Relationship between asymptomatic anicteric hepatitis and asymptomatic myositis in a cohort of adult Sri Lankan dengue patients admitted to a medical unit of a tertiary referral centre

Objective: To study the relationship between asymptomatic anicteric hepatitis and asymptomatic myositis in a cohort of adult Sri Lankan dengue patients admitted to a medical unit of a tertiary care centre. Methods: Case notes of 88 consecutive confirmed dengue patients admitted to the principal authors unit at Sri Jayewardenapura Teaching Hospital, Kotte, Sri Lanka from January 2012 to June 2012 were retrospectively analyzed to obtain the required information. Clinical criteria defined for suspected dengue fever were a confirmed viral infection with a platelet count less than 100000/cumm3 during the epidemic. Results: Age ranged from 13 to 64 years with a mean age of 28.6+/- 8.62 SD. Sex distribution was male: female = 56:32 (6:4). An elevated AST level (>37u/l) and elevated ALT level (>40 u/l) were found in 95% and 90.9% of the instances respectively. AST levels were above ALT levels in 86.2% of the instances. Elevated CPK levels were seen in 87.5% patients. There was no linear relationship between asymptomatic transaminitis and elevated CPK levels. Hypocalcaemia was noted in 72% as described in the literature, without any relationship to either tramsaminitis or myositis. Conclusions: Immunological mechanisms resulting in anicteric hepatitis and asymptomatic myositis in dengue seem to differ. Elevation in AST and ALT levels seem to differ from other viral infections mimicking what is seen in acute alcoholic liver disease. The role of hypocalcaemia was uncertain.

Demographic and clinical profile of adult Sri Lankans having hepatocellular carcinoma admitted to medical units of a tertiary referral center; 4 years experience

Objective: To study the demographic and clinical profile of adult Sri Lankans having hepatocellular carcinoma. Methods: Clinical notes of 42 patients having hepatoma admitted to medical units at Sri Jayawardenepura General Hospital, Kotte, Sri Lanka from January 2008 to January 2012 were retrospectively analyzed to obtain the required data. Results: The age range was 43-91 years with a mean age of 65.5+/- 11.1 SD. Sex distribution was male: female; 38:4 (9:1). 90.5% were alcoholics. 57.1% had established liver disease at the time of diagnosis. 27.7% of patients with undiagnosed liver disease at presentation had radiological evidence of cirrhosis. On presentation ascites, abdominal pain, hepatic encephalopathy, anorexia and weight loss were found in 38.1%, 19%, 19%, 16.7% and 14.7% respectively. Uni-focal tumors were found in 61.9%. Secondaries were seen in 11.9%. The detectable sites were lymph nodes, bones, lungs, and the inferior vena cava extending into the right atrium. Hepatitis B and C infection were not seen. The available curative therapeutic modalities were minimal. Conclusions:A marked male dominance was seen. Alcohol etiology was the dominant cause. Hepatoma may be the first presentation in undiagnosed liver disease. In all patients the diagnosis had been made at an advanced stage of the tumor thus resulting in a poor prognosis. We recommend that ultrasound scanning of the abdomen and alpha-feto protein estimation to be done at every six months interval in chronic liver disease patients

Epigenetic regulation of prostate cancer

Prostate cancer is a commonly diagnosed cancer in men and a leading cause of cancer deaths. Whilst the underlying mechanisms leading to prostate cancer are still to be determined, it is evident that both genetic and epigenetic changes contribute to the development and progression of this disease. Epigenetic changes involving DNA hypo- and hypermethylation, altered histone modifications and more recently changes in microRNA expression have been detected at a range of genes associated with prostate cancer. Furthermore, there is evidence that particular epigenetic changes are associated with different stages of the disease. Whilst early detection can lead to effective treatment, and androgen deprivation therapy has a high response rate, many tumours develop towards hormone-refractory prostate cancer, for which there is no successful treatment. Reliable markers for early detection and more effective treatment strategies are, therefore, needed. Consequently, there is a considerable interest in the potential of epigenetic changes as markers or targets for therapy in prostate cancer. Epigenetic modifiers that demethylate DNA and inhibit histone deacetylases have recently been explored to reactivate silenced gene expression in cancer. However, further understanding of the mechanisms and the effects of chromatin modulation in prostate cancer are required. In this review, we examine the current literature on epigenetic changes associated with prostate cancer and discuss the potential use of epigenetic modifiers for treatment of this disease

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Motherhood: Female Perspectives and Experiences of Being a Parent with ASC

Little is known about the emotional pressures and practical management of daily challenges and, intra and interpersonal demands of raising a child as a parent with a diagnosis of Autistic Spectrum Conditions. The present study utilised a qualitative approach to understand perceptions of females diagnosed on the autistic spectrum of ‘being a parent’. Eight semi-structured interviews were analysed using Interpretative Phenomenological Analysis. Benefits and challenges of being a parent were highlighted alongside population-specific skill and characteristics associated with strength and resilience, love, nurture, routine and sensory considerations. Findings identify the need for population-specific specialist parenting support, provide direction for professionals in clinical settings and expand the paucity of research in this area

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

The distribution and characteristics of Extended-Spectrum β-Lactamase producing Escherichia coli and Klebsiella species among urinary isolates in a tertiary care hospital

