Objective:To identify the clinical manifestations of hump nosed viper envenomation and to recognize the available treatment methods to prevent complications.Methods:Descriptive observational study involving a series o...Objective:To identify the clinical manifestations of hump nosed viper envenomation and to recognize the available treatment methods to prevent complications.Methods:Descriptive observational study involving a series of 1 543 patients admitted with hump nosed viper bite to 5 major hospitals in Sri Lanka was conducted.Data collection was done consecutively during February 1990 and February 2008.Except Hypnale,identification of the biting snake was made by the corresponding author after visual examination of the dead or live snakes,which were brought to hospital.Results:Sixty seven(4.34%) patients developed systemic effects and two (0.1%) patients died due to effects of envenomation or complications of treatment.Systemic effects varied from coagulopathy,nephropathy to some neurological manifestations.Fifty nine (3.8%) patients had only coagulopathy and they received either,intravenous isotonic saline to ensure adequate urine out put i.e.0.5 mL/kg /hour or 15 mL/kg of fresh frozen plasma(FFP). None of the patients that had coagulopathy developed renal failure.Contamination of the sample by mildly venomous species of Hypnale may have contributed to the low incidence of systemic complications.Conclusions:It is likely that early hydration with normal saline or FFP can prevent acute renal failure.FFP showed a tendency for early correction of coagulopathy.Role of FFP in hump nosed viper envenomation is worth studying in randomized double blind controlled clinical trials.展开更多
Introduction: Thrombosis is a major cause of maternal death worldwide. During pregnancy, the risk of venous thromboembolism (VTE) increases fourfold to five-fold and contributes towards maternal morbidity and mortalit...Introduction: Thrombosis is a major cause of maternal death worldwide. During pregnancy, the risk of venous thromboembolism (VTE) increases fourfold to five-fold and contributes towards maternal morbidity and mortality. Sri Lanka does not have a proper assessment tool to detect and manage it in the antenatal care. Objectives: To identify risks factors for VTE among pregnant mothers, postpartum mothers according to RCOG (Royal College of Obstetricians) risk categorization and to assess the requirement of thromboprophylaxis. Method: A cross sectional study was conducted at the antenatal clinics and obstetrics and gynaecology wards (ward 2, 5, 8) of De Soysa Hospital for Women in 2021. Obstetric thromboprophylaxis risk assessment tool recommended by the RCOG was used for the risk assessment of pregnant mothers during the antenatal and postpartum period. Results: In antenatal period, obesity (BMI > 35), age more than 35 years and parity more than 3 were the commonest risk factors. Out of 404 mothers, 67.33% did not have any risk factors. Among others, 18.56%, 0.40%, 2.72%, 0.99% had a score of 1, 2, 3 and 4 respectively. Patients with intermediate (0.99%) and high risk (2.72%) were commenced on thromboprophylaxis from 28 weeks. The low-risk category was not started on any treatment (28.96%, n = 97). Approximately 96% of mothers did not require any thromboprophylaxis during antenatal period. Another 404 postnatal mothers were recruited for the study group. Elective caesarean section and caesarean section during labour were the main risks identified other than pre-existing antenatal risks. 39.95 % of mothers did not have any risk factors and 37.22% of mothers had a score of 1. Conclusions: VTE risk assessment tool can be implemented at national level to detect patients at risk of VTE and improve maternal care.展开更多
BACKGROUND:The process of microcrystallization,its sequel and the assessment of nucleation time is ignored.This systematic review aimed to highlight the importance of biliary microlithiasis,sludge,and crystals,and the...BACKGROUND:The process of microcrystallization,its sequel and the assessment of nucleation time is ignored.This systematic review aimed to highlight the importance of biliary microlithiasis,sludge,and crystals,and their association with gallstones,unexplained biliary pain,idiopathic pancreatitis, and sphincter of Oddi dysfunction.DATA SOURCES:Three reviewers performed a literature search of the PubMed database.Key words used were'biliary microlithiasis','biliary sludge','bile crystals','cholesterol crystallisation','bile microscopy','microcrystal formation of bile','cholesterol monohydrate crystals','nucleation time of cholesterol','gallstone formation','sphincter of Oddi dysfunction'and'idiopathic pancreatitis'.Additional articles were sourced from references within the studies from the PubMed search.RESULTS:We found that biliary microcrystals account for almost all patients with gallstone disease,7%to 79%with idiopathic pancreatitis,83%with unexplained biliary pain, and 25%to 60%with altered biliary and pancreatic sphincter function.Overall,the detection of biliary microcrystals in gallstone disease has a sensitivity ranging from 55%to 87%and a specificity of 100%.In idiopathic pancreatitis,the presence of microcrystals ranges from 47%to 90%.A nucleation time less than 10 days in hepatic bile or ultra-filtered gallbladder bile has a specificity of 100%for cholesterol gallstone disease.CONCLUSIONS:Biliary crystals are associated with gallstone disease,idiopathic pancreatitis,sphincter of Oddi dysfunction, unexplained biliary pain,and post-cholecystectomy biliary pain.Pathways of cholesterol super-saturation,crystallisation, and gallstone formation have been described with scientificsupport.Bile microscopy is a useful method to detect microcrystals and the assessment of nucleation time is a good method of predicting the risk of cholesterol crystallisation.展开更多
Dear Editor,Phaeochromocytoma of thelurinary bladder is a rare tumour that originates from chromaffin tissue of the sympathetic nervous system situated within the urinary bladder wall[1].These are tumours of the sympa...Dear Editor,Phaeochromocytoma of thelurinary bladder is a rare tumour that originates from chromaffin tissue of the sympathetic nervous system situated within the urinary bladder wall[1].These are tumours of the sympathetic nervous tissue and the symptom profile will depend on the secretory function[1].These account for less than 0.05%of all bladder tu-mours and less than 1%of all phaeochromocytoma[1].As phaeochromocytoma of the urinary bladder is such a rare condition,only limited literature is available to direct clinical decision making.展开更多
