A study of long-term complications associated with enteral ostomy and their contributory factors

BACKGROUND: Complications of ostomy significantly affect the quality of life of ostomates. There is little evidence on the rate of long-term complications in ostomates, especially from the developing countries which include Sri Lanka. This study was aimed to describe the long-term complications of enteral ostomies and their contributory factors. METHODS: A retrospective analysis was carried out on 192 patients who underwent ostomy creation over a period of 5 years. Data on type of complications, age, sex, type of ostomy, type of surgery and perioperative care by enteric stoma therapist were gathered. Associations were established using Chi square test and multiple logistic regression. RESULTS: Out of 192 patients, only 146 patients presented regularly for follow up. The mean follow up duration was 28 months (range: 3–183). Around 34.2% developed surgical long-term complications related to the ostomy. Common complications were prolapse (n = 24, 16.4%), skin excoriation (n = 22, 15.1%) and parastomal hernia (n = 14, 9.6%). Overall complication rate was significantly less in loop ostomies (p < 0.05) and defunctioning ostomies (p < 0.05). Skin excoriation was significantly high in males (p < 0.05) and in ileostomies (p < 0.001). Parastomal hernia was commoner in end ostomies (p < 0.05). Perioperative care by enteric stoma therapist reduced the overall and specific complications (p < 0.001). CONCLUSION: The overall complication rate in our cohort of patients was 34.2%. The perioperative care of a stoma therapist may be very effective in preventing complications particularly in a setting with limited resources. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13104-016-2304-z) contains supplementary material, which is available to authorized users

A comprehensive assessment of lymphatic filariasis in Sri Lanka six years after cessation of mass drug administration

The Sri Lankan Anti-Filariasis Campaign conducted 5 rounds of mass drug administration (MDA) with diethycarbamazine plus albendazole between 2002 and 2006. We now report results of a comprehensive surveillance program that assessed the lymphatic filariasis (LF) situation in Sri Lanka 6 years after cessation of MDA.Transmission assessment surveys (TAS) were performed per WHO guidelines in primary school children in 11 evaluation units (EUs) in all 8 formerly endemic districts. All EUs easily satisfied WHO criteria for stopping MDA. Comprehensive surveillance was performed in 19 Public Health Inspector (PHI) areas (subdistrict health administrative units). The surveillance package included cross-sectional community surveys for microfilaremia (Mf) and circulating filarial antigenemia (CFA), school surveys for CFA and anti-filarial antibodies, and collection of Culex mosquitoes with gravid traps for detection of filarial DNA (molecular xenomonitoring, MX). Provisional target rates for interruption of LF transmission were community CFA <2%, antibody in school children <2%, and filarial DNA in mosquitoes <0.25%. Community Mf and CFA prevalence rates ranged from 0-0.9% and 0-3.4%, respectively. Infection rates were significantly higher in males and lower in people who denied prior treatment. Antibody rates in school children exceeded 2% in 10 study sites; the area that had the highest community and school CFA rates also had the highest school antibody rate (6.9%). Filarial DNA rates in mosquitoes exceeded 0.25% in 10 PHI areas.Comprehensive surveillance is feasible for some national filariasis elimination programs. Low-level persistence of LF was present in all study sites; several sites failed to meet provisional endpoint criteria for LF elimination, and follow-up testing will be needed in these areas. TAS was not sensitive for detecting low-level persistence of filariasis in Sri Lanka. We recommend use of antibody and MX testing as tools to complement TAS for post-MDA surveillance

A cross-sectional study of quality of life in a cohort of enteral ostomy patients presenting to a tertiary care hospital in a developing country in South Asia

