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Characteristics associated with successful treatment outcome in children with overweight and obesity at a tertiary care clinic in Sri Lanka 斯里兰卡一家三级保健诊所超重和肥胖儿童成功治疗结果的相关特征
Pub Date : 2023-08-17 DOI: 10.4038/sljm.v32i1.365
G. Vidanapathirana, N. S. Vidanapathirana, S. Tennakoon, D. V. K. Kiridana
Background: Lack of response to childhood obesity management programmes is a global concern. Western studies show that the age and the body mass index of the child at the commencement of the treatment, frequency of clinic visits and parental level of education affect the outcome of such treatment programmes.Objectives: To identify factors associated with z-BMI reduction in children with overweight or obesity who underwent a 6-month clinic-based obesity management programme.Methods: A retrospective analysis of medical records was carried out on children between 2 and 15 years of age who had undergone a weight management programme of 6 months duration at the Teaching Hospital, Peradeniya between 2017 and 2020. Reduction in z-BMI was considered as the successful treatment outcome. Anthropometric, demographic and lifestyle factors at the first and the last visits were extracted and described using means with 95% confidence intervals. Adherence to treatment was evaluated under the categories of diet, physical activity and behavioural modification. Logistic regression was applied to create a model that explains the effect on the treatment outcome.Results: Out of 401 subjects, 94 (23.44%) completed follow up. Eighty subjects (85.1%) achieved a mean z-BMI reduction of 1.981±0.584.The Logistic regression returned a model with screen time as the only statistically significant explanatory variable for changes in BMI. Compared to no screen time those with screen times of over 4 hours were 5.85 (CI 1.25 – 27.28) times more likely to have a negative response.Conclusion: Strategies to minimize screen time are needed to enhance the effectiveness of weight management interventions.
背景:儿童肥胖管理规划缺乏响应是一个全球关注的问题。西方研究表明,儿童在治疗开始时的年龄和身体质量指数、就诊频率和父母的教育水平会影响这种治疗方案的结果。目的:确定超重或肥胖儿童接受6个月临床肥胖管理计划后z-BMI降低的相关因素。方法:回顾性分析2017年至2020年期间在Peradeniya教学医院接受为期6个月体重管理计划的2至15岁儿童的医疗记录。z-BMI的降低被认为是成功的治疗结果。提取第一次和最后一次访问时的人体测量学、人口统计学和生活方式因素,并使用95%置信区间的均值进行描述。根据饮食、身体活动和行为改变等类别对治疗依从性进行评估。应用逻辑回归来创建一个模型来解释对治疗结果的影响。结果:401例患者中,94例(23.44%)完成随访。80名受试者(85.1%)的z-BMI平均降低1.981±0.584。Logistic回归的模型显示,屏幕时间是BMI变化的唯一具有统计学意义的解释变量。与没有屏幕时间的人相比,屏幕时间超过4小时的人产生负面反应的可能性是5.85倍(CI 1.25 - 27.28)。结论:需要减少屏幕时间的策略来提高体重管理干预的有效性。
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引用次数: 0
Usefulness of HbA1C in differentiating Gestational Diabetes Mellitus and preexisting Diabetes Mellitus in the early stages of pregnancy HbA1C在妊娠早期鉴别妊娠期糖尿病和既往糖尿病的价值
Pub Date : 2023-08-17 DOI: 10.4038/sljm.v32i1.352
P. B. Renz, Gabriela, Cavagnolli, L. Weinert
Introduction: Diabetes mellitus in pregnancy can cause several complications for the mother and the neonate if left untreated. This study identifies the proportion of undiagnosed pre-existing diabetic pregnant women and the necessity of doing an HbA1C test in the first trimester for its diagnosis.Methodology: Pregnant women in the first trimester without a history of hypertensive disorders, Diabetes Mellitus in their previous pregnancies were recruited for the studies. Then blood samples were withdrawn from them to perform OGTT and the HbA1C test on booking visit (8-12 weeks of gestation). The results were used to diagnose and find the proportions of pregnant women with pre-existing diabetes mellitus and gestational diabetes mellitus.Results: The HbA1C test was done for 428 pregnant women and among them, 25 (5.8%) had levels above ≥ 48 mmol/mol (6.5%) and were diagnosed with pre-existing diabetes. Of the 428 pregnant women, only 267 attended the OGTT. Among the 267 pregnant women, 15 had HbA1C levels equal to or more than 6.5% and they were identified to have pre-existing diabetes. Pregnant women diagnosed with gestational diabetes were 34 and the HbA1C of these women was <6.5%. However, the 15 pregnant women who were diagnosed with preexisting diabetes were not identified with gestational diabetes from the OGTT.Conclusion: HbA1C can be used as a useful tool for screening pre-existing diabetes during pregnancy. Due to the high prevalence of pregnant women with pre-existing diabetes (5.8%) found in this study, it can be recommended to perform a HbA1C test at the booking visit to identify high-risk, pregnant women.