AIM: To analyze the frequency and severity of faecal incontinence (FI) and its effect on the quality of life (QOL) in inflammatory bowel disease (IBD) patients. METHODS: All patients who attended surgical and medical ...AIM: To analyze the frequency and severity of faecal incontinence (FI) and its effect on the quality of life (QOL) in inflammatory bowel disease (IBD) patients. METHODS: All patients who attended surgical and medical gastroenterology outpatient clinics in a tertiary care center with an established diagnosis of either ulcerative colitis (UC) or Crohn’s disease (CD) over a period of 10 mo were included in this study. Before enrollment into the study, the patients were explained about the study and informed consent was obtained. The patients with unidentified colitis were excluded. The data on demographics, disease characteristics, FI (Vaizey score), and quality of life (IBD-Q) were collected. Data were analyzed using SPSS version 21. RESULTS: There were 184 patients (women = 101, 54.9%; UC = 153, 83.2%) with a female preponderance for UC (male/female ratio = 1:1.5) and a male preponderance for CD (male/female = 2:1). Forty-eight (26%) patients reported symptoms of FI. Among the patients with FI, 70.8% were women (n = 34) and 29.2% were men (n = 14) with an average age of 52.7 years (range, 20-78 years). Average age of onset of FI was 48.6 (range, 22-74) years. Ten percent (n = 5) reported regular FI. Incontinence to flatus was seen in 33.3% (n = 16), to liquid faeces in 56.2% (n = 27), to solid faeces in 6.2% (n = 3) and to all three in 4.1% (n = 2). Twenty-one percent (n = 10) complained of disruption of their physical and social activity. There was no association between FI and type of IBD. Significant associations were found between FI and age (P = 0.005) and gender (P CONCLUSION: In our study, nearly a quarter of patients reported FI. There was a significant correlation between FI and QOL. Therefore, enquiring about FI in IBD patients can lead to identification of this debilitating condition. This will enable early referral for continence care in this group of patients.展开更多
AIM To estimate prevalence and phenotypic associations of selected inflammatory bowel disease(IBD)-associated genetic variants among Sri Lankan patients. METHODS A case study of histologically confirmed ulcerative col...AIM To estimate prevalence and phenotypic associations of selected inflammatory bowel disease(IBD)-associated genetic variants among Sri Lankan patients. METHODS A case study of histologically confirmed ulcerative colitis(UC) or Crohn's disease(CD) patients with ≥ 1 year disease duration, who were compared to unrelated, gender-matched, healthy individuals as controls, was conducted at four major centers in Sri Lanka. Phenotypic data of the cases were obtained and all participants were genotyped for 16 selected genetic variants: IL12 B :rs1045431, IL23 R :rs11805303, ARPC2 :rs12612347, IRGM :rs13361189, IL26/IL22 :rs1558744, CDH1 :rs1728785, IL10 :rs3024505, FCGR2 A :rs3737240, PTGER4 :rs4613763, IL17 REL/PIM3 :rs5771069, HNF4 a :rs6017342, STAT3 :rs744166, SMURF1 :rs7809799, LAMB1 :rs886774, HLA-DRB5, DQA1, DRB1, DRA :rs9268853, MST1, UBA7, and APEH :rs9822268. The genotypes of all variants were in Hardy-Weinberg Equilibrium(P > 10^(-3)). To account for multiple hypothesis testing, P-values < 0.003 were considered significant.RESULTS A total of 415 patients and 465 controls were recruited. Out of the single nucleotide polymorphisms(SNPs) tested, the majority were not associated with IBD in Sri Lankans. Significant positive associations were noted between rs886774(LAMB1-gene) and UC(odds ratio(OR) = 1.42, P = 0.001). UC patients with rs886774 had mild disease(OR = 1.66, P < 0.001) and remained in remission(OR = 1.48, P < 0.001). A positive association was noted between rs10045431(IL 12 B gene) and upper gastrointestinal involvement in CD(OR = 4.76, P = 0.002). CONCLUSION This confirms the heterogeneity of allelic mutations in South Asians compared to Caucasians. Most SNPs and disease associations reported here have not been described in South Asians.展开更多
Obstetric cholestasis (also referred to as intrahepatic cholestasis of pregnancy—ICP) is a pruritic form of reversible cholestasis that is associated with significant fetal risks. There is a paucity of research regar...Obstetric cholestasis (also referred to as intrahepatic cholestasis of pregnancy—ICP) is a pruritic form of reversible cholestasis that is associated with significant fetal risks. There is a paucity of research regarding pregnancy outcomes of the mothers with obstetric cholestasis in the South Asian setting. Hence, the objective of this study was to determine the prevalence of obstetric cholestasis among mothers presenting with pruritus during pregnancy and to describe the characteristics and outcomes for those diagnosed with ICP in comparison with those with pruritus in the absence of ICP. Methods: All mothers presenting with pruritus to De Soyza Maternity hospital in Colombo Sri Lanka, between 1st January 2011 to 1st January 2014, were recruited for the study. A standard set of biochemical tests were used for diagnosis of ICP. An interviewer administered questionnaire and patient records were used for data collection. Presentation, characteristics and pregnancy outcomes were assessed and compared for mothers with ICP against those with pruritus in the absence of ICP. Results: The prevalence of ICP in the study population was found to be 27% (n = 27). Generalized pruritus with pruritus of the palms and soles was identified as the commonest pattern of pruritus for diagnosed with ICP. Delivery before 37 weeks (p = 0.001), meconium stained liquor (p = 0.004), placental abruption (p = 0.005), postpartum hemorrhage (p = 0.005), bleeding manifestation (p = 0.006), preterm labor (p = 0.031) and fetal distress (p = 0.035) were found to be significantly associated with the presence of ICP. Conclusions: Nearly 1/3 of mothers presenting with pruritus in pregnancy in Sri Lanka are affected by ICP which is associated with an increase in a wide range of adverse maternal and fetal outcomes compared to those with pruritus in the absence of ICP.展开更多
The 6 minute walk test (6MWT) is well established in the clinical assessment of heart failure, pulmonary hypertension and COPD. Its value as a submaximal stress test in the risk stratification of chronic stable ischae...The 6 minute walk test (6MWT) is well established in the clinical assessment of heart failure, pulmonary hypertension and COPD. Its value as a submaximal stress test in the risk stratification of chronic stable ischaemic syndromes is as yet not validated. 95 patients undergoing coronary angiography for assessment of chronic stable angina performed the 6MWT according to a modified protocol. The gamma correlation test indicated a moderately significant relationship between ECG changes plus symptoms at the end of the 6MWT and multi vessel coronary arterial disease. The T wave changes showed no significant correlation. Hence the 6MWT is a useful tool in the risk stratification of stable ischaemic syndromes which can be safely performed in a general ward prior to hospital discharge. It would be a useful preliminary test before planning a programme of cardiac rehabilitation.展开更多
This review concentrates on different aspects of malaria chemoprophylaxis,namely drug combinations,resistance,impact of malaria prevention in pregnancy and cost effectiveness. A MEDLINE search was performed for all ar...This review concentrates on different aspects of malaria chemoprophylaxis,namely drug combinations,resistance,impact of malaria prevention in pregnancy and cost effectiveness. A MEDLINE search was performed for all articles with the key word ’Malaria’ in the title field and ’Prophylaxis’ in any field.The search was restricted to articles published in English within the last decade(1999-2009).Data sources included review articles published in core clinical journals,cohort studies,interventional studies,case control studies and cross sectional analyses. The mechanism of action,trial evidence of efficacy,side effects and geographical distribution of resistance is discussed for each prophylactic drug regimen.Impact of prophylaxis in pregnancy and the cost considerations are discussed under two separate sub topics.展开更多