BACKGROUND: Enteral ostomy creation affects the quality of life (QOL) of stoma patients significantly. Studying the QOL and its determinants is important as it may help in the early identification of those with poor QOL leading to appropriate intervention. This study was aimed to assess the possible contributory factors of QOL of stoma patients. METHODS: A cross sectional study was conducted among 43 ostomy patients who presented for follow up at a surgical clinic of a tertiary care hospital in Sri Lanka over a period of 1 year. Relevant demographic and ostomy related data were collected using an interviewer administered questionnaire. Stoma quality of life scale (Stoma-QOL) and stoma care self-efficacy scale (SCSE) which are validated questionnaires were used to assess QOL and self-efficacy in managing stoma respectively. Associations were established using independent samples t test and Spearman’s correlation. RESULTS: The median age of the study participants was 47.5 years (range 18–83). The median follow up duration was 38 months (range 6–183). The mean overall QOL score was 53.07 ± SD 12.68. Approximately 70% of the study participants scored less than 60. Higher QOL was associated with female sex, colostomies, comfortable income and satisfactory sexual activity. Significantly lower overall QOL was found in those who reported a significant change in the style of dressing (p < 0.05), those who felt depressed (p < 0.05), and those who had thoughts of self-harm soon after surgery (p < 0.05). There was a significant positive correlation between QOL and self-efficacy (p < 0.01). Those who took longer time to learn to take care of the stoma had lower QOL (p < 0.05). CONCLUSIONS: The overall QOL score was considerably low in our study. The QOL was significantly associated with self-efficacy which indicates the importance of patient education and training during follow up visits to maintain a higher QOL. Furthermore integrating with other non-surgical specialities to address multi-dimensional problems including psychosocial and sexual aspects may be helpful to achieve a better QOL

Comparison of Solvent-Free Microwave Extraction and Conventional Hydro-Distillation of Essential Oils from four Selected Underutilised Citrus sp. Plants

Essential oils (EOs) are widely used in cosmetic, pharmaceutical, fragrance and food industry. Solvent Free Microwave Extraction (SFME) is a green method for the extraction of essential oils from aromatic plants. The aim of the study is to compare SFME with conventional hydro-distillation (HD) technique, for the extraction of EO from four selected underutilised Citrus plant species in the essential oil industry; Citrus medica, C. reticulata, C. madurensis and C. limon in terms of chemical composition, antioxidant activity and energy consumption. The EOs were extracted using SFME (Microwave power: 700 W for 5 minutes and 400 W for 55 minutes) and HD (for 1 hour) and chemically analysed using Gas Chromatography (GC) and Gas Chromatography and Mass Spectrometry (GC-MS). The Antioxidant activity of the EOs were determined using Ferric Reducing Antioxidant Power (FRAP) and Total Polyphenolic Content (TPC) assays. The GC and GCMS identified 4(10)-Thujene (33.82%) as the major compound in C. medica oil, extracted by HD while that was L- terpinene-4-ol (18%) when extracted by SFME technique. The β-Linalool was the major component in C. reticulata (42.98%) and C. madurensis (37.95%) in SFME extracted EOs, however, it has been dropped down to 26.71% and 26.83% respectively during HD extraction. In C. limon, D-Limonene (43.069%) was abundant in HD- extracted EOs while it was (R)-(+)-Citronellal (39.08%) in SFME-extracted EO. SFME yielded EOs with higher amounts of more valuable oxygenated compounds with higher antioxidant capacities over HD. In comparison with HD, the SFME technique presented higher efficiency with reduced extraction times, costs and energy, yielding EOs with excellent chemical profiles and relatively high antioxidant activity.Keywords: Essential oils, Solvent free Microwave extraction, GC, GCMS, Antioxidan

Synapse loss in the prefrontal cortex is associated with cognitive decline in amyotrophic lateral sclerosis

