Colombo North Teaching Hospital

Small for gestational age and fetal growth restriction are two leading causes for low birth weight in term newborns. Due to the considerable overlap, the exact interactions between these groups have not been adequately studied. We aim to determine the prevalence, interactions, determinants, and outcomes of low birth weight, small for gestational age, and fetal growth restriction in term neonates. A cross-sectional study with a short-term follow-up was conducted at Colombo North Teaching Hospital, Ragama, Sri Lanka, between June and August 2025. All neonates of singleton pregnancies born at term were eligible. Stillbirths, multiple pregnancies and newborns born preterm, post-term, with uncertain gestations or with antenatally diagnosed congenital anomalies were excluded. The prevalence and interactions of low birth weight, small for gestational age, and fetal growth restriction were determined, and their risk factors were analysed. 437 term newborns (male-54.0%, primipara-53.3%) were recruited. The prevalence of low birth weight, small for gestational age, and fetal growth restriction were 14.0%, 15.1% and 14.9%, respectively. Of the low birth weight neonates, 75.4% were small for gestational age, and 50.8% had fetal growth restriction, while 20% did not have either. Of the low birth weight neonates who were small for gestational age, 18 did not have fetal growth restriction, indicating 29.5% of low birth weight neonates were constitutionally small. Female sex of the baby, low paternal education level, and pregnancy induced hypertension in the mother were significant independent risk factors for low birth weight. Low birth weight and fetal growth restriction were associated with a higher incidence of intensive care admissions, neonatal sepsis, and neonatal jaundice. The prevalence of low birth weight, small for gestational age, and fetal growth restriction in term neonates was 14.0%, 15.1% and 14.9%, respectively. Among low birth weight neonates, one-fifth had neither small for gestational age nor fetal growth restriction; therefore, healthy. An additional 30% of low birth weight babies did not have fetal growth restriction, indicating they are constitutionally small. Neonatal complications were associated more with low birth weight and fetal growth restriction than with small for gestational age.

Rationale and Major Conclusions Splenectomy is a conventional surgical intervention in transfusion-dependent beta thalassaemia (TDT) to manage symptomatic hypersplenism and reduce annual blood transfusion requirements. While the procedure successfully reduces the immediate volume of required transfusions, it fundamentally alters the ferrokinetic profile of the patient by removing a secondary storage reservoir for iron. Our study demonstrates that despite lower transfusion requirements, splenectomy is independently associated with a significant and clinically relevant increase in liver stiffness measurements (LSM), suggesting that the loss of the splenic "iron buffer" may accelerate hepatic fibrogenesis. These findings highlight a critical need for clinicians to prioritize medical management of hypersplenism over surgical intervention when possible and to implement rigorous hepatic monitoring for those who have already undergone the procedure.

Abstract Background Chronic kidney disease represents a significant public health burden in Sri Lanka, where the majority of patients with end-stage renal disease rely on haemodialysis as their primary renal replacement therapy. Most patients receive haemodialysis through arteriovenous fistulas (AVFs), which constitute the preferred vascular access modality. This study investigates the associations between flow dynamics and morphometric parameters of arteriovenous fistulas with dialysis adequacy, as measured by Kt/V ratios. Methods We conducted an analytical cross-sectional study from December 2024 to June 2025, recruiting patients undergoing regular long-term haemodialysis via AVF at dialysis units in Colombo North Teaching Hospital, Ragama, and Divisional Hospital Kandana, Sri Lanka. Access dimensions and peak systolic velocity (PSV) were measured using duplex ultrasonography. Patient demographics and clinical data were collected through structured interviews and medical record review, while dialysis parameters were obtained directly from dialysis machine monitors. Results Seventy-seven patients were enrolled, with 62.3% (n = 48) being male and a mean age of 55.97 years (SD 10.47). The mean PSV was 59.48 cm/s (SD 24.11). Adequate dialysis (Kt/V ≥ 1.2) was achieved in 76.6% (n = 59) of patients, with a population mean Kt/V of 1.51 (SD 0.46). PSV was significantly higher in patients achieving adequate dialysis (p = 0.008). Both linear and logistic regression models demonstrated significant associations between PSV and dialysis adequacy (p = 0.022 and p = 0.038, respectively). Receiver operating characteristic (ROC) analysis identified a PSV threshold of 72.5 cm/s, demonstrating high specificity (94.4%) but limited sensitivity (41%). Conclusion Haemodialysis adequacy, as measured by Kt/V, demonstrates a strong association with peak systolic velocity, suggesting PSV's potential utility as a surrogate indicator for dialysis effectiveness. The optimal PSV threshold for predicting adequate dialysis is 72.5 cm/s.