Introduction: Two spread methods of Covid-19, namely airborne and respiratory droplets, can be prevented by proper use of face masks. However, it has been reported an inadequate knowledge attitude and practice of prop...Introduction: Two spread methods of Covid-19, namely airborne and respiratory droplets, can be prevented by proper use of face masks. However, it has been reported an inadequate knowledge attitude and practice of proper use of face masks among school students. Therefore, the knowledge, attitude, and practice of school students should be improved. Different approaches are used to improve knowledge, attitude, and practice. However, e-posters are rare, and the effect of e-posters on improving the knowledge, attitude, and practice of school students on the proper use of face masks has not been studied. Objectives: The objective of this study was to determine the effect of an e-educational poster on knowledge, attitude, and practice of the proper use of face masks among school students. Method: This study was conducted as a pre-test and post-test design. The sample was 364 grade 11 students of the Gampaha educational division, Sri Lanka. Data were collected using self-administered questionnaires distributed pre and post to the interventional e-education poster. Data analyses were conducted by using SPSS Software. Results: Results show no significant demographic difference (p = 0.446) between the pre and post-test groups. A significant increase was observed between the pre and post-test mean scores of knowledge (p ≤ 0.05), attitude (p ≤ 0.05), and practice (p ≤ 0.05) on the proper use of face masks. In pre-group knowledge (p = 0.155), attitude (p = 0.258) and practice (p = 0.211) shows no significant difference due to gender. Also post group knowledge (p = 0.079), attitude (p = 0.835) and practice (p = 0.435) shows no significant difference due to gender. Conclusions: The results suggest that e-educational posters may be useful to improve the knowledge, attitude, and practice on the proper use of face masks among school students. The improvement of knowledge, attitude, and practice on the proper use of face masks by e-educational posters among school students occurs irrespective of gender.展开更多
<strong>Background and Purpose:</strong> Walking difficulties are defined as any reduction in speed, balance, or change of gait, causing limited ambulation. These difficulties are a common problem in older...<strong>Background and Purpose:</strong> Walking difficulties are defined as any reduction in speed, balance, or change of gait, causing limited ambulation. These difficulties are a common problem in older adults and may greatly affect their quality of life (QOL) and restrict their personal independence and participation. This study aimed to determine the effect of intermittent pneumatic compression (IPC) on lower leg pain, walking capacity, functional mobility, ankle range of motion (AROM), and QOL of community-dwelling older people with walking difficulties. <strong>Methods:</strong> In this randomized controlled trial, 34 eligible participants with self-reported lower limb pain and limited ambulation were randomized either to the intermittent pneumatic compression intervention group (IPCIG) or static compression control group (SCCG). The IPCIG and SCCG were trained to receive IPC and SC respectively for both lower legs and instructed to continue the application independently at home for 15 minutes per session, 2 sessions a day, 7 days per week for 4 weeks independently at the home. Outcome measures of lower leg pain, AROM, walking capacity, and functional mobility were assessed at baseline and at the first, second, third, and fourth weeks after randomization. Quality of life was assessed at baseline and immediately after the intervention. <strong>Results and Discussion:</strong> IPCIG showed a more significant improvement compared to the SCCG at the post-interventional stage for QOL and all the subscales. The findings show that “80% improved QOL” is 53% higher with the application of IPC than with SC for 4 weeks. The IPCIG showed a more significant improvement in the 6-minute walk test (6 MWT) at the third and fourth weeks compared to the SCCG. A pairwise comparison of mean values of 6 MWT over 4 weeks within the IPCIG showed a significant difference between all the weeks. Pairwise comparisons between groups at each time point showed that the IPCIG showed a more significant improvement in the timed up and go (TUG) test at the third and fourth weeks compared to the SCCG. Pairwise comparison of mean values of TUG test within the IPCIG showed a significant difference over 4 weeks, except between the second and third weeks, fourth week, and third and fourth weeks. The IPCIG showed a more significant improvement in lower leg pain between all weeks except the first week compared to the SCCG. Pairwise comparison of mean values of lower leg pain over 4 weeks within the IPCIG showed a significant difference among all weekly outcomes except between 1 and 2 weeks. The IPCIG showed a more significant improvement in left and right ankle dorsiflexion ROM at the third and fourth weeks compared to the SCCG. <strong>Conclusions:</strong> The IPC was effective in reducing lower leg pain and increasing the AROM and improving the walking capacity, functional mobility level, and QOL of community-dwelling older people with walking disabilities. Walking disability in old age is a common condition requiring physical therapy. Intermittent pneumatic compression can be used as a physical therapy modality for this patient group.展开更多
Choledochal cysts are benign cystic dilatations of the extra-and intrahepatic bile ducts[1,2].If untreated,their sequelae include recurrent cholangitis,secondary biliary cirrhosis,acute pancreatitis,and cholangiocarci...Choledochal cysts are benign cystic dilatations of the extra-and intrahepatic bile ducts[1,2].If untreated,their sequelae include recurrent cholangitis,secondary biliary cirrhosis,acute pancreatitis,and cholangiocarcinoma[3,4].Todani et al.[5]classified choledochal cysts into 5 subtypes,of which type V is Caroli’s disease.The disease is either localized,where unilobar biliary dilatation,commonly in the left,is present,or diffuse,where the entire liver is involved.展开更多
