Ceylon Medical Journal最新文献

Introduction: Incidence of non communicable diseases such as diabetes, cardiovascular disease (CVD), several forms of cancer, hypertension, obesity etc is increasing in our country. It is suggested that these diseases can be moderated, in part, by consuming foods that produce a low blood sugar response. It is presumed that kithul treacle is comparable to simple sugars for sweetness, although currently the beneficial effects are not widely known.

Objectives: To assess the chemical composition and glycaemic indices (GI) of kithul treacle and confectionary (aluwa) made using table sugar and kithul treacle.

Methods: Chemical composition was analysed with standard AOAC methods. FAO/WHO guidelines were used to determine the glycaemic responses with glucose as the standard.

Results: The moisture, crude protein, crude fat, total carbohydrate, starch & glucose and total dietary fibre contents of treacle were 28%, 0.3%, 7.9%, 81%, 28% and 2.20% (DM) with negligible ash content. Similarly both aluwa had negligible ash contents. Total carbohydrate (88-89%), fat (2.9%), protein (3.7-4.2%) and total dietary fibre (7.78-8.32%) contents of both aluwa were not significantly different. However, the digestible carbohydrate contents of treacle (67%) and sugar aluwa (59%) were significantly different (p<0.05). The GI of kithul treacle, aluwa made with treacle and sugar were 35, 55 and 63 respectively.

Conclusion: Kithul treacle was categorized as a low GI food whereas both aluwa were categorized as medium GI foods. In comparison to aluwa made with table sugar, the glycaemic response of aluwa made with treacle was lower proving that replacing sugar with treacle leads to lower glycaemic response.

Acquired hepatocerebral degeneration (AHCD) is an acquired, extrapyramidal, neurodegenerative condition, encountered in patients with cirrhosis. It is an uncommon and usually irreversible condition, resulting in widespread cerebral, basal ganglia and cerebellar damage. We describe here four cases of AHCD, with varying presentations, highlighting the need for increased awareness of this condition, to avoid diagnostics delays and unnecessary management.

Abstract: Bone marrow failure (BMF) in children can be idiopathic (70-80%) or inherited. Haematopoietic stem cell transplantation (HSCT) is the only cure for both causes. Allogeneic HSCT requires a suitable donor. Many children will not have a HLA matched sibling or unrelated donor. A haploidentical donor is available for all children as eaazch parent will have at minimum a 50% HLA match. This report of a 7-year old girl with BMF treated with a haplo-HSCT, the first in Sri Lanka, highlights the importance of developing a haploidentical HSCT programme as a potential cure for a disease with a dismal outcome.

Background: Despite being the third most prevalent psychiatric disorder, social anxiety disorder remains under-diagnosed due to multiple reasons. Although many screening instruments are available in the English language, to date no instrument has been translated into Tamil.

Objective: To translate and validate the Liebowitz Social Anxiety Scale (LSAS-SR) into Tamil among a group of Sri Lankan university students whose mother tongue is Tamil.

Method: The process of translation and validation involved standard procedures. DSM- 5 was used as the gold standard to diagnose social anxiety disorder. As part of the psychometric study, test-retest reliability and analysis of items for internal consistency of the instrument were assessed.

Results: A cut off of55.5had the optimum sensitivity and specificity for the Tamil version of the LSAS-SR. The Cronbach's alpha between the avoidance subscale, total and the fear subscale total was 0.860 while the figures for Cronbach's alpha between the total score and fear subscale total score and the avoidance subscale total score were 0.880 and 0.855, respectively. The test- retest reliability correlation coefficients for the fear subscale, avoidance subscale and the total score were 0.890, 0.925 and 0.918, respectively (p<0.001 for all).

Conclusions: The cut off score of 55.5had the optimum sensitivity and specificity for the LSAS-SR Tamil version. It had good internal consistency and test-retest reliability. Further studies will enable the assessment of the prevalence of social phobia and investigation of cultural and environmental factors associated with social phobia in Sri Lanka.

Background and objectives: Spontaneous, non-traumatic intracerebral hemorrhages (ICH) is the second most common cause of stroke after acute ischemia. However, it causes significant mortality and morbidity and has comparatively worse outcomes. Most studies show that ICH when treated with good medical care has lower mortality. Our primary aim was to evaluate how ICH is currently managed at the National hospital of Sri Lanka (NHSL), the premier tertiary care hospital in the country, whilst identifying strengths, weaknesses and deficiencies. We plan to develop a comprehensive management protocol for ICH patients and to reevaluate the treatment practices after applying them. NHSL is a research centre for the international, multicenter INTERACT2 trial, which emphasizes intensive blood pressure, blood sugar and temperature control and managing coagulopathy in ICH leading to better outcomes. We are recruiting new ICH cases to this trial. Methodology: The prospective standard audit was conducted at NHSL for a period of 3 months and the study population consisted of 76 patients with spontaneous ICH. The 2015 AHA/ASA guideline for the management of spontaneous intracerebral hemorrhage was used as the standard guide for the management.

Results: Of 76 patients with ICH 46 (60.5%) were males and mean age was 61.3+- 12.6 years. The blood pressure (BP) and blood sugar control was achieved only in 51.3% (39) and 15.8% (12) respectively. Although prophylactic anti-epileptics are not recommended in ICH almost 70% were started on them, in spite of only 15.8% having overt convulsions. Steroids though not recommended to lower intracranial pressure in ICH 51% were on them. Of those ICH admitted to medical and neurology wards 81% were referred to neurosurgery irrespective of the location and the nature of the bleed and when not indicated (based on AHA/ASA guidelines) delaying and interfering with optimal medical care.

Conclusions: Several deficiencies were identified in the current management routines of ICH at NHSL including delayed, suboptimal medical care, unnecessary widespread use of AEDs and steroids. Large majority of neurosurgical referrals too were unnecessary and not indicated.