25th Anniversary International Scientific Conference-2016

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Plenaries, Symposia and free papers presented at the 25th Anniversary International Scientific Conference, held on 6-8th April 2016, Faculty of Medicine, University of Kelaniya to celebrate the Silver Jubilee Anniversary of Faculty of Medicine

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Health seeking behavior of elders in Batticaloa district, Sri Lanka: Descriptive cross sectional study
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Arulanandem, K.; Jayawickramarajah, P.T.; Ramanayake, R.P.J.C.; Hettige, S.; Kisokanth, G.
BACKGROUND: Global population of elderly would increase by 15% in year 2025. The change in age structure affects the society in social, cultural and economic aspects of life. The provision of health care to elderly varies across most of the developing countries. Health care is an important issue for ageing population and living with chronic illnesses become a challenge. Health care services are essential for the population it serves. The health seeking behavior of elders depends on the availability of services, health problems and socio economic status. OBJECTIVE: To describe the health seeking behavior of elders in Batticaloa district, Sri Lanka METHODS: A cross sectional descriptive study was carried out in Batticaloa district on a sample of 845 elders selected by simple random sampling method. Interviewer administrated questionnaire was used to collect data and descriptive statistical analysis was done. RESULTS: Study population consisted of 78% of elders in young old category of whom 57% were females. Most (93%) attended outpatient departments of government hospitals and 8%, general practitioners as their first contact care for acute illnesses. 48% attended clinics for chronic illnesses at government hospitals. Approximately half of them used public transport to access the health facility. 50% of their health expenditure was managed by their children. Frequency of health seeking behavior for acute illness was higher among females and the difference between the two sexes was statistically significant (p<0.05). CONCLUSIONS: First contact care for acute and chronic disease conditions for more than 90% of elders in Batticaloa district was government hospitals.
Levamisole induced toxic epidermal necrolysis in a patient with nephrotic syndrome: A case report
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Prasangika, T.G.C.; Warnasuriya, W.; Mendis, W.J.S.; Fernando, M.; Jayasinghe, C.
INTRODUCTION: Toxic epidermal necrolysis (TEN) is an uncommon, potentially life-threatening muco-cutaneous condition, which may occur as an adverse reaction (Type IV hypersensitivity) to a number of drugs. It is characterized by variable degrees of epidermal necrosis and detachment leading to increase morbidity and mortality. We describe the case of a patient with nephrotic syndrome who developed TEN, presumably induced by Levamisole. To our knowledge, this is the first report of TEN arising during levamisole treatment. CASE REPORT: A 11 year old girl, who has steroid dependent nephrotic syndrome, was started on levamisole. She developed skin and mucosal lesions suggestive of TEN 3 weeks after taking levamisole. The diagnosis of TEN in our patient was made clinically and confirmed histologically. Based on the temporal relationship of levamisole therapy and the development of her adverse cutaneous reaction, we concluded that levamisole was the offending agent. CONCLUSION: We report this case to increase awareness of this potential life-threatening complication of levamisole.
Household air pollution research and policy: a worked example
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Sathiakumar, N.
OBJECTIVES: 1) To describe the importance of scientific evidence in policy development in the area of household air pollution 2) To present a framework on designing evidence based interventions and policy on exposure reduction related to household air pollution The future of policy development in the area of household air pollution (HAP) depends on credible scientific data that documents the health risks associated with HAP. In most instances, it is necessary to base decisions on the evidence generated elsewhere and to make inferences about the extent to which this evidence is generalizable to another location or country. The ways in which elements of the structural, physical, social and/or cultural environmental factors can influence HAP and how these factors may influence the effectiveness of interventions to reduce HAP exposure are discussed. A framework to be used by public health professionals who are designing, executing, reporting and synthesizing research on HAP, designing and implementing interventions for HAP exposure reduction or formulating policy is suggested.
