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Chronic diarrhoea due to severe strongyloidiasis in a Chronic Kidney Disease patient: A case report 一例慢性肾脏病患者因严重强直性脊柱炎引起的慢性腹泻病例报告
Pub Date : 2021-12-30 DOI: 10.4038/amj.v15i2.7683
A. Karunatilaka, T. Hewageegana, N. Y. Perera, C. Kumarasinghe, D. Sinharachchi
Strongyloides stercoralis is a soil-transmitted helminth that is endemic in tropical and subtropical regions. S. stercoralis is considered to have a complicated life-cycle on its ability to reproduce through asexual autoinfection and the capability of remaining dormant inside the host for decades [1]. The adult worms live in the small intestine while the larvae penetrate other vital organs such as the liver, brain, lungs, and kidneys, resulting in strongyloidiasis. Therefore, the clinical spectrum of strongyloidiasis varies largely, from asymptomatic to fatal disseminated infection [1]. Chronic kidney disease (CKD) is affiliated with the development of severe strongyloidiasis, owing to the associated immune system dysfunction [2]. This is a report of a patient with endstage kidney disease who was infected with S. stercoralis . We aim to highlight the importance of high clinical suspicion and timely diagnosis of S. stercoralis in high-risk populations from endemic regions.
斯特科拉利斯强线虫是一种土壤传播的蠕虫,在热带和亚热带地区很常见。stercoralis被认为具有复杂的生命周期,其通过无性自身感染繁殖的能力和在宿主体内休眠数十年的能力[1]。成虫生活在小肠中,而幼虫则穿透其他重要器官,如肝脏、大脑、肺部和肾脏,导致线虫病。因此,强直性脊柱炎的临床谱差异很大,从无症状到致命的播散性感染[1]。由于相关的免疫系统功能障碍,慢性肾脏疾病(CKD)与严重的强直性脊柱炎的发展有关[2]。这是一例晚期肾病患者的报告,他感染了粪珊瑚虫。我们的目的是强调在流行地区的高危人群中高度临床怀疑和及时诊断粪珊瑚虫的重要性。
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引用次数: 0
The current practice of clinical handover process in emergency departments in National Hospital, Kandy and University Teaching Hospital, Peradeniya: a descriptive cross-sectional study 坎迪国立医院和佩拉迪亚大学教学医院急诊科临床交接流程的现状:一项描述性横断面研究
Pub Date : 2021-12-30 DOI: 10.4038/amj.v15i2.7692
S. Jayathilake, R. Weerakoon, V. Pinto
The aim of establishing an accident and emergency department is prompt initial assessment, stabilization and early referral for definitive care. This study aims to describe the current practice of the clinical handover process at the emergency departments of the national hospital, Kandy and the teaching hospital, Peradeniya and to describe the adherence of the medical officer shift hand over to “iSoBAR” (identification, situation, observation, background, assessment, recommendation/ read back) handover method.
建立事故和急诊科的目的是迅速进行初步评估,稳定和早期转诊,以确定护理。本研究旨在描述Kandy国立医院和Peradeniya教学医院急诊科临床交接流程的现状,并描述医官轮班交接对“iSoBAR”(识别、情况、观察、背景、评估、建议/回读)交接方法的遵守情况。
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引用次数: 0
Tolosa-Hunt syndrome; a diagnosis of exclusion: a case report Tolosa-Hunt综合症;排除性诊断:1例报告
Pub Date : 2021-08-19 DOI: 10.4038/amj.v15i1.7667
D. Satharasinghe, S. Weerasinghe, H. Senanayake, N. Lokunarangoda, P. Weerawansa
Tolosa-Hunt Syndrome is a rare cause of unilateral headache with painful ophthalmoplegia. Only a limited number of cases are reported in the literature. We present a case of Tolosa-Hunt syndrome in a middle-aged male who presented to Teaching Hospital Anuradhapura. A previously well, hypertensive gentleman presented with gradual onset right-sided headache and diplopia for five days duration. On examination, there were right-sided palsies of right-sided cranial nerves III, IV, V-1, VI  on examination. Magnetic Resonance Imaging (MRI) of the brain with contrast was unremarkable. The patient was treated with steroids after excluding other possible causations of painful ophthalmoplegia. He was started on steroids, to which a dramatic response was observed. Tolosa-Hunt syndrome responds well to steroid therapy even though there is no proven benefit of steroids to reduce recurrence rates. Careful evaluation needs to be carried out to rule out other possible causes of similar clinical and radiological features as they may be masked by steroid therapy.
