Abstract Background Leptospirosis, a spirochaete infection, can lead to Leptospirosis Pulmonary Haemorrhage Syndrome (LPHS), which requires intensive care admission and has a high mortality. Although data on short-term outcomes are available, the long-term respiratory sequelae of LPHS survivors are not known. We aimed to identify the post-discharge pulmonary functions and functional limitations in survivors of LPHS. Methods We conducted a prospective cohort study from January to December 2022 at the Medical Intensive Care Unit (ICU) of the National Hospital of Sri Lanka to assess the sequential changes in the spirometry parameters in patients who survived LPHS. The Forced Vital Capacity (FVC) and Forced Expiratory Volume in 1 s (FEV1) were measured on the day of discharge from the ICU (D0), 7th day after discharge (D7) and 28th day after discharge (D28). The predicted lung volume was calculated using the gender, age and height as per standard protocol. Physical and functional role limitations were assessed on D28 using the modified Medical Outcomes Study Questionnaire Short Form 36 Health Survey (SF-36). Results Twenty-one patients with a mean age of 44 years (SD 16.07) were enrolled for the study. The majority were male patients ( n = 19, 90.5%). Leptospirosis was serologically confirmed in all individuals. Seventeen (81%) patients had reduced FEV1 and FVC on D0, indicating a restrictive lung abnormality. FVC and FEV1 improved during the first 7 days ( p < 0.01) but did not change significantly afterwards. Only seven individuals (33.3%) achieved a normal FVC (exceeding 80% of the predicted volume) at D28. However, 19 (90.5%) individuals achieved a normal FEV1 (exceeding 80% of predicted volume) by D28. In our study, administering corticosteroids during ICU stay did not impact lung recovery in FVC ( p = 0.521) or FEV1 ( p = 0.798). The participants did not have significant physical, functional, and role limitations at D28. Conclusions The spirometry measurements of individuals diagnosed with LPHS significantly improved during the first 7 days. Most survivors did not have a functional impairment despite the FVC not recovering to normal by D28.
Diabetes is a growing epidemic disease in the world and the associated micro and macrovascular complications cause significant morbidity and mortality. We conducted a descriptive cross sectional study to evaluate the adequacy of screening and to identify the factors relating to poor diabetes complication screening in type 2 Diabetes Mellitus (DM) patients during follow ups. We have included patients with type 2 DM, admitted to a medical unit in a tertiary care center. Study was conducted from September 1 to October 31, 2012. The study participants were interviewed using an interviewer administered questionnaire. Patients were examined to assess microvascular complications, macro vascular complications, BMI and blood pressure. All patients had FBS, lipid profile, Urine albumin estimation and renal function testing. Screening performed during their follow up was assessed during the interview. There were 147 patients (81 males and 66 females) with an average age of 58.5 ± 9yrs. There were 97 (65.9%) patients who followed up at National Hospital of Sri Lanka (NHSL). Majority (n=133, 90.5%) were given disease education during follow up. Out of the total, 23(15.6%) were using SMBG while only 69(46.9%) had at least one HbA1c performed in the preceding year. Patients following up at NHSL had lower BMI, better glycaemic control, better lipid values and had received better microvascular complication screening. Follow up at a hospital other than NHSL was associated with poor microvascular complication screening. Female gender and increasing age was associated with poor retinopathy screening. Microvascular complication screening is suboptimal and the adherence to guidelines depends on the healthcare facility of follow up, sex and age of the patient. There is an urgent need to educate medical practitioners and patients on proper diabetes care.
