How does the quality of life and the underlying biochemical indicators correlate with the performance in academic examinations in a group of medical students of Sri Lanka?

Background: Individual variation of examination performance depends on many modifiable and non-modifiable factors, including pre-examination anxiety. Medical students’ quality of life (QoL) and certain biochemical changes occurring while they are preparing for examinations has not been explored. Purpose: We hypothesize that these parameters would determine the examination performance among medical students. Methods: Fourth-year medical students (n=78) from the University of Ruhuna, Sri Lanka, were invited. Their pre- and post-exam status of QoL, using the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire, and the level of biochemical marker levels (i.e., serum levels of thyroid profile including thyroglobulin, cortisol and ferritin) were assessed. Differences between the scores of QoL and serum parameters were compared with their performance at the examination. Results: The mean QoL score was significantly lower at pre-exam (56.19±8.1) when compared with post-exam (61.7±7.1) levels (p<0.001). The median serum TSH level prior to the exam (0.9 mIU/L; interquartile range 0.74–1.4 mIU/L) was significantly lower (p=0.001) when compared with the level after the exam (median of 2.7 mIU/L; IQR 1.90–3.60). The mean±SD fT4 level was significantly higher before the exam (19.48±0.4 pmol/L at study entry vs. 17.43±0.3 pmol/L after the exam; p<0.001). Median serum ferritin (SF) level prior to the exam (43.15 (23.5–63.3) µg/L) was significantly lower (p≤0.001) when compared with after-exam status (72.36 (49.9–94.9) µg/L). However, there was no difference in mean serum cortisol levels (16.51±0.7 at pre-exam and 15.88±0.7 at post-exam, respectively; p=0.41). Conclusions: Students had higher fT4 and low ferritin levels on pre-exam biochemical assessment. It was evident that students who perform better at the examination had significantly higher QoL scores at each domain tested through the questionnaire (Physical health, Psychological, Social interaction and Environment). The higher the QoL scores, the better the grades were. It was also found that students who failed exhibited profound differences in the QoL score

A Case of Polyarteritis Nodosa Presenting as Rapidly Progressing Intermittent Claudication of Right Leg

Background. Polyarteritis nodosa (PAN) is a medium vessel vasculitis which causes significant morbidity and mortality. Usually, it presents with constitutional symptoms with angiographic evidence of aneurysms or segmental stenosis of arteries of mesenteric or renal vasculature. It is exceedingly uncommon for PAN to present with symptomatic progressive intermittent claudication. Case Presentation. We describe a 60-year-old male who presented with rapidly progressive intermittent claudication of his right leg. He did not have any significant atherosclerotic risk factors. He had recent onset hypertension and loss of weight. He also had mononeuropathy of right common peroneal nerve and livedo reticularis rash. With negative autoimmune markers and suggestive histology in deep punch skin biopsy and angiographic evidence of segmental stenosis of femoral and renal arteries, we diagnosed PAN. We treated him with aggressive immunosuppressants and vascular bypass surgery of right femoral vessels; he showed a good response. Conclusion. Rapidly progressive unilateral intermittent claudication could be a very rare, but noteworthy presentation of PAN. With suggestive histology and exclusion of other comorbidities aggressive immunosuppressants should be instituted. Vascular bypass surgery for critical ischaemia of the limbs is an option that could be considered for limb-threatening disease

Pulmonary haemorrhage as a frequent cause of death among patients with severe complicated Leptospirosis in Southern Sri Lanka.

BackgroundLeptospirosis is a tropical disease associated with life threatening complications. Identifying clinical and investigation-based parameters that predict mortality and morbidity is vital to provide optimal supportive care.MethodsWe conducted an observational study in an endemic setting, in the southern Sri Lanka. Consecutive patients having complicated leptospirosis were recruited over 18 months. Clinical, investigational and treatment data were collected and the predictors of mortality were analysed.ResultsOut of 88 patients having complicated leptospirosis, 89% were male. Mean age was 47yrs (±16.0). Among the total major complications 94.3% had acute kidney injury, 38.6% pulmonary haemorrhages, 12.5% fulminant hepatic failure, 60.2% hemodynamic instability and 33% myocarditis. An acute significant reduction of haemoglobin (Hb) was observed in 79.4% of patients with pulmonary haemorrhage. The mean of the highest haemoglobin reduction in patients with pulmonary haemorrhage was 3.1g/dL. The presence of pulmonary haemorrhage (PH) and hemodynamic instability within first 48 hours of admission significantly predicted mortality (pConclusionsWithin first 48 hours of admission, major complications such as pulmonary haemorrhage and haemodynamic instability and other parameters such as atrial fibrillation, acute haemoglobin reduction, elevated SGOT level could be used as early parameters predictive of mortality in severe leptospirosis. PH and FHF during the first week of admission in leptospirosis are associated with high morbidity and mortality requiring prolonged ICU care and hospitalisation. Above parameters could be used as parameters indicating severity for triaging and intensifying treatment. Using ECMO is a plausible treatment option in patients with severe pulmonary haemorrhage