Epidemiology and mortality of burns in a general hospital of Eastern Sri Lanka

This 2-year prospective study examined the epidemiology and mortality of 345 patients admitted with burn injuries. Sixty-four percent of all burns were accidental in nature and at least 25% were self-inflicted. The rest were due to assaults or had a doubtful cause. The median age was 22 years. Forty-one percent of the accidents were due to the fall of a homemade kerosene bottle lamp. The main cause was flames, followed by scalds. Females outnumbered males in all categories of burns except cases of assault, and suffered from a higher mortality. Most at risk of accidental burns were children between 1 and 4 years, who suffered primarily from scalds. Self-inflicted burns were most common among women aged 20–29 years. The overall median total body surface area (TBSA) burned was 16%. Self-inflicted and ‘doubtful’ burns were much more extensive and more often fatal than accidental ones. The overall mortality rate was 27%. Burns involving more than 50% of the body surface area were invariably fatal. Mortality was highest in the elderly and in the 20–29 years age group. Burns were the first single cause of mortality in the surgical wards. The case is made for the establishment of more Burns Units.     

Carrier Status of Leptospirosis Among Cattle in Sri Lanka: A Zoonotic Threat to Public Health

Leptospirosis is a zoonotic disease of global importance and one of the notifiable diseases in Sri Lanka. Recent studies on human leptospirosis have suggested that the cattle could be one of the important reservoirs for human infection in the country. However, there is a dearth of local information on bovine leptospirosis, including its implications for human transmission. Thus, this study attempted to determine the carrier status of pathogenic Leptospira spp in cattle in Sri Lanka. A total of 164 cattle kidney samples were collected from the meat inspection hall in Colombo city during routine inspection procedures conducted by the municipal veterinary surgeons. The DNA was extracted and subjected to nested PCR for the detection of leptospiral flaB gene. Amplicons were sequenced, and phylogenic distances were calculated. Of 164 samples, 20 (12.2%) were positive for flaB‐PCR. Sequenced amplicons revealed that Leptospira species were deduced to L. borgpetersenii (10/20, 50%), L. kirschneri (7/20, 35%) and L. interrogans (3/20, 15%). The results indicate that a high proportion of the sampled cattle harbour a variety of pathogenic Leptospira spp, which can serve as important reservoirs for human disease.     

Association between bone mineral density,lean mass,and fat mass among healthy middle-aged premenopausal women: a cross-sectional study in southern Sri Lanka

Associations between lean mass, fat mass, and bone mass have been reported earlier; however, most of those studies have been done in Caucasian populations, and data from Asian countries, especially those in South Asia, are limited. We examined the associations between lean mass, fat mass, bone mineral density (BMD), and bone mineral content (BMC), determined by dual-energy X-ray absorptiometry technology, in a group of healthy, middle-aged, premenopausal female volunteers. The mean (SD) age of the women (n = 106) was 42.1 (6.1) years and the mean (SD) body mass index was 24.3 (3.6) kg/m². Total body BMD, total body BMC, and BMD in total spine, total hip, and femoral neck showed statistically significant partial correlations (adjusted for age) with total fat mass (r = 0.19–0.43, P < 0.05) and lean body mass (r = 0.28–0.54, P < 0.05). Truncal fat mass correlated positively with total body BMC and BMD at total hip and femoral neck (r = 0.33–0.40, P < 0.001). When a stepwise regression model was fitted, lean mass remained the strongest predictor of total body BMD, total body BMC, and total spine BMD (regression coefficients = 0.004–0.008 g/cm² per 1-kg change in lean mass, P < 0.001). Similarly, crude BMD and BMC increased across the tertiles of lean mass (P trend < 0.05). We show that lean mass is the strongest predictor of total body BMC and BMD at different sites, although positive correlations with fat mass also exist.     