A prospective study was carried out to determine the distribution of ESBL producing uropathogens in different units of a tertiary care hospital in Colombo and in community acquired UTIs presenting to this hospital. A total of 2303 urine samples from adult patients were received in the microbiology laboratory of the hospital during a four-month period, of which 626 were significant positive cultures. Escherichia coli and Klebsiella species accounted for 46% (n=286) of the total isolates with the majority (n=228, 80%) being E. coli. Thirty three percent (n=94) of these isolates produced extended-spectrum β-lactamases (ESBLs). Half (50%) of the Klebsiella isolates were ESBL producers while 29% of the E. coli produced ESBLs. Ten of 11 isolates in the intensive care unit and 6 of 8 in the genito-urinary unit were ESBL producers. The ESBL rate in the general medical and surgical wards and the out-patient department were 33% and 14% respectively. Out of the 181 isolates from community acquired UTIs, 13% produced ESBLs. Resistance to multiple drugs was considerably higher in ESBL positives compared to ESBL negative isolates. Urinary catheters, diabetes mellitus, previous antibiotic use, urinary tract abnormalities and recurrent urinary tract infections were associated with a higher risk of acquiring ESBL producing organisms (P&lt;0.001). DOI: http://dx.doi.org/10.4038/sljid.v2i2.4235 Sri Lankan Journal of Infectious Diseases Vol.2(2) 2012: 30-36</p

Demographic and clinical profile of enteric fever admitted to a medical unit of a tertiary referral centre in Sri Lanka

Objectives: To study the demographics and clinical features of enteric fever patients admitted to a medical unit of a tertiary referral centre in Sri Lanka Method: Clinical notes of 114 patients diagnosed as having enteric fever admitted to the principal author’s unit at Sri Jayawardenepura General Hospital, Kotte, Sri Lanka from January 2011 to June 2012 were retrospectively analyzed to obtain the required data. Results: Age range was 12-82 years with a mean age of 35+/- 14.0 SD. Sex distribution male: female =78:36 (2:1). Fever, abdominal pain, diarrhea, headache and constipation were present in 100%, 36.0%, 26.4%, 9.6% and 9.0% of instances respectively. Paratyphoid and typhoid serology were positive in 48.2%and 51.1% respectively. Anicteric hepatitis was found in 73.7%. Inflammatory markers (ESR and/or C-RP) were elevated only in 42.1%.Thrombocytopenia (<150,000mm) was found in 25.1%. Abdominal ultrasound showed hepatic, splenic and gall bladder involvement in 31.8%, 27.3% and 10.1% of instances respectively. Blood cultures were positive only in 47.2%. Ceftriaxone resistance was seen in 3.5%. Acute transverse myelitis was seen in one patient. The classically described ‘step ladder’ fever pattern, doughy abdomen and rose spots were not observed. Conclusion: A male dominance was noted. Hepatobilliary involvement was asymptomatic. Response to antibiotics and a falling Salmonella antibody titre confirmed diagnosis in culture negative patients. Pretreatment with antibiotics in the community could have influenced the clinical picture, serology and culture positivity.

The clinical profile of adult Sri Lankans having microscopic colitis not otherwise specified (NOS) admitted to a medical unit of a tertiary care hospital

Objective: To study the clinical profile of adult Sri Lankans having microscopic colitis not otherwise specified (NOS) admitted to a medical unit of a tertiary care hospital. Method: Case notes of 83 consecutive patients admitted to Sri Jayawardenepura General Hospital, histologically diagnosed as having microscopic colitis from January 2008 to January 2012 were retrospectively analyzed. Results: Age range was 21-84 years, mean age 51.1+/- 17.4 SD years. Sex distribution male: female 48:35 (1.3:1). Presentation had been a watery diarrhea, abdominal pain, weight loss, asthenia and bleeding per rectum in 55.4%, 42.2%, 40.9%, 38.1% and 2.4% of the instances respectively. 71.1% had no major associated background problems. Hypertension, diabetes mellitus, bronchial asthma was present in 21.7%, 8.0% and 7.2% of the instances respectively. The salient histological feature was infiltration of plasmacytes and lymphocytes beyond lamina propria without other specific features of colitides. Rectum, sigmoid, transverse colon, ascending colon, descending colon, ceacum were histologically involved in 89.2%, 86.7%, 68.7%, 65.1%, 60.2%, 38.1% of the instances respectively. Pancolitis was seen in 25.3%. Inflammatory markers (ESR and/or C-RP) were elevated in 20.8% where they have been done. Neutrophilia was noted in 13.3%. Non steroidal anti inflammatory drugs and proton pump inhibitors have been prescribed in 6.0% and 4.8% instances respectively where information was available. Conclusions: Microscopic colitis not specified otherwise seem to be an ill defined colitis which could represent low grade immunological reaction to an unidentified intra-luminal antigen causing therapeutic dilemmas. Further studies are needed for better categorization and to define the outcome

Towards a common telecommunication antenna structure farm network through GIS technology

When establishing towers for telecommunication sector on a location, the most of service providers violate rules and regulations regulated by the government, even though there is a possibility to share towers among 3 facility providers. Therefore it is a common scenery in Sri Lanka that the most of tops of mountains are consisted with two or more telecommunication towers with closer locations. This would influence severely the people living in the close proximity and their properties and also to the natural environment. The study was designed to select suitable locations for antenna structures that satisfy the national policies for the study area (Balangoda DS Division, Ratnapura District). The model for the selecting the suitable locations using different criteria was developed using the Model Builder tool in the ArcGIS Software. Using ArcGIS software and different criteria, it was able to prepare the coverage maps for both existing and newly designed tower networks. The study reveals that it needs only two towers to cover up the full study area, even though there are five towers which are maintained by TSPs separately. Further, it discovered that the present network is not so enough for the future demands. And also it is suggesting that the concept of sharing antenna structures is very important to overcome environmental and social issues