Role of Cancer antigen 15.3 in the pre-operative assessment of primary breast cancer
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Peiris, H.H.; Mudduwa, L.K.B.; Wijeratne, W.M.D.G.B.; Liyanage, T.G.; Liyanage, N.C.; Gunasekara, S.N.; Kaushalya, M.H.A.
BACKGROUND: Cancer antigen (CA) 15.3 is the most commonly used tumour marker in predicting recurrence of breast cancer. The role of pre-operative CA 15.3 in the assessment of breast cancer has not been substantiated yet. OBJECTIVE: To determine the role of CA 15.3 in the pre-operative assessment of breast cancer patients METHODS: All patients who were diagnosed of primary breast cancer and underwent surgery at a tertiary-care hospital from April 2014 to October 2015 were enrolled. Serum level of CA 15.3 was assessed on a pre-operative blood sample by ELISA and ≥30 U/ml was considered as the cut off as defined by the manufacturer’s literature. The association of CA 15.3 levels with the clinico-pathological parameters was analyzed with chi-square test. RESULTS: Of the 150 patients (mean age 56.83 [SD=13.39] years) enrolled, majority (85.6%) had grade 2/3 tumours with lymph node metastasis (58.2%) at the time of presentation. None had distant metastasis. Elevated pre-operative serum level of CA 15.3 was detected in 34% of patients who had more estrogen receptor negative(43.13%), progesterone receptor negative (50.98%) and triple negative(29.1%) tumours compared to those without elevated pre-operative CA 15.3 (p=0.017,0.036 and 0.001 respectively). There was no association with other clinico-pathological features. CONCLUSIONS: Pre-operative serum level of CA15.3 is elevated only in one third of breast cancer patients. Elevated pre-operative CA 15.3 has a prognostic value as it is elevated mostly in the hormone receptor negative and triple negative breast cancers predicting a poor prognosis.
Blood alcohol concentration in motorcycle fatalities reported to a tertiary care hospital in Sri Lanka
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Senarathne, U.D.; Edirisinghe, P.A.S.; Kitulwatte, I.D.G.
BACKGROUND: Motorcycle, the common man’s vehicle in Sri Lanka when crashes is fatal due to its inherent instability and absence of an outside shield to absorb energy during a collision. Managing an unstable vehicle after consuming alcohol, a central nervous system depressant, increases the risk of a fatal collision. Research on motor-cycle fatalities and blood alcohol concentrations has not been reported from Sri Lanka earlier. OBJECTIVES: To describe the contribution of blood alcohol concentrations (BAC) to fatal motorcycle accidents. METHODS: A retrospective descriptive study based on post-mortems of motorcycle fatalities referred to a tertiary care hospital from 2010-2014 was done using a pro-forma. RESULTS: Out of 180 motorcycle accidents reviewed, 166(92%) were riders, 14(8%) were pillion riders. 171(95%) were males and majority (n=142, 79%) were between 20-60 years of age. BAC was requested for 88(49%) and reports were available only for 76(86%) victims. Out of them 34(45%) had BAC >80mg/100ml. The highest BAC reported was 428mg/100ml with the mean value being 104mg/100ml. Cause of death (COD) given for 78(43%) victims was head injury for 69(38%) multiple injuries. Presence of >25 injuries (p=0.028) and COD given as multiple injuries (p=0.029) were significantly associated with BAC >80mg/100ml. CONCLUSIONS: Having BAC >80mg/100ml significantly contributes to the motorcycle rider being subjected to more injuries in a collision. Since less than half the cases were subjected to BAC analysis, actual magnitude of the problem could be greater than illustrated by the study.
Ability to use computer software among new medical entrants to the Faculty of Medicine, University of Kelaniya
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Solangaarachchi, D.I.K.; Kumara, A.A.K.B.; Hettige, S.; Ediriweera, E.P.D.S.