妊娠期糖尿病如果不及时治疗,会给母亲和新生儿带来多种并发症。本研究确定了未确诊的已有糖尿病孕妇的比例,以及在妊娠早期进行HbA1C检测诊断糖尿病的必要性。方法:研究招募了妊娠前三个月无高血压、糖尿病病史的孕妇。然后在预约就诊时(妊娠8-12周)抽取血样进行OGTT和糖化血红蛋白检测。结果用于诊断和发现妊娠期已存在糖尿病和妊娠期糖尿病的孕妇比例。结果:428例孕妇进行了HbA1C检测,其中25例(5.8%)HbA1C水平高于≥48 mmol/mol(6.5%),并诊断为既往存在糖尿病。在428名孕妇中,只有267人参加了OGTT。在267名孕妇中,有15名HbA1C水平等于或超过6.5%,并被确定患有糖尿病。诊断为妊娠期糖尿病的孕妇34例,HbA1C <6.5%。然而,在OGTT中,15名被诊断为既往存在糖尿病的孕妇并没有被确诊为妊娠糖尿病。结论:HbA1C可作为筛查妊娠期糖尿病的有效工具。由于本研究发现孕妇既往糖尿病患病率较高(5.8%),建议在预约就诊时进行HbA1C检测,以识别高危孕妇。
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引用次数: 0
Non-Alcoholic fatty liver disease and metabolic syndrome in patients with HIV/AIDS and its correlation with antiretroviral therapy and severity of disease 艾滋病毒/艾滋病患者的非酒精性脂肪性肝病和代谢综合征及其与抗逆转录病毒治疗和疾病严重程度的相关性
Pub Date : 2023-08-17 DOI: 10.4038/sljm.v32i1.348
Pankaj Gupta, S. Tyagi, S. Mathews, R. Saini, H. Sesama, A. Chugh, K. Singh, M. Chawla
Introduction: Metabolic syndrome (MetS) and Non-alcoholic fatty liver disease (NAFLD) are two major causes of morbidity in chronic HIV infected patients on antiretroviral therapy (ART). This study was done on HIV infected individuals by comparing ART naive patients with patients on different ART regimens and evaluating the effect of ART on Metabolic syndrome and NAFLD.Method: It was a cross-sectional observational study done on 120 HIV infected individuals in a tertiary care centre in New Delhi. All cases with hypertension, diabetes, chronic kidney or liver disease, thyroid disorders or on any drugs except ART were excluded. The risk markers for metabolic syndrome were assessed and compared within groups on different ART regimens.Results: Metabolic syndrome and NAFLD were found to be significantly more in cases on ART as compared to ART naïve cases. Metabolic syndrome was found to be associated with type of ART protease inhibitors (ATV/r)> nonucleoside reverse transcriptase inhibitors (NNRTI) > no ART] and low CD4 cell counts (p=0.01). In those patients who were on ART, these parameters were found to be more in those on second line ART [i.e., protease inhibitor (PI)(ATV/r) based regimens] as compared to those on first line ART, [i.e., nonnucleoside reverse transcriptase inhibitors (NNRTI) based regimen]. 15% of cases on 2nd line ART (group C) had MetS as compared to 12.5% in those on 1st line ART (group B) and nil in ART naïve cases (group A). One third (34%) of all 120 cases were found to have NAFLD. A significantly higher number of cases (45%) in group C had NAFLD as compared to 32.5% in group B and 25% in group A respectively. Insulin resistance and metabolic risk markers were also significantly higher in cases on ART as compared to ART naïve.Conclusions: In HIV patients, the use of antiretroviral therapy (ART) is linked to an increase in the prevalence of metabolic risk factors, including insulin resistance, lipoatrophy and dystrophy, dyslipidaemia, and abnormalities of fat distribution. Although care of Opportunistic infections and recently CVD has received a lot of attention, it is equally important to address the metabolic abnormalities such as metabolic syndrome and NAFLD brought on by ART.