This study used the Global Burden of Disease data (2010-2021) to analyze the rates and trends of point prevalence, annual incidence, and years lived with disability (YLDs) for metabolic dysfunction-associated steatotic liver disease (MASLD) in 204 countries. Total numbers and age-standardized rates per 100,000 population for MASLD prevalence, annual incidence, and YLDs were compared across regions and countries by age, sex, and sociodemographic index (SDI). Smoothing spline models were used to evaluate the relationship between the burden of MASLD and SDI. Estimates were reported with uncertainty intervals (UI). Globally, in 2021, the age-standardized rates per 100,000 population of point prevalence of MASLD were 15,018.1 cases (95% UI 13,756.5-16,361.4), annual incidence rates were 608.5 cases (598.8-617.7), and YLDs were 0.5 (0.3-0.8) years. MASLD point prevalence was higher in men than women (15,731.4 vs. 14,310.6 cases per 100,000 population). Prevalence peaked at ages 45-49 for men and 50-54 for women. Kuwait (32,312.2 cases per 100,000 people; 95% UI: 29,947.1-34,839.0), Egypt (31,668.8 cases per 100,000 people; 95% UI: 29,272.5-34,224.7), and Qatar (31,327.5 cases per 100,000 people; 95% UI: 29,078.5-33,790.9) had the highest prevalence rates in 2021. The largest increases in age-standardized point prevalence estimates from 2010 to 2021 were in China (16.9%, 95% UI 14.7%-18.9%), Sudan (13.3%, 95% UI 9.8%-16.7%) and India (13.2%, 95% UI 12.0%-14.4%). MASLD incidence varied with SDI, peaking at moderate SDI levels. MASLD is a global health concern, with the highest prevalence reported in Kuwait, Egypt, and Qatar. Raising awareness about risk factors and prevention is essential in every country, especially in China, Sudan and India, where disease incidence and prevalence are rapidly increasing. This research provides a comprehensive analysis of the global burden of MASLD, highlighting its rising prevalence and incidence, particularly in countries with varying sociodemographic indices. The findings are significant for both clinicians and policymakers, as they offer critical insights into the regional disparities in MASLD burden, which can inform targeted prevention and intervention strategies. However, the study's reliance on modeling and available data suggests cautious interpretation, and further research is needed to validate these findings in clinical and real-world settings.
Sepsis is a life-threatening condition involving a dysregulated immune response to infectious agents that cause injury to host tissues and organs. Current treatments are limited to early administration of antibiotics and supportive care. While appealing, the strategy of targeted inhibition of individual molecules in the inflammatory cascade has not proved beneficial. Non-targeted, systemic immunosuppression with steroids has shown limited efficacy and raises concern for secondary infection. Iminosugars are a class of small molecule glycomimetics with distinct inhibition profiles for glycan processing enzymes based on stereochemistry. Inhibition of host endoplasmic reticulum resident glycoprotein processing enzymes has demonstrated efficacy as a broad-spectrum antiviral strategy, but limited consideration has been given to the effects on host glycoprotein production and consequent disruption of signalling cascades. This work demonstrates that iminosugars inhibit dengue virus, bacterial lipopolysaccharide and fungal antigen-stimulated cytokine responses in human macrophages. In spite of decreased inflammatory mediator production, viral replication is suppressed in the presence of iminosugar. Transcriptome analysis reveals the key interaction of pathogen-induced endoplasmic reticulum stress, the resulting unfolded protein response and inflammation. Our work shows that iminosugars modulate these interactions. Based on these findings, we propose a new therapeutic role for iminosugars as treatment for sepsis-related inflammatory disorders associated with excess cytokine secretion.
