Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Bites and stings: Exotic causes of stroke in Asia(Karger, 2024) Ranawaka, U.K.BACKGROUND Many unusual and fascinating causes of stroke are seen in Asia. Although rarely encountered in the Western world, such cases are seen not so infrequently by neurologists, physicians, and other healthcare workers in Asian countries. This article highlights some of these intriguing causes of stroke such as snakebite, scorpion stings, and bee and wasp stings.SUMMARY Snakebite is a neglected tropical disease of global importance affecting over 5 million people each year, and scorpion stings and bee and wasp stings affect over a million people worldwide every year. Strokes due to these uncommon causes predominantly affect young males in their most productive years, and many victims die or remain with residual disability with significant socioeconomic consequences to the affected families and society. Both ischaemic and haemorrhagic strokes are seen, with ischaemic strokes being more common. Many unanswered questions remain regarding the pathophysiological mechanisms, clinical spectrum, and the natural history of stroke due to these causes. Antivenom is effective in snake envenoming, antivenom and prazosin are effective in scorpion envenoming, and treatment of anaphylaxis and allergy is recommended in systemic reactions due to bee or wasp stings. However, there are no treatment guidelines or expert recommendations to guide the management of stroke in these patients, and there are no data on the safety and efficacy of stroke-specific treatments such as antiplatelet therapy, thrombolysis or endovascular treatment.KEY MESSAGES More research is clearly needed to unravel the complexities related to stroke following snakebite, scorpion envenoming, and bee and wasp stings, and to guide the development of optimal stroke treatment strategies in these unusual situations. Awareness of these exotic stroke aetiologies is important in early recognition and appropriate management of patients presenting with stroke symptoms in Asian countries, and in global travellers from the region. International collaborations would go a long way in improving our understanding of these rare but fascinating causes of stroke.Item Content analysis of policy documents related to non-communicable diseases prevention and control in Sri Lanka: a developing country in the South-East Asia(F1000 Research, 2024) Talagala, I.; Abeysena, C.; Wickremasinghe, R.BACKGROUND: Health policies form the foundation for provisioning best level care and are important for all stakeholders including patients and healthcare providers. Health policy analysis and evaluation allows policy makers to improve an existing policy, terminate a non-effective policy and to successfully implement future policies. The objective was to assess the coherence between the two local policy documents on NCD prevention and control in Sri Lanka, the national NCD policy (NCD policy) and the multisectoral action plan (MSAP), and to assess the consistency of MSAP with the global action plan for NCDs. METHODS: The content analysis of the NCD policy and MSAP of Sri Lanka was conducted based on the modified criteria developed to the ‘Analysis of determinants of policy impact’ model, by two reviewers independently. Coherence between MSAP and the global NCD action plan were also assessed by two reviewers independently. Consensus for discrepancy was achieved through discussion. RESULTS: Accessibility was the strongest criteria for the NCD policy, while, resources and obligations were the weakest. Goals and monitoring and evaluation criteria were the strongest in the MSAP. Requirement for improvement were identified in policy background, goals, monitoring and evaluation, and public opportunities for the NCD policy. Accessibility, policy background, resources, public opportunities and obligations require further improvement in the MSAP. The MSAP is well coherent with the global road map for NCD prevention and control. CONCLUSION: Policy documents related to NCD prevention and control in Sri Lanka are coherent with the global action plan, while, there are areas within the local policy documents that need to be improved to enhance the coherence between the local documents. Lessons learnt by this activity need to be utilized by Sri Lanka and other countries to improve the uniformity between the NCD policy documents within the country as well as internationally.Item A Systematic review on diagnostic methods of red cell membrane disorders in Asia(Blackwell Scientific Publications, 2022) Silva, R.; Amarasinghe, D.; Perera, S.; Premawardhena, A.Membranopathies are a group of inherited blood disorders where the diagnosis could form a challenge due to phenotype-genotype heterogeneity. In this review, the usage and limitations of diagnostic methods for membranopathies in Asian countries were evaluated. A systematic review was done using articles from PubMed, Google Scholar, and EBSCO from 2000 to 2020. Thirty-six studies conducted in seven Asian countries had used different diagnostic methods to confirm membranopathies. In 58.3% of studies, full blood count (FBC), reticulocyte count, and peripheral blood smear (PBS) were used in preliminary diagnosis. The combination of the above three with osmotic fragility (OF) test was used in 38.8%. The flowcytometric osmotic fragility (FC-OF) test was used in 27.7% where it showed high sensitivity (92%-100%) and specificity (96%-98%). The eosin-5-maleimide (EMA) assay was used in 68.1% with high sensitivity (95%-100%) and specificity (93%-99.6%). About 36.1% of studies had used sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) as a further diagnostic method to detect defective proteins. Genetic