BACKGROUND: Computer software is essential to enhance academic life of students. OBJECTIVES: To describe the level of confidence and ability on using computer software among new entrants to Faculty of Medicine, University of Kelaniya METHODS: Moodle based self-administered questionnaire was given to new entrants in 2015 and 2016 and their perception on the level of confidence, ability and usage were recorded. RESULTS: The results are described according to the 2015 (n=159) and 2016 (n=147) batches respectively. Proportion of males were 27% and 35%. Proportions who could install software in each batch was 20% (n=32 and 29) and could not were 15.7% (n=25) and 27.2% (n=40). Those who could and could not install a printer were 10.1% (n=16)/ 16.3% (n=24) and 30.8% (n=49)/ 34% (n=50) respectively. Proportions who could and could not install a pen drive were 28.9% (n=46)/ 40.1% (n=59) and 15.7% (n=25)/ 17% (n=25) respectively. Nine percent (n=14) and 13.6% (n=20) had used, 63.5% (n=101) and 50.3% (n=74)) were aware but had not used and 27.7% (n=44)) and 36.1% (n=53) were not aware of open source software. CONCLUSIONS: A majority of students had no awareness on software installation and pen drive scanning and have not used open source software at the point of entry to the Medical Faculty.
Research on the use of medicinal plants: a systematic review on methodology
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Kalki, P.; Riewpaiboon, A.
BACKGROUND: A large number of people in the world rely on medicinal plants (MP). Among 1500 species, 208 are frequently used in Sri Lanka. The knowledge of the people about many MPs is very poor. One can argue forever what precise percentage of the world’s population use MPs. To address this question, scientific research on MP usage have been conducted. OBJECTIVE: To conduct a systematic review of research methodology of MP consumption and usage. METHODS: The English articles available on Pubmed database were reviewed. The search term was “treat**Title+) OR consum**Title+) OR use**Title+) OR utili**Title+)) AND medicinal plants *MeSH Terms]. The inclusion criteria were consumption, study, survey of MP published between 2009 and 2013. Exclusion criteria were review, chemical, clinical, pharmacological, animal studies and MP for specific illness. RESULTS: Of the 225 articles, sixteen were selected for full review. The results were summarized under following headings: settings, study design, aim/objective of study, study population, sample, data collection, and statistics used. Europe and Africa were contributing to 75% of the articles. The study population comprised key informants and lay people. None of the studies indicated the sample size calculation formula. Mean sample size of articles was 99.36 (SD=78). The sampling method was purposive (09), random (03), and snowballing (02). The data collection was done by interview using questionnaires. Descriptive (09) and advanced (07) statistics have been used. CONCLUSIONS: All articles were surveys. Number of publications was three articles per year. Most of them were conducted in developing countries and analysed using descriptive statistics.
Species distribution and in-vitro antifungal susceptibility pattern of Candida clinical isolates
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Sigera, L.S.M.; Jayasekera, P.I.; Shabry, U.L.F.
BACKGROUND: An increase in incidence of Candida infections and isolation of resistant isolates were common occurrences in recent years due to increase in immunocompromised patients and advances in medical field. OBJECTIVES: To determine the Candida species isolated from various clinical specimens received at the Department of Mycology, Medical Research Institute from 08/08/14 - 25/10/14 and to determine their antifungal susceptibility pattern for commonly used antifungals in Sri Lanka. METHODS: Identification of 90 clinical isolates was done by using conventional methods of Candida identification and API kits. In-vitro antifungal susceptibility pattern of isolates to fluconazole, amphotericine B, ketoconazole, itraconazole, miconazole, nystatin, clotrimazole and voriconazole were determined according to CLSI M44A. RESULTS: Candida tropicalis (37.7%) was the most frequently isolated species, followed by C.albicans (36.6%), C.parapsilosis (24.4%) and C.krusei (1.1%). C.tropicalis was the predominant isolate from blood, sterile fluids and urine specimens. Majority of the isolates from scraping specimens were C.parapsilosis while C.albicans was the commonest in respiratory specimens. Variations in resistance were seen, depending on the species and the respective type of specimens. All Candida isolates were sensitive to amphotericin B. Twenty-three (24.44%) fluconazole resistant isolates were detected from blood, urine, pus, sterile fluids and respiratory and scraping specimens. Variable sensitivity patterns were observed for voriconazole, miconazole, itraconazole, ketoconazole, nystatin and clotrimazole. CONCLUSIONS: All clinical yeast isolates should be identified up to species level and antifungal susceptibility testing should be performed to prevent therapeutic failures. Resistance to fluconazole, is an alarming sign for emerging antifungal resistance in Sri Lanka.