托罗萨-亨特综合征是一种罕见的单侧头痛伴疼痛性眼麻痹的病因。文献中只报道了有限数量的病例。我们提出一例托洛萨-亨特综合征的中年男性谁提出了教学医院阿努拉德普勒。先前良好,高血压的绅士表现为逐渐开始的右侧头痛和复视持续5天。检查发现右侧脑神经III、IV、V-1、VI麻痹。脑磁共振成像(MRI)对比无明显差异。排除其他可能引起疼痛性眼麻痹的原因后,给予类固醇治疗。他开始服用类固醇,并观察到戏剧性的反应。托罗萨-亨特综合征对类固醇治疗反应良好,尽管没有证据表明类固醇对降低复发率有好处。需要进行仔细的评估,以排除其他可能引起类似临床和放射学特征的原因,因为它们可能被类固醇治疗掩盖。
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引用次数: 0
Are imported cases the reason for increase in incidence of dengue in Anuradhapura District during the recent years? 输入病例是近年来阿努拉德普勒地区登革热发病率上升的原因吗?
Pub Date : 2021-08-19 DOI: 10.4038/amj.v15i1.7670
S. Gunathilaka, S. Kularatne, J. Rajapakse, R. Muthugala
Dengue has now become endemic in almost all districts of Sri Lanka. An increase in the percentage contribution from North Central Province (NCP) to dengue incidence in the country has been noted since the 2015 dengue outbreak. During the year 2017, 338 patients per 100,000 population were reported to have clinically suspected dengue according to the epidemiology unit records. The daily records available at the dengue control unit of regional director of health services office, Anuradhapura, and the freely available data at the epidemiology unit, which comprised of weekly cases of dengue, were extracted and analysed against the meteorological parameters and the vector density data. According to our observations, a statistically significant association between daily rainfall and daily temperature and clinically diagnosed dengue cases does not exist in Anuradhapura. The monthly vector indices did not show any correlation with the monthly incidence of dengue in the medical officer of health area with the highest overall incidence of dengue. The proportion of paediatric patients were also very low in the Anuradhapura district (9%) compared to other districts. Based on these observations, the authors suggest that imported cases of dengue to this district is a major cause of increased incidence of dengue, rather than indigenous transmission in the area.
登革热现在已成为斯里兰卡几乎所有地区的地方病。自2015年登革热疫情以来,注意到中北部省对该国登革热发病率的贡献百分比有所增加。根据流行病学单位的记录,2017年每10万人中报告有338名患者临床疑似登革热。提取了阿努拉德普勒地区卫生服务办公室主任登革热控制股提供的每日记录,以及流行病学股免费提供的数据,其中包括每周登革热病例,并根据气象参数和媒介密度数据进行了分析。根据我们的观察,在阿努拉德普勒,日降雨量和日温度与临床诊断的登革热病例之间不存在统计学上显著的关联。病媒月指数与登革热总发病率最高的卫生区医务人员登革热月发病率无相关性。与其他地区相比,阿努拉德普勒区的儿科患者比例也很低(9%)。基于这些观察结果,作者认为该地区输入的登革热病例是登革热发病率增加的主要原因,而不是该地区的本地传播。
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引用次数: 0
Prevalence of molecular subtypes of breast cancer: Experience in a tertiary care cancer centre in Sri Lanka 乳腺癌分子亚型的流行:斯里兰卡三级保健癌症中心的经验
Pub Date : 2021-08-19 DOI: 10.4038/amj.v15i1.7697
B. Ubayawansa, S. Shilpage, K. D. Silva
