Ceylon Medical Journal最新文献

{"title":"Species distribution, antifungal susceptibility pattern and associated factors of Candida blood stream infections in Sri Lanka from 2018 to 2022.","authors":"P G R Udari M Welagedara, Primali I Jayasekera","doi":"10.4038/cmj.v69iSI3.9968","DOIUrl":"https://doi.org/10.4038/cmj.v69iSI3.9968","url":null,"abstract":"<p><strong>Introduction: </strong>Candidemia can be life-threatening in immunocompromised individuals thus, prompt diag-nosis and treatment with antifungal agents is mandatory for successful outcome. Surveillance data on species distribution, antifungal susceptibility and associated factors of candidemia is utmost important to decide on empiric antifungal therapy, to impose infection control measures as well to promote antifungal stewardship in a country. Therefore, this study was aimed at retrospective review of data on candidemia at Mycology Reference Laboratory in Sri Lanka for 5 years duration to identify the species causing candidemia, their antifungal susceptibility pattern and associated factors.</p><p><strong>Results: </strong>A twofold rise in candidemia cases were seen during this 5-year duration compared to previous 7 years (2011-2017). Predominant species causing candidemia was C. tropicalis (35%) followed by C. parapsilosis (33%). C. albicans was the 3rd commonest species causing candidemia in Sri Lanka. There were 3% C. glabrata cases, 2% C. guilliermondii and 1% C. famata and C. krusei cases. Importantly two sequencing confirmed C. auris cases were identified for the first time in Sri Lanka in 2021. Overall good antifungal susceptibility was seen for both fluconazole and amphotericin B and there were only 7%and 1.6% resistance respectively. Long term hospital stay (47%) was commonly seen in this study group followed by use of broad-spectrum antibiotics (24%) and involvement of gastro-intestinal tract (21%).</p><p><strong>Conclusion: </strong>Candida tropicalis is the commonest species causing candidemia in Sri Lanka. Common Candida species had good susceptibility to antifungals. Long term hospital stay was associated with candidemia in majority of patients.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 SI3","pages":"47-53"},"PeriodicalIF":0.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069313","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":"Sri Lanka's journey through antimicrobial resistance - gaps and gains.","authors":"Nambage Shirani Chandrasiri, Dhammika Sirisena Vidanagama, Gayana Pradeepi Subasinghe Gunaratna, Jayanthi Priyanganie Elwitigala, Charini Geethika Upulkanthi Arukattu Patabendige, Shashika Kushlani Jayatilleke","doi":"10.4038/cmj.v69iSI3.9991","DOIUrl":"https://doi.org/10.4038/cmj.v69iSI3.9991","url":null,"abstract":"","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 SI3","pages":"83-89"},"PeriodicalIF":0.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069218","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":"Understanding chromoblastomycosis in Sri Lanka; insights into fungal aetiology and antifungal susceptibility patterns.","authors":"Harshani Priyanwada Mendis Jayawardena Thabrew, Preethi Perera, Primali Irosha Jayasekera","doi":"10.4038/cmj.v69iSI3.9938","DOIUrl":"https://doi.org/10.4038/cmj.v69iSI3.9938","url":null,"abstract":"<p><strong>Introduction: </strong>Chromoblastomycosis is a chronic disfiguring fungal infection of the subcutaneous tissue found mainly in the socio-economically marginalized population in the tropical and sub-tropical regions, characterized by the presence of sclerotic cells. This study was done with the aim of identifying the antifungal sensitivity patterns of the causative agents of chromoblastomycosis in Sri Lanka from 1992 to 2019.</p><p><strong>Methodology: </strong>Study was done on the stored isolates received from patients with chromoblastomycosis since 1992 to 2019, to the Mycology Reference Laboratory of Medical Research Institute, Colombo. Isolates were revived by subculture on Potato dextrose agar. Identification was done phenotypically. Antifungal sensitivity testing was performed by E test method. Available demographic and clinical data were analysed.</p><p><strong>Results: </strong>Of the 74 isolates, 71 (96%) were caused by Fonsecaea pedrosoi. Mean MIC for the antifungals tested were lowest for posaconazole 0.015 μg/ml followed by itraconazole 0.225 μg/ml, and voriconazole 0.768 μg/ml while amphotericin B demonstrated complete resistance with mean MIC of 30.591 μg/ml. No statistically significant differences were noted on the antifungal sensitivity of the isolates from 1992 to 2004 and 2005 to 2019.