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Prevalence, risk factors, and short-term outcome of contrast-induced nephropathy among patients with chronic kidney disease: A cross-sectional study from Sri Lanka
(Hagerstown, Md : Lippincott Williams & Wilkins, 2025-08) Herath, N.; Rajakrishna, P.; Suriyaarachi, L.; Premathilaka, S.; Perera, N.; Samarasinghe, S.; De Silva, S.; Weerakoon, K.
Contrast-induced nephropathy (CIN) is a significant complication following the administration of radiocontrast media, defined as acute deterioration of renal function within 24 to 48 hours post-procedure. It represents the third most common cause of hospital-acquired acute kidney injury, accounting for approximately 11% of cases. CIN increases short-term morbidity and mortality while accelerating the progression of chronic kidney disease (CKD). This study investigated the prevalence, risk factors, and short-term outcomes of CIN among CKD patients undergoing contrast studies at 2 tertiary care centers in Sri Lanka. This descriptive cross-sectional study was conducted at the nephrology units of Colombo North Teaching Hospital and Teaching Hospital Kurunegala from August 2018 to September 2023. The study included 405 CKD patients over 18 years referred for pre-procedural nephrology consultation before undergoing contrast-enhanced imaging. All patients received intravenous normal saline hydration (1 mL/kg/h) 12 hours before and after contrast administration, with temporary discontinuation of nephrotoxic medications. Data was collected via an interviewer-administered questionnaire. CIN was defined per KDIGO guidelines as a rise in serum creatinine >25% or 0.5 mg/dL from baseline. The mean age of patients was 62.6 years (SD = 12.4), with 310 (76.5%) being male. Comorbidities included diabetes mellitus (48.9%), hypertension (44.2%), coronary artery disease (13.3%), and chronic liver disease (6.2%). CIN occurred in 45 patients (11.1%), with diabetes mellitus identified as a significant risk factor (P = .0044). Arterial contrast administration had a higher risk (17.7%) than venous administration (10.7%). Seven patients (1.7%) required acute hemodialysis, and 1 patient died. Age, gender, and CKD stage did not significantly influence CIN development. CIN remains a common complication in CKD patients undergoing contrast studies, with diabetes mellitus being a significant independent risk factor. Pre-procedural risk assessment and appropriate prophylactic measures are essential to minimize CIN incidence and associated complications.
First-aid practices and pre-hospital care in paediatric snakebites
(London : BioMed Central, 2025-08) Dayasiri, K.; Suraweera, N.; Burhan, P.
BACKGROUND: Snakebites pose a serious health risk to children in Sri Lanka, particularly in rural areas. Inappropriate first-aid measures and delayed hospital access contribute to adverse outcomes. This study examined caregiver first-aid practices and factors linked to harmful responses. METHODS: A descriptive cross-sectional mixed-methods study was conducted across four tertiary hospitals in Sri Lanka. Quantitative data were collected from 364 pediatric snakebite cases through structured caregiver interviews. First-aid practices were categorized as safe or potentially harmful. Logistic regression identified predictors of harmful practices. Additionally, 54 qualitative interviews explored caregiver beliefs and behaviours. RESULTS: While 264 (73.4%) caregivers washed the wound with soap and water and 222 (61.1%) reassured the child. Harmful practices were frequently observed: 97 (26.7%) applied tourniquets, 27 (7.4%) used herbal or home remedies such as lime or mashed onions, 9 (2.5%) attempted to suck out venom, 5 (1.5%) performed religious rituals before hospital care, 2 (0.5%) made incisions to drain blood, and 1 (0.2%) applied Condy's crystals. Harmful practices were significantly associated with low maternal education (AOR 1.94; p < 0.001), low paternal education (AOR 2.26; p < 0.001), low socioeconomic status (AOR 3.67; p < 0.001), and cultural beliefs regarding traditional cures (AOR 2.64; p < 0.001). Remote healthcare access was a borderline significant factor (AOR 1.28; p = 0.05). Prior training in snakebite first aid was protective (AOR 0.21; p < 0.001). Qualitative findings revealed coexistence of traditional and biomedical practices and frequent transport-related delays. CONCLUSION: Despite moderate awareness of recommended first aid, harmful practices persist in paediatric snakebite care in Sri Lanka. Targeted, culturally sensitive education and improved rural emergency transport services are essential to reduce delays and prevent complications.
Illustrative case series of intra-abdominal abscesses - a radiological viewpoint
(Sri Lanka College of Internal Medicine, 2025-08) Siriwardana, S.A.S.R.; Anjula, P.D.
Intra-abdominal abscesses (IAA) may commonly arise following complicated gastrointestinal tract infections and, on occasion, from infections within the urinary system. Many of these IAA arise as a consequence of post-surgical complications. These abscesses have a substantial risk of morbidity and mortality. It is crucial to diagnose and treat them to minimise these adverse outcomes promptly. Radiological modalities play a vital role in diagnosing, localising, and detecting associated complications of IAA, as sometimes other investigations can be less reliable and non-specific. Radiological techniques such as ultrasound scans (USS), contrast-enhanced computed tomography (CECT), and even magnetic resonance imaging (MRI) are immensely helpful in diagnosing these conditions. These imaging tools guide clinicians in determining the most appropriate patient management strategies. In this article, we compile a case series involving tubo-ovarian abscess, appendicular abscess, diverticular abscess and infected walled-off pancreatic necrosis, delineating characteristic radiological features which aid in their diagnosis.
Sepsis-Induced Purpura Fulminans in a Patient with Advanced Chronic Liver Disease: A Call for Timely Intervention
(The Kandy Society of Medicine, 2025-08) Keerthisinghe, B.D.C.H.; De Silva, S.T.
Purpura fulminans is a severe thrombotic condition and hematologic emergency marked by disseminated intravascular coagulation and endovascular thrombosis. Timely recognition and treatment are crucial to reduce its high morbidity and mortality. This condition is linked to significant acquired deficiencies in protein C and dysfunction in the protein C-thrombomodulin pathway. Management involves treating the underlying infection, aggressive anticoagulation, and substantial transfusion support to correct deficiencies in natural anticoagulant proteins. We present a case of acute infectious Purpura fulminans with disseminated intravascular coagulation due to pneumonia in a middle-aged male with advanced chronic liver disease.
Getting back on track to meet global anaemia reduction targets: a Lancet Haematology Commission
(Elsevier Ltd, 2025-08) Atkinson, S. H.; Suchdev, P. S.; Bode, M.; Carducci, B.; Cerami, C.; Mwangi, M. N.; Namaste, S.; Winichagoon, P.; Leung, S.; Mutua, A. M.; Abuga, K. M.; Angeles-Agdeppa, I.; Blythe, R.; Carvalho, N.; Cepeda-Lopez, A.; Cross, J. H.; de Pee, S.; Di Ruggiero, E.; Fanzo, J.; Gentilini, U.; Gichohi-Wainaina, W. N.; Glover-Wright, C.; Gomes, F.; Hess, S.; Holloway-Brown, J.; Joof, F.; Karakochuk, C.; Kassebaum, N. J.; Larson, L.; Mettananda, S.; Muriuki, J. M.; Mwangome, M.; Ohuma, E. O.; Olive,r V.; Perumal, N.; Phiri, K.; Samuel, F.; Sinharoy, S.; Tizifa, T.; Valleriani, G.; Van Zutphen-Küffer, K. G.; Vasta, F.; Verhoef, H.; Wang, Y.; Yadav, K.; Yang, Z.; Young, M.; Zimmermann, M. B.; Pasricha, S. R.
No abstract available