Documenting norms for typical phonological processes in Sri Lankan Tamil, Sinhala and Sri Lankan English in children aged between 3;0- 3;11 years
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Udugama, L.
Sri Lankan Tamil, Sinhala and Sri Lankan English are distinct languages which contain language specific features. In Sri Lanka, to identify typical phonological processes in clinical practice, clinicians use normative data developed for British English-speaking children. It is essential to document normative data for Sinhala, Sri Lankan Tamil and Sri Lankan English as it will be useful in differentially diagnosing between typical phonological processes, phonological delays and disorders. The aim of the studies conducted was to document the phonological processes in 3;0- 3;11 year old typically developing children in different dialects of Sinhala and Sri Lankan Tamil as well as in Sri Lankan English. Three picture-based assessments devised by the researchers and the South Tyneside Assessment of Phonology were used to gain speech samples from 160 Sinhala speaking, 160 Tamil-speaking and 30 Sri Lankan English speaking children between the ages of 3 – 3; 11 years from four geographical locations (Matara, Matale, Kandy district-Akurana and Kandy district- tea estate) for the former two groups and from Colombo for the latter group. The data were phonetically transcribed and the phonological processes were described in relation to word positions. In addition, the data were statistically analyzed using t-tests on SSPS 16.0. The findings indicate a statistically significant influence of age, dialect and gender on the phonological processes produced. In addition, some unclassified phonological processes, language and dialect-specific processes were observed and will be discussed in relation to British English phonology norms and its implications for clinical practice.
Prenatal and early childhood biomass smoke exposure and child neuro-developmental outcomes
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Godamunne, P.
For many families in developing countries such as Sri Lanka, burning wood is the cheapest and most available source of cooking and heating fuel. However the household air pollution (HAP) resulting from burning of bio mass fuel is hazardous to children’s health. The numerous chemicals contained in wood smoke have been shown to have adverse effects on various aspects of children’s health. While the impact of HAP on children’s lung function, allergic diseases and childhood cancer has been investigated fairly extensively, less attention has been paid to the impact of exposure to wood smoke on neurodevelopment. The developing nervous system is especially vulnerable to environmental toxins and elevated levels of incomplete combustion products of wood smoke such as carbon monoxide are known to have neurotoxin effects. An ongoing collaborative study between the Faculty of Medicine, University of Kelaniya and the University of Alabama at Birmingham aims to assess the impact of prenatal and postnatal exposure to HAP on children’s neurodevelopment. HAP exposure is determined through questionnaires and measurement of PM2.5, PM1.0, PM10, CO and NO2. Neurodevelopment of children is assessed at birth and then at regular intervals up to 36 months using the Bayley Scales of Infant and Toddler Development. Preliminary results from this study add to the growing body of evidence on the impact of HAP on children’s neurodevelopment.
Post-Traumatic Stress: the Sri Lankan experience
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Williams, S.
