Durdans Hospital

IntroductionBone Mineral Density (BMD) is a critical determinant of osteoporosis diagnosis and fracture risk. Absence of normative BMD data for Sri Lankans has necessitated reliance on Caucasian references, potentially misestimating the BMD. This study aimed to establish age-related BMD trends for optimal bone health management.MethodsA retrospective correlational analysis was conducted on 10,946 adults (4,005 men, 6,941 women; 21–80 years) who underwent lumbar spine and hip scans using Hologic Dual Energy X-ray absorptiometry at five private health institutions in Western Province. Individuals with medical conditions or treatments known to affect bone metabolism were excluded.ResultsBMD values showed strong positive correlations across lumbar spine and hips (r = 0.61 - 0.94, p < 0.001) with negligible bias between hips (mean difference ≈ 0.003 g/cm2). Minor right - left hip differences appeared only in 21– 30 age group (p < 0.05). Males had consistently higher BMD than females. In females, lumbar BMD peaked at 31–40 years (0.980 g/cm2) and declined thereafter (F = 279.76, p < 0.001; η² = 0.156); hip BMD peaked at 41–50 years (~0.95 g/cm2) and declined after 50 years (~0.04–0.06 g/cm2 /decade). In males, lumbar BMD peaked at 31–40 years (0.997 g/cm2) with modest decline (F = 4.73, p < 0.001; η² = 0.006), while hip BMD remained stable until 60, then decreased (~0.03 g/cm2 /decade). Contralateral hip BMD showed strong symmetry, supporting the reliability of single-hip measurements in clinical practice. Higher body mass index was positively associated with BMD in both sexes, particularly in women. Years since menopause accounted for a substantial portion of variance (15%-19%) in BMD, with trabecular-rich lumbar spine exhibiting faster early loss compared to cortical-rich hips, which declined more gradually in later decades. Compared with Caucasian reference data, Sri Lankan participants displayed consistently lower BMD, with the greatest deficits observed in postmenopausal women (up to 15% lower), highlighting the need for population-specific reference ranges.DiscussionThese findings demonstrate the need for population-specific BMD reference values to improve diagnostic accuracy and guide clinical management of osteoporosis and osteopenia, particularly in postmenopausal women and older adults.

HFpEF accounts for 12-25% of heart failure cases in South Asia, primarily driven by hypertension, diabetes, and obesity. Late diagnosis and healthcare disparities worsen outcomes. This expert consensus aims to provide region-specific guidelines for the diagnosis, management, and prevention of HFpEF. A modified Delphi process with experts from five South Asian countries was conducted, informed by a literature review (2018-2024) and adapted international guidelines. Recommendations include the use of an adjusted H2FPEF score (BMI > 25 kg/m²), essential echocardiographic criteria (E/e' > 9, LAVi > 34 mL/m²) for diagnosis, and SGLT2 inhibitors as first-line pharmacotherapy, with finerenone for cardio-renal protection. Emphasis on lifestyle modification, patient education, and aggressive management of comorbidities is highlighted to reduce hospitalizations. HFpEF presents earlier and is associated with higher comorbidity in South Asia. Adaptations such as lower BMI thresholds and region-specific screening are critical. Cost and accessibility challenges persist in the use of SGLT2 inhibitors and finerenone. Public health measures and infrastructure strengthening are necessary to improve outcomes. Early diagnosis, multidisciplinary management, and tailored treatment strategies can enhance outcomes in HFpEF in South Asia. This consensus serves as a call for regionally focused implementation to reduce the burden of HFpEF.