Breast cancer is the commonest cancer among females. Patient outcome and treatment options are largely influenced by its molecular subtypes. This study aims to evaluate molecular subtypes of breast cancers among patients treated at a tertiary cancer centre in Sri Lanka. Clinical and demographic data were collected retrospectively from electronic medical records available at the cancer institute, Maharagama, Sri Lanka. Histology reports of 200 patients who had undergone mastectomy or wide local excision during an 18-month period starting from January 2018 were analyzed. Patients' age, histological subtype of cancer, receptor status of estrogen receptor (ER) progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), Ki-67 index, and tumour grading were considered. The age range of the patients was 29 to 84 years (mean=57.7, SD=11.76). The 50-59 and 60-69 age groups represented the most patients (28% each). Females represented 99% (n=199) of the total while three patients had bilateral breast cancer. Histologically, invasive carcinoma of no special type (NST) was the commonest cancer type (n=178, 89%), with the majority being grade 2 cancers (52.5%) according to the Nottingham cancer grading (grade 1=15.1% and grade 3=32%). Luminal A was the most common (64%) molecular subtype, followed by basal-like (21%), HER2-enriched (11.5%), and luminal B (4.5%). Data on the Ki-67 index was available for only 98 patients, and 8.1% (8) of them had a Ki-67 index less than 10, while 22.5% (n=22) between 10 and 20. All others (69%) had a higher Ki-67 index (>20). There is a significant association between the molecular subtype of breast cancer and Nottingham grading (p Majority of Sri Lankan women with breast cancers present in the 5th and 6th decades of their lives. Luminal A molecular subtype was the predominant, followed by basal-like, HER2- enriched, and luminal B. Aggressive HER2- enriched and basal subtypes are more common in younger age groups. We recommend breast cancer subtyping before surgery so that more people will benefit from neoadjuvant chemotherapy.
癌症是女性中最常见的癌症。患者的预后和治疗选择在很大程度上受到其分子亚型的影响。本研究旨在评估在斯里兰卡癌症三级中心接受治疗的患者中乳腺癌的分子亚型。临床和人口统计数据是从斯里兰卡马哈拉加马癌症研究所的电子医疗记录中回顾性收集的。分析了从2018年1月开始的18个月内接受乳房切除术或广泛局部切除的200名患者的组织学报告。考虑患者的年龄、癌症的组织学亚型、雌激素受体(ER)、孕酮受体(PR)和人表皮生长因子受体2(HER2)的受体状态、Ki-67指数和肿瘤分级。患者的年龄范围为29至84岁(平均值=57.7,标准差=11.76)。50-59岁和60-69岁年龄组的患者最多(各占28%)。女性占总数的99%(n=199),而三名患者患有双侧癌症。组织学上,无特殊类型的侵袭性癌(NST)是最常见的癌症类型(n=178,89%),根据诺丁汉癌症分级,大多数为2级癌(52.5%)(1级=15.1%,3级=32%)。Luminal A是最常见的分子亚型(64%),其次是基底型(21%)、富含HER2(11.5%)和Luminal B(4.5%)。Ki-67指数的数据仅适用于98名患者,其中8.1%(8)的Ki-67指标小于10,22.5%(n=22)的Ki指数在10至20之间。所有其他人(69%)的Ki-67指数均较高(>20)。癌症的分子亚型与诺丁汉分级之间存在显著关联(p大多数患有乳腺癌的斯里兰卡妇女在其生命的第5和第6个十年。Luminal a分子亚型占主导地位,其次是基底样、富含HER2和Luminal B。侵袭性HER2富集亚型和基础亚型在年轻群体中更常见。我们建议在手术前对癌症进行分型,这样更多的人将从新辅助化疗中受益。
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引用次数: 0
Aetiopathogenesis of gallstone disease in Sri Lanka; what do we know? 斯里兰卡胆石病的病原学;我们知道什么?