Age-related trends in hip geometry in Sri Lankan women: a cross-sectional study

Indices of hip geometry are known to be predictive of hip fractures while sex and ethnic differences in hip geometry have been previously demonstrated. Age-related trends in hip geometry among Asians, however, have not been studied sufficiently. A total of 280 healthy, perimenopausal women, aged between 32 and 97 years, were selected from the Community Study Area of the Faculty of Medicine, Galle, Sri Lanka. Hip DXA images were analyzed further to calculate the hip axis length, neck-shaft angle, and femoral neck width at the narrowest point of the femoral neck. Standard formulae were used to calculate cross-sectional area, cross-sectional moment of inertia, and section modulus in the femoral neck region. Mean (SD) age, weight, height, femoral neck bone mineral density (BMD), hip axis length, neck-shaft angle, neck width, cross-sectional area, and cross-sectional moment of inertia of the study sample were 56.8 (13.0) years, 47.8 (10.1) kg, 1.48 (0.06) m, 0.704 (0.147) g/cm², 90.6 (5.6) mm, 123.2 (5.7)°, 2.99 (0.24) cm, 2.00 (0.42) cm², and 1.62 (0.47) cm⁴, respectively. Height and weight of subjects had positive correlations with most of the indices of hip geometry. Femoral neck BMD, cross-sectional area and section modulus showed a rapid reduction during the postmenopausal period. With advancing age, there was a marginal but statistically nonsignificant expansion of the neck width, increase in the hip axis length, and narrowing of the neck-shaft angle. In conclusion, this study demonstrated a gradual loss of BMD in postmenopausal age, accompanied by thinning of the cortical shell and deterioration of the resistance to bending in the femoral neck of this group of healthy women. The clinical relevance of the marginal changes seen in other indices such as neck-shaft angle, hip axis length, and neck width is not known.     

Bladder cancer in Sri Lanka: Experience from a tertiary referral center

BACKGROUND: Bladder cancer is one of the most common malignancies occurring worldwide. No published data exists on bladder cancer in Sri Lanka. The objective of the study was to determine the clinicopathological characteristics of histologically confirmed transitional cell carcinoma (TCC) of the bladder in Sri Lanka. METHODS: Three hundred and one patients were diagnosed with primary bladder cancer during a 7.5-year period from 1993 to 2000. Two hundred and eighty-one patients (239 men and 42 women; mean age, 66 years; range, 26-88) with TCC of the bladder were evaluated with regard to clinical presentation, cystoscopic findings and histopathological data. RESULTS: Transitional cell carcinoma accounted for 93.4% of primary bladder cancer. There was a male predominance with a sex ratio of 6:1. The majority of patients (63.7%) were in the 7th and 8th decades of life. Painless hematuria was the most common presenting symptom (52.7%), followed by painful hematuria (39.2%). The median duration of hematuria for all TCC patients, as well as for muscle-invasive TCC patients, was 3 months. Papillary configuration at cystoscopy, was found in 89.7% of non-invasive urothelial tumors. In contrast, 77.8% of invasive TCC patients had a solid/mixed tumor configuration. One hundred and forty-five patients (51.6% of TCC) had non-invasive urothelial tumor and 136 patients (48.4%) had muscle-invasive disease. In the non-invasive urothelial tumor category, 61 patients (42.0%) had pTa tumors and 84 patients (58.0%) had pT1 tumors. Of newly diagnosed TCC cases, 5.3% were found to be T1G3 urothelial carcinomas. Fifty-six patients (38.6%) with non-invasive urothelial tumor had a tumor greater than 5 cm in size. CONCLUSIONS: More than 90% of primary bladder tumors in Sri Lanka are TCC, with nearly half the patients having muscle-invasive diseases on initial presentation. Even in non-invasive urothelial tumors, the majority (58.0%) have lamina propria invasion.     

