Ceylon Medical Journal最新文献

Introduction: Developing countries with limited resources are yet to establish universal liver transplant (LT) services to cater to their population free of charge. In this unique setting, no data are published on the long-term Quality of life (QOL) of LT survivors.

Objectives: Compare the long-term quality of life of post-liver transplant patients with a matching cohort of pretransplant cirrhotic patients and a matching non cirrhotic control group. Methods: Of the 45 liver transplants that were performed there were 24 patients who completed over 6 months of follow-up. Of these, 4 patients died (including one lost to follow-up) after six months. The remaining 20 post-transplant patients were the subjects for QOL assessment. One post-transplant recipient was matched with two pre-transplant cirrhotic patients and non-cirrhotic healthy control group. QOL was evaluated by the SF-36 questionnaire.

Results and conclusions: The median age was 54 years (27-67) and 85% (n=17) were male. The median follow up was 24 months (6- 94 months). The median MELD score was 17 (11-22) and 75% (n=15) were due to cryptogenic cirrhosis. Post-operatively three (15%) developed graft rejection, five (25%) had infections and ten (50%) suffered drug related complications. 95% (n= 19) of the population had satisfactory drug compliance. The study population had significantly better QOL compared to control in all eight domains (p<0.05) including physical functioning (76% vs 52.7%), physical health (80% vs 7.9%), emotional problems (93% vs 17.1%), energy (77% vs 47%), emotional wellbeing (80% vs 61.1%), social functioning (86.9% vs 56.9%), pain (82% vs 47.5%) and general health (67.5% vs 37.5%). The study population had similar quality of life compared to the healthy control group with better-perceived emotional well-being.

Conclusion: Long-term survivors after LT have significantly improved QOL in a setting with limited resources.

Introduction: Breast density plays a significant role in increasing an individual's risk of breast cancer and its mortality rate.

Objectives: We aimed to assess the correlations of mammographic breast density with age, body mass index, weight, height and parity for the first time in Sri Lankan women.

Methods: 52 participants who underwent diagnostic mammographic examinations at a tertiary care hospital in Sri Lanka were selected for the study. Demographic data and digital mammograms in DICOM format were collected. Mammographic breast density was quantitatively estimated using a validated, semi-automated computer programme devised by the authors using Java programming language.

Results: 65.4% of the participants were postmenopausal, and 34.6% were premenopausal. Mammographic breast density showed a significant negative correlation with age (r = -0.40, p < 0.05) and significant positive correlations with body mass index (r = 0.49, p< 0.05) and weight (r = 0.52, p< 0.05). The study did not find any correlation between mammographic breast density and height. Additionally, it did not find a significant difference between right and left breasts or between parous and nulliparous patients. Mammographic breast density was significantly higher among premenopausal patients compared to postmenopausal patients.

Conclusions: Quantitative mammographic breast density demonstrated significant correlations with age, body mass index and weight. The findings of the study will be constructive in predicting breast density in the future and individualizing the breast cancer screening requirements based on the breast density without radiation exposure for females in Sri Lanka.

Introduction: Anaemia is a commonly encountered condition among the elderly population which calls for further evaluation to identify the cause and to prevent complications.

Objectives: To determine the prevalence, causes and complications related to anaemia among elderly patients admitted to two medical wards (15/16) of Colombo North (Teaching) Hospital, Ragama, Sri Lanka.

Methods: Patients aged over>65 years admitted to the above wards between April -Sep 2020 and who had anaemia were included in the study. Clinical and nutritional data were collected using an interviewer-administered questionnaire. Laboratory findings were extracted from hospital records.

Results: The majority of the patients were females (63.2%; n = 129). The mean age was 72.5 years (65 - 92 years). Most of the patients (62.3%; n = 127) were symptomatic for anaemia at the time of hospital admission. The majority of the participants (75.5%; n = 154) did not demonstrate any complications related to anaemia. The severity of the anaemia was moderate among more than half of the patients (52.5%; n=107). Anaemia of chronic disease (54.4%; n=111) was the commonest etiological category detected. The majority of the cases with anaemia of chronic disease were due to chronic renal insufficiency (73.9%; n=82). The severity of the anaemia increased significantly with the presence of chronic disease (p 0.030).

Conclusion: Most patients in the present study had moderate anaemia whilst anaemia of chronic disease was the leading aetiological class contributor. Community-based studies are needed to understand the true burden of anaemia in the ageing population in Sri Lanka.

Autonomic instability is a rare complication following elapid bites. Blindness too is a rare complication following Russell's viper bite and is most likely due to cerebral infarction or direct ocular toxicity. We report a case of a young male from Sri Lanka who developed both transient blindness and autonomic instability following severe envenomation by a Russell's viper bite.

Introduction: Breast cancer has a high incidence and is showing a rising trend in Sri Lanka. Mammographic breast density is a radiologically measurable risk factor which has been found to be significantly associated with breast cancer risk in women with minor variations between ethnicities. However, the Asian populations studied in previous international studies were of Japanese, Chinese and Filipino ethnicities and not Sri Lankan or other South Asian ethnicities. Also, a previous Sri Lankan study found no significant association between breast density and breast cancer. Therefore it is of interest to study whether there is actually an association between breast density and breast cancer in Sri Lankan women.