代谢综合征(MetS)和非酒精性脂肪性肝病(NAFLD)是接受抗逆转录病毒治疗(ART)的慢性HIV感染患者发病的两个主要原因。本研究在HIV感染者中进行,通过比较ART初始患者和不同ART方案的患者,评估ART对代谢综合征和NAFLD的影响。方法:对新德里一家三级保健中心的120名艾滋病毒感染者进行了横断面观察研究。所有患有高血压、糖尿病、慢性肾脏或肝脏疾病、甲状腺疾病或服用抗逆转录病毒治疗以外的任何药物的病例均被排除在外。对不同抗逆转录病毒治疗方案组内代谢综合征的危险标志物进行评估和比较。结果:ART组代谢综合征和NAFLD发生率明显高于ART naïve组。代谢综合征与ART蛋白酶抑制剂(ATV/r)>非核苷类逆转录酶抑制剂(NNRTI) >无ART和CD4细胞计数低相关(p=0.01)。在接受抗逆转录病毒治疗的患者中,与接受一线抗逆转录病毒治疗的患者(即以蛋白酶抑制剂(PI)(ATV/r)为基础的治疗方案)相比,接受二线抗逆转录病毒治疗的患者(即以非核苷类逆转录酶抑制剂(NNRTI)为基础的治疗方案),这些参数更高。15%的二线ART患者(C组)有met,而一线ART患者(B组)为12.5%,ART naïve患者(A组)为零。所有120例患者中有三分之一(34%)被发现患有NAFLD。与B组的32.5%和A组的25%相比,C组NAFLD的病例数(45%)明显高于B组。与抗逆转录病毒治疗相比,接受抗逆转录病毒治疗的患者胰岛素抵抗和代谢风险指标也明显更高naïve。结论:在HIV患者中,抗逆转录病毒治疗(ART)的使用与代谢危险因素的患病率增加有关,包括胰岛素抵抗、脂肪萎缩和营养不良、血脂异常和脂肪分布异常。尽管机会性感染和最近的心血管疾病的治疗受到了很多关注,但同样重要的是解决由ART引起的代谢综合征和NAFLD等代谢异常。
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引用次数: 0
A rare presentation of Acute Abamectin poisoning under alcohol influence: A case series 酒精影响下急性阿维菌素中毒的罕见表现:病例系列
Pub Date : 2023-08-17 DOI: 10.4038/sljm.v32i1.358
S. Kajananan, S. Sivansuthan, R. Arujun
Abamectin is a commonly used insecticide and anthelmintic. Human intoxication is uncommon but potentially fatal. We present the case of a 50-year-old man who developed hypotension, respiratory paralysis with aspiration, and myoclonus following self-ingestion of abamectin under alcohol influence. With supportive treatment, he completely recovered.
阿维菌素是一种常用的杀虫剂和驱虫药。人类中毒并不常见,但可能致命。我们报告一例50岁男性在酒精影响下自行摄入阿维菌素后出现低血压、误吸性呼吸麻痹和肌阵挛。经过支持性治疗,他完全康复了。
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引用次数: 0
A neonate with metatropic dysplasia: A case report 新生儿萎缩性发育不良1例
Pub Date : 2023-08-17 DOI: 10.4038/sljm.v32i1.387
M. Wettasinghe, N. Herath, E. Halangoda, N. Wickramasinghe
Metatropic dysplasia is a rare form of skeletal dysplasia in which characteristic clinical and imaging features are found at birth. The short limbs with relatively long trunk seen in the neonatal period change to short trunk in childhood due to progressive kyphoscoliosis. This rare condition should be diagnosed in the neonatal period to avoid diagnostic dilemma in later life. A 2-day-old baby girl was referred for a skeletal survey study to diagnose the underlying skeletal dysplasia. The metatropic dysplasia was diagnosed based on plain radiographic findings. This case report highlights the characteristic radiographic findings of this rare disease entity.