Few countries in the world have experienced the myriad traumas that Sri Lanka has faced over the past three decades. The 30 year civil war was perhaps the most traumatic and disabling. It was not only the people in the north and the combatants and their families that suffered, but many in the south as well. Of note is the quelling of the dissent by Sinhala youth in the south by the government during the late 1980s which resulted in many young people going missing with no records as to their whereabouts, accepted now as dead. However, the tsunami of 2004 eclipsed all the others in terms of its magnitude and ability to wreak havoc within a few minutes, 15 leaving thousands dead and many others deprived of their families, friends, livelihoods and lifetime earnings. In the midst of these major traumas, the day to day traumas that are seen in middle income countries with limited resources are often ignored. Snake bite related trauma among farmers, accidental injuries such as spinal cord transections and even suicide. These and other traumas and their psychological impact is the thrust of this oration. The following studies will be discussed: delayed psychological morbidity associated with snakebite envenoming and possible psychological interventions to reduce the adverse outcomes; the role of religiosity and cultural perception as predictors of depression in relation to a spinal cord injury patient population; suicidal trends and their relationship to trauma in post-war Sri Lanka. Also discussed are the high prevalence of depressive disorder and post- traumatic stress disorder (PTSD) in war affected females and elders, andfinally, the persisting psychological issues in families of missing individuals from the war, youth unrest in the 1980s and the tsunami. The wider issues in achieving ‘closure’ in those with unresolved grief, and the need for an appropriate national response is highlighted.
Gastric motility in FGIDs: pathological and therapeutic implications
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Karunanayake, A.
Healthy GI motility is essential of optimal digestion and absorption. The electrophysiological properties of the smooth muscles and hierarchical four level integrative organization of neural network control the GI motor functions. Gastrointestinal dysmotility can develop through the dysfunction of the control mechanism at any level of the brain-gut axis. Abnormality in upper gastrointestinal function is a clearly identified pathophysiological mechanism in pain predominant functional GI diseases such as functional abdominal pain, irritable bowel syndrome and functional dyspepsia in children. Impaired solid and liquid gastric emptying and antroduodenal motility, enhanced visceral sensitivity, are in the fore front of it. In addition, abnormalities in the proximal gastric accommodation and small bowel transit are also some recognized physiological abnormalities in children. Emerging research has demonstrated alteration of gastric motility by pharmacological interventions as a possible therapeutic modality to improve symptoms and health related quality of life in children.
Anovulation as cause of infertility and novel methods of ovulation induction
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Palihawadana, T.S.
Infertility is known to affect one in six couples. Ovulatory dysfunction is a common underlying cause and is seen in approximately 38% of couples seeking infertility treatment. Polycystic ovary syndrome was the commonest underlying cause of anovulation and was seen in nearly 60% women. Hypogonadotropic hypogonadism and ovarian failure are uncommon causes of anovulation seen in only about 1-2% of women with anovulation. Clomifene citrate is the commonest medication used for induction of ovulation. It is successful in achieving ovulation in over three quarters of women with WHO group II anovulation. However, factors such as hirsutism, a high antral follicle count and a high LH:FSH ratio are associated with clomifene resistance. Aromatase inhibitor, letrozole, is a novel medication for induction of ovulation. It is successful in achieving ovulation in nearly 75% of women who respond to clomifene and 25% of women with clomifene resistance. Factors associated with resistance to letrozole included a high day2 LH level, hirsuitism and clomifene resistance had the highest association. The use of letrozole for augmentation of ovulation, in comparison to clomifene, resulted in a higher endometrial thickness and a trend towards monofollicle development. Gonadotropin (FSH) is used in induction of ovulation among women with resistance to oral medication. A low-dose step down regimen of rFSH, in comparison to a low-dose step-up regimen, showed a shorter duration of treatment, with no significant reduction in the total drug requirement. These findings have improved our understanding of different modes of induction of ovulation, which helps in further research and clinical practice.
Micro-mapping of common α+ thalassaemia deletions (3.7 kb, 4.2 kb) in Sri Lanka and assessment of the contribution of α thalassaemia to hypochromic microcytosis
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Premawardhena, A.P.