Objective: To review the management experience of a consecutive series of patients presenting as acute surgical abdomen whom were ultimately diagnosed to have DF(Dengue fever)/ DHF(Dengue heamorrhagic fever),Methods: ...Objective: To review the management experience of a consecutive series of patients presenting as acute surgical abdomen whom were ultimately diagnosed to have DF(Dengue fever)/ DHF(Dengue heamorrhagic fever),Methods: Clinical data of all cases of apparent acute abdomen(AA) which were later confirmed as having DF/DHF reviewed by two surgical units from December 2012 to December 2013 were analyzed,Initially confirmed patients with DF/DHF who developed abdominal symptoms were not considered,Results: Out of the seventeen cases(7 males,age range 10-71 years) presented with fever and AA; appendicitis,cholecystitis,pancreatitis and non-specific peritonitis were suspected initially in 8,5,1 and 3 cases,respectively,Neutropenia or thrombocytopenia signifying DF/DHF occurred only in 11 patients at first evaluation thus six remained as surgical candidates beyond 24 h,One patient underwent appendicectomy with a prolonged hospital stay,DF was confirmed by serology in all patients,latest by fourth day of admission,One required blood product transfusion,4 needed critical care treatment and there was 1 death,Conclusions: DF/DHF misleads the clinicians when it presents as AA,Initial heamatological and ultrasonographic findings may be equivocal creating a diagnostic and management dilemma,Vigilant clinical suspicion and early dengue serological assessment is advisable in equivocal cases of AAs with fever in dengue endemic areas,to confirm/exclude the infection in order to avoid unnecessary surgical morbidity in the presence of DF.展开更多
AIM To assess the performance of a newly designed,culturally adapted screening tool for autism spectrum disorder(ASD).METHODS Items for the screening tool were modeled from already documented checklists and diagnostic...AIM To assess the performance of a newly designed,culturally adapted screening tool for autism spectrum disorder(ASD).METHODS Items for the screening tool were modeled from already documented checklists and diagnostic criteria for ASD.Each item in text was paired with a photograph that illustrated the written content,which was in the 2 main local languages.The final product had 21 items and was named the pictorial autism assessment schedule(PAAS).Performance of PAAS was tested on a clinical sample of 18-48 mo old children,diagnosis na?ve,presenting with developmental deficits.Mothers completed PAAS checklist.Based on clinical diagnosis,which was taken as the gold standard,children were later grouped into ASD(Group 1) and non-ASD developmental disorders(Group 2).Mothers of a control sample of typically developing children also completed PAAS(Group 3).RESULTS A total of 105 children(Group 1-45,Group 2-30,Group 3-30) participated in the study.Mean age of Group 1 and Group 2 were 36 and 40 mo respectively.Majority were male in all 3 groups.Performance of PAAS in discriminating between ASD and non-ASD developmental disorders was sensitivity 88.8%,specificity 60.7%,positive predictive value(PPV) 78.4%,negative predictive value(NPV) 77.2%,likelihood ratio(LR+) 2.26,and LR-0.18.Performance of PAAS in discriminating between ASD and typical development was sensitivity 88.0%,specificity 93.3%,PPV 95.2%,NPV 84.0%,LR+ 13.3 and LR- 0.12.The results indicated that that a positive result from PAAS was 2.26 times more likely to be found in a child with ASD than in a child with non-ASD developmental disorder.A positive result from PAAS was 13.3 times more likely to be found in a child with ASD than in a child with typical development.CONCLUSION PAAS is an effective tool in screening for ASD.Further study is indicated to evaluate the feasibility of using this instrument for community screening for ASD.展开更多
Introduction: The presence of multiple renal arteries (MRA) in the donor allograft was once a contraindication to transplantation. Despite concerns about risks, these allografts are being increasingly used to overcome...Introduction: The presence of multiple renal arteries (MRA) in the donor allograft was once a contraindication to transplantation. Despite concerns about risks, these allografts are being increasingly used to overcome a shortage of renal donors. Objectives: To compare the outcomes of live-donor renal allografts with multiple and single renal arteries (SRA) in terms of overall ischemia times, early and late graft function, and vascular and urological complications. Methods: A prospective, non-randomized cohort study was conducted including all live donor renal transplants done by the Vascular and Transplant Unit of the National Institute of Nephrology Dialysis and Transplantation, Sri Lanka between March 2010 and March 2016. 312 recipients of live donor renal allografts were recruited to the study. Patients were divided into three groups: Group 1—SRA: single anastomosis (n = 264, 85%);Group 2—MRA: single conjoined anastomosis (n = 39, 12%);and Group 3—MRA: ≥2 anastomoses (n = 9, 3%). Results: Mean ischaemia times (donor clamping to graft reperfusion) in the three groups were 14, 21 and 17 minutes respectively. Failure to normalize creatinine within 72 hours was seen in 29/264 (11%), 4/39 (10.2%) and 1/9 (11%), (P >0.05). Delayed graft function (attributable to severe rejection) occurred in only one patient who was from group 2. One-year graft survival among the groups was 243/264 (92%), 35/39 (90%) and 8/9 (89%), (P > 0.05). One patient from groups 1 and 2 developed transplant renal artery stenosis. Two patients from group 1 needed stenting for ureteric stenosis. Conclusions: Donor grafts with MRA may be accepted safely with careful surgical reconstruction and close surveillance post-transplant.展开更多
Globally,the discipline of neurosurgery has evolved remarkably fast.Despite being one of the latest medical specialties,which appeared only around hundred years ago,it has witnessed innovations in the aspects of diagn...Globally,the discipline of neurosurgery has evolved remarkably fast.Despite being one of the latest medical specialties,which appeared only around hundred years ago,it has witnessed innovations in the aspects of diagnostics methods,macro and micro surgical techniques,and treatment modalities.Unfortunately,this development is not evenly distributed between developed and developing countries.The same is the case with neurosurgical education and training,which developed from only traditional apprentice programs in the past to more structured,competencebased programs with various teaching methods being utilized,in recent times.A similar gap can be observed between developed and developing counties when it comes to neurosurgical education.Fortunately,most of the scholars working in this field do understand the coherent relationship between neurosurgical education and neurosurgical practice.In context to this understanding,a symposium was organized during the World Federation of Neurological Surgeons(WFNS)Special World Congress Beijing 2019.This symposium was the brain child of Prof.Yoko Kato-one of the eminent leaders in neurosurgery and an inspiration for female neurosurgeons.Invited speakers from different continents presented the stages of development of neurosurgical education in their respective countries.This paper summarizes the outcome of these presentations,with particular emphasis on and the challenges faced by developing countries in terms of neurosurgical education and strategies to cope with these challenges.展开更多