Delivery at 'term' is considered low risk for mothers and neonates. Evidence suggests variable outcomes at different gestations, even within 'term'. This study aims to compare pregnancy characteristics and neonatal outcomes of delivery at different gestations at 'term'. We analysed the data of the island-wide multicentre Sri Lanka Birth Weight Study, which recruited all live-born newborns in 13 hospitals over 2 months in 2023. Only data of singleton pregnancies and term neonates were included. Pregnancy complications and neonatal outcomes of each gestation were analysed by logistic regression. 8053 'term' singleton deliveries (1805, 2367, 2087, 1762, and 32 at 37, 38, 39, 40 and 41 weeks) were included. A higher proportion of mothers delivering at 37 weeks had pregestational diabetes (AOR: 7.84, 95% CI: 4.24-14.37), chronic hypertension (AOR: 4.37, 95% CI: 2.01-9.49), pregnancy-induced hypertension (AOR: 2.65, 95% CI: 1.92-3.66) and gestational diabetes (AOR: 1.96, 95% CI: 1.57-2.44) compared to mothers delivering at 39 weeks. The elective caesarean section rate was highest at 37 weeks (783, 43.4%) compared to 38 weeks (737, 31.1%) or higher gestations. Delivery at 37 weeks was associated with inferior neonatal outcomes of 5-min APGAR <8 (AOR: 3.04, 95% CI: 1.36-6.76), requiring resuscitation (AOR: 1.74, 95% CI: 1.27-2.38) and admission to intensive care (AOR: 1.62, 95% CI: 1.09-2.41) compared to 38 weeks. Neonates born at 38 weeks showed better outcomes than those born at 37 weeks. When elective delivery is necessary, postponing it from 37 weeks to at least 38 weeks would positively impact neonatal outcomes. UNICEF, Sri Lanka, funded the Sri Lanka Birth Weight Study. No funding obtained for this manuscript.

Erythropoietin is a hormone that stimulates erythropoiesis. The role of erythropoietin in the pathophysiology of HbE β-thalassaemia, a subtype of thalassaemia, is understudied. Here, we aim to evaluate the determinants and associations of erythropoietin in HbE β-thalassaemia patients. We conducted a cross-sectional study in Thalassaemia Centres of Colombo North Teaching Hospital, Sri Lanka, from September to December 2024. All patients with HbE β-thalassaemia were recruited. Clinical details were collected using an interviewer schedule. Haemoglobin, ferritin and erythropoietin were measured using standard laboratory methods. Serum samples of non-thalassaemia healthy volunteers were used as controls for erythropoietin measurements. Fifty-two patients (male-42.3%; mean age 24.5 ± 13.4 years) were recruited. The mean erythropoietin of HbE β-thalassaemia patients [137 (± 127) mIU/mL] was significantly higher than that of controls [21.2 (± SD16.3) mIU/mL, p < 0.001]. Among HbE β-thalassaemia patients, erythropoietin showed a gradual and significant decline with age (r = − 0.34, p < 0.05) irrespective of the haemoglobin level. Patients who underwent splenectomy had a significantly lower median erythropoietin level compared to those who did not (40 vs. 129 mIU/mL, p < 0.001). Patients with haemolysis and anaemia-related complications, especially gallstones, had significantly lower median erythropoietin level compared to those without (69.2 vs. 125.9 mIU/mL, p = 0.039). Erythropoietin response in HbE β-thalassaemia decreased gradually with age, irrespective of the degree of anaemia. Splenectomised patients had significantly lower erythropoietin levels compared to non-splenectomised patients. Lower erythropoietin level, which could be due to age-related decline or splenectomy, was positively associated with a high prevalence of haemolysis and anaemia-related complications.