Objectives: This study aimed to assess whether there is a significant association between mammographic breast density and breast cancer in a Sri Lankan women and also to assess factors affecting breast density.

Methodology: We conducted a retrospective unmatched case control study of 110 women (22 cases of breast cancer and 88 controls) aged between 40 and 75 years who came for mammography to Sri Jayewardenepura General Hospital. Breast density was categorized in to two, as lower density (BIRADS type a and b compositions) and higher density (type c and d compositions) for the analysis.

Results: Contrary to most international research findings and similar to the previous Sri Lankan study, no significant association was found between breast density and breast cancer. Additionally, out of multiple factors, only age, menopausal state and BMI were found to be significantly associated with breast density. Conclusion :These findings may indicate that there is a true difference in the Sri Lankan population form the previously studied international populations suggesting that there is no association between breast density and breast cancer in Sri Lankan women. A further multicenter research is necessary to prove or disprove this theory.

Introduction: Bladder cancer has the 9th highest incidence among Sri Lankan males. This study describes the demographic profiles and survival in bladder cancer patients at two tertiary care centres in Sri Lanka.

Methods: A group of patients with urothelial bladder cancer, presenting for the first time for definitive treatment, were prospectively enrolled from 2013 to 2017.

Results: There were sixty-six patients, with median age of 65 years and male to female ratio of 7:1. Histopathologically pTa 24%, pT1 47% and pT2 29%. Of the pT1 tumours 61% were low grade (LG). The majority (71%) of non-muscle invasive bladder cancer (NMIBC) patients underwent transurethral resection of bladder tumour only. For the entire cohort the 5-year overall survival was 59% and cancer specific survival (CSS) was 65%. CSS in NMIBC was 75% and 30% in muscle invasive bladder cancer (MIBC). The 5-year female CSS (22%) was significantly lower than in males (71%).

Conclusion: Our cohort has a high male to female ratio. The percentage of MIBC was lower than reported in previous Sri Lankan studies. Of the pT1 tumours there is a higher percentage of pT1 LG patients in comparison to Western reports. There is low utilisation of intravesical mitomycin / bacillus Calmette-Guérin (BCG) in the treatment of NMIBC. The 5-year CSS in the Sri Lankan (lower middle-income economy) cohort lies between the values of high-income economies and upper middle-income economies in Asia. The reasons for poor CSS among Sri Lankan women with bladder cancer needs to be further investigated.

Background: Post Mortem Clots (PMC) are considered as artifacts observed during forensic autopsies; hence, their medico legal importance has not been evaluated at length in the past. This study was designed with the intent of finding the association of age, gender, cause of death (COD) and postmortem interval (PI) with PMC formation.

Methods: Secondary data of all postmortems performed by the 1st author from June,2015 to June,2018 at Teaching Hospital Anuradhapura were extracted. Eligible autopsies were evaluated for the presence of PMCs in the heart. Length of the PMCs present was quantified as a percentage of the length of the cardiac chambers. Presence of PMCs varied according to the COD which were clustered based on their mechanism of death.

Results: The study evaluated 1259 autopsies with a median age of 56 years (IQR 40-67). PMCs were found in 46% of the subjects and showed a female predominance. The percentage of length of PMCs ranged from 20% to 100%. A higher rate of PMC formation was observed in natural and infectious causes, especially in the elderly. Traumatic causes with multiple injuries, heavy bleeding and a short agonal period showed less tendency of PMC formation. A higher duration of hospital stay/injury to death (> 90 h) was associated with formation of PMC. PMC is not associated with PI while it's associated with increased age.

Conclusion: PMC is not a mere artifact but has significant medicolegal importance with regards to COD and time from injury to death.

Introduction: A significant proportion of patients are being treated at hospitals in the government sector in Sri Lanka. Informal caregivers play a major role in taking care of hospitalized surgical patients while facing physical, social, and psychological challenges.

Objective: To describe the socio-economic effects on informal caregivers of long-term hospitalized adult patients.

Methods: A cross-sectional descriptive study was conducted among 202 informal caregivers of long-term hospitalized patients in a tertiary care hospital in Sri Lanka, using an interviewer-administered questionnaire. Sociodemographic assessment of both caregiver and care recipient, the health status of the care recipient, effects on social life, and economic aspect of informal caregiver were assessed.

Results: Most of the caregivers were married (n=164, 81.2%), first degree relative of the care receiver (n=139, 68.8%), employed (n=115, 56.9%) and sole caregivers (n=130, 64.4%). Four out of 5 caregivers (n=181, 89.6%) showed moderate to severe socio-economic maladaptation. Increasing age (p=0.00), marital status (p=0.00) and sole caregiving (p=0.01) are significantly associated with the level of maladaptation.

Conclusion: Moderate to severe levels of maladaptation is present among a substantial number of informal caregivers of long-term hospitalized patients. Sole caregiving is one of the contributing factors and can be addressed by adequate formal caregivers appointed by health care authorities or from voluntary services to minimize informal caregiver burnout.

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.