Introduction:Pseudoainhum(dactylolysis spontanea)is characterized by the development of a fibrous band around the digit that gradually leads to autoamputation.Digital pain associated with Pseudoainhum may not be evide...Introduction:Pseudoainhum(dactylolysis spontanea)is characterized by the development of a fibrous band around the digit that gradually leads to autoamputation.Digital pain associated with Pseudoainhum may not be evident in patients with neuropathic conditions.Here,we present a rare case of pseudoainhum patient,which describes a very rare association of pseudoainhum with leprosy.Case presentation:A 48 year old male with lepromatous leprosy,with resorption of digits,charcot joints and tropical ulcers was seen in the clinic.The forth digit of the left hand had a narrowing due to a fibrous band at the 2nd inter phalangeal joint with shiny tethering distal phalanx.He could not recall the duration of the ainhum.He was not suffering from any pain.Discussion:The current report describes a very rare association of pseudoainhum with leprosy.The case involved a 48-year-old man in the dermatology ward with lepromatous leprosy presenting with a pseudoainhum.Conclusion:This case highlights the possibility of delayed presentation of patients with pseudoainhum to physicians when the patients have underlying neuropathic conditions that prevent feeling finger pain and cause abnormal appearance of the digits,especially in leprosy.展开更多
Dengue is an important mosquito-borne disease, caused by one of the four serotypes of dengue virus.According to the reports from the World Health Organization, every year 50 to 100 million infections occur, including ...Dengue is an important mosquito-borne disease, caused by one of the four serotypes of dengue virus.According to the reports from the World Health Organization, every year 50 to 100 million infections occur, including 500 000 dengue hemorrhagic fever cases and 22 000 deaths, mostly among children.1 The main features of severe infection are hypotension, fluid leak and shock. Management of dengue shock syndrome and its pathophysiology are not fully understood. We reported two patients with dengue who developed hypotension without considerable fluid accumulation in the third space and explaining an alternative cause for hypotension in these patients.展开更多
文摘Objective:To identify the clinical manifestations of hump nosed viper envenomation and to recognize the available treatment methods to prevent complications.Methods:Descriptive observational study involving a series of 1 543 patients admitted with hump nosed viper bite to 5 major hospitals in Sri Lanka was conducted.Data collection was done consecutively during February 1990 and February 2008.Except Hypnale,identification of the biting snake was made by the corresponding author after visual examination of the dead or live snakes,which were brought to hospital.Results:Sixty seven(4.34%) patients developed systemic effects and two (0.1%) patients died due to effects of envenomation or complications of treatment.Systemic effects varied from coagulopathy,nephropathy to some neurological manifestations.Fifty nine (3.8%) patients had only coagulopathy and they received either,intravenous isotonic saline to ensure adequate urine out put i.e.0.5 mL/kg /hour or 15 mL/kg of fresh frozen plasma(FFP). None of the patients that had coagulopathy developed renal failure.Contamination of the sample by mildly venomous species of Hypnale may have contributed to the low incidence of systemic complications.Conclusions:It is likely that early hydration with normal saline or FFP can prevent acute renal failure.FFP showed a tendency for early correction of coagulopathy.Role of FFP in hump nosed viper envenomation is worth studying in randomized double blind controlled clinical trials.
文摘Introduction: Thrombosis is a major cause of maternal death worldwide. During pregnancy, the risk of venous thromboembolism (VTE) increases fourfold to five-fold and contributes towards maternal morbidity and mortality. Sri Lanka does not have a proper assessment tool to detect and manage it in the antenatal care. Objectives: To identify risks factors for VTE among pregnant mothers, postpartum mothers according to RCOG (Royal College of Obstetricians) risk categorization and to assess the requirement of thromboprophylaxis. Method: A cross sectional study was conducted at the antenatal clinics and obstetrics and gynaecology wards (ward 2, 5, 8) of De Soysa Hospital for Women in 2021. Obstetric thromboprophylaxis risk assessment tool recommended by the RCOG was used for the risk assessment of pregnant mothers during the antenatal and postpartum period. Results: In antenatal period, obesity (BMI > 35), age more than 35 years and parity more than 3 were the commonest risk factors. Out of 404 mothers, 67.33% did not have any risk factors. Among others, 18.56%, 0.40%, 2.72%, 0.99% had a score of 1, 2, 3 and 4 respectively. Patients with intermediate (0.99%) and high risk (2.72%) were commenced on thromboprophylaxis from 28 weeks. The low-risk category was not started on any treatment (28.96%, n = 97). Approximately 96% of mothers did not require any thromboprophylaxis during antenatal period. Another 404 postnatal mothers were recruited for the study group. Elective caesarean section and caesarean section during labour were the main risks identified other than pre-existing antenatal risks. 39.95 % of mothers did not have any risk factors and 37.22% of mothers had a score of 1. Conclusions: VTE risk assessment tool can be implemented at national level to detect patients at risk of VTE and improve maternal care.
文摘BACKGROUND:The process of microcrystallization,its sequel and the assessment of nucleation time is ignored.This systematic review aimed to highlight the importance of biliary microlithiasis,sludge,and crystals,and their association with gallstones,unexplained biliary pain,idiopathic pancreatitis, and sphincter of Oddi dysfunction.DATA SOURCES:Three reviewers performed a literature search of the PubMed database.Key words used were'biliary microlithiasis','biliary sludge','bile crystals','cholesterol crystallisation','bile microscopy','microcrystal formation of bile','cholesterol monohydrate crystals','nucleation time of cholesterol','gallstone formation','sphincter of Oddi dysfunction'and'idiopathic pancreatitis'.Additional articles were sourced from references within the studies from the PubMed search.RESULTS:We found that biliary microcrystals account for almost all patients with gallstone disease,7%to 79%with idiopathic pancreatitis,83%with unexplained biliary pain, and 25%to 60%with altered biliary and pancreatic sphincter function.Overall,the detection of biliary microcrystals in gallstone disease has a sensitivity ranging from 55%to 87%and a specificity of 100%.In idiopathic pancreatitis,the presence of microcrystals ranges from 47%to 90%.A nucleation time less than 10 days in hepatic bile or ultra-filtered gallbladder bile has a specificity of 100%for cholesterol gallstone disease.CONCLUSIONS:Biliary crystals are associated with gallstone disease,idiopathic pancreatitis,sphincter of Oddi dysfunction, unexplained biliary pain,and post-cholecystectomy biliary pain.Pathways of cholesterol super-saturation,crystallisation, and gallstone formation have been described with scientificsupport.Bile microscopy is a useful method to detect microcrystals and the assessment of nucleation time is a good method of predicting the risk of cholesterol crystallisation.