Y-chromosomal.microdeletions and partial deletions of the Azoospermia Factor c （AZFc） region in normozoospermic, severe oligozoospermic and azoospermic men in Sri Lanka

Aim:To assess for the first time the occurrence of Y chromosomal microdeletions and partial deletions of theAzoospermia Factor c(AZFc)region in Sri Lankan men and to correlate them with clinical parameters.Methods:Ina retrospective study,we analyzed 96 infertile men(78 with non-obstructive azoospermia)and 87 controls withnormal spermatogenesis.AZFa,AZFb,AZFc and partial deletions within the AZFc region were analyzed by multiplexpolymerase chain reaction(PCR)according to established protocols,Results:No AZFa,AZFb or AZFc deletionswere found in the control group.Seven patients in the group of infertile men were found to have deletions as following:one AZFa,two AZFc,two AZFbc and two AZFabc.The relative distribution of these patterns was significantlydifferent compared with that found in the German population.Extension analysis confirmed that the deletions oc-curred according to the current pathogenic model.gr/gr deletions were found to be equally present both in the patients(n=4)and in the control group(n=4).One b2/b3 deletion was found in the patient group.Conclusion:Theseresults suggest that the frequency and pattern of microdeletions of the Y chromosome in Sri Lankan men are similarto those found in other populations and confirm that gr/gr deletions are not sufficient to cause spermatogenetic failure.(Asian J Androl 2006 Jan;8:39-44)     

Early weight bearing in tibial shaft fractures protected with wooden splints

Evaluation of the rate of union of 40 adult tibial shaft fractures treated in below-knee wooden splints together with early weight bearing showed that fractures healed faster and patients returned to normal activity earlier than patients who were allowed early weight bearing in above-knee casts. Shortening was not increased.     

Hantavirus antibodies among phyllostomid bats from the arc of deforestation in Southern Amazonia,Brazil

In order to determine whether southern Amazonian bats could harbour hantaviruses we, serologically and molecularly, screened blood, saliva, excreta and organ tissues of 47 bats captured from September to December 2015. We found that only phyllostomid bats presented antibodies against hantavirus. The seropositive bats belonged to two species of Phyllostomid bats: the greater spear‐nosed bat Phyllostomus hastatus (omnivorous) and the gnome fruit‐eating bat Dermanura gnoma. The overall seroprevalence was of 4.2%. Therefore, we show here that hantaviruses are circulating among phyllostomid bats in the Amazonian arc of deforestation.     

Arousal from hibernation and reactivation of Eptesicus fuscus gammaherpesvirus (EfHV) in big brown bats

Many viruses that cause serious and often fatal disease in humans have spilled over from bats. Recent evidence suggests that stress may enhance virus shedding by bats increasing the possibility of transmission to other species. To understand the reasons for spillover is therefore important to determine the molecular pathways that link stress to virus reactivation and shedding in bats. We recently isolated and characterized a gammaherpesvirus (Eptesicus fuscus herpesvirus, EfHV) autochthonous to North American big brown bats. Since herpesviruses are known to reactivate from latent infections in response to a wide variety of stressors, EfHV presents us with an opportunity to study how physiological, behavioural or environmental changes may influence the big brown bats’ relationship with EfHV. To understand the biology of the virus and how the extended periods of torpor experienced by these bats during hibernation along with the stress of arousal might influence the virus‐host relationship, we attempted to detect the virus in the blood of wild‐caught non‐hibernating bats as well as captive bats arising from hibernation. We compared the prevalence of EfHV in the blood (using PCR) and EfHV‐specific antibodies (using ELISA) between captive hibernating bats and wild‐caught non‐hibernating bats. We detected EfHV only in the blood of captive hibernating bats (27.8% = 10/36) and not in wild‐caught non‐hibernating bats (0.0% = 0/43). In contrast, the EfHV‐specific antibody titres were higher in the non‐hibernating bats compared to the hibernating bats. Our study suggests that: (a) viral DNA in blood indicates reactivation from latency, (b) long periods of hibernation lead to suppression of immunity, (c) stress of arousal from hibernation reactivates the virus in bats with lower levels of anti‐viral immunity (indicated by humoral immune response), and (d) levels of anti‐viral immunity increase in non‐hibernating bats following reactivation.     