In addition to motor neurone degeneration, up to 50% of amyotrophic lateral sclerosis (ALS) patients present with cognitive decline. Understanding the neurobiological changes underlying these cognitive deficits is critical, as cognitively impaired patients exhibit a shorter survival time from symptom onset. Given the pathogenic role of synapse loss in other neurodegenerative diseases in which cognitive decline is apparent, such as Alzheimer's disease, we aimed to assess synaptic integrity in the ALS brain. Here, we have applied a unique combination of high-resolution imaging of post-mortem tissue with neuropathology, genetic screening and cognitive profiling of ALS cases. Analyses of more than 1 million synapses using two complimentary high-resolution techniques (electron microscopy and array tomography) revealed a loss of synapses from the prefrontal cortex of ALS patients. Importantly, synapse loss was significantly greater in cognitively impaired cases and was not due to cortical atrophy, nor associated with dementia-associated neuropathology. Interestingly, we found a trend between pTDP-43 pathology and synapse loss in the frontal cortex and discovered pTDP-43 puncta at a subset of synapses in the ALS brains. From these data, we postulate that synapse loss in the prefrontal cortex represents an underlying neurobiological substrate of cognitive decline in ALS

Human epidermal growth factor receptor-2 gene expression positivity determined by silver in situ hybridization/immunohistochemistry methods and associated factors in a cohort of Sri Lankan patients with gastric adenocarcinoma : a prospective study

Objective: Positive human epidermal growth factor 2 (HER2) expression and its predictive clinicopathological features remain unclear in Sri Lankan gastric cancer (GC) patients. Here, we aimed to determine GC HER2 status predictors by analyzing associations between clinicopathological features and HER2 expression using immunohistochemistry (IHC) and silver in situ hybridization (SISH). Methods: During this 4-year prospective study, clinicopathological data were collected from participants in the National Hospital of Sri Lanka. HER2 IHC and SISH were performed using commercial reagents. Using chi-square tests, associations of HER2-IHC/SISH with clinicopathological features were analyzed. Results: Overall, 145 GC patients were included, 69 had gastrectomies and 76 had biopsies. Positive HER2 expression by IHC was associated with age 5/high-power field, with additional perineural invasion and lymphovascular invasion in resections. These features, excluding lymphovascular invasion but including male sex, were associated with HER2 expression by SISH. Conclusions: Age <60 years, high nuclear grade, tumor necrosis, and perineural invasion are associated factors of HER2 status. These could be used to triage GC patients for HER2 status testing in limited resource settings where IHC/SISH analysis is costly

Risk assessment and mitigation within a Tsunami forecasting and early warning framework : case study Port City of Galle

The primary objective of this report is to present the results of a case study on tsunami risk assessment and management for a coastal city, on this occasion for the port city of Galle in the southern province of Sri Lanka. Preliminary studies were implemented by Hettiarachchi et.al (2009). Thereafter detailed studies were undertaken at regular intervals on a number of critical areas to examine post tsunami rehabilitation and risk assessment and management which is presented in this report. The report is presented in a manner that it provides the important steps relating to tsunami risk assessment and management in the generic context and thereafter at the end of each chapter the outcome of the applications to the port city of Galle is presented in text boxes. Components of risk and its assessment, assessment of impacts of hazards, vulnerability, community resilience, risk and risk management methods are discussed in detail in Chapters 2 to 7. A total of eleven text boxes are presented on the applications to the port city of Galle. Of specific importance is Chapter 8 on Tsunami Risk Assessment within a Tsunami Forecasting and Early Warning Framework, whereby an integrated approach for the analysis of results from early warning systems and inundation modelling for risk assessment is presented for improved tsunami wave height forecasting on the shoreline. This identifies the need to refine the tsunami wave forecasting provided by the Regional Tsunami Service Providers (RTSPs) for cities having complex geometrical shoreline features and bathymetrical features. The basic concept of this approach is presented in Chapter 8 whereas a dedicated case study on improved tsunami wave height forecasting is presented as a separate report (refer Chapter 8 for details). If this case study was included in the main text it would have caused an imbalance in the report due to the very technical nature of the subject matter covered. Here again, the case study is presented initially in the generic form followed by the application to the port city of Galle. Chapter 9 is dedicated to Resilient Cities, focusing on the UN-ISDR initiative which is fully supported by the Working Group on Risk Assessment and Reduction of the IOTWS.Project funded by the UNESCAP-TRATE (IOTWS) Proje