文摘Dear Editor,Phaeochromocytoma of thelurinary bladder is a rare tumour that originates from chromaffin tissue of the sympathetic nervous system situated within the urinary bladder wall[1].These are tumours of the sympathetic nervous tissue and the symptom profile will depend on the secretory function[1].These account for less than 0.05%of all bladder tu-mours and less than 1%of all phaeochromocytoma[1].As phaeochromocytoma of the urinary bladder is such a rare condition,only limited literature is available to direct clinical decision making.
文摘AIM: To analyze the frequency and severity of faecal incontinence (FI) and its effect on the quality of life (QOL) in inflammatory bowel disease (IBD) patients. METHODS: All patients who attended surgical and medical gastroenterology outpatient clinics in a tertiary care center with an established diagnosis of either ulcerative colitis (UC) or Crohn’s disease (CD) over a period of 10 mo were included in this study. Before enrollment into the study, the patients were explained about the study and informed consent was obtained. The patients with unidentified colitis were excluded. The data on demographics, disease characteristics, FI (Vaizey score), and quality of life (IBD-Q) were collected. Data were analyzed using SPSS version 21. RESULTS: There were 184 patients (women = 101, 54.9%; UC = 153, 83.2%) with a female preponderance for UC (male/female ratio = 1:1.5) and a male preponderance for CD (male/female = 2:1). Forty-eight (26%) patients reported symptoms of FI. Among the patients with FI, 70.8% were women (n = 34) and 29.2% were men (n = 14) with an average age of 52.7 years (range, 20-78 years). Average age of onset of FI was 48.6 (range, 22-74) years. Ten percent (n = 5) reported regular FI. Incontinence to flatus was seen in 33.3% (n = 16), to liquid faeces in 56.2% (n = 27), to solid faeces in 6.2% (n = 3) and to all three in 4.1% (n = 2). Twenty-one percent (n = 10) complained of disruption of their physical and social activity. There was no association between FI and type of IBD. Significant associations were found between FI and age (P = 0.005) and gender (P CONCLUSION: In our study, nearly a quarter of patients reported FI. There was a significant correlation between FI and QOL. Therefore, enquiring about FI in IBD patients can lead to identification of this debilitating condition. This will enable early referral for continence care in this group of patients.
基金Supported by National Research Council,Sri Lanka,Grant No.NRC 13-108
文摘AIM To estimate prevalence and phenotypic associations of selected inflammatory bowel disease(IBD)-associated genetic variants among Sri Lankan patients. METHODS A case study of histologically confirmed ulcerative colitis(UC) or Crohn's disease(CD) patients with ≥ 1 year disease duration, who were compared to unrelated, gender-matched, healthy individuals as controls, was conducted at four major centers in Sri Lanka. Phenotypic data of the cases were obtained and all participants were genotyped for 16 selected genetic variants: IL12 B :rs1045431, IL23 R :rs11805303, ARPC2 :rs12612347, IRGM :rs13361189, IL26/IL22 :rs1558744, CDH1 :rs1728785, IL10 :rs3024505, FCGR2 A :rs3737240, PTGER4 :rs4613763, IL17 REL/PIM3 :rs5771069, HNF4 a :rs6017342, STAT3 :rs744166, SMURF1 :rs7809799, LAMB1 :rs886774, HLA-DRB5, DQA1, DRB1, DRA :rs9268853, MST1, UBA7, and APEH :rs9822268. The genotypes of all variants were in Hardy-Weinberg Equilibrium(P > 10^(-3)). To account for multiple hypothesis testing, P-values < 0.003 were considered significant.RESULTS A total of 415 patients and 465 controls were recruited. Out of the single nucleotide polymorphisms(SNPs) tested, the majority were not associated with IBD in Sri Lankans. Significant positive associations were noted between rs886774(LAMB1-gene) and UC(odds ratio(OR) = 1.42, P = 0.001). UC patients with rs886774 had mild disease(OR = 1.66, P < 0.001) and remained in remission(OR = 1.48, P < 0.001). A positive association was noted between rs10045431(IL 12 B gene) and upper gastrointestinal involvement in CD(OR = 4.76, P = 0.002). CONCLUSION This confirms the heterogeneity of allelic mutations in South Asians compared to Caucasians. Most SNPs and disease associations reported here have not been described in South Asians.
文摘Obstetric cholestasis (also referred to as intrahepatic cholestasis of pregnancy—ICP) is a pruritic form of reversible cholestasis that is associated with significant fetal risks. There is a paucity of research regarding pregnancy outcomes of the mothers with obstetric cholestasis in the South Asian setting. Hence, the objective of this study was to determine the prevalence of obstetric cholestasis among mothers presenting with pruritus during pregnancy and to describe the characteristics and outcomes for those diagnosed with ICP in comparison with those with pruritus in the absence of ICP. Methods: All mothers presenting with pruritus to De Soyza Maternity hospital in Colombo Sri Lanka, between 1st January 2011 to 1st January 2014, were recruited for the study. A standard set of biochemical tests were used for diagnosis of ICP. An interviewer administered questionnaire and patient records were used for data collection. Presentation, characteristics and pregnancy outcomes were assessed and compared for mothers with ICP against those with pruritus in the absence of ICP. Results: The prevalence of ICP in the study population was found to be 27% (n = 27). Generalized pruritus with pruritus of the palms and soles was identified as the commonest pattern of pruritus for diagnosed with ICP. Delivery before 37 weeks (p = 0.001), meconium stained liquor (p = 0.004), placental abruption (p = 0.005), postpartum hemorrhage (p = 0.005), bleeding manifestation (p = 0.006), preterm labor (p = 0.031) and fetal distress (p = 0.035) were found to be significantly associated with the presence of ICP. Conclusions: Nearly 1/3 of mothers presenting with pruritus in pregnancy in Sri Lanka are affected by ICP which is associated with an increase in a wide range of adverse maternal and fetal outcomes compared to those with pruritus in the absence of ICP.
文摘The 6 minute walk test (6MWT) is well established in the clinical assessment of heart failure, pulmonary hypertension and COPD. Its value as a submaximal stress test in the risk stratification of chronic stable ischaemic syndromes is as yet not validated. 95 patients undergoing coronary angiography for assessment of chronic stable angina performed the 6MWT according to a modified protocol. The gamma correlation test indicated a moderately significant relationship between ECG changes plus symptoms at the end of the 6MWT and multi vessel coronary arterial disease. The T wave changes showed no significant correlation. Hence the 6MWT is a useful tool in the risk stratification of stable ischaemic syndromes which can be safely performed in a general ward prior to hospital discharge. It would be a useful preliminary test before planning a programme of cardiac rehabilitation.