Detection of bovine coronavirus in nasal swab of non‐captive wild water deer,Korea

Bovine coronavirus (BCoV) is a causative agent of respiratory and enteric diseases in cattle and calves. BCoV infection was also evident in captive wild ruminants. Recently, water deer are recognized as the most common wildlife to approach farmhouses and livestock barns in Korea. Therefore, we investigated 77 nasal swab samples from non‐captive wild water deer (Hydropotes inermis ) between November 2016 and September 2017 and identified three samples positive for coronavirus, indicating potential for respiratory shedding. The full genomic sequences of the water deer coronavirus were closely related to BCoV (>98%). Therefore, effective biosecurity system in bovine farms would be necessary to prevent contact between farm ruminants and free‐ranging wild water deer.     

Circulation of pantropic canine coronavirus in autochthonous and imported dogs,Italy

Canine coronavirus (CCoV) strains with the ability to spread to internal organs, also known as pantropic CCoVs (pCCoVs), have been detected in domestic dogs and wild carnivores. Our study focused on the detection and molecular characterization of pCCoV strains circulating in Italy during the period 2014–2017 in autochthonous dogs, in dogs imported from eastern Europe or illegally imported from an unknown country. Samples from the gut and internal organs of 352 dogs were screened for CCoV; putative pCCoV strains, belonging to subtype CCoV‐IIa, were identified in the internal organs of 35 of the examined dogs. Fifteen pCCoV strains were subjected to sequence and phylogenetic analyses, showing that three strains (98960‐1/2016, 98960‐3/2016, 98960‐4/2016) did not cluster either with Italian or European CCoVs, being more closely related to alphacoronaviruses circulating in Asia with which they displayed a 94%–96% nucleotide identity in partial spike protein gene sequences. The pCCoV‐positive samples were also tested for other canine viruses, showing co‐infections mainly with canine parvovirus.     

飞行人员泌尿系结石患病率与水土中钙镁钠浓度相关性分析

目的:探讨飞行人员泌尿系结石患病率与驻地土壤及饮用水中钙镁钠含量的关系。方法:调查飞行部队驻地飞行人员结石患病率,对驻地农作物土壤及饮用水进行采样,测定土壤和饮用水中钙镁钠含量。应用SPSS 13.0统计软件包对测定结果进行相关性分析。结果:飞行人员泌尿系结石患病率与部队驻地农作物土壤中钙元素含量呈正相关(P<0.01)。泌尿系结石患病率与土壤中镁元素和钠元素含量无相关性(P>0.05)。部队驻地农作物土壤中镁元素与钙元素含量之间无相关性(P>0.05)。飞行人员泌尿系结石患病率与部队驻地饮用水中钙元素含量无相关性(P>0.05),但与镁元素含量呈负相关(P<0.05),与饮用水中钙镁比值呈正相关(P<0.01)。部队驻地饮用水中钙元素与镁元素含量之间无相关性(P>0.05)。结论:飞行人员泌尿系结石患病率与部队驻地农作物土壤中钙元素含量呈正相关,避免高钙饮食及在处理饮用水时适当降低钙镁元素含量比值,对飞行人员泌尿系结石的预防起到一定作用。     

Results of triple muscle (sartorius,tensor fascia latae and part of gluteus medius) pedicle bone grafting in neglected femoral neck fracture in physiologically active patients

Background:

Femoral neck fractures are notorious for complications like avascular necrosis and nonunion. In developing countries, various factors such as illiteracy, low socioeconomic status, ignorance are responsible for the delay in surgery. Neglected fracture neck femur always poses a formidable challenge. The purpose of this study was to evaluate the results of triple muscle pedicle bone grafting using sartorius, tensor fasciae latae and part of gluteus medius in neglected femoral neck fracture.