SummaryBackgroundProgress in reducing morbidity and mortality due to neonatal sepsis has slowed in recent decades and is threatened by the global rise of antimicrobial resistance. The populous Southeast Asian region has a high burden of both neonatal sepsis and antimicrobial resistance (AMR). Despite this, there remains a lack of robust data on the epidemiology of neonatal sepsis and the prevalence of AMR within the region.MethodsWe evaluated positive blood cultures and susceptibility profiles responsible for neonatal sepsis across 10 clinical sites in five countries in South and Southeast Asia (Sri Lanka, Indonesia, The Philippines, Malaysia, and Vietnam). Retrospective data on all blood cultures collected from neonates over two years (1st January 2019–31st December 2020) were extracted from laboratory records. Data were also collected on the availability and implementation of infection prevention and control resources, and antimicrobial prescribing practices. Pooled estimates across sites and pathogens were generated, with adjustment for clustering.FindingsOf 14,804 blood cultures collected over the study period, a total of 2131 positive isolates (including 1483 significant pathogens) were identified. Gram-negative bacteria predominated as causative of neonatal sepsis (78·4%; 1163/1483) with Klebsiella spp. (408/1483; 27·5%) and Acinetobacter spp. (261/1483; 17·6%) most frequently isolated overall. Adjusted pooled non-susceptibility for Klebsiella spp. was 86·7% (95% CI 54·0–98·5) for third-generation cephalosporins (ceftriaxone and/or cefotaxime; 3GC) and 17·1% (95% CI 8·1–24·7) for carbapenems; while non-susceptibility for Escherichia coli was 46·4% (95% CI 20·0–72·0) for 3GC and 15·4% (95% CI 2·7–31·0) for carbapenems. Carbapenem non-susceptibility for Acinetobacter spp. was 76·5% (95% CI 59·4–84·5). Gram-positive bacteria accounted for 13·2% (196/1483) of pathogens causative of neonatal sepsis, whilst Candida spp. accounted for 8·3% (123/1483) of culture-positive sepsis episodes.InterpretationNeonatal sepsis in tertiary hospitals in Southeast Asia is predominantly caused by gram-negative bacteria, with high rates of non-susceptibility to commonly prescribed antibiotics.FundingThis study was supported by an 10.13039/501100000925Australian National Health and Medical Research Council (NHMRC) grant. The NHMRC was not involved in the design or conduct of the research.

Abstract Background: In South Asia, dengue led to substantial morbidity, mortality, and health system strain. Timely detection of outbreaks is crucial. We evaluated the utility of ProMED-mail in providing early warnings of dengue outbreaks across five South Asian countries. Methods: ProMED-mail reports (January 1, 2024-January 31, 2025) published as outbreak alerts, situation updates, or mortality events were reviewed for Bangladesh, India, Nepal, Pakistan, and Sri Lanka. National dengue trends from ministries of health and WHO-SEAR were analyzed by epidemiological week/month to identify outbreak onset, using a trend-based definition. Lead time was defined as time between the first ProMED-mail alert to estimated national outbreak start. Sensitivity analysis was performed by adjusting the outbreak start time by ±1 week. The median and interquartile range (IQR) of lead times was calculated to assess variability. Findings: 34/150 ProMED-mail reports were outbreak alerts. Calculated lead times ranged –8.6 weeks (Pakistan) to +5 weeks (Bangladesh and Event 2 Sri Lanka), and median (IQR) lead time 4.15(2-5) weeks. ProMED issued early alerts; Bangladesh (+5 weeks), India (+4 weeks), Nepal (~4.3 weeks), and Sri Lanka’s October case rise (+5 weeks). In Pakistan, ProMED identified the outbreak in the absence of publicly available surveillance data. Sensitivity analysis yielded median (IQR) lead times of 3.15(1-4) weeks and 5.15(3-6) weeks when outbreak onset was adjusted by –1 and +1 week, respectively. Conclusion: ProMED-mail provided meaningful lead time in detecting dengue outbreaks in South Asia, supporting its role as an effective early warning system and may facilitate enhance epidemic preparedness in resource-limited settings.