文摘This review concentrates on different aspects of malaria chemoprophylaxis,namely drug combinations,resistance,impact of malaria prevention in pregnancy and cost effectiveness. A MEDLINE search was performed for all articles with the key word ’Malaria’ in the title field and ’Prophylaxis’ in any field.The search was restricted to articles published in English within the last decade(1999-2009).Data sources included review articles published in core clinical journals,cohort studies,interventional studies,case control studies and cross sectional analyses. The mechanism of action,trial evidence of efficacy,side effects and geographical distribution of resistance is discussed for each prophylactic drug regimen.Impact of prophylaxis in pregnancy and the cost considerations are discussed under two separate sub topics.
文摘Introduction: Two spread methods of Covid-19, namely airborne and respiratory droplets, can be prevented by proper use of face masks. However, it has been reported an inadequate knowledge attitude and practice of proper use of face masks among school students. Therefore, the knowledge, attitude, and practice of school students should be improved. Different approaches are used to improve knowledge, attitude, and practice. However, e-posters are rare, and the effect of e-posters on improving the knowledge, attitude, and practice of school students on the proper use of face masks has not been studied. Objectives: The objective of this study was to determine the effect of an e-educational poster on knowledge, attitude, and practice of the proper use of face masks among school students. Method: This study was conducted as a pre-test and post-test design. The sample was 364 grade 11 students of the Gampaha educational division, Sri Lanka. Data were collected using self-administered questionnaires distributed pre and post to the interventional e-education poster. Data analyses were conducted by using SPSS Software. Results: Results show no significant demographic difference (p = 0.446) between the pre and post-test groups. A significant increase was observed between the pre and post-test mean scores of knowledge (p ≤ 0.05), attitude (p ≤ 0.05), and practice (p ≤ 0.05) on the proper use of face masks. In pre-group knowledge (p = 0.155), attitude (p = 0.258) and practice (p = 0.211) shows no significant difference due to gender. Also post group knowledge (p = 0.079), attitude (p = 0.835) and practice (p = 0.435) shows no significant difference due to gender. Conclusions: The results suggest that e-educational posters may be useful to improve the knowledge, attitude, and practice on the proper use of face masks among school students. The improvement of knowledge, attitude, and practice on the proper use of face masks by e-educational posters among school students occurs irrespective of gender.
文摘<strong>Background and Purpose:</strong> Walking difficulties are defined as any reduction in speed, balance, or change of gait, causing limited ambulation. These difficulties are a common problem in older adults and may greatly affect their quality of life (QOL) and restrict their personal independence and participation. This study aimed to determine the effect of intermittent pneumatic compression (IPC) on lower leg pain, walking capacity, functional mobility, ankle range of motion (AROM), and QOL of community-dwelling older people with walking difficulties. <strong>Methods:</strong> In this randomized controlled trial, 34 eligible participants with self-reported lower limb pain and limited ambulation were randomized either to the intermittent pneumatic compression intervention group (IPCIG) or static compression control group (SCCG). The IPCIG and SCCG were trained to receive IPC and SC respectively for both lower legs and instructed to continue the application independently at home for 15 minutes per session, 2 sessions a day, 7 days per week for 4 weeks independently at the home. Outcome measures of lower leg pain, AROM, walking capacity, and functional mobility were assessed at baseline and at the first, second, third, and fourth weeks after randomization. Quality of life was assessed at baseline and immediately after the intervention. <strong>Results and Discussion:</strong> IPCIG showed a more significant improvement compared to the SCCG at the post-interventional stage for QOL and all the subscales. The findings show that “80% improved QOL” is 53% higher with the application of IPC than with SC for 4 weeks. The IPCIG showed a more significant improvement in the 6-minute walk test (6 MWT) at the third and fourth weeks compared to the SCCG. A pairwise comparison of mean values of 6 MWT over 4 weeks within the IPCIG showed a significant difference between all the weeks. Pairwise comparisons between groups at each time point showed that the IPCIG showed a more significant improvement in the timed up and go (TUG) test at the third and fourth weeks compared to the SCCG. Pairwise comparison of mean values of TUG test within the IPCIG showed a significant difference over 4 weeks, except between the second and third weeks, fourth week, and third and fourth weeks. The IPCIG showed a more significant improvement in lower leg pain between all weeks except the first week compared to the SCCG. Pairwise comparison of mean values of lower leg pain over 4 weeks within the IPCIG showed a significant difference among all weekly outcomes except between 1 and 2 weeks. The IPCIG showed a more significant improvement in left and right ankle dorsiflexion ROM at the third and fourth weeks compared to the SCCG. <strong>Conclusions:</strong> The IPC was effective in reducing lower leg pain and increasing the AROM and improving the walking capacity, functional mobility level, and QOL of community-dwelling older people with walking disabilities. Walking disability in old age is a common condition requiring physical therapy. Intermittent pneumatic compression can be used as a physical therapy modality for this patient group.
文摘Choledochal cysts are benign cystic dilatations of the extra-and intrahepatic bile ducts[1,2].If untreated,their sequelae include recurrent cholangitis,secondary biliary cirrhosis,acute pancreatitis,and cholangiocarcinoma[3,4].Todani et al.[5]classified choledochal cysts into 5 subtypes,of which type V is Caroli’s disease.The disease is either localized,where unilobar biliary dilatation,commonly in the left,is present,or diffuse,where the entire liver is involved.
文摘Objective: To review the management experience of a consecutive series of patients presenting as acute surgical abdomen whom were ultimately diagnosed to have DF(Dengue fever)/ DHF(Dengue heamorrhagic fever),Methods: Clinical data of all cases of apparent acute abdomen(AA) which were later confirmed as having DF/DHF reviewed by two surgical units from December 2012 to December 2013 were analyzed,Initially confirmed patients with DF/DHF who developed abdominal symptoms were not considered,Results: Out of the seventeen cases(7 males,age range 10-71 years) presented with fever and AA; appendicitis,cholecystitis,pancreatitis and non-specific peritonitis were suspected initially in 8,5,1 and 3 cases,respectively,Neutropenia or thrombocytopenia signifying DF/DHF occurred only in 11 patients at first evaluation thus six remained as surgical candidates beyond 24 h,One patient underwent appendicectomy with a prolonged hospital stay,DF was confirmed by serology in all patients,latest by fourth day of admission,One required blood product transfusion,4 needed critical care treatment and there was 1 death,Conclusions: DF/DHF misleads the clinicians when it presents as AA,Initial heamatological and ultrasonographic findings may be equivocal creating a diagnostic and management dilemma,Vigilant clinical suspicion and early dengue serological assessment is advisable in equivocal cases of AAs with fever in dengue endemic areas,to confirm/exclude the infection in order to avoid unnecessary surgical morbidity in the presence of DF.