Materials and Methods:

This is a retrospective study with medical record of 50 patients, who were operated by open reduction, internal fixation along with muscle pedicle bone grafting by the anterior approach. After open reduction, two to three cancellous screws (6.5 mm) were used for internal fixation in all cases. A bony chunk of the whole anterior superior iliac spine of 1 cm thickness, 1 cm width and 4.5 cm length, taken from the iliac crest comprised of muscle pedicle of sartorius, tensor fascia latae and part of gluteus medius. Then the graft with all three muscles mobilized and put in the trough made over the anterior or anterosuperior aspect of the femoral head. The graft was fixed with one or two 4.5 mm self-tapping cortical screw in anterior to posterior direction.

Results:

14 patients were lost to followup. The results were based on 36 patients. We observed that in our series, there was union in 34, out of 36 (94.4%) patients. All patients were within the age group of 15-51 years (average 38 years) with displaced neglected femoral neck fracture of ≥30 days. Mean time taken for full clinicoradiological union was 14 weeks (range-10-24 weeks).

Conclusion:

Triple muscle pedicle bone grafting gives satisfactory results for neglected femoral neck fracture in physiologically active patients.     

COVID‐19 in solid organ transplant recipients: A single‐center case series from Spain

The clinical characteristics, management, and outcome of coronavirus disease 2019 (COVID‐19) caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) after solid organ transplant (SOT) remain unknown. We report our preliminary experience with 18 SOT (kidney [44.4%], liver [33.3%], and heart [22.2%]) recipients diagnosed with COVID‐19 by March 23, 2020 at a tertiary‐care center at Madrid. Median age at diagnosis was 71.0 ± 12.8 years, and the median interval since transplantation was 9.3 years. Fever (83.3%) and radiographic abnormalities in form of unilateral or bilateral/multifocal consolidations (72.2%) were the most common presentations. Lopinavir/ritonavir (usually associated with hydroxychloroquine) was used in 50.0% of patients and had to be prematurely discontinued in 2 of them. Other antiviral regimens included hydroxychloroquine monotherapy (27.8%) and interferon‐β (16.7%). As of April 4, the case‐fatality rate was 27.8% (5/18). After a median follow‐up of 18 days from symptom onset, 30.8% (4/13) of survivors developed progressive respiratory failure, 7.7% (1/13) showed stable clinical condition or improvement, and 61.5% (8/13) had been discharged home. C‐reactive protein levels at various points were significantly higher among recipients who experienced unfavorable outcome. In conclusion, this frontline report suggests that SARS‐CoV‐2 infection has a severe course in SOT recipients.     

Renal transplantation during the SARS‐CoV‐2 pandemic in the UK: Experience from a large‐volume center

There is uncertainty about the safety of kidney transplantation during the SARS‐CoV‐2 pandemic due to the risk of donor transmission, nosocomial infection and immunosuppression use. We describe organ donation and transplant practice in the UK and assess whether kidney transplantation conferred a substantial risk of harm. Data from the UK transplant registry were used to describe kidney donation and transplant activity in the UK, and a detailed analysis of short‐term, single‐center, patient results in two periods: during the pre‐pandemic era from 30th December 2019 to 8th March 2020 (“Pre‐COVID era”) and the 9th March 2020 to 19th May 2020 (“COVID era”). Donor and recipient numbers fell by more than half in the COVID compared to the pre‐COVID era in the UK, but there were more kidney transplants performed in our center (42 vs. 29 COVID vs. pre‐COVID respectively). Overall outcomes, including re‐operation, delayed graft function, primary non‐function, acute rejection, length of stay and graft survival were similar between COVID and pre‐COVID era. 6/71 patients became infected with SARS‐CoV‐2 but all were discharged without critical care requirement. Transplant outcomes have remained similar within the COVID period and no serious sequelae of SARS‐CoV‐2 infection were observed in the peri‐transplant period.     

