Anuradhapura Medical Journal最新文献

{"title":"Chronic diarrhoea due to severe strongyloidiasis in a Chronic Kidney Disease patient: A case report","authors":"A. Karunatilaka, T. Hewageegana, N. Y. Perera, C. Kumarasinghe, D. Sinharachchi","doi":"10.4038/amj.v15i2.7683","DOIUrl":"https://doi.org/10.4038/amj.v15i2.7683","url":null,"abstract":"Strongyloides stercoralis is a soil-transmitted helminth that is endemic in tropical and subtropical regions. S. stercoralis is considered to have a complicated life-cycle on its ability to reproduce through asexual autoinfection and the capability of remaining dormant inside the host for decades [1]. The adult worms live in the small intestine while the larvae penetrate other vital organs such as the liver, brain, lungs, and kidneys, resulting in strongyloidiasis. Therefore, the clinical spectrum of strongyloidiasis varies largely, from asymptomatic to fatal disseminated infection [1]. Chronic kidney disease (CKD) is affiliated with the development of severe strongyloidiasis, owing to the associated immune system dysfunction [2]. This is a report of a patient with endstage kidney disease who was infected with S. stercoralis . We aim to highlight the importance of high clinical suspicion and timely diagnosis of S. stercoralis in high-risk populations from endemic regions.","PeriodicalId":30600,"journal":{"name":"Anuradhapura Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45077357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The current practice of clinical handover process in emergency departments in National Hospital, Kandy and University Teaching Hospital, Peradeniya: a descriptive cross-sectional study","authors":"S. Jayathilake, R. Weerakoon, V. Pinto","doi":"10.4038/amj.v15i2.7692","DOIUrl":"https://doi.org/10.4038/amj.v15i2.7692","url":null,"abstract":"The aim of establishing an accident and emergency department is prompt initial assessment, stabilization and early referral for definitive care. This study aims to describe the current practice of the clinical handover process at the emergency departments of the national hospital, Kandy and the teaching hospital, Peradeniya and to describe the adherence of the medical officer shift hand over to “iSoBAR” (identification, situation, observation, background, assessment, recommendation/ read back) handover method.","PeriodicalId":30600,"journal":{"name":"Anuradhapura Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42833305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tolosa-Hunt syndrome; a diagnosis of exclusion: a case report","authors":"D. Satharasinghe, S. Weerasinghe, H. Senanayake, N. Lokunarangoda, P. Weerawansa","doi":"10.4038/amj.v15i1.7667","DOIUrl":"https://doi.org/10.4038/amj.v15i1.7667","url":null,"abstract":"Tolosa-Hunt Syndrome is a rare cause of unilateral headache with painful ophthalmoplegia. Only a limited number of cases are reported in the literature. We present a case of Tolosa-Hunt syndrome in a middle-aged male who presented to Teaching Hospital Anuradhapura. A previously well, hypertensive gentleman presented with gradual onset right-sided headache and diplopia for five days duration. On examination, there were right-sided palsies of right-sided cranial nerves III, IV, V-1, VI  on examination. Magnetic Resonance Imaging (MRI) of the brain with contrast was unremarkable. The patient was treated with steroids after excluding other possible causations of painful ophthalmoplegia. He was started on steroids, to which a dramatic response was observed. Tolosa-Hunt syndrome responds well to steroid therapy even though there is no proven benefit of steroids to reduce recurrence rates. Careful evaluation needs to be carried out to rule out other possible causes of similar clinical and radiological features as they may be masked by steroid therapy.","PeriodicalId":30600,"journal":{"name":"Anuradhapura Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45332703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are imported cases the reason for increase in incidence of dengue in Anuradhapura District during the recent years?","authors":"S. Gunathilaka, S. Kularatne, J. Rajapakse, R. Muthugala","doi":"10.4038/amj.v15i1.7670","DOIUrl":"https://doi.org/10.4038/amj.v15i1.7670","url":null,"abstract":"Dengue has now become endemic in almost all districts of Sri Lanka. An increase in the percentage contribution from North Central Province (NCP) to dengue incidence in the country has been noted since the 2015 dengue outbreak. During the year 2017, 338 patients per 100,000 population were reported to have clinically suspected dengue according to the epidemiology unit records. The daily records available at the dengue control unit of regional director of health services office, Anuradhapura, and the freely available data at the epidemiology