National Hospital (Teaching Hospital) Kandy is the second largest hospital in Sri Lanka. The bed strength of the hospital was 2291, as of 2011.In 2019, Teaching Hospital Kandy was upgraded as the second National Hospital of Sri Lanka.
Lupus nephritis (LN) is a common and severe manifestation of systemic lupus erythematosus (SLE). We sought to evaluate treatment patterns, treat-to-target state attainment, and outcomes of patients with active LN on non-biologic, conventional therapy, in a large real-world cohort from the Asia–Pacific region. Adult patients enrolled in a multinational lupus cohort were studied for evidence of active LN, defined based on the SLE Disease Activity Index-2000 (SLEDAI-2K)-proteinuria threshold (> 0.5 g/24 h or > 0.05g/mmol), ≥ 2 visits of data, and no exposure to biologics. The subset of these patients who had kidney biopsy-confirmed LN was retrospectively determined. Attainment of treatment goals, including modified versions of complete renal response (mCRR) and primary efficacy renal response (mPERR), lupus low disease activity state (LLDAS) and DORIS remission (REM), and organ damage accrual, were assessed over time following the first visit with proteinuria. One thousand one hundred eighty patients were studied for a median 2.7 [IQR 1.0, 5.0] years, 435 (37
Residual blood specimens collected at health care facilities provide a low-cost and readily available specimen source to monitor population immunity through serological surveillance compared to more resource-intensive probability-based surveys. Despite concerns about the representativeness of these specimens, there has recently been increased interest in the use of residual specimens, driven by the need for rapid estimates of seroprevalence during outbreaks to inform response and prevention. Although residual specimen collection is a key component of surveillance systems in some settings, there is limited evidence of its implementation in low-and middle-income countries. We conducted a pilot project at three health facilities in two districts in Zambia between September 2021 through July 2022 to demonstrate the feasibility of residual blood specimen collection integrated into the health system to estimate measles seroprevalence. Through this pilot project, we were able to collect residual pediatric and adult specimens but with some modifications needed if residual specimen collection were to be implemented at scale, such as better integration into the routine functioning of laboratories and health facilities. This paper summarizes our experiences designing and implementing this residual blood specimen collection, including the lessons learned and recommendations for collecting residual specimens from hospitals.
Objectives Organ damage in SLE is assessed using the SLICC/ACR Damage Index (SDI), which quantifies damage in 12 organ systems but generally reports a total score. We examined whether the risk factors for overall organ damage accrual captured those associated with domain-specific damage accrual in patients with SLE. Methods Data from a 13-country longitudinal SLE cohort were collected between 2013 and 2020 using standard templates. SDI was used to assess overall and domain-specific organ damage. A series of multi-failure, multivariate models were performed to examine the risk factors associated with overall and domain-specific damage accrual. Results A total of 3449 patients with a median of 2.8 [interquartile range (IQR): 1.1, 5.6] years of follow-up were studied. Twenty-one percent (n = 717) patients accrued damage in at least one domain during the study period (musculoskeletal, 6%; renal and ocular, 5% each, neuropsychiatric, 2.5%; <2%, other domains). Risk factors for damage accrual differed among domains. Older age, cumulative glucocorticoid dose, existing skin damage, and diabetes were strong predictors in multiple but discrete domains. Asian ethnicity conferred greater risk of ocular, musculoskeletal, and diabetic damage accrual but was protective against peripheral vascular damage accrual. Smoking was a significant risk factor for peripheral vascular and skin damage accrual, while male sex was associated with the malignancy domain. Conclusion Risk factors for individual organ system damage accrual were highly varied in patients with SLE. Not all factors associated with domain-specific damage accrual were captured by the risk factors analysed for overall organ damage accrual. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, NCT03138941.
Background In mid-November, 2021, the SARS-CoV-2 omicron variant (B.1.1.529; BA.1 sublineage) was detected in southern Africa, prompting international travel restrictions. We aimed to investigate the spread of omicron BA.1 in Africa. Methods In this observational study, samples from patients infected with SARS-CoV-2 from 27 laboratories in 24 African countries, collected between June 1, 2021 and April 14, 2022, were tested for omicron BA.1 and delta (B.1.617.2) variants using real-time RT-PCR. Samples that tested positive for BA.1 by RT-PCR and were collected before estimated BA.1 emergence according to epidemiological properties were excluded from downstream analyses. The diagnostic precision of the assays was evaluated by high-throughput sequencing of samples from four countries. The observed spread of BA.1 was compared with mobility-based mathematical simulations and entries for SARS-CoV-2 in the Global Initiative on Sharing All Influenza Data (GISAID) genomic database. We estimated the effective reproduction number (R-t) at the country level considering the BA.1 fraction and the reported numbers of infections. Phylogeographical analyses were done in a Bayesian framework. Findings Through testing of 13 294 samples from patients infected with SARS-CoV-2, we established that, by November-December, 2021, omicron BA.1 had replaced the delta variant of SARS-CoV-2 in all African subregions, following a south-north gradient, with a median R-t of 2.60 (95% CI 2.46-2.71). This south-north spread, established on the basis of PCR data, was substantiated by phylogeographical reconstructions, ancestral state reconstructions, and GISAID data. PCR-based reconstructions of country-level BA.1 predominance and the availability of BA.1 genomic sequences in GISAID correlated significantly in time (p=0.0002, r=0.78). The first detections of BA.1 in high-income settings beyond Africa were predicted accurately in time by mobility-based mathematical simulations (p<0.0001). Comparing PCR-based reconstructions with mobility-based mathematical simulations suggested that SARS-CoV-2 infections in Africa were under-reported by approximately ten times. Inbound travellers infected with BA.1, departing from five continents, were identified in six African countries by early December, 2021. Interpretation Omicron BA.1 was widespread in Africa when travel bans were implemented, limiting their effectiveness. Combined with genomic surveillance and mobility-based mathematical modelling, PCR-based strategies can inform R-t and the geographical spread of emerging pathogens in a cost-effective and timely manner, and can guide evidence-based, non-pharmaceutical interventions such as travel restrictions or physical distancing. Copyright (c) 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
PURPOSE:Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA. MATERIALS AND METHODS:A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process. RESULTS:Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit. CONCLUSIONS:This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines.