Fluorescence in the Sclera,Nails, and Teeth Secondary to Favipiravir Use for COVID-19 Infections

Favipiravir, an antiviral agent originally used for influenza infections, has become popular due to its beneficial signals in coronavirus disease. It is currently used in some countries within COVID-19 treatment protocols. This is an initial report of favipiravir-related fluorescence observed in three healthcare providers working in the same ward in our hospital. All three individuals had been diagnosed with COVID-19 two months earlier and were treated with favipiravir. None of the three individuals received hydroxychloroquine or tetracyclines. Wood’s light examination led to an incidental discovery of favipiravir-induced fluorescence involving the sclera, nails, and teeth. In all patients, white linear, square, and band-like specks of fluorescence were noticed on the sclera of both eyes, some teeth, and the proximal part of all fingernails and toenails. Exposure of the eyes to the Wood’s light was for a brief duration of 3 to 5 seconds during examination and photodocumentation. Favipiravir might cause bright white fluorescence of nails, sclera, and teeth, detectable by Wood’s light even two months after its cessation.     

新型冠状病毒感染者器官捐献专家共识

新型冠状病毒（新冠病毒）感染疫情传播、防控和新冠病毒从捐献者传播到受者的潜在风险及其不确定性等,给器官捐献和移植工作带来严重影响和巨大挑战。越来越多的证据表明使用来自新冠病毒感染的捐献者非肺脏器官（肾脏、肝脏和心脏）无论在获取时是否存在症状,传播的风险都很低。推迟新冠病毒抗原或核酸检测阳性者逝世后的器官捐献时间,待病毒检测阴性后再行捐献,将导致相当数量医学上适合移植的器官丢失。为最大限度满足终末期器官衰竭患者移植就医需求,中华医学会器官移植学分会组织相关专家,结合国内新冠病毒感染流行形势及器官捐献和移植工作的临床实践,参考国内外相关研究结果及临床研究证据制定了公民逝世后器官捐献《新型冠状病毒感染者器官捐献专家共识》,旨在为新冠病毒感染者捐献器官的获取和应用提供建议和参考。     

2020年肾移植研究大盘点——来自中国的声音

肾移植是终末期肾病患者改善生存质量、回归正常生活的首选途径。随着医疗技术与免疫抑制剂的不断更新发展, 移植肾的短期存活时间显著延长, 但其长期存活问题仍亟待解决。肾缺血-再灌注损伤(IRI)、急性排斥反应、慢性移植肾失功、肾脏纤维化等因素仍是影响移植肾存活的几大难题, 相关研究一直是肾移植领域的热点。同时, 2020年是不平凡的一年, 新型冠状病毒肺炎(新冠肺炎)疫情对各行各业发展的影响巨大, 与肾移植相关的研究报道亦呈百家争鸣之态。本文就我国2020年肾移植相关的临床与基础研究的前沿热点以及肾移植领域新冠肺炎相关的研究做一综述, 以期提供新的治疗思路和策略。     

Evaluation of semen quality in 1808 university students,from Wuhan,Central China

The aim of this study was to evaluate the semen quality of university students in Wuhan, the largest city in the world in terms of the number of university students. All student sperm donors recorded in the Hubei Province Human Sperm Bank from 1 March 2010 to 31 December 2013 were screened. At last, a total of 3616 semen samples from 1808 university student sperm donors were eligible and retrospectively analyzed. Each donor''s semen parameters were averaged over two samples and compared with the World Health Organization criteria, and a generalized linear regression model was used to examine several determinants of semen quality. We found that the mean and median values were 3.0 ml and 2.8 ml for semen volume, 50.2 × 10⁶ ml⁻¹ and 50.0 × 10⁶ ml⁻¹ for sperm concentration, 148.1 × 10⁶ and 142.1 × 10⁶ for total sperm count, and 58.6% and 60.0% for total sperm motility. About 85.0% of donors had parameters that were all normal. Season and duration of abstinence were critical factors affecting semen quality. We also found a decrease in sperm concentration during the 4 years observation; however, this may not be a strong evidence to confirm the declining trend of semen quality. In conclusion, semen quality of university students in Wuhan was not optimal and should be paid high attention, long-term observation and further study should be carried out to confirm the present situation.