Pub Date : 2021-08-18 DOI: 10.4038/amj.v15i1.7698
H. Weerakoon
Pathogenesis of gallstones (GS) involves a complex interaction between multiple genetic and exogenous risk factors. As the prevalence, disease burden, aetiopathogenesis, and the complications of GS disease vary across different populations, a better understanding of the disease, specific to a given community is imperative. Though some of the initial studies reveal a higher incidence of pigment and mixed cholesterol GS over pure cholesterol stones among Sri Lankans, GS disease is largely underexplored in local context. Therefore, the prevalence, disease burden and aetiological factors of the GS disease in Sri Lanka need to be rigorously studied. Further research on exploring the possible factors triggering the development of GS on a pigment nidus is essential in discovering the aetiopathogenesis of GS among Sri Lankans and will be the key in identifying effective preventive measures.
胆结石(GS)的发病机制涉及多种遗传和外源危险因素之间的复杂相互作用。由于GS疾病的患病率、疾病负担、病因和并发症在不同人群中各不相同,因此必须更好地了解特定社区的疾病。尽管一些初步研究表明,在斯里兰卡人中,色素和混合胆固醇GS的发病率高于纯胆固醇结石,但GS疾病在当地的研究大多不足。因此,需要对斯里兰卡GS病的患病率、疾病负担和病因因素进行严格研究。进一步研究色素巢上引发GS发展的可能因素,对于发现斯里兰卡人GS的病因至关重要,也是确定有效预防措施的关键。
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引用次数: 0
A challenging diagnosis of pyrexia of unknown origin: isolated iliac tuberculous lymphadenitis complicated by psoas abscess 不明原因发热的一个具有挑战性的诊断:孤立性髂结核性淋巴结炎并发腰肌脓肿
Pub Date : 2021-08-15 DOI: 10.4038/amj.v15i1.7687
W. Wanniarachchi, W. Pemasiri, C. Munagama, A. Sugathapala, M. N. N. Masaima
Pyrexia of unknown origin is a challenge in clinical practice. Extrapulmonary tuberculosis is considered a common cause for pyrexia of unknown origin which has a wide spectrum of clinical manifestations, culminating in delayed diagnosis. However, due to its treatable nature and good prognosis, a high index of suspicion is needed to diagnose atypical presentations. This case report elaborates isolated involvement of iliac lymph node in tuberculosis which is a rare presentation of tuberculous lymphadenitis.
不明原因的发热在临床实践中是一个挑战。肺外结核被认为是不明原因发热的常见原因,具有广泛的临床表现,最终延误诊断。然而,由于其可治疗性和良好的预后,诊断非典型表现需要高度的怀疑指数。本病例报告阐述孤立性髂淋巴结累及结核性淋巴结炎的罕见表现。
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引用次数: 0
Melioidosis presenting as knee joint septic arthritis: a case report 类鼻疽表现为膝关节化脓性关节炎1例
Pub Date : 2021-08-15 DOI: 10.4038/amj.v15i1.7672
H. Hettige, P. Weerawansa, S. Siribaddana, C. Sarathchandra
A 56-year-old woman having type 2 diabetes, presented with intermittent high-grade fever for three weeks and right knee joint pain and swelling with restricted movements. She has had a prick injury to the left sole two weeks ago in the paddy field. Investigations revealed neutrophil leucocytosis and raised inflammatory markers. Blood culture was sterile. Joint fluid was turbid with neutrophil predominance, but the culture was sterile. Chest x-ray showed bilateral multiple patchy consolidations, that turned out to be abscesses on contrast-enhanced CT scan. The history of prick injury, diabetes, and the presence of multiple lung abscesses made us ponder a diagnosis of melioidosis. Although cultures were negative, melioidosis antibody titer was raised. She was treated with ceftazidime and doxycycline for one month, followed by co-cotrimoxazole and doxycycline for three months. She was completely cured after the course of antibiotics.