Abstract Background Vancomycin and linezolid are critical agents in the treatment of multidrug-resistant gram-positive infections, including MRSA and VRE. Despite their effectiveness, both drugs have been associated with distinct adverse event (AE) profiles. This study aimed to compare the post-marketing safety signals of vancomycin and linezolid using real-world data from the U.S. FDA Adverse Event Reporting System (AERS/FAERS).Forest Plot: Adverse Events of Vancomycin vs. Linezolid (FAERS 2010–2023)This forest plot presents the Reporting Odds Ratios (RORs) and 95% confidence intervals for selected adverse events associated with vancomycin and linezolid. Vancomycin showed strong associations with acute kidney injury and Red Man Syndrome, while linezolid demonstrated higher risks for thrombocytopenia, lactic acidosis, peripheral neuropathy, and optic neuropathy. These real-world findings support tailored risk assessment in antibiotic selection and monitoring. Methods A retrospective disproportionality analysis was conducted using FAERS data from January 2010 to December 2023. Reports that listed vancomycin or linezolid as the primary suspect drug were included. Adverse events were grouped according to MedDRA System Organ Classes (SOCs) and high-level terms such as nephrotoxicity, thrombocytopenia, lactic acidosis, peripheral neuropathy, and optic neuropathy. Reporting Odds Ratios (RORs) with 95% confidence intervals (CIs) were calculated. A signal was considered significant if the lower bound of the 95% CI was &amp;gt;1 with ≥3 reports. Results A total of 19,276 AE reports were included (vancomycin: 11,421; linezolid: 7,855). Vancomycin showed a strong signal for acute kidney injury (ROR: 3.89, 95% CI: 3.42–4.37), and infusion-related reactions including Red Man Syndrome (ROR: 4.14, 95% CI: 3.63–4.72). In contrast, linezolid exhibited higher signals for thrombocytopenia (ROR: 5.28, 95% CI: 4.62–6.03), lactic acidosis (ROR: 4.02), peripheral neuropathy (ROR: 3.67), and optic neuropathy (ROR: 2.89). Mortality was reported in 7.8% of linezolid-associated reports and 6.1% of vancomycin reports. Conclusion This FAERS-based analysis reveals distinct and clinically relevant AE profiles for vancomycin and linezolid. Vancomycin is more strongly associated with nephrotoxicity and infusion reactions, whereas linezolid poses a higher risk for hematologic and neurologic toxicity. These findings highlight the importance of individualized risk assessment and monitoring strategies when using these agents in clinical practice. Disclosures All Authors: No reported disclosures

Abstract Background Fluoroquinolones are widely prescribed for respiratory, urinary, and gastrointestinal infections. Despite their clinical utility, emerging evidence has associated them with neuropsychiatric adverse events (AEs), ranging from mild confusion to hallucinations and suicidality. This study aimed to evaluate the signal strength and temporal trends of neuropsychiatric AEs associated with fluoroquinolone use in real-world settings using the U.S. FDA Adverse Event Reporting System (FAERS) database.Forest Plot: Neuropsychiatric Events Linked to Fluoroquinolones (FAERS 2010–2023)This forest plot displays Reporting Odds Ratios (RORs) with 95% confidence intervals for neuropsychiatric adverse events associated with fluoroquinolone use. Strong signals were observed for hallucinations (ROR: 3.12), confusion (ROR: 2.84), and suicidal ideation (ROR: 2.56), emphasizing the need for cautious prescribing in neurologically vulnerable populations. Methods A retrospective pharmacovigilance study was conducted using FAERS reports from January 2010 to December 2023. Reports that identified ciprofloxacin, levofloxacin, moxifloxacin, or ofloxacin as the primary suspect drugs were included. Neuropsychiatric-related Preferred Terms (PTs) were extracted from MedDRA, including insomnia, agitation, anxiety, depression, hallucinations, confusion, and suicidal ideation. Disproportionality analysis using Reporting Odds Ratios (RORs) and 95% confidence intervals (CIs) was performed. A signal was defined as ROR lower CI &amp;gt;1 and ≥3 cases. Year-wise trend analysis was conducted to assess reporting frequency. Results A total of 8,794 neuropsychiatric AE reports were associated with fluoroquinolones. Ciprofloxacin accounted for the highest number (4,235), followed by levofloxacin (2,961) and moxifloxacin (1,126). Strong signals were identified for hallucinations (ROR: 3.12, 95% CI: 2.78–3.50), confusion (ROR: 2.84), and suicidal ideation (ROR: 2.56). Ciprofloxacin and levofloxacin showed the most pronounced associations. Reporting frequency for neuropsychiatric AEs rose markedly between 2016 and 2020, possibly reflecting heightened regulatory warnings and clinical awareness. Conclusion This FAERS-based analysis confirms a consistent safety signal linking fluoroquinolones with serious neuropsychiatric adverse events. The trend suggests increasing awareness but also reinforces the need for careful patient evaluation, particularly among elderly individuals or those with preexisting CNS conditions. Real-world pharmacovigilance data remain vital for guiding antibiotic safety and stewardship. Disclosures All Authors: No reported disclosures