</p><p><strong>Conclusions: </strong>Fonsecaea pedrosoi was the commonest causative agent causing chromoblastomycosis in the studied population. Posaconazole demonstrated the lowest MIC values for the tested isolates followed by itraconazole and voriconazole. Amphotericin B demonstrated very high MIC values which were likely to result in clinical failure upon treatment. MIC values demonstrated minimal fluctuations throughout the tested time.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 SI3","pages":"8-13"},"PeriodicalIF":0.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069232","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":"Impact of bacteraemia caused by third-generation cephalosporin non-susceptible Enterobacteriaceae - a cohort study.","authors":"Manushi Pamoda Sucharitharathne, Yasas Dahamuna Kolambage, Sashika Kushlani Jayatilleke","doi":"10.4038/cmj.v69iSI3.9982","DOIUrl":"https://doi.org/10.4038/cmj.v69iSI3.9982","url":null,"abstract":"<p><strong>Introduction: </strong>Bacteraemia caused by Enterobacteriaceae poses a significant threat to hospitalized patients, with rising rates of resistance to third-generation cephalo-sporins (3GC) complicating treatment efficacy. This is the first study done in Sri Lanka to assess the impact of 3GC resistance in bacteraemia patients.</p><p><strong>Objective: </strong>The aim was to study the impact of 3GC non-susceptibility on outcomes in patients with Entero-bacteriaceae bacteraemia Methods: This is a retrospective cohort study, conducted at Sri Jayewardenepura General Hospital in Sri Lanka. Patients who had bacteraemia with Enterobacteriaceae from March 2022 to April 2024 were included. Data were collected from hospital medical records and laboratory data and by calling the patient or caregiver.</p><p><strong>Results: </strong>Of the 335 cases identified, 59.4% were bacteraemia with 3GC non-susceptible Enterobac-teriaceae (3GCNSE). Patients with 3GCNSE tended to be older with more comorbidities, and urinary infections were predominant in both groups. E. coli and K. pneumoniae exhibited high resistance rates. Significant differences were observed in 7, 14, and 30-day all-cause mortality rate, healthcare cost, and duration of hospital stay between the two cohorts. However, in regression analysis, 3GCNSE were more likely to increase healthcare cost and, underlying chronic liver disease significantly increased the severity of illness and mortality rates.</p><p><strong>Conclusions: </strong>As nearly 60% of the bacteraemia caused by Enterobacteriaceae were 3GCNS, healthcare cost was higher when managing such patients, this highlights the economic burden of antimicrobial resistance (AMR). Therefore, it is important to control the AMR in lower-middle income countries such as Sri Lanka.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 SI3","pages":"61-70"},"PeriodicalIF":0.2,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069256","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":"Chemical composition of radio-lucent urinary stones in Sri Lanka.","authors":"Waduthanthri Supun Lakmal De Silva, Pitipanage Mihika Samidini Fernando, Eresha Jasinghe, Weerasighe Arachchige Susantha De Silva, Manjula Wijewardene, Anuruddha Mahasen Abeygunasekera","doi":"10.4038/cmj.v69i2.9890","DOIUrl":"https://doi.org/10.4038/cmj.v69i2.9890","url":null,"abstract":"<p><strong>Introduction: </strong>Determining the epidemiological characteristics and clinical and radiological predictors of different types of radiolucent urinary stones is important in the Sri Lankan setting, where routine stone analysis is not freely available.</p><p><strong>Method: </strong>This was a prospective, multi-centre study involving a sample of patients having radiolucent urinary stones. It was conducted in four urology units in Colombo over one year, starting from August 2019. A urinary stone that was not recognisable in plain X-ray KUB was considered a radiolucent stone. The diagnosis of the stone was made by non-contrast computerised tomography (NCCT KUB). Chemical analysis of the stones was carried out using Fourier-transform infrared spectroscopy (FTIR) technology.