Abstract Background Influenza A has been named as a priority pathogen by the WHO due to the potential to cause pandemics. Genomic sequencing of influenza strains is important to understand the evolution of the influenza strains and also to select the appropriate influenza vaccines to be used in the different influenza seasons in Sri Lanka. Therefore, we sought to understand the molecular epidemiology of the influenza viruses in the Western Province of Sri Lanka, including mutational analysis to investigate the evolutionary dynamics. Methodology A total of 349 individuals presenting with fever and respiratory symptoms were enrolled in this study from November 2022 to May 2024. Nasopharyngeal and oropharyngeal specimens were collected and screened using quantitative PCR to detect Influenza A, Influenza B, and SARS-CoV-2. Subtyping and genomic sequencing was carried out on influenza A strains using Oxford Nanopore Technology. Results Influenza A was detected in 49 (14 %) patients, influenza B in 20 (5.7%) and SARS-CoV-2 in 41 (11.7%). Co-infections were observed in five participants. The phylogenetic analysis assigned the H1N1 HA gene sequences within the 6B.1A.5a.2a clade. The HA gene of the H1N1 sequences in 2023 were assigned as belonging to the subclades C.1, C.1.2, and C.1.8, while the 2024 sequences were assigned to subclades C.1.8 and C.1.9. The H3N2 sequences from 2023 were assigned to the 3C.2a1b.2a.2a.1b clade and subclade G.1.1.2, while the 2024 sequences were assigned to the 3C.2a1b.2a.2a.3a.1 clade and subclade J.2. The K54Q, A186T, Q189E, E224A, R259K, K308R, I418V, and X215A amino acid substitutions were seen in the H1N1 in the 2023 and 2024 sequences. The 2024 H1N1 sequences additionally exhibited further substitutions, such as V47I, I96T, T120A, A139D, G339X, K156X, and T278S. Conclusion In this first study using genomic sequencing to characterize the influenza A strains in Sri Lanka, which showed different influenza A viruses circulating in an 18-month period. As the Sri Lankan strains also had certain mutations of unknown significance, it would be important to continue detailed surveillance of the influenza strains in Sri Lanka to choose the most suitable vaccines for the population and the timing of vaccine administration.
Non motor symptoms (NMS) of Parkinson’s disease (PD) lead to morbidity, impaired quality of life and frequent hospitalization. NMS are under-recognized and under-reported. NMS Quest is a validated screening tool adopted to identify these symptoms in patients with PD. We conducted a descriptive cross sectional study during March 2012 – September 2012 in a tertiary care hospital in Sri Lanka to describe the non-motor symptoms of PD and to determine the percentage of NMS that remain undeclared to the healthcare professionals. 103 patients, age 64.55 (SD 9.62, range 43-86) years, 58 (56.3%) males and 45 (43.7%) females completed the study. Mean duration of illness was 3.16 yrs. 98.1% of patients had at least one NMS. The mean total NMSQ-T was 9.08 +/- 5.087(SD). Memory loss was the commonest NMS. NMSQ-T increased with the severity of PD (p<0.001) but no association was found between NMSQ-T and age, sex or duration of illness. Loss of weight, difficulty in swallowing and falls were significantly commoner among males than females. (p <0.05) A significant proportion of NMS (Mean 76.1 +/- 17.7, range 36.7% to 100%) were undeclared to the health care personnel. Incomplete bowel evacuation, sweating, diplopia and anxiety were the least declared symptoms. In conclusion, NMS are present in the majority of patients with PD increasing with the severity of disease. A significant proportion of NMS are undeclared to the healthcare personnel highlighting the importance of using screening tools to identify these symptoms during health visits.
Purpose of the study: To describe the demographic factors, pattern of anti-Parkinsonism drugs used and to identify factors influencing treatment in PD patients attending Colombo South Teaching Hospital (CSTH) in Sri Lanka.Methods: A descriptive cross sectional study was conducted at CSTH during March 2012 - September 2012, recruiting patients with PD (according to diagnostic criteria of the United Kingdom Parkinson’s Disease Society Brain Bank) attending neurology and medical clinics.Results: There were 103 PD patients, with a mean age of 64 yrs (SD 9.6, range 43-86) and 58 (56.3%) were males. Duration of illness ranged from 1 month to 15 yrs (median 2 yrs) and average age of onset was 61yrs (SD 9.6, range 41 - 82). 13 patients (12.6%) had onset of PD before 50yrs. Majority (n=57, 55.3%) had at least one co-morbidity. Levodopa alone was the treatment in 100 (97.1%) patients, Ropinirole alone in one, and 10 (9.7%) on Levodopa and Ropinirole combination with 2 (2%) drug-naïve patients. Benzhexol was used in 82 (79.6%) patients. Sex, disease severity, duration of illness, education level or employment status did not differ between treatment groups.Conclusion: PD is a commonly seen neurodegenerative disorder in hospital outpatient clinics and majority had other co-morbidities. Levodopa and Benzhexol are the commonly used drugs in Sri Lanka. Use of dopa agonists are much less common when compared to other countries. Age, the age of onset of PD, cost, and availability are major determinants of treatment.
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