analysis to identify mutations was done using Sanger sequencing, next-generation sequencing (NGS), and whole-exome sequencing (WES) in 33.3%, 22.2%, and 13.8% of studies, respectively. The diagnostic yield of NGS ranged from 63% to 100%. Proteomics was used in 5.5% of studies to support the diagnosis of membranopathies. A single method could not diagnose all membranopathies. Next-generation sequencing, Sanger sequencing, and proteomics will supplement the well-established screening and confirmatory methods, but not replace them in hereditary hemolytic anemia assessment.Item Incidence and phenotype of Inflammatory Bowel Disease from 2012-2013 across 9 countries in Asia: results from the 2012 access inception cohort(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2015) Ng, S.C.; Zeng, Z.; Chen, M.; Tang, W.; de Silva, H.J.; Niriella, M.A.; Senanayake, Y.U.; Yang, hong; Qian, J.M.; Yu, H.H.; Li, M.F.; Zhang, J.; Ng, K.K.; Ong, D.E.; Ling, K-L; Goh, K.L.; Hilmi, I.; Pisespongsa, P.; Aniwan, S.; Limsrivilai, J.; Manatsathit, S.; Abdullah, M.; Simadibrata, M.; Gunawan, J.A.; Chong, V.H.; Tsang, S.; Chan, K.H.; Lo, F.H.; Hui, A.J.; Chow, C.M.; Kamm, M.A.; Hu, P.; Ching, J.; Chan, F.K.L.; Sung, J.J.Y.BACKGROUND: The incidence of inflammatory bowel disease (IBD) in Asia was first reported in the 2011 ACCESS inception cohort. This study aims to validate the incidence reported in 2011 by including a second independent cohort from 8 of the participating countries in 2011 and Brunei to investigate the incidence of IBD in Asia in 2012. METHODS: Incident IBD cases diagnosed between April 1, 2012 and March 31, 2013 from 18 centres, 11 cities and 9 countries in Asia were enrolled. Data including demographics and disease phenotype were entered into a Web-based database (http://www.access-apibd.com/access/index.html). Disease location and behavior were classified according to the Montreal classification. RESULTS: A total of 325 IBD patients were identified including 189 (58%) ulcerative colitis (UC), 119 (37%) Crohn’s disease (CD), and 17 (5%) indeterminate colitis (IC). The crude overall annual incidence per 100,000 of IBD was 1.61 (95% confidence interval, CI, 1.44-1.79) in 2012 compared with 1.15 (95% CI, 1.25-1.51) in 2011. The highest incidence in Asia was in Guangzhou (3.86 per 100,000), Hong Kong (2.91 per 100,000) followed by Macau (2.60 per 100,000). Overall ratio of UC to CD in 2012 was similar to that of 2011 (1.57 vs. 1.69; p=0.211). There were more male than female patients in both years (59% vs 60%; p=0.773). Mean age of diagnosis was 40 years (±15.96) in 2011 and 42 years (±16.30; p=0.084) in 2012. Median time from symptom onset to diagnosis was 6 months (IQR 3-24) and 7 months (IQR 2-16), respectively, in 2011 and 2012 (p=0.958). Disease behavior (B1: 72.0%, B2: 9.9%, B3: 4.4%, perianal: 13.2%), location for CD (L1: 25.3%, L2: 25.3%, L3: 49.5%) and UC (E1: 30.9%, E2: 40.1%, E3: 28.9%) did not differ from previous year. Most CD patients were non-smokers (80.3%) whereas 9.9% were current smokers and 9.9% were ex-smokers. CONCLUSION: The incidence of IBD, UC to CD ratio and age of disease onset in the ACCESS 2012 cohort was not significantly different from that reported in the 2011 cohort. Disease phenotype was also similar over 2 years. The ACCESS inception cohort reflects the true incidence of IBD in Asia.Item The Global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths(Public Library of Science, 2008) Kasturiratne, A.; Wickremasinghe, A.R.; de Silva, N.; Gunawardena, N.K.; Pathmeswaran, A.; Premaratna, R.; Savioli, L.; Lalloo, D.G.; de Silva, H.J.BACKGROUND: Envenoming resulting from snakebites is an important public health problem in many tropical and subtropical countries. Few attempts have been made to quantify the burden, and recent estimates all suffer from the lack of an objective and reproducible methodology. In an attempt to provide an accurate, up-to-date estimate of the scale of the global problem, we developed a new method to estimate the disease burdendue to snakebites. METHODS AND FINDINGS: The global estimates were based on regional estimates that were, in turn, derived from data available for countries within a defined region. Three main strategies were used to obtain primary data: electronic searching for publications on snakebite, extraction of relevant country-specific mortality data from databases maintained by United Nations organizations, and identification of grey literature by discussion with key informants. Countries were grouped into 21 distinct geographic regions that are as epidemiologically homogenous as possible, in line with the GlobalBurden of Disease 2005 study (Global Burden Project of the World Bank). Incidence rates for envenoming were extracted from publications and used to estimate the number of envenomings for individual countries; if no data were available for a particular country, the lowest incidence rate within a neighbouring country was used. Where death registration data were reliable, reported deaths from snakebite were used; in other countries, deathswere estimated on the basis of observed mortality rates and the at-risk population. We estimate that, globally, at least 421,000 envenomings and 20,000 deaths occur each year due to snakebite. These figures may be as high as 1,841,000 envenomings and 94,000 deaths. Based on the fact thatenvenoming occurs in about one in every four snakebites, between 1.2 million and 5.5 million snakebites could occur annually. CONCLUSIONS: Snakebites cause considerable morbidity and mortality worldwide. The highest burden exists in South Asia, Southeast Asia, and sub-Saharan Africa. Comment in Estimating the global burden of snakebite can help to improve management. [PLoS Med. 2008]