</p><p><strong>Results: </strong>A total of 71 patients were included. The male-to-female ratio was 3:1, and the average age was 48 years. Forty-three (60.5%) stones were uric acid stones, while 26 (36.7%) were calcium oxalate monohydrate stones. There was one calcium oxalate dihydrate stone and one apatite stone (1.4% each). In multivariate analysis, advanced age, unilateral stone location and low radiodensity were associated with uric acid stones. A radiodensity of 548 HU or lower in the NCCT KUB was predictive of a uric acid stone with 96.2% sensitivity and 76.4% specificity.</p><p><strong>Conclusion: </strong>The majority of radiolucent stones in our study are uric acid stones. The presence of a stone with a radiodensity of 548 HU or lower in the NCCT KUB is predictive of a uric acid stone. Calcium oxalate monohydrate stones constitute a significant proportion of radiolucent stones in Sri Lanka.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 2","pages":"31-35"},"PeriodicalIF":0.2,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069164","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":"Substandard and falsified medical products.","authors":"Chandana Merenchi Abeysekara, Lal Panapitiya","doi":"10.4038/cmj.v69i2.9988","DOIUrl":"https://doi.org/10.4038/cmj.v69i2.9988","url":null,"abstract":"<p><p>The report examines the pervasive issue of substandard and falsified medical products globally and within Sri Lanka, emphasising its impact on health systems and society. It outlines key definitions, including sub-standard, unregistered, and falsified medical products, highlighting their socioeconomic and health conse-quences. Challenges in combating this issue in Sri Lanka, such as weak regulatory frameworks and a lack of public awareness, are discussed. Recommendations focus on proactive measures, regulatory strengthening, and public education to address the problem effectively. Legal and administrative considerations, alongside collaborative efforts, are crucial in safeguarding public health and ensuring access to quality medical products.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 2","pages":"58-60"},"PeriodicalIF":0.2,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069123","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":"Clinical presentations and genetic variants of biotinidase deficiency in eight Sri Lankan children: A case series.","authors":"Thilini Premadasa, Ni-Chung Lee, Schorder Sabine, Mihika Fernando, Pyara Rathnayake, Shi-Ping Chou, Thayani Arooran, Nishani De Silva, Subhashini Jayasena, Hashini Jayatissa, Eresha Jasinge","doi":"10.4038/cmj.v69i2.10251","DOIUrl":"https://doi.org/10.4038/cmj.v69i2.10251","url":null,"abstract":"<p><p>Biotinidase deficiency (BD) is a rare, autosomal recessive disorder associated with neurological and skin-related consequences, resulting from impaired biotin recycling. Eight children diagnosed with BD between 2013 and 2023 were included. All were identified based on the clinical features of BD, with no established newborn screening programme in place. Clinical features, labo-ratory investigations, and variant analysis data were collected and analysed retrospectively. This study aimed to examine genotypic and phenotypic variations of BD in the Sri Lankan population. We identified six genotypic variants, including four novel variants in the biotinidase gene. Genotype did not significantly influence phenotypic variations. While the most common clinical findings were consistent with the literature, this cohort presented with some rare features such as developmental regression, hypertonia, spasticity, dystonic reactions, and hyper-reflexia. In contrast to other studies, patients in our cohort showed marked improvement in cognitive impairment, developmental regression, and visual and hearing defects, with minimal residual impairments upon initiating biotin treatment. Patients who were diagnosed and commenced treatment earlier responded better compared to those who experienced delayed diagnosis and exhibited some residual impairment. Therefore, a newborn screening programme for BD should be established in Sri Lanka to enable early diagnosis and prevent symptomatic cases of BD.