变态发育不良是一种罕见的骨骼发育不良,其典型的临床和影像学特征是在出生时发现的。由于进行性脊柱后凸,新生儿时期的短肢和较长的躯干在儿童期变为短躯干。这种罕见的情况应在新生儿期诊断,以避免在以后的生活中诊断困境。一个2天大的女婴被转介进行骨骼调查研究,以诊断潜在的骨骼发育不良。异萎缩性不典型增生的诊断是基于平片表现。本病例报告强调了这种罕见疾病的特征性影像学表现。
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引用次数: 0
Transfusion reaction: A blind spot in autopsy 输血反应:尸检中的一个盲点
Pub Date : 2023-08-17 DOI: 10.4038/sljm.v32i1.370
S. Senavirathna, S. Wijerathne
Although blood transfusion is generally safe, there are adverse events with varying severity even that can lead to death including Acute Haemolytic Transfusion Reaction (AHTR), anaphylaxis, bacterial sepsis, Transfusion Related Acute Lung Injury (TRALI) and Transfusion Associated Circulatory Overload (TACO). Transfusion Associated Graft vs Host Disease (TAGVHD) is a delayed type of reaction that can lead to death. Ascertaining the cause of death is complicated in such situations and multidisciplinary investigations are needed.Serological investigations should be performed in the transfusion laboratory to detect haemolysis, immunological incompatibility, and bacterial contamination. In the postmortem examination AHTR can be diagnosed with serological investigations and presence of incompatible red cells can be identified in postmortem tissue samples by immune-histochemical methods. Detection of HLA antibodies in the respiratory tract tissues and intended donor investigations can confirm the diagnosis of TRALI. In a case of suspected bacterial contamination isolation of same organism in the postmortem blood and in the intended pack can conclude the diagnosis. In anaphylaxis, inflammation of the respiratory tract with eosinophilia can be seen and measuring the serum tryptase level is useful. In TAGVHD host tissue necrosis and lymphocyte infiltration are +seen and that can be confirmed by showing the DNA chimerism by PCR analysis.Further studies are recommended to establish protocols and guidelines for postmortem examination following a transfusion reaction.
虽然输血通常是安全的,但也存在严重程度不同甚至可导致死亡的不良事件,包括急性溶血性输血反应(AHTR)、过敏反应、细菌性败血症、输血相关急性肺损伤(TRALI)和输血相关循环超负荷(TACO)。输血相关移植物抗宿主病(TAGVHD)是一种可导致死亡的迟发性反应。在这种情况下,确定死亡原因是复杂的,需要进行多学科调查。血清学调查应在输血实验室进行,以检测溶血、免疫不相容和细菌污染。在死后检查中,AHTR可以通过血清学调查诊断,并且通过免疫组织化学方法可以在死后组织样本中发现不相容的红细胞。在呼吸道组织中检测HLA抗体和意向供者调查可以确认TRALI的诊断。在疑似细菌污染的情况下,在死后血液和预定包装中分离出相同的生物体可以得出诊断结论。在过敏反应中,可以看到呼吸道炎症伴嗜酸性粒细胞增多,测定血清胰蛋白酶水平是有用的。在TAGVHD中,可见宿主组织坏死和淋巴细胞浸润,这可以通过PCR分析显示DNA嵌合来证实。建议开展进一步研究,为输血反应后的尸检制定方案和指南。
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引用次数: 0
Pinpointing the additive: A peculiar skin manifestation among intravenous drug injectors 确定添加剂:静脉注射药物者的特殊皮肤表现
Pub Date : 2023-08-17 DOI: 10.4038/sljm.v32i1.359
B.M Munasinghe, S. Pranavan, U. Mayorathan
No abstract available
没有摘要
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引用次数: 0
General health characteristics, psychological stress of inmates and living environment of a main prison in Sri Lanka 斯里兰卡一所主要监狱囚犯的一般健康特征、心理压力和生活环境
Pub Date : 2023-08-17 DOI: 10.4038/sljm.v32i1.366
C. Wickramatilake, B. D. De Silva, T. Nanayakkara, R. Nanayakkara, K. P. K. Gayashani
Background: Prison inmates, a deprived community are a part of general population. Understanding of their health characteristics, psychological stress and living environment is important to upgrade the existing situation.Objectives: To describe sociodemographic data, general health characteristics, psychological stress of prison inmates and living environment of a main prison in Sri Lanka.Methods: This was a descriptive cross-sectional study conducted among prison inmates of a main prison in Southern Sri Lanka. A self-administered questionnaire, K10 psychological distress scale and a checklist formulated by International Committee of Red Cross for evaluating the living environment and medical records were used to collect data.Results: There were 845 inmates with a median age of 33 years and 576/845(68.1%) were below 40 years. Majority of them had received school education 816/845(96.6%) and 401/845(47.4%) were skilled workers. There were inmates with a past history of being 560/845(66.2%) smokers, 525/845(62.1%) alcohol, 107/845(12.6%) heroin and 143/845(16.9%) cannabis users. Diabetes mellitus, hypertension, ischemic heart disease, psychiatric disorders, asthma and trauma were reported in 72/845(8.5%), 60/845(7.1%), 27/845(3.2%), 148/845(17.5%), 46/845(5.4%) and 33/845(3.9%) inmates respectively and psychological stress was experienced by 265/845(31.3%). Less number of inmates had communicable diseases. Score of standards for living environment was 50.Conclusions: Inmates were from young working group of the community. Past history of psychoactive substance use was high. The proportion of inmates with non-communicable diseases was higher than communicable diseases. Living environment of the prison was at an acceptable level.
