Ceylon Medical Journal最新文献

Background: Data on the alcoholic fatty liver (AFL) is limited. Therefore, we investigated alcohol use and AFL patterns among urban, adult Sri Lankans.

Methods: The study population (selected by age-stratified random sampling) was screened in 2007 (35-64 years) and re-evaluated in 2014. They were assessed by structured interviews, anthropometric measurements, liver-ultrasound, and biochemical and serological tests. AFL was diagnosed on ultrasound criteria, 'unsafe' alcohol consumption (Asian standards: males>14units, females>7units per week) and absence of hepatitis B/C markers. Controls were unsafe alcohol consumers who had no fatty liver on ultrasound.

Results: 2985/3012 (99%) had complete data for analysis. 272/2985 (9.1%) were unsafe-drinkers in 2007 [males-270; mean-age-51.9, SD-8.0 years]. 86/272 (31.6%) had AFL [males-85; mean-age-50.2, SD-8.6 years]. Males [p<0.001], increased waist circumference (WC) [OR 4.9, p<0.01] and BMI>23kg/m2 [OR 3.5, p<0.01] and raised alanine aminotransferase (ALT) [OR 2.8, p<0.01] were independently associated with AFL. 173/272 (63.6%) unsafe alcohol consumers from 2007 were re-evaluated in 2014. 134/173 had either had AFL or had changed to 'safe' or no alcohol consumption. 21/39 (53.8%) [males-21 (100%), mean-age-57.9, SD-7.9 years] who remained 'unsafe' alcohol users who had no fatty liver in 2007 developed AFL after 7-years (annual incidence 7.7%). On bivariate analysis, only males were associated with new-onset AFL. Of the 42 who had AFL at baseline but changed their drinking status from unsafe to safe or no alcohol, 6 had resolution of fatty liver in 2014.

Conclusion: In conclusion, in this community-based study among urban Sri Lankan adults, the annual incidence of AFL among unsafe alcohol users was 7.7%. Furthermore, new-onset AFL was associated with males.

Pancreatic cancer has a high mortality and morbidity and its incidence has increased over the years. Our objective was to analyze the demographic and clinical data among pancreatic adenocarcinoma patients who presented to the University Surgical Unit, CSTH from 2018 to 2021. Of the 103 patients included, majority were males above the age of 60. The commonest presentation was epigastric pain (54%). 46% were resectable at the time of diagnosis but 50% of the study population were lost to follow up due to a multitude of reasons.

Cerebral salt wasting (hyponatraemia associated with renal sodium loss and hypovolumia) has been reported secondary to intra-cerebral pathology and following certain infections. Cerebral salt wasting following typhus infection has been reported rarely. We report a case of transient cerebral salt wasting that occurred during the convalescent phase of scrub typhus infection resulting in severe symptomatic hyponatraemia.

The Embryological remnants (ERs) must be removed to achieve a safe and complete 'total' thyroidectomy. Residual ERs, after thyroidectomy, may cause recurrence of the initial pathology. This poses management dilemmas, including a difficult reoperation. Active search and removal of the ERs intraoperatively is essential. Primary overt malignancy is rare in ERs. Literature reports several cohort studies of same. The incidence of a Micropapillary Carcinoma in an ER has not been reported and this brief report describes two patients with Incidental Micropapillary Carcinoma in the Pyramidal lobe, reiterating the need to make removal of ERs the accepted norm in total thyroidectomies.

Background & aim: Maintaining good health in haemodialysis patients is a challenging task that helps to reduce morbidity and mortality. The prevalence of nutrition-related complications is uncertain in Sri Lankan maintenance haemodialysis population. This study was carried out as a baseline study to identify the common nutrition-related complications in maintenance haemodialysis patients.

Methods: A single-centre cross-sectional study was carried out on adult patients on maintenance haemodialysis in a tertiary care centre in the central part of Sri Lanka. Simple random sampling was used, and patients' clinical, anthropometric, body composition via bioelectrical impedance analysis (BIA), laboratory parameters and muscle power were assessed.

Results: We evaluated 114 patients, 87 (76.3%) were males, and the mean age was 52.6 (±12.3) years. Only 9 (7.9%) patients were underweight in the sample population, 77.2% had normal mid-upper arm circumference (MUAC), 81.6% had high muscle mass percentage in BIA analysis, and all patients had normal mid-arm muscle circumference (MAMC). But in 80.5% of patients hand grip power was lower than the cut off for sarcopenia according to EWGSOP2 recommendations. The prevalence of low serum albumin is 33.3% and 60.5% had anaemia. The majority had normocytic normochromic anaemia with high serum ferritin levels. Vitamin D deficiency or insufficiency was 91.2% and electrolyte abnormalities were very common; 57.9% had hypocalcaemia, 61.4% had hyperphosphatemia and all patients had hyperkalaemia.

Conclusions: Muscle mass was preserved in most patients in this population, but the muscle power was significantly low, along with a high prevalence of hypoalbuminaemia, anaemia, vitamin D deficiency or insufficiency, hypocalcaemia, hyperphospatemia and hyperkalaemia.

Introduction: Regional differences in thyroid hormones are noted, especially during pregnancy.

Objectives: Establish reference values for thyroid function tests for Sri Lankan pregnant women and to determine their comparability with regional data; and determine the prevalence of 2. Thyroid Peroxidase (TPO) antibody positivity and 3. Iodine deficiency among pregnant women with uncomplicated clinical history.

Methods: A cross-sectional study conducted in antenatal clinics of a tertiary care maternity center recruited a minimum of 56 women in each trimester in a multistep approach to derive an "ideal-reference population"; Participants with clinically manifested thyroid disease, followed by subjects with sonographically abnormal thyroids and finally those at high risk for thyroid disease as shown by positive TPO levels and urine iodine deficiency were excluded in sequence. Thyroid hormones were measured by chemiluminescence in the ideal reference population. Reference ranges were derived using median and 5th and 95th centiles.

Results: Final sample included 369 women. TSH reference ranges of the first (n=64), second (n=188) and third (n=117) trimesters were 0.014-2.77mIU/L, 0.31-3.2 mIU/L and 0.34-3.4 mIU/L, respectively. TPO antibody level showed a weak but significant correlation with TSH (r=0.10,p 0.021) in the final sample. No significant association was found between urine iodine and thyroid function tests.

Conclusions: TSH reference ranges observed in this study are concordant with the Caucasian reference values more than the regional values. Discrepancies in study methodology, defining and selection of reference population and methods employed in measuring thyroid hormones in different studies may have accounted for these differences.