Teaching Hospital Batticaloa

Soluble transferrin receptor (sTfR), a cleaved form of transferrin receptor 1 (TfR),serves as a marker of cellular iron demand and is largely unaffected by inflammatory responses. This makes it a potentially reliable indicator of iron status, even in the context of inflammation. Human soluble transferrin receptor (sTfR) concentrations were measured by ELISA in a group of 40 pregnant women with gestational diabetes mellitus (GDM) and a comparison group of 40 pregnant women without GDM. Iron-related parameters were also assessed in both groups using the Cobas Integra 400 Plus systems. Women with GDM exhibited significantly elevated sTfR levels compared to the control group. Ferritin levels were also increased among those with GDM. The results demonstrate elevated sTfR levels in pregnant women with GDM compared to those without the condition. Moreover, a positive association was identified between sTfR ferritin, and hepcidin levels. Elevated ferritin was also positively linked to increased GDM risk Highlights: Pregnant women with gestational diabetes showed significantly higher serum sTfR levels compared to controls. Ferritin levels were markedly elevated in the GDM group, while serum iron and TIBC showed no significant differences. sTfR demonstrated limited diagnostic accuracy for GDM, with only 55% sensitivity and 43% specificity.

The COVID-19 pandemic required an efficient uplift of health professional competencies. Accordingly, the Sri Lankan Ministry of Health implemented novel online training for 50 hospitals in COVID-19 management. This study aimed to evaluate the impact of these online training programs to enable refinements for future implementation. Cluster sampling selected seven hospitals for the descriptive cross-sectional study. An interviewer-administered questionnaire was provided to 840 randomly selected health staff who participated in the training programs, and 637 responded. The most useful, satisfied, and effective training was ‘Use of Personal Protective Equipment’. The highest-ranked advantages of online training were time and cost savings, while more interaction and effectiveness were for face-to-face training. Most participants (>75%) preferred online training during the pandemic, but approximately 33% preferred face-to-face training under normal conditions. Hospital, age, gender, staff, educational, and healthcare experience categories were significantly associated with the perceived effectiveness and preference for online training versus face-to-face training in different circumstances. While these novel online training programs were considered effective and preferred during the pandemic, future utilization for professional development programs in non-pandemic environments needs to account for health professional preferences varying with contextual factors, integration with strategies for interaction, and provision of required resources.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease presenting a variable clinical course ranging from mild to severe multiorgan dysfunction. While the exact etiology of SLE remains elusive, genetic and environmental factors are known to play crucial roles in its pathogenesis. Similarly, tuberous sclerosis complex (TSC) is a multisystem autosomal dominant genetic condition that manifests as benign hamartomatous proliferation in various organs. We present the case of a 46-year-old woman diagnosed with SLE who exhibited clinical features of TSC two decades after the initial diagnosis of SLE. The definitive diagnosis of TSC was made based on major clinical criteria, including facial angiofibroma and bilateral renal angiomyolipomas. As the patient remained asymptomatic without neurological complications, specific treatment for TSC was not initiated. The coexistence of SLE and TSC is exceedingly rare and has been scarcely reported in medical literature.

In contemporary times, nations like Sri Lanka are actively enhancing their efforts to improve the life expectancy of their citizens, with a strong focus on public health. The relationship between health and life expectancy is pivotal. Poor health conditions tend to diminish life expectancy, while robust health measures tend to extend it. Within the context of health, birth and death events are of paramount importance. Birth represents the genesis of life, enabling individuals to contribute to future generations and the overall population's expansion. It's the cornerstone of life on our planet. However, modern times have witnessed challenges in pregnancy and childbirth, with some infants not surviving the prenatal period or being born with health complications. Consequently, there is a pressing need to present a solution that can contribute to the betterment of maternal and infant health, ultimately augmenting Sri Lanka's life expectancy. The proposed solution is the development of a mobile application, encompassing features such as a Nutrition Predictor, Medicine Effect Predictor, AI chatbot, and Baby Status Predictor. This innovative application aims to address the complex issues surrounding pregnancy and childbirth, with the overarching goal of improving the nation's life expectancy.

Glycogenic hepatopathy (GH) is a rare condition that can occur in individuals with poorly controlled diabetes mellitus, particularly in those with type 1 diabetes mellitus(T1DM). This condition is characterised by hepatomegaly and elevated liver enzymes. GH is associated with the accumulation of glycogen in the liver, which is a result of uncontrolled hyperglycemia and excessive glycogen storage in liver cells. We present a case of a 15-year-old boy who has been diagnosed with T1DM at the age of 8 and has experienced recurrent episodes of diabetic ketoacidosis (DKA). In this specific instance, he was admitted for treatment of DKA and was also diagnosed with GH.