背景:监狱囚犯是一个被剥夺权利的群体,是普通人群的一部分。了解他们的健康特点、心理压力和生活环境对改善现状具有重要意义。目的:描述斯里兰卡一家主要监狱的社会人口统计数据、一般健康特征、监狱囚犯的心理压力和生活环境。方法:这是一项描述性横断面研究,在斯里兰卡南部一所主要监狱的囚犯中进行。采用自填问卷、K10心理困扰量表和红十字国际委员会制定的生活环境评估和医疗记录核对表收集数据。结果:845名在押人员中位年龄为33岁,其中年龄在40岁以下的占576/845人(68.1%)。受过学校教育的占816/845(96.6%),熟练工人占401/845(47.4%)。有囚犯有抽烟560/845(66.2%)、酗酒525/845(62.1%)、吸食海洛因107/845(12.6%)和吸食大麻143/845(16.9%)的历史。在72/845(8.5%)、60/845(7.1%)、27/845(3.2%)、148/845(17.5%)、46/845(5.4%)和33/845(3.9%)的囚犯中分别报告有糖尿病、高血压、缺血性心脏病、精神障碍、哮喘和创伤,265/845(31.3%)的囚犯有心理压力。患传染病的囚犯人数较少。生活环境标准得分为50分。结论:囚犯来自社区青年工作群体。既往精神活性物质使用史高。患有非传染性疾病的囚犯比例高于患有传染病的囚犯比例。监狱的生活环境处于可接受的水平。
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引用次数: 0
An undiscussed distribution of chest X-ray findings in pulmonary tuberculosis 未讨论的肺结核胸片表现的分布
Pub Date : 2023-08-17 DOI: 10.4038/sljm.v32i1.378
H. Bandara, D. Dharmasena, T. Bandara, C. Rathnayake, T. Priyangika, T. P. S. Wickramasinghe, S. Liyanage, H. De Silva, S. Kularatne
Chest X-Ray is a paramount important investigation in Pulmonary Tuberculosis (PTB). We here explain a common observation of distribution of X-Ray findings in PTB which has not been previously discussed. When the disease is bilateral and extensive, we have noted that in most of the patients the left lung is involved extensively while the right lung is less extensively involved with limitation to upper zone. The reverse pattern is rarely noted. The potential pathogenesis for this would be the differences of the anatomy of the bronchia tree, lymphatics, and the blood vessels.
胸部x线检查是肺结核(PTB)最重要的检查方法。我们在这里解释了以前没有讨论过的PTB x线表现分布的常见观察。当疾病是双侧和广泛的,我们注意到在大多数患者中,左肺广泛受累,而右肺较少受累,局限于上区。相反的模式很少被注意到。潜在的发病机制可能是支气管树、淋巴管和血管解剖结构的差异。
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引用次数: 0
Navigation through blood vessels - My journey in vascular surgery 血管导航——我的血管外科之旅
Pub Date : 2023-08-17 DOI: 10.4038/sljm.v32i1.434
MS Samarasinghe B MBBS
No abstract available
没有摘要
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引用次数: 0
期刊
Sri Lanka Journal of Forensic Medicine Science Law
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