Quantitative Evaluation of Biologic Therapy Options for Psoriasis:A Systematic Review and Network Meta-Analysis

Multiple biologic treatments are licensed for psoriasis. The lack of head-to-head randomised controlled trials (RCTs) makes choosing between them difficult for patients, clinicians and guideline developers. To establish their relative efficacy and tolerability, we searched MEDLINE, PubMed, Embase and Cochrane for RCTs of licensed biologic treatments for skin psoriasis. We performed a network meta-analysis to identify direct and indirect evidence comparing biologics to one another, methotrexate or placebo. We combined this with hierarchical cluster analysis to consider multiple outcomes related to efficacy and tolerability in combination for each treatment. Study quality, heterogeneity and inconsistency were evaluated. Direct comparisons from 41 RCTs (20,561 participants) were included. All included biologics were efficacious compared with placebo or methotrexate at 3-4 months. Overall, cluster analysis showed adalimumab, secukinumab and ustekinumab were comparable in terms of high efficacy and tolerability. Ixekizumab and infliximab were differentiated by very high efficacy but poorer tolerability. The lack of longer-term controlled data limited our analysis to short-term outcomes. Trial performance may not equate to real-world performance, and so results need to be considered alongside real-world, long-term safety and effectiveness data. These data suggest that it is possible to discriminate between biologics to inform clinical practice and decision-making. PROSPERO 2015:CRD42015017538.</p

Factors influencing the approaches to studying of preclinical and clinical students and postgraduate trainees

<p>Abstract</p> <p>Background</p> <p>Students can be classified into three categories depending on their approaches to studying; namely, deep approach (DA), strategic approach (SA) and surface apathetic or superficial approach (SAA). The aim of this study was to identify factors affecting the approaches to studying among Sri Lankan medical undergraduates and post graduate trainees and to analyze the change in the pattern of study skills with time and experience.</p> <p>Method</p> <p>Pre-clinical and clinical students of the Faculty of Medicine, University of Colombo and postgraduate trainees in Surgery at the National Hospital of Sri Lanka were invited to complete the Approaches and Study Skills Inventory for Students (ASSIST) questionnaire.</p> <p>Results</p> <p>A total of 187 pre clinical (M: F = 96:91), 124 clinical (M: F = 61:63) and 53 post graduate trainees (M: F = 50:3) participated in the study. Approaches of male and female students were similar. SA was significantly affected by age among the preclinical students (p = 0.01), but not in other groups. Among pre-clinical students, males preferred a teacher who supported understanding (p = 0.04) but females preferred a passive transmission of information (p < 0.001). This, too, was not visible among other groups. A linear regression performed on group (batch), gender, island rank at GCE Advance Level (AL) examination, self appraisal score and the preference scores of type of teacher only managed to explain 35% or less of variance observed for each approach in individual groups.</p> <p>Conclusion</p> <p>Different factors affect the approach to studying in different groups but these explain only a small fraction of the variance observed.</p

Unexpected outcome from Trousseau syndrome

<p>Abstract</p> <p>Background</p> <p>Unprovoked superficial thrombophlebitis and subsequent venous thromboembolism are well-described albeit rare presenting features of advanced visceral malignancy that often manifest too late for curative intervention to be beneficial.</p> <p>Case Presentation</p> <p>We present the first reported case of early gastric carcinoma presenting with these paraneoplastic phenomena in an otherwise healthy farmer. The early presentation allowed for a curative partial gastrectomy, which itself was complicated by the presence of a deep vein thrombosis extending into the inferior vena cava. Fortunately, stabilization of the clot allowed for surgery to proceed without the need for a caval filter. The patient was referred for adjuvant chemotherapy and has since made an excellent recovery.</p> <p>Conclusions</p> <p>This case provides new evidence for the presentation of superficial thrombophlebitis in early gastric carcinoma and the potential for curative surgery in such instances. A high index of suspicion and a prompt diagnostic workup are essential for timely planning and execution of surgery in these early albeit rare presentations.</p