Ceylon Medical Journal最新文献

Introduction: Studies on bladder cancer in Sri Lanka have shown varying results in relation to clinicopathological characteristics and data on outcomes is limited. This study was aimed to describe the clinicopathological characteristics and outcomes of histologically confirmed urothelial bladder malignancies and to compare with previous studies.

Methods: A retrospective analysis of prospectively collected data of 314 newly diagnosed primary bladder malignancies between January-2007 and January-2017, was performed. After excluding the non-urothelial cancers, 289(92%) urothelial cancers (males=245, 84.8%, mean age = 65.4±SD10.9 years) were analysed. Data on clinical presentation, cystoscopic findings, histopathology and outcomes were studied.

Results: The majority (87.9%, n=254) presented with haematuria with a median duration of symptoms of 1 month. Non-muscle invasive cancers were seen among 64.4% (pTa:n=87(30.1%),pT1:n=99(34.3%)). The pT1 high grade (pT1-HG) tumours were seen in 17.5%. Muscle invasive bladder cancer (MIBC) were seen in 35.6%(n=103). The majority were high grade tumours (n=156,54%). Urothelial MIBC were significantly associated with solid tumours (p<0.001), high grade (p<0.001) and size>3cm (p<0.001). Comparison with previous studies showed a decline in the proportion of MIBC while the pT1-HG tumours are on the rise. Of those followed up, 52.5% developed recurrences with a median duration of 4 months (interquartile range (IQR): 3-12 months). Eighteen (9%) progressed to a higher stage with a median duration of 17 months (IQR:3.75-41.75).

Conclusions: Urothelial cancer in the study population was 92%. Higher proportion of MIBC, high grade tumours and pT1-HG tumours were noted. The recurrence rate was high. Future studies should focus on the causative factors for this trend.

Background: Arishta have been used in Ayurveda medicine for over thousands of years in Sri Lanka to treat various diseases. Ashwagandharishta, Balarishta and Dashamoolarishta are usually prescribed to obtain an anabolic effect, and Ashwagandharishta and Dashamoolarishta for androgenic effect in males. Thus, these arishta have been shown to have similar effect as anabolic androgenic steroids and stimulants in Western medicine. Therefore, arishta could potentially be used by athletes to improve their performance in sports leading to unintentional doping. Additionally, ethanol develops in-source during arista fermentation, which can affect athletes health.

Objective: The aim of this study is to investigate whether the anabolic androgenic steroids or stimulants banned by World Anti-Doping Agency are present in these arishta, and to determine their ethanol content.

Methods: Methanol extractions of Ashwagandarishta, Balarishta, Dashamoolarishta from four different manufacturers were screened for 21 stimulant and 22 anabolic androgenic steroids banned by World Anti-Doping Agency, using Gas Chromatography Mass Spectrometer. Ethanol content of the twelve Arishta samples were also measured.

Results: Anabolic androgenic steroids or stimulants were not present in the tested Arishta samples, and percentage volume / volume ethanol content of all Arishta was between (5.80-8.35) ±0.5.

Conclusion: The tested brands of Ashwagandharishta, Balarishta and Dashamoolarishta did not contain stimulants or anabolic androgenic steroids banned by World Anti-Doping Agency.

Introduction: Poor sleep quality have been reported among adults in most countries and are increasingly been reported in their predecessors, the college students. The present study aimed to assess sleep patterns and determine its association with various correlates amongst college students for effective and timely interventions in the habit-forming years of the life.

Methodology: This was a cross sectional study done among college students enrolled in different courses, in Rishikesh municipal corporation area, in Dehradun district of Uttarakhand, India. Sleep Quality was assessed using a validated Pittsburgh Sleep Quality Index (PSQI), which has seven components while Perceived Stress Scale-10 assessed Stress.

Results: Poor sleep quality was reported among 66% of respondents. Mean sleep latency among respondents was 27.2 minutes (SD 20.75 min), with a median and mode of 20 minutes and 60 minutes respectively.On logistic regression analysis, yoga/ meditation, which have been recognized as effective relaxation techniques since ages, were found to have a positive association with better sleep quality (OR 0.47, 95% CI (0.26 - 0.84). Stress (OR 4.10, 95% CI 1.71- 9.83) and mobile use before bedtime (OR 1.956, 95% CI: 1.02- 3.75) were also significant predictors of poor sleep quality.

Conclusions and recommendations: The prevalence of poor sleep quality was quite high. Relaxation techniques such as yoga/ meditation and stress relieving workshops may pay rich dividends. Use of electronic devices before bedtime need to be restricted for better sleep quality.

Introduction: The majority of Sri Lankan Moors fast during Ramadan. This may have an effect on their glycaemic control and anthropometric parameters. However, limited information exists about the impact of Ramadan fasting on diabetes in Sri Lanka.

Objectives: The main objective of this study was to investigate the effect of Ramadan fasting on glycaemic control and anthropometric parameters in patients with type 2 diabetes mellitus (T2DM). Patients were also observed for symptoms of hypoglycaemia, timing and association with different antidiabetic agents.

Methods: One hundred and twenty Sri Lankan Moors with T2DM were recruited for this study. Biochemical investigations and anthropometric parameters were done before and after Ramadan fasting. The statistical analysis was done with paired t test to compare glycaemic control and anthropometric parameters before and after Ramadan.

Results: There was a significant decrease in body weight (mean body weight 66.17 to 65.52 kg; p= < 0.001) and waist circumference (93.84 to 92.16cm; p= < 0.001). However, the glycaemic control worsened in all patients during Ramadan with rise in mean fructosamine value of 354.1 to 996.9µmol/L. Out of 104 participants 43 participants experienced symptoms of hypoglycaemia.

Conclusions: The current study showed an improvement in the body weight and waist circumference during Ramadan fasting, however the glycaemic control has been worsened. More follow-up studies are warranted in order to draw a conclusion on the effect of Ramadan fasting in glycaemic control and anthropometric parameters in diabetes patients.

Introduction: Steroid hydroxylase deficiency due to CYP21A2 gene mutation is the most common cause of Congenital Adrenal Hyperplasia (CAH). Mutation spectrum in Sri Lankan CAH patients has not been investigated adequately.

Objectives: This study attempted to study the spectrum of mutations in CYP21A2 gene in 30 patients with salt wasting form of CAH in Sri Lanka.

Methods: Allele specific polymerase chain reaction was carried out using mutation site specific primers for eight mutations (P30L, I2G, 8bp deletion, I172N, E6 cluster, V281L, Q318X and R356W) reported as frequently occurring in other populations.

Results: Fourteen patients had homozygous mutations; six patients were compound heterozygotes as determined by investigating parents of the patients, one patient had a large gene deletion which was previously reported and the remaining patients had at least one heterozygous mutation. The following allele frequencies were observed for each mutation P30L-10%, I2G- 40%, 8bp-18.33%, I172N-3.33%, E6 cluster- 5%, Q318X-40% and R356W-3.33%. V281L mutation was not observed in the study cohort. DNA sequencing revealed a novel mutation G292S in one patient.

Conclusion: This is the first report describing a broad spectrum of mutations in CYP21A2 gene in Sri Lankan patients with CAH. Mutation frequencies did not vary from other ethnic groups reported around the world.