Jaffna Teaching Hospital

Stem cells, due to their unique capacities for self-renewal and differentiation, represented a highlypromising therapeutic strategy for a range of currently incurable diseases. This systematic review andmeta-analysis aimed to assess the clinical efficacy of stem cell interventions acrossneurodegenerative, cardiovascular, diabetic, and hematological disorders. A comprehensive literaturesearch of PubMed, Embase, Web of Science, and CENTRAL databases was conducted, covering theperiod from January 1995 to July 2025. A total of seventy studies were included in the qualitativesynthesis, of which forty-five studies were incorporated into the quantitative meta-analysis. Thepooled results demonstrated that stem cell therapy significantly improved functional outcomes inpatients with neurodegenerative disorders, enhanced cardiac performance in cardiovascular disease,promoted glycemic control in diabetic patients, and facilitated hematopoietic recovery inhematological conditions. Effect sizes ranged from moderate to large, indicating clinically meaningfulbenefits. Mechanistic analyses suggested that the therapeutic effects were mediated through multiplepathways, including differentiation into target cell types, paracrine signaling that modulated the localmicroenvironment, immunomodulatory actions that reduced inflammation, and stimulation ofangiogenesis that improved tissue perfusion. Despite these encouraging findings, several challengeswere identified. Heterogeneity in study protocols, including variations in stem cell type, source, dose,and delivery route, contributed to inconsistent outcomes. Potential risks such as tumorigenicity—especially with embryonic stem cells and induced pluripotent stem cells—and immune rejection wererecognized as significant safety concerns. Additionally, most studies had limited follow-up durations,restricting the evaluation of long-term efficacy and safety. Addressing these limitations throughstandardized protocols, large multicenter randomized trials, and extended follow-up was deemedessential. Collectively, the evidence supported the therapeutic potential of stem cell interventionswhile emphasizing the need for further research.

Chronic leg ulcers are one of the clinical manifestations of untreated traumatic arteriovenous fistula (AVF). Ulcers due to secondary venous etiology like AVF are rare and easily missed. We present the case of a 31-year-old male who sustained a gunshot injury to the knee 12years ago. Despite the absence of varicose veins, he presented with a neglected venous ulcer persisting for 2years. A computed tomographic venogram revealed an AVF in the supra-genicular popliteal artery and vein. The patient subsequently underwent open surgical correction. Complete ulcer healing was achieved in 6months. This case underscores the potential for a high-flow post-traumatic AVF to induce a non-healing venous ulcer even in the absence of apparent varicose veins. Secondary causes of chronic venous diseases are often overlooked, leading to complications. Early recognition is crucial to preventing further morbidity.

Endoscopic retrograde cholangiopancreatography (ERCP) is invasive for pancreaticobiliary diseases. Perforation is a rare but severe complication among its associated risks. A 45-year-old female with biliary colic and multiple gallbladder calculi was diagnosed with choledocholithiasis based on imaging showing CBD dilation and gallstones. ERCP was planned for stone removal. Sphincterotomy was performed, but stone retrieval attempts failed, leading to severe pneumo-peritoneum and respiratory compromise. Immediate CBD stenting was done, avoiding surgical intervention. The patient recovered uneventfully, later undergoing laparoscopic cholecystectomy with CBD exploration and stone removal. ERCP-related perforations, rare but severe, involve retroperitoneal air collection. Clinical signs include abdominal discomfort, and imaging confirms diagnosis. Management varies by type, with some requiring surgical repair. Conservative management sufficed in this case, with successful patient recovery. ERCP-related complications like pneumo-peritoneum require prompt diagnosis and conservative management if no perforation is evident.

Although fungal infections are common in clinical practice, usually they are superficial and invasive infections are very rare among immunocompetent people. Invasive fungal infections in immunocompromised people are life threatening if left untreated. Among invasive fungal infections, mucormycosis is uncommon. Pulmonary mucormycosis is rarely seen in clinical practice and is often life-threatening. This case report describes a patient with poorly controlled diabetes who presented with pulmonary mucormycosis and responded well to systemic antifungals.

Introduction: Breast cancer is the commonest cancer among females in Sri Lanka. The markers that define the treatment recommendations are Estrogen receptors (ER) status, Progesterone receptor (PR) status, HER-2 neu and Ki-67 proliferative index. Methodology: This is a retrospective study performed on the pathological specimens of invasive ductal carcinoma at Teaching Hospital Jaffna from January 2020 to July 2022. Ki-67 index above 20 was considered high and below 20 as low. The correlation between Ki-67 and other prognostic markers was analyzed as categorical variables using chi-square test. Results: 143 specimens were analyzed, of which 101 were core biopsies and 42 were mastectomy/ WLE specimens. ER, PR and HER2/neu positivity were noted in 100 (69.9%), 85 (59.4%) and 41(28.7%) cases, respectively. Nottingham tumour grade 1,2 and 3 was noted in 16 (11.2%), 74 (51.7%) and 38 (26.6%) cases, respectively. The mean Ki-67 index was 40.21 %. High Ki-67 index was noted in 107(74.8%) and low in 36(25.2%) cases. A significant correlation was noted between ER, PR positivity and Ki-67 index (p=0.02, 0.01). The correlation between HER2/neu positivity and Ki-67 was insignificant (p=0.06). A significant correlation was found between the Ki-67 index and tumour grade (p=0.01). Conclusion: This study showed that high Ki-67 expression is associated with high tumour grade, ER/PR positivity and HER2/neu negativity. Varying results with the published literature reveal geographical variations and warrant large-scale analysis with a bigger sample size.

Background: The painDETECT questionnaire (PDQ) is a useful tool for screening of patients with neuropathic pain. This study aimed to translate the PDQ into the Malay language (PDQ-M) and to achieve cross-cultural adaptation of the questionnaire for use in Malaysia. Methods: The translation and cultural adaptation process of the English version of PDQ was performed based on international guidelines. Subsequently, 97 patients with neuropathic and nociceptive pain based on clinician’s diagnoses were recruited to complete three-type numeric rating scale (NRS) of pain followed by PDQ-M. Results: On the basis of cognitive debriefing, several changes of the translated PDQ-M were made. A total of 53 patients with neuropathic pain and 44 with nociceptive pain (54.6% females, 45.4% males, mean age 52.4 years ± 14.2) were recruited into this study. The most common class of analgesia prescribed for patients with neuropathic pain was anti-convulsant, whereas co-analgesic therapy, which includes NSAID and COX-2 inhibitor, was the most prescribed for patients with nociceptive pain. Combination analgesia was used in 32.1% of those with neuropathic pain, and 11.4% of patients with nociceptive pain. The median time taken for respondents to complete the questionnaire was 420 seconds. In regression analysis, active smoking (beta 0.586, p<0.001) and female gender (beta -0.422, p=0.008) were associated with higher PDQ-M scores only among those with neuropathic pain. Conclusions: The Malay version of the painDETECT questionnaire was translated and cross-culturally adapted for ease of understanding among the local population via careful face-to-face interview.

Abamectin is a commonly used insecticide and anthelmintic. Human intoxication is uncommon but potentially fatal. We present the case of a 50-year-old man who developed hypotension, respiratory paralysis with aspiration, and myoclonus following self-ingestion of abamectin under alcohol influence. With supportive treatment, he completely recovered.