Alpha thalassaemia is one of the most common haemoglobinopathies, but the exact prevalence and distribution of α thalassaemia in Sri Lanka is not well known. This study was an attempt to micro-map the distribution of the common α thalassaemia deletions in Sri Lanka and to assess its contribution to hypochromic microcytosis in the community. A national survey on haemoglobin disorders was carried out between 2009 and 2010, covering all 25 districts. A total of 7539 school children, 300 from each district were screened for haemoglobin disorders and anaemia. 3.7 kb and 4.2 kb common α+ deletional forms were analysed using PCR in 2038 individuals with hypochromic microcytic anaemia and 1305 individuals with non-anaemia individuals, representing all districts. The overall prevalence of α-thalassaemia was 9.5%, and 3.7 kb was the commonest deletion (8.3%) while the 4.2 kb deletion accounted for 1.2%. The prevalence of α-thalassaemia showed a remarkable variability within districts, ranging from 16.3% in Kurunegala to 3.0% in Galle. Contrary to common belief, it was found that α-thalassaemia due to single gene deletions was almost always associated with hypochromic microcytic anaemia.
Chronic liver disease in Sri Lanka: cirrhosis and its complications
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Niriella, M.A.
The predominant cause of chronic liver disease in Sri Lanka is alcoholic cirrhosis (AC) and cryptogenic cirrhosis (CC). The latter is probably due to non-alcoholic steatohepatitis (NASH). With increasing incidence and prevalence of non-alcoholic fatty liver disease (NAFLD), NASH related cirrhosis will likely become the leading cause of chronic liver disease in Sri Lanka. The prevalence of chronic hepatitis B and hepatitis C is very low in the community, as well as among ‘high risk’ populations such as prisoners and those with transfusion dependent anaemia. This has led to a unique population of non-viral chronic liver disease patient population predominating in our country, which is a contrast to the rest of the South Asian region. In fact NAFLD is the leading cause for listing for liver transplantation and is the leading liver disease among potential liver donors for living donor liver transplantation. The long term transplant free survival of AC and CC patients is similar and death in both groups is predominantly liver related. We have also studied and published on hepatocellular carcinoma and chronic kidney disease in cirrhosis, minimal hepatic encephalopathy and road traffic collisions and the quality of life in cirrhosis.
Utilization pattern and perception on service quality among patients attending Out Patient Department, District General Hospital, Kalutara.
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Wijegunasekara, J.L.H.R.; Ferdinando, R.
BACKGROUND: Outpatient department (OPD) is an important wing of a hospital. Assessment of patients’ perceived quality is a useful measure in identifying quality gaps to plan corrective actions to improve the quality of service delivery. OBJECTIVES: This paper outlines the distribution of patients during the opening hours and their perception on service quality in the OPD of District General Hospital, Kalutara. METHODS: A descriptive cross sectional study was conducted, taking a sample of 423 patients aged 18-70 years, using systematic sampling technique and collecting data with a validated and a culturally adapted interviewer administered questionnaire. RESULTS: Average daily attendance was 1154; 53% attended before 10 am; 30% between 10 am - 2 pm and only 8.8% between 2 pm - 4 pm and 9% between 4pm - 8pm. Patients’ positive perceptions on service quality were as follows; Functional quality 61.2%, Technical quality 83.1%, Environment quality 65.3% and Administrative quality 66.5%.There were significant associations between time of arrival and perception of functional quality (p=0.026), environment quality (p=0.011) and administrative quality (p=0.004). However there is no association between time of arrival and perception of technical quality (p=0.590). CONCLUSIONS: Afternoon and evening sessions are under-utilized. There is considerable scope for the improvement of all four aspects of quality. Perception of quality has been affected by the patients’ time of arrival. Measures are to be taken to improve all aspects of quality and to popularize evening opening hours of the OPD.
Phenotype and outcomes of IBD in Sri Lanka
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Niriella, M.A.
Inflammatory bowel disease, especially ulcerative colitis (UC), is increasing in many "non-Western" countries, including Sri Lanka. Outcome of IBD has been poorly studied in these emerging populations compared to the West. In a prospective population-based study, we found that the early course of disease in patients with IBD in Asia, including Sri Lanka, was comparable to that of the West. Patients with Crohn disease (CD) frequently progress to complicated disease and have accelerated use of immunosuppressants. Few patients with early stage UC undergo surgery. We also evaluated long-term outcomes of ulcerative colitis in a Sri Lankan population. A retrospective cohort study was conducted at the gastroenterology clinics of the Colombo North Teaching Hospital, Ragama and the National Hospital of Sri Lanka, Colombo; the two major referral centers for ulcerative colitis. Three outcomes: colectomy, development of colorectal carcinoma, and death were assessed. In this cohort, colectomy, colorectal carcinoma, and death rates were low, suggesting a relatively benign disease course for UC.