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 2","pages":"50-57"},"PeriodicalIF":0.2,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069132","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":"Epidemiology, risk factors, and outcomes of patients with carbapenem-resistant gram-negative bacterial infections in Southern Sri Lanka.","authors":"John William Bollinger, Subodha Samanthini Wickramasinghe, Ajith De S Nagahawatte, D L Bhagya Piyasiri, Wmd Gaya Bandara Wijayaratne, M Ruvini P Kurukulasooriya, Tianchen Sheng, P G Thilini Sithara Wickramatunga, Mh Madureka Premamali, Anusha H Ekanayaka, Heshan Shalika Premalal, Bradly P Nicholson, Christopher W Woods, Champica K Bodinayake, L Gayani Tillekeratne","doi":"10.4038/cmj.v69i2.10011","DOIUrl":"https://doi.org/10.4038/cmj.v69i2.10011","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance is a major public health problem that threatens economic security, puts health at risk, and jeopardises global progress towards the Sustainable Development Goals. Limited data exist regarding burden, risk factors, treatment, and health outcomes of infections due to carbapenem-resistant gram-negative bacteria (CR-GNB) in Sri Lanka.</p><p><strong>Methods: </strong>A case-control study was conducted among patients admitted to a tertiary care hospital in Southern Province, Sri Lanka, from September 2019 to January 2020. Laboratory-based surveillance was performed using routine clinical samples of urine, blood, sputum, pus, and sterile fluid received by the clinical microbiology laboratory to identify cases (CR-GNB isolates) and controls (carbapenem-susceptible GNB isolates). Entero-bacteriaceae, Pseudomonas spp, and Acineto-bacter spp. were included.</p><p><strong>Results: </strong>Of 4176 positive cultures during the study period, 1472 (35.2%) were Enterobacteriaceae, 301 (7.2%) were Pseudomonas spp., and 148 (3.5%) were Acinetobacter. Of all 1921 GNB isolates, carbapenem resistance in Acinetobacter, Enterobacteriaceae and Pseudomonas were 79.7%, 19.2% and 13.0% respectively. In a subset of 143 patients in whom the case-control study was performed, 75 patients had CR-GNB positive cultures, and the median age was 58.0 years, and 62.7% were males. In logistic regression, none of the sociodemo-graphic or clinical factors explored was independently associated with carbapenem resistance. Nevertheless, patients infected with CR-Acinetobacter had a significantly higher mortality rate (OR 3.72: 95%CI 1.15-12.25; p=0.03).</p><p><strong>Conclusions: </strong>We identified a high prevalence of carbapenem resistance among GNB in Sri Lanka. Further studies are needed to elucidate the risk factors and outcomes of CR-GNB infections specific to the Sri Lankan context.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 2","pages":"36-43"},"PeriodicalIF":0.2,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069129","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 hidden burden of non-viral hepatitis-related hepatocellular carcinoma: a Sri Lankan perspective.","authors":"Madunil Anuk Niriella, Viranga Sathsarani Ranathunga, Suchintha Bandara Tillakaratne, Rohan Chaminda Siriwardana","doi":"10.4038/cmj.v69i2.10020","DOIUrl":"https://doi.org/10.4038/cmj.v69i2.10020","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) is a growing public health concern in Sri Lanka. While the incidence is lower than in other Asian countries, it is on the rise. In this point-of-view article, we describe the hidden burden of disease, unique characteristics and associations of HCC in Sri Lanka. We conducted a selective literature search across electronic databases (PubMed, MEDLINE, Embase, and Cochrane Library) to identify relevant publications on HCC in Sri Lanka. Original, descriptive, epidemiological studies and relevant systematic reviews were included. We excluded randomised controlled trials, narrative reviews, evidence-based clinical practice guidelines and expert consensus statements. In Sri Lanka, HCC primarily affects men at age 64 years at diagnosis. Most cases occur in individuals with underlying cirrhosis. Non-alcoholic cryptogenic cirrhosis is the major risk factor. At diagnosis, most HCCs were in an intermediate or advanced stage, often presenting as single large tumours with significant blood vessel invasion. TACE was the most common treatment offered. The overall survival remains limited to less than 2 years.</p>","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 2","pages":"61-65"},"PeriodicalIF":0.2,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069213","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":"Inferior vena cava tumours and surgical management: experience with 30 cases.","authors":"Joel Arudchelvam","doi":"10.4038/cmj.v69i2.10048","DOIUrl":"https://doi.org/10.4038/cmj.v69i2.10048","url":null,"abstract":"","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":"69 2","pages":"44-49"},"PeriodicalIF":0.2,"publicationDate":"2024-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069150","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}