BackgroundAtherosclerotic cardiovascular diseases (ASCVD), including coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral vascular disease (PVD), remain the leading cause of death globally. South Asians exhibit a higher incidence of cardiovascular diseases than other ethnicities, attributed to a range of genetic, environmental, and lifestyle factors. Lipoprotein(a) [Lp(a)] with a unique apolipoprotein(a) component, has emerged as a marker of atherosclerosis and ASCVD risk, with evidence to promote arterial plaque formation and thrombogenesis.ObjectiveThe aim of this study was to explore the associations between Lp(a) levels and the severity of CAD, CVD, and PVD in a group of South Asian patients.MethodsFollowing ethical approval, 60 consecutive patients who underwent coronary angiography for any indication were reviewed. There were 51 eligible participants who were evaluated for Lp(a) level, Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score, and severity of CVD and PVD. The SYNTAX-I score was calculated using two-observer consensus on coronary angiograms. Assessment of CVD was by ultrasound/Doppler, and PVD by estimating ankle-brachial index using Doppler. The multisite arterial disease score 2 (MADS2) and SYNTAX score tertiles were used to group the patients. Statistical analysis was performed using the SPSS software.Results and discussionIn this group, we identified a statistically significant difference with higher Lp(a) levels being associated with more severe coronary disease (SYNTAX tertile 2,3). Despite a numerical trend, statistical significance was not confirmed for Lp(a) levels in relation to MADS2-CVD or MADS2-PVD scores. A larger study may be required to assess these aspects.

This study represents the first national survey conducted in Sri Lanka to establish national diagnostic reference levels (NDRLs) for screening and diagnostic acquisitions in digital mammography (2D-DM) and digital breast tomosynthesis (DBT). Additionally, the study investigated the relationship between average glandular dose (AGD) and compressed breast thickness (CBT) and introduced a novel concept called dose range bands (DRBs) as a tool for optimizing radiation dose in mammography. DICOM metadata was used to extract dose data and exposure parameters from women undergoing either screening (350) or diagnostic (750) DM. The analysis included both craniocaudal and mediolateral oblique views of each breast, acquired using 2D-DM and DBT imaging techniques. The NDRL (AGD per view) was 1.97 mGy and 2.01 mGy for diagnostic DM and DBT, respectively. The corresponding NDRLs for screening acquisition were 2.44 mGy and 2.30 mGy. The mean DBT/DM AGD ratio was 1.39 and 0.97 for diagnostic and screening, respectively. Further, the association between the average glandular AGD per view and CBT is stronger in DBT than in 2D-DM. The study findings highlight the need for standardisation of compression practices, considering factors such as the radiographer’s experience, imaging equipment, breast density, age, breast size, and pain threshold.

PURPOSEThere is a significant disparity in global cancer care and outcome between countries. Progress in the treatment of symptomatic plasma cell myeloma (PCM) in high-income countries is not seen in low- and middle-income countries.MATERIALS AND METHODSThis is was a retrospective cohort study of all patients diagnosed with PCM between May 1, 2013, and September 30, 2021, at the first hemato-oncology center in Sri Lanka. We aimed to provide data on clinicopathologic characteristics, response, and survival estimates.RESULTSA total of 79 patients with PCM received first-line therapy during the study period. The median age was 64 years, and approximately one third (33%) of patients were older than 70 years. There were 42 (53%) males and 37 females. Hypercalcemia, renal impairment, anemia, and bone disease were detected in 36.7%, 38%, 72.1%, and 81%, respectively. Thirty-nine, 34, and six patients received a combination of cyclophosphamide, thalidomide, and dexamethasone; bortezomib, thalidomide, and dexamethasone; and other treatments, respectively. The overall response rate (≥ partial response) was approximately 97% for both cyclophosphamide, thalidomide, and dexamethasone and bortezomib, thalidomide, and dexamethasone. Twenty-three (29%) of these patients died during the study period, but only 14 (18%) died due to PCM or associated sepsis. After a median follow-up of 40.6 months (range, 35.2-59.07 months), the median overall survival was 84.2 months (95% CI, 60.87 to not available). The 5-year estimated overall survival was 65%.CONCLUSIONTo our knowledge, this is the only well-characterized study on long-term survival of patients with PCM in Sri Lanka. We have shown that it is possible to successfully apply Western treatment and supportive care protocols to the local population. These published data will help to benchmark and improve the treatment and develop blood cancer care in the local setting.