unit, which comprised of weekly cases of dengue, were extracted and analysed against the meteorological parameters and the vector density data. According to our observations, a statistically significant association between daily rainfall and daily temperature and clinically diagnosed dengue cases does not exist in Anuradhapura. The monthly vector indices did not show any correlation with the monthly incidence of dengue in the medical officer of health area with the highest overall incidence of dengue. The proportion of paediatric patients were also very low in the Anuradhapura district (9%) compared to other districts. Based on these observations, the authors suggest that imported cases of dengue to this district is a major cause of increased incidence of dengue, rather than indigenous transmission in the area.","PeriodicalId":30600,"journal":{"name":"Anuradhapura Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47107536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of molecular subtypes of breast cancer: Experience in a tertiary care cancer centre in Sri Lanka","authors":"B. Ubayawansa, S. Shilpage, K. D. Silva","doi":"10.4038/amj.v15i1.7697","DOIUrl":"https://doi.org/10.4038/amj.v15i1.7697","url":null,"abstract":"Breast cancer is the commonest cancer among females. Patient outcome and treatment options are largely influenced by its molecular subtypes. This study aims to evaluate molecular subtypes of breast cancers among patients treated at a tertiary cancer centre in Sri Lanka. Clinical and demographic data were collected retrospectively from electronic medical records available at the cancer institute, Maharagama, Sri Lanka. Histology reports of 200 patients who had undergone mastectomy or wide local excision during an 18-month period starting from January 2018 were analyzed. Patients' age, histological subtype of cancer, receptor status of estrogen receptor (ER) progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2), Ki-67 index, and tumour grading were considered. The age range of the patients was 29 to 84 years (mean=57.7, SD=11.76). The 50-59 and 60-69 age groups represented the most patients (28% each). Females represented 99% (n=199) of the total while three patients had bilateral breast cancer. Histologically, invasive carcinoma of no special type (NST) was the commonest cancer type (n=178, 89%), with the majority being grade 2 cancers (52.5%) according to the Nottingham cancer grading (grade 1=15.1% and grade 3=32%). Luminal A was the most common (64%) molecular subtype, followed by basal-like (21%), HER2-enriched (11.5%), and luminal B (4.5%). Data on the Ki-67 index was available for only 98 patients, and 8.1% (8) of them had a Ki-67 index less than 10, while 22.5% (n=22) between 10 and 20. All others (69%) had a higher Ki-67 index (>20). There is a significant association between the molecular subtype of breast cancer and Nottingham grading (p Majority of Sri Lankan women with breast cancers present in the 5th and 6th decades of their lives. Luminal A molecular subtype was the predominant, followed by basal-like, HER2- enriched, and luminal B. Aggressive HER2- enriched and basal subtypes are more common in younger age groups. We recommend breast cancer subtyping before surgery so that more people will benefit from neoadjuvant chemotherapy.","PeriodicalId":30600,"journal":{"name":"Anuradhapura Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41696816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aetiopathogenesis of gallstone disease in Sri Lanka; what do we know?","authors":"H. Weerakoon","doi":"10.4038/amj.v15i1.7698","DOIUrl":"https://doi.org/10.4038/amj.v15i1.7698","url":null,"abstract":"Pathogenesis of gallstones (GS) involves a complex interaction between multiple genetic and exogenous risk factors. As the prevalence, disease burden, aetiopathogenesis, and the complications of GS disease vary across different populations, a better understanding of the disease, specific to a given community is imperative. Though some of the initial studies reveal a higher incidence of pigment and mixed cholesterol GS over pure cholesterol stones among Sri Lankans, GS disease is largely underexplored in local context. Therefore, the prevalence, disease burden and aetiological factors of the GS disease in Sri Lanka need to be rigorously studied. Further research on exploring the possible factors triggering the development of GS on a pigment nidus is essential in discovering the aetiopathogenesis of GS among Sri Lankans and will be the key in identifying effective preventive measures.","PeriodicalId":30600,"journal":{"name":"Anuradhapura Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48301379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A challenging diagnosis of pyrexia of unknown origin: isolated iliac tuberculous lymphadenitis