文摘AIM To assess the performance of a newly designed,culturally adapted screening tool for autism spectrum disorder(ASD).METHODS Items for the screening tool were modeled from already documented checklists and diagnostic criteria for ASD.Each item in text was paired with a photograph that illustrated the written content,which was in the 2 main local languages.The final product had 21 items and was named the pictorial autism assessment schedule(PAAS).Performance of PAAS was tested on a clinical sample of 18-48 mo old children,diagnosis na?ve,presenting with developmental deficits.Mothers completed PAAS checklist.Based on clinical diagnosis,which was taken as the gold standard,children were later grouped into ASD(Group 1) and non-ASD developmental disorders(Group 2).Mothers of a control sample of typically developing children also completed PAAS(Group 3).RESULTS A total of 105 children(Group 1-45,Group 2-30,Group 3-30) participated in the study.Mean age of Group 1 and Group 2 were 36 and 40 mo respectively.Majority were male in all 3 groups.Performance of PAAS in discriminating between ASD and non-ASD developmental disorders was sensitivity 88.8%,specificity 60.7%,positive predictive value(PPV) 78.4%,negative predictive value(NPV) 77.2%,likelihood ratio(LR+) 2.26,and LR-0.18.Performance of PAAS in discriminating between ASD and typical development was sensitivity 88.0%,specificity 93.3%,PPV 95.2%,NPV 84.0%,LR+ 13.3 and LR- 0.12.The results indicated that that a positive result from PAAS was 2.26 times more likely to be found in a child with ASD than in a child with non-ASD developmental disorder.A positive result from PAAS was 13.3 times more likely to be found in a child with ASD than in a child with typical development.CONCLUSION PAAS is an effective tool in screening for ASD.Further study is indicated to evaluate the feasibility of using this instrument for community screening for ASD.
文摘Introduction: The presence of multiple renal arteries (MRA) in the donor allograft was once a contraindication to transplantation. Despite concerns about risks, these allografts are being increasingly used to overcome a shortage of renal donors. Objectives: To compare the outcomes of live-donor renal allografts with multiple and single renal arteries (SRA) in terms of overall ischemia times, early and late graft function, and vascular and urological complications. Methods: A prospective, non-randomized cohort study was conducted including all live donor renal transplants done by the Vascular and Transplant Unit of the National Institute of Nephrology Dialysis and Transplantation, Sri Lanka between March 2010 and March 2016. 312 recipients of live donor renal allografts were recruited to the study. Patients were divided into three groups: Group 1—SRA: single anastomosis (n = 264, 85%);Group 2—MRA: single conjoined anastomosis (n = 39, 12%);and Group 3—MRA: ≥2 anastomoses (n = 9, 3%). Results: Mean ischaemia times (donor clamping to graft reperfusion) in the three groups were 14, 21 and 17 minutes respectively. Failure to normalize creatinine within 72 hours was seen in 29/264 (11%), 4/39 (10.2%) and 1/9 (11%), (P >0.05). Delayed graft function (attributable to severe rejection) occurred in only one patient who was from group 2. One-year graft survival among the groups was 243/264 (92%), 35/39 (90%) and 8/9 (89%), (P > 0.05). One patient from groups 1 and 2 developed transplant renal artery stenosis. Two patients from group 1 needed stenting for ureteric stenosis. Conclusions: Donor grafts with MRA may be accepted safely with careful surgical reconstruction and close surveillance post-transplant.
文摘Globally,the discipline of neurosurgery has evolved remarkably fast.Despite being one of the latest medical specialties,which appeared only around hundred years ago,it has witnessed innovations in the aspects of diagnostics methods,macro and micro surgical techniques,and treatment modalities.Unfortunately,this development is not evenly distributed between developed and developing countries.The same is the case with neurosurgical education and training,which developed from only traditional apprentice programs in the past to more structured,competencebased programs with various teaching methods being utilized,in recent times.A similar gap can be observed between developed and developing counties when it comes to neurosurgical education.Fortunately,most of the scholars working in this field do understand the coherent relationship between neurosurgical education and neurosurgical practice.In context to this understanding,a symposium was organized during the World Federation of Neurological Surgeons(WFNS)Special World Congress Beijing 2019.This symposium was the brain child of Prof.Yoko Kato-one of the eminent leaders in neurosurgery and an inspiration for female neurosurgeons.Invited speakers from different continents presented the stages of development of neurosurgical education in their respective countries.This paper summarizes the outcome of these presentations,with particular emphasis on and the challenges faced by developing countries in terms of neurosurgical education and strategies to cope with these challenges.
文摘Introduction:Pseudoainhum(dactylolysis spontanea)is characterized by the development of a fibrous band around the digit that gradually leads to autoamputation.Digital pain associated with Pseudoainhum may not be evident in patients with neuropathic conditions.Here,we present a rare case of pseudoainhum patient,which describes a very rare association of pseudoainhum with leprosy.Case presentation:A 48 year old male with lepromatous leprosy,with resorption of digits,charcot joints and tropical ulcers was seen in the clinic.The forth digit of the left hand had a narrowing due to a fibrous band at the 2nd inter phalangeal joint with shiny tethering distal phalanx.He could not recall the duration of the ainhum.He was not suffering from any pain.Discussion:The current report describes a very rare association of pseudoainhum with leprosy.The case involved a 48-year-old man in the dermatology ward with lepromatous leprosy presenting with a pseudoainhum.Conclusion:This case highlights the possibility of delayed presentation of patients with pseudoainhum to physicians when the patients have underlying neuropathic conditions that prevent feeling finger pain and cause abnormal appearance of the digits,especially in leprosy.
文摘Dengue is an important mosquito-borne disease, caused by one of the four serotypes of dengue virus.According to the reports from the World Health Organization, every year 50 to 100 million infections occur, including 500 000 dengue hemorrhagic fever cases and 22 000 deaths, mostly among children.1 The main features of severe infection are hypotension, fluid leak and shock. Management of dengue shock syndrome and its pathophysiology are not fully understood. We reported two patients with dengue who developed hypotension without considerable fluid accumulation in the third space and explaining an alternative cause for hypotension in these patients.