一名56岁的女性,患有2型糖尿病,间歇性高热持续三周,右膝关节疼痛和肿胀,活动受限。两周前,她在稻田里左脚足底被刺破。调查显示中性粒细胞白细胞增多,炎症标志物升高。血液培养是无菌的。关节液混浊,中性粒细胞占优势,但培养物无菌。胸部x线片显示双侧多发斑片状实变,CT增强扫描显示为脓肿。点刺损伤、糖尿病和多发性肺脓肿的病史使我们思考类鼻疽的诊断。尽管培养物为阴性,但类鼻疽抗体滴度升高。她接受了头孢他啶和多西环素治疗一个月,随后接受了复方新诺明和多西环素治疗三个月。经过一个疗程的抗生素治疗,她完全治愈了。
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引用次数: 0
Cerebral venous sinus thrombosis complicated with haemorrhagic venous infarction and seizures, successfully treated with oral anticoagulation for one year: a case report 口服抗凝治疗脑静脉窦血栓形成并发出血性静脉梗死和癫痫发作1例
Pub Date : 2020-12-31 DOI: 10.4038/amj.v14i2.7664
H. Hettige, S. Pilapitiya, N. Lokunarangoda, H. Senanayake
A 43-year-old mother of two children presented with an episode of cerebral venous sinus thrombosis (CVST) complicated with haemorrhagic venous infarction and seizure. She had two first trimester miscarriages and was on combined oral contraceptive pills (COCP) for two months. Computed tomography (CT) venogram revealed venous sinus thrombosis with a right partial lobe haemorrhagic infarction. She was treated with subcutaneous enoxaparin for 14-days followed by oral warfarin for one year. The patient was started on oral levetiracetam but gradually tailed off over four months. Physiotherapy and occupational therapy were continued. She was advised on non-hormonal family planning methods. Thrombophilia and autoimmune screening were negative. Haemorrhagic venous infarction complicated with seizures is a rare manifestation of venous sinus thrombosis. Timely and personalized anticoagulation is the mainstay of treatment.
一位43岁的两个孩子的母亲出现了脑静脉窦血栓形成(CVST)并伴有出血性静脉梗死和癫痫发作。她在妊娠早期有两次流产,并服用了两个月的联合口服避孕药。计算机断层扫描(CT)静脉造影显示静脉窦血栓形成伴右半叶出血性梗死。她接受了皮下依诺肝素治疗14天,然后口服华法林治疗一年。患者开始口服左乙拉西坦,但在四个月内逐渐减少。继续进行物理治疗和职业治疗。建议她采用非激素计划生育方法。血栓形成倾向和自身免疫筛查均为阴性。出血性静脉梗死并发癫痫发作是静脉窦血栓形成的罕见表现。及时和个性化的抗凝治疗是治疗的支柱。
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引用次数: 0
Non-communicable diseases care model & its integration with the primary health care system in Norway 挪威非传染性疾病护理模式及其与初级卫生保健系统的整合
Pub Date : 2020-12-31 DOI: 10.4038/amj.v14i2.7657
D. Perera, B. Moen
Non-communicable diseases (NCDs) account for an estimated 71% of all deaths globally. In Norway, in 2015, 71% of all deaths were due to cardiovascular diseases, cancers and neurological disorders. NCDs are mostly chronic diseases where individuals live a long period with the disease, thus the disease becomes a part of everyday life. This perspective explores the NCD care model within the Norwegian health delivery system in relation to the integration of prevention, diagnosis, treatment and rehabilitation services of non-communicable diseases to the primary health care system, and also explores several best practices and lessons that can be adapted to minimize the critical gaps and areas of the non-communicable diseases care model in Sri Lanka.
非传染性疾病估计占全球所有死亡人数的71%。在挪威,2015年,71%的死亡是由心血管疾病、癌症和神经系统疾病引起的。非传染性疾病大多是慢性疾病,个体与疾病共存很长一段时间,因此疾病成为日常生活的一部分。这一观点探讨了挪威卫生服务体系中的非传染性疾病护理模式,将非传染性疾病的预防、诊断、治疗和康复服务纳入初级卫生保健体系,还探讨了可以调整的几种最佳做法和经验教训,以最大限度地缩小斯里兰卡非传染性疾病护理模式的关键差距和领域。
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引用次数: 0
期刊
Anuradhapura Medical Journal
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