complicated by psoas abscess","authors":"W. Wanniarachchi, W. Pemasiri, C. Munagama, A. Sugathapala, M. N. N. Masaima","doi":"10.4038/amj.v15i1.7687","DOIUrl":"https://doi.org/10.4038/amj.v15i1.7687","url":null,"abstract":"Pyrexia of unknown origin is a challenge in clinical practice. Extrapulmonary tuberculosis is considered a common cause for pyrexia of unknown origin which has a wide spectrum of clinical manifestations, culminating in delayed diagnosis. However, due to its treatable nature and good prognosis, a high index of suspicion is needed to diagnose atypical presentations. This case report elaborates isolated involvement of iliac lymph node in tuberculosis which is a rare presentation of tuberculous lymphadenitis.","PeriodicalId":30600,"journal":{"name":"Anuradhapura Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47313309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Melioidosis presenting as knee joint septic arthritis: a case report","authors":"H. Hettige, P. Weerawansa, S. Siribaddana, C. Sarathchandra","doi":"10.4038/amj.v15i1.7672","DOIUrl":"https://doi.org/10.4038/amj.v15i1.7672","url":null,"abstract":"A 56-year-old woman having type 2 diabetes, presented with intermittent high-grade fever for three weeks and right knee joint pain and swelling with restricted movements. She has had a prick injury to the left sole two weeks ago in the paddy field. Investigations revealed neutrophil leucocytosis and raised inflammatory markers. Blood culture was sterile. Joint fluid was turbid with neutrophil predominance, but the culture was sterile. Chest x-ray showed bilateral multiple patchy consolidations, that turned out to be abscesses on contrast-enhanced CT scan. The history of prick injury, diabetes, and the presence of multiple lung abscesses made us ponder a diagnosis of melioidosis. Although cultures were negative, melioidosis antibody titer was raised. She was treated with ceftazidime and doxycycline for one month, followed by co-cotrimoxazole and doxycycline for three months. She was completely cured after the course of antibiotics.","PeriodicalId":30600,"journal":{"name":"Anuradhapura Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45266722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral venous sinus thrombosis complicated with haemorrhagic venous infarction and seizures, successfully treated with oral anticoagulation for one year: a case report","authors":"H. Hettige, S. Pilapitiya, N. Lokunarangoda, H. Senanayake","doi":"10.4038/amj.v14i2.7664","DOIUrl":"https://doi.org/10.4038/amj.v14i2.7664","url":null,"abstract":"A 43-year-old mother of two children presented with an episode of cerebral venous sinus thrombosis (CVST) complicated with haemorrhagic venous infarction and seizure. She had two first trimester miscarriages and was on combined oral contraceptive pills (COCP) for two months. Computed tomography (CT) venogram revealed venous sinus thrombosis with a right partial lobe haemorrhagic infarction. She was treated with subcutaneous enoxaparin for 14-days followed by oral warfarin for one year. The patient was started on oral levetiracetam but gradually tailed off over four months. Physiotherapy and occupational therapy were continued. She was advised on non-hormonal family planning methods. Thrombophilia and autoimmune screening were negative. Haemorrhagic venous infarction complicated with seizures is a rare manifestation of venous sinus thrombosis. Timely and personalized anticoagulation is the mainstay of treatment.","PeriodicalId":30600,"journal":{"name":"Anuradhapura Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49340386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-communicable diseases care model & its integration with the primary health care system in Norway","authors":"D. Perera, B. Moen","doi":"10.4038/amj.v14i2.7657","DOIUrl":"https://doi.org/10.4038/amj.v14i2.7657","url":null,"abstract":"Non-communicable diseases (NCDs) account for an estimated 71% of all deaths globally. In Norway, in 2015, 71% of all deaths were due to cardiovascular diseases, cancers and neurological disorders. NCDs are mostly chronic diseases where individuals live a long period with the disease, thus the disease becomes a part of everyday life. This perspective explores the NCD care model within the Norwegian health delivery system in relation to the integration of prevention, diagnosis, treatment and rehabilitation services of non-communicable diseases to the primary health care system, and also explores several best practices and lessons that can be adapted to minimize the critical gaps and areas of the non-communicable diseases care model in Sri Lanka.","PeriodicalId":30600,"journal":{"name":"Anuradhapura Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42790762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}