Background Chronic kidney disease (CKD) is increasingly recognized as a global public health concern, impacting about 700 million people worldwide. Due to the presence of both pro- and anti-apoptotic properties, tumor necrosis factor (TNF)- related apoptosis-inducing ligand (TRAIL) can be a double-edged sword in the pathogenesis and progression of CKD. Systematic mapping of the available evidence is pivotal in identifying the exact role of TRAIL in CKD. Therefore, this protocol explains the methodological approach for a scoping review to map evidence regarding the role of TRAIL and its receptors in CKD. Methods The proposed scoping review will be conducted in line with Arksey and O’Malley’s methodological framework and the Joanna Briggs Institute (JBI) reviewer’s manual. Accordingly, the review will be guided by the five-stage approach, namely (1) identify the research question; (2) identify relevant studies; (3) select studies; (4) chart the data; and (5) collate, summarize, and report the results. Eligibility criteria and search strategy will be formulated based on population, concept, and context (PCC) strategy. Articles published up to July 2025 will be searched using electronic databases, PubMed/ MEDLINE, Science Direct, Scopus, CINAHL, and Cochrane Library, while considering the Google Scholar reference lists of review articles as grey literature sources. A formal quality appraisal of the selected studies will be conducted using the mixed-method appraisal tool (MMAT version 2018). The reporting will be done following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for the Scoping Reviews checklist. The literature search is expected to commence after the protocol acceptance process, followed by study selection and data extraction by November 2025. Data synthesis will be completed by February 2026. Scoping review registration The review protocol is registered at Open Science Framework (OSF) under https://doi.org/10.17605/OSF.IO/AENBX.

No abstract available

Abstract Introduction &amp; Objectives The COVID-19 pandemic has claimed over 6.8 million lives globally, with varying impacts across different healthcare systems. Sri Lanka reported 591 and 15,800 deaths during the Second and Third Waves, respectively. This study investigates COVID-19 mortality patterns at a major tertiary care hospital in Sri Lanka during the pandemic, providing crucial insights for resource-limited settings. Methods This descriptive cross-sectional study evaluated COVID-19 deaths at Colombo North Teaching Hospital, Ragama, Sri Lanka from November 2020 to December 2021. Data were sourced from hospital records, supplemented by telephone interviews with family members for missing information, following informed consent. Statistical analyses included Mann-Whitney U tests and Pearson's Chi-squared tests for group comparisons. Results The hospital mortality rate was 14.9% among 8,531 COVID-positive admissions. Among 1,004 recorded deaths, the median age was 72 years (IQR: 62–79, range: 19–99), with males constituting 57.2% of the cohort. Diabetes (61.6%), hypertension (36.9%), and coronary artery disease (14%) were the predominant comorbidities, with 37.2% having multiple comorbidities. COVID-19 pneumonia was the primary cause of death (83%). A majority (78.3%) of the deceased were unvaccinated, while 21.7% had received at least one vaccine dose. Unvaccinated individuals were older, had longer hospital stays, and exhibited more severe symptoms compared to their vaccinated counterparts. Conclusions The high prevalence of diabetes and hypertension among COVID-19 deaths mirrors patterns seen across South Asia, emphasizing the need for integrated management of non-communicable diseases during infectious disease outbreaks. The lower proportion of vaccinated individuals among the deceased suggests vaccine effectiveness, reinforcing the importance of prioritizing high-risk populations in vaccination campaigns. These findings provide guidance for strengthening pandemic preparedness in resource-constrained settings, with potential applications across similar healthcare systems globally.