retrospective chart review(Oxford University Press, 2020) de Mel, S.; Thilakawardana, B.U.; de Mel, P.; de Silva, A.P.; de Mel, C.; Chandrasena, L.; Seneviratne, S.L.; Abeysuriya, V.BACKGROUND: The role of steroids in dengue infection (DI) remains uncertain. METHODS: A retrospective chart review was conducted on patients ≥18 y of age diagnosed with DI based on positivity for dengue non-structural antigen 1 or immunoglobulin M between October 2017 and November 2018. RESULTS: Hydrocortisone was administered to 106 of 406 patients. DI with warning signs occurred in nine patients (9.5%) in the steroid cohort and eight patients (2.5%) in the non-steroid group. The incidence of severe DI, bleeding and admission duration were similar between the groups. CONCLUSIONS: Our study shows no significant benefit of empirical steroids in DI. KEYWORDS: clinical outcomes; corticosteroids; dengue.