Background: The COVID-19 infection was rapidly spreading almost all over the world, and the first case was confirmed on 27th January 2020 by a foreign tourist in Sri Lanka. The first Sri Lankan citizen with COVID-19 was confirmed on 11th March 2020. Soon after the confirmation of the disease, long days of lockdown were imposed in almost all parts of the world, including Sri Lanka, to control the spread of the disease. Objectives: To determine the demographic characteristics such as age, sex, number of patients, and disease pattern among non-COVID-19 patients admitted to the medical units during the lockdown of the COVID-19 pandemic and to compare these characteristics with the data before the lockdown.Methods: This was a cross-sectional analytical study. It was conducted at the Teaching Hospital in Batticaloa, Sri Lanka. All the non-COVID-19 patients admitted to medical wards and intensive care units (ICU) were included in this study. Patients admitted to the medical intensive care unit (MICU) and coronary care unit (CCU) were considered ICU admissions in this study. They were studied over a period of one month during lockdown (11th March 2020 to 10th April 2020) and compared with the patients admitted one month prior to the lockdown (11th February 2020 to 10th March 2020).Results: Totally, 2340 non-COVID-19 patients (52.5% males) were admitted before the lockdown, and 1376 non-COVID-19 patients (56.2% males) were admitted during the lockdown. This reduction in admission is statistically significant (p-value is <0.001, df=3715). Patients admitted to the wards before lockdown were 2283 (97.6%) and during lockdown were 1309 (95.1%). ICU admissions were N=57 (2.4%) before lockdown and N=67 (4.9%) during lockdown. The common age distribution before the lockdown showed that 26.4% were 31-50 and 41.5% were 51-70 years. Similarly, during lockdown, the age distribution disclosed that 28.9% were 31-50 years and 42.9% were 51-70 years. The disease pattern demonstrated that before lockdown, the majority of patients were admitted for routine hemodialysis (13.2%), to get an injection (9.9%), ischemic heart disease (8.4%), chronic kidney disease (7.3%), and viral fever, including dengue (7.2%). Likewise, during lockdown, more patients were admitted for routine hemodialysis (10.7%), viral fever, including dengue (9.3%), ischemic heart disease (8.8%), to get an injection (8.5%), and chronic kidney disease (5.9%). Conclusion: There was a significant reduction in the number of non-COVID-19-related admissions during the period of lockdown. However, there was not much difference in the proportion of admissions according to gender, age, and disease pattern before and during lockdown. More number of male patients were admitted than female patients. Most of the admitted patients were under the age group of 51-70 years. The highest number of patients were admitted for routine hemodialysis before and during lockdown. However, a slightly higher number of patients were admitted to the ICU during lockdown. Therefore, strengthening the ICU facilities may be an important preparation to accommodate more patients in the future if a similar kind of emergency lockdown occurs in a pandemic situation. In addition, admissions due to non-communicable diseases (NCD) didn't fall in proportion during the pre-COVID-19 period and the lockdown period. Therefore, the redistribution of healthcare facilities needs to be done wisely to face the challenges caused by the NCDs.

Ornithine transcarbamylase deficiency (OTCD) is the most common inherited disorder of the urea cycle and, in general, is transmitted as an X-linked recessive trait. Defects in the OTC gene cause an impairment in ureagenesis, resulting in hyperammonemia, which is a direct cause of brain damage and death. Patients with late-onset OTCD can develop symptoms from infancy to later childhood, adolescence or adulthood. Clinical manifestations of adults with OTCD vary in acuity. Clinical symptoms can be aggravated by metabolic stressors or the presence of a catabolic state, or due to increased demands upon the urea. A prompt diagnosis and relevant biochemical and genetic investigations allow the rapid introduction of the right treatment and prevent long-term complications and mortality. This narrative review outlines challenges in diagnosing and managing patients with late-onset OTCD.

Here, we present a case of a 55-year-old male, who was admitted with a spider bite, which caused swelling of the hand and painful muscle spasms along with palpitations. The patient made a complete recovery after the administration of intravenous calcium gluconate, followed by oral calcium supplements. Although no specific treatment exists in Sri Lanka for spider bites, calcium supplements can be beneficial for Sri Lankan ornamental tarantula (Poecilotheria fasciata) bites.

AimsHuman scabies is a common contagious infestation in the developing world that is predominantly related to poverty and overcrowding. This study aimed to assess the clinical–demographic profile and quality of life in patients presenting with scabies to a tertiary care hospital in eastern Sri Lanka.MethodsA prospective observational cross-sectional study was conducted at the Teaching Hospital in Batticaloa over a period of one year (August 2020-August 2021). The study included all children diagnosed to have scabies. The data included demographic information, clinical features, treatment modalities on presentation, and quality of life in children and their parents. All data were collected by trained medical graduates using a pre-tested interviewer-administered, structured questionnaire. The data were analysed in SPSS 19.0.ResultsOut of 153 patients, 62.7% were females. The most commonly affected age group was the under ones (51%) followed by 1-3 years (38.5%). The majority of patients were from rural areas (66.7%) with the highest numbers from Eravur (29.4%). Around 51.6% of families had an income of less than 50,000 Sri Lankan rupees (51.6%). The majority had received high secondary education (51%). The complaints which brought them to the hospital included skin lesions (100%), itchiness (64%), sleep disturbances (68%), not responding to prior treatment (58.2%), and night-time aggravation (68.6%). The most affected sites were hands and feet (44%) and whole-body (33%). The most common lesions were papules (96%) and excoriation (34%). 16% had a past history of scabies whilst 51% had a recent contact history. On presentation, 46% were diagnosed with scabies whilst the rest were diagnosed as either having allergy (22.9%) or were undiagnosed (31.4%). The majority (68.6%) were prescribed topical applications whilst 47.7% were prescribed oral medications without success. The biggest risk factor was overcrowding (47%). Secondary bacterial infection was the most noted complication (34%). Quality of life was adversely affected in 48% of parents.ConclusionScabies is an important health problem in Eastern Sri Lanka and affects the quality of life of both children and their families. Increased awareness among health professionals facilitates early diagnosis and treatment.

Multisystem inflammatory syndrome in children (MIS-C) has become a serious disease entity following the high prevalence of coronavirus disease 2019 (COVID-19) infection with the involvement of gastrointestinal organs, kidneys, heart, and lungs. When the patient presents with mucocutaneous findings such as conjunctival injection, red lips, neurocognitive symptoms, swollen hands and lymphadenopathy, it is always highly recommended to exclude multisystem inflammatory syndrome. As it affects multiple organs, it can result in more serious consequences. The manifestations depend largely on the organ involved. Therefore, successful management partly depends on the early diagnosis. Many treatment strategies have been put forth to tackle the disorder so far.