Quality of the specimens received at the histopathology laboratory of Department of Pathology, Faculty of Medicine, Ragama
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Weerasinghe, T.M.B.; Weddagala, W.M.S.R.; Weerasekara, W.M.M.O.R.; Wasala, W.M.A.D.; Weerasinghe, M.P.A.M.
INTRODUCTION: The accuracy of the histopathology reporting depends on the completeness of the request forms and the condition of specimens. OBJECTIVE: To assess the completeness of pathology request forms and the condition of specimens received by a university pathology laboratory. METHODS: This cross sectional study was conducted at the pathology laboratory of a medical faculty in Sri Lanka. We included 342 consecutive specimens received from the professorial units of the teaching hospital during the study period, September to November 2014. Data were collected using a checklist consisting of 10 items for the request form, 6 for the label, 7 for the container and sample. SPSS16.2 was used to analyze the data. RESULTS: Only 56.1% had completed request forms. Patients’ sex and a short clinical history with a probable diagnosis were missing in12.6% and 24.6% respectively. Labeling was incomplete in 14.6% and date of specimen collection was missing in 11.4%. Compatibility of the 6 items on the label with the request form was observed in 71.3%, most mismatched item was the date of specimen collection (17%). Appropriate container was used in 89.5%. Inadequate amount of fixative was found in 13.2% of specimens. Only 24% of specimens fulfilled all requirements. CONCLUSION: This study demonstrates that the quality of the specimens is poor mainly due to the incomplete request forms, poor labelling and use of inappropriate containers. Redesigning the request form and introducing printed labels and standard set of containers may improve the quality of specimens.
The Global Challenge of Snakebite: where are we in 2016?
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Lalloo, D.
OBJECTIVE: To understand the ongoing challenges to improving outcomes following snakebite around the world. The existing state of our knowledge about the epidemiology and management of snakebite around the world will be reviewed, including identifying the major contributions made to the literature by Sri Lankan researchers. The future research agenda and the inherent challenges in achieving improved outcomes will be highlighted and discussed.
Neutropenic patient presented with subcutaneous nodules
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) de Silva, S.H.C.K.; Jayasekera, P.I.; Wanigasooriya, S.; Gunasekara, S.
BACKGROUND: Fusarium spp. is the second most-common mold infection in immunocompromised patients. Disseminated fusariosis is life-threatening and the outcome is influenced by the host’s immune status. Mortality ranges from 50-80%. Prolonged and profound neutropenia is a major risk factor. We report the first case of disseminated fusariosis with Fusarium aquaeductuum in Sri Lanka. CASE REPORT: A 5 1/2 year old boy with acute lymphoblastic leukemia (ALL) after completing chemotherapy was admitted with a relapse after 6 months. On admission he was asymptomatic. But the absolute neutrophil count was 650/L. He was started with IV vancomycin and IV ciprofloxacin empirically. While on those two antibiotics for 11 days, fever spikes appeared and meropenem and IV fluconazole were added. Fever continued and after 2 days he developed multiple painful subcutaneous nodules about 2cm in radius, mainly on limbs. Blood culture was positive for branching fungal filaments and it was later identified as Fusarium aquaeductuum.IV amphotericin B (conventional) was started and oral voriconazole was added after 2 days and both were continued for a total of 2 weeks after negative repeat blood cultures. CONCLUSIONS: Our patient was started on amphotericin B, with high clinical suspicion. Voriconazole was added due to initial poor response and positive repeat blood cultures. Although the mortality rate following disseminated fusariosis ranges 50% to 80%, with timely management our patient fully recovered.