Teaching Hospital, Peradeniya

Background: Leptospirosis is a globally prevalent zoonosis with significant morbidity and mortality, especially in tropical regions like South Asia. In its severe form, the disease often leads to multiorgan dysfunction, with pulmonary haemorrhage being a major cause of death. Evidence supporting specific treatments for severe leptospirosis with pulmonary involvement remains limited. Recent studies suggest that immunomodulatory therapies, such as therapeutic plasma exchange (TPE), may offer survival benefits. This case series explores the application and outcomes of TPE in patients with severe leptospirosis at a tertiary care hospital in Sri Lanka. Methods: We studied a case series involving nine patients with confirmed severe leptospirosis and multiorgan involvement from September 2021 to October 2022. All patients received standard care, including intravenous antibiotics and methylprednisolone. TPE was initiated in all nine patients based on clinical severity, particularly in the presence of pulmonary haemorrhage. Clinical, laboratory, and radiological data were collected from patient records and follow-up. Leptospirosis diagnosis was confirmed through ELISA IgM testing. TPE decisions were made by a multidisciplinary team. Results: Of the nine patients who received TPE, seven survived (78%). Pulmonary haemorrhage was the primary indication for TPE in all cases. All patients had multiorgan involvement: renal failure (89%), hepatic dysfunction (55%), and myocarditis (67%). Mortality was associated with inotropic-dependent myocarditis and mechanical ventilation at TPE initiation. Patients requiring intubation had a 50% mortality rate, compared to 14% in those who were not intubated. Non-survivors also had significantly elevated lactate levels (>4 mmol/L) and worsening acid-base status. Four patients required dialysis: three survived. Conclusions: Early initiation of TPE may be safe and beneficial in severe leptospirosis, and future randomised controlled studies are necessary to examine its benefits further. These findings are hypothesis-generating for further research, particularly on patient selection for TPE.

Health care workers have access to intravenous potassium chloride (KCl), making them vulnerable to suicide in the presence of risk factors. A 54-year-old registered female nurse was found unconscious during the night shift at her duty station in a hospital. She was declared dead soon after. One empty vial of KCl, 1 empty vial of acetylcysteine, 2 intravenous cannulae, a used syringe, a piece of flexible plastic tube and a burette with flexible tubing were found beside her. Autopsy revealed a swelling surrounding a puncture mark in the anterior surface of the left forearm, suggestive of the injection site. Internal examination was unremarkable, except for pulmonary edema and splenic congestion. There was no evidence of violence. Antemortem arterial blood obtained during initial resuscitation demonstrated hyperkalemia at 8.9 mmol/L. Autopsy blood, analyzed using flame emission spectrophotometry, yielded a potassium level of 35 to 40 mmol/L. Collateral history revealed frequent marital disputes and treatment for depression. It was apparent that she had self-administered KCl, which attributed to her death. Health care workers, especially those with psychiatric illnesses, are more prone to utilize easily approachable therapeutic agents to commit suicide. Care must be taken when assigning those individuals to man such stations.

Parkinson's disease (PD) manifests in motor impairments that are detectable through digitized spiral drawings. This study introduces an explainable framework for PD screening using a novel radial-sampling feature fusion approach. We transform 2D spiral images into 1D revolution signals via a systematic ray-sampling technique to extract three distinct revolutions. We integrate spatial metrics, such as inter-revolution spacing variability and RMS radial derivatives, with spectral descriptors derived from Fast Fourier Transform (FFT) analysis across low, mid, and high harmonic bands. A total of 20 features were utilized to train state-of-the-art machine learning models, including Support Vector Machines (SVMs), Random Forests (RFs), and Light Gradient Boosting Machines (LightGBMs). Among these, the RF classifier demonstrated superior performance. Subsequent 5-fold cross-validation stability analysis along with feature importance analysis identified RMS radial derivative of the outer revolution as the most critical biomarker. Stratified Cross-Validation demonstrates that combining spatial and frequency features significantly enhances detection accuracy compared to single-domain methods, facilitating effective clinical deployment even in data-scarce environments. This interpretable pipeline provides a robust, low-cost white-box screening tool, offering a practical alternative to opaque deep-learning models for early clinical intervention.

A rapid antigen test (RAT) was compared with a point-of-care real-time RT-PCR for the diagnosis of COVID-19 using "50 nasopharyngeal swabs (25 positive and 25 negative by POC-rtRT-PCR)". The samples were collected from symptomatic patients at the Teaching Hospital, Peradeniya (March-August 2021) and tested using the STANDARDTM Q COVID-19 Ag RAT. The diagnostic performance of the RAT was assessed by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) using Microsoft Excel 2010 and MedCalc software. The RAT showed 100% sensitivity for high viral loads (Ct <= 20.3) with 96% specificity. Sensitivity dropped to 48% for samples with low viral loads (Ct = 20.9-33.0). The RAT was highly reliable at detecting high viral loads but showed reduced sensitivity at lower viral loads, making it most suitable for detecting highly infectious COVID-19 cases.

BACKGROUND:Blood-pressure reduction is the only proven treatment to prevent stroke. Whether a single pill that combines three antihypertensive drugs at low doses, in addition to standard antihypertensive treatment, can lower blood pressure more than standard care alone and reduce the risk of recurrent stroke after intracerebral hemorrhage is uncertain. METHODS:We conducted a multinational, double-blind, randomized, placebo-controlled trial involving patients with a history of intracerebral hemorrhage. Patients were eligible for the trial if they had a systolic blood pressure of 130 to 160 mm Hg at baseline and were in clinically stable condition. After a 2-week active run-in phase during which all the patients received a once-daily pill containing three antihypertensive agents at low doses (telmisartan at 20 mg, amlodipine at 2.5 mg, and indapamide at 1.25 mg; the triple pill), the patients were randomly assigned to continue receiving the triple pill or to receive matching placebo. The primary outcome was the first recurrent stroke. Secondary outcomes included blood-pressure control, major cardiovascular events, death from cardiovascular causes, and safety. RESULTS:Of 1670 patients who underwent randomization, 833 were assigned to receive the triple pill and 837 to receive placebo. The mean age of the patients was 58 years. At a median follow-up of 2.5 years, recurrent stroke had occurred in 38 patients (4.6%) in the triple-pill group and 62 (7.4%) in the placebo group (hazard ratio, 0.61; 95% confidence interval [CI], 0.41 to 0.92; P = 0.02). The mean systolic blood pressure during follow-up was 127 mm Hg and 138 mm Hg, respectively. The incidence of major cardiovascular events was lower with the triple pill than with placebo (6.6% vs. 9.8%; P = 0.04). Serious adverse events occurred in 23.2% of the patients in the triple-pill group and 26.0% of those in the placebo group. Early discontinuation of the trial regimen due to an adverse event occurred in 13.6% and 6.0%, respectively. The most common adverse event leading to discontinuation was an increase of 20% or more in the serum creatinine level. CONCLUSIONS:Among patients with intracerebral hemorrhage, treatment with a combination of three low-dose antihypertensive agents in a single pill, in addition to standard care, was associated with a lower incidence of recurrent stroke and major cardiovascular events than placebo. (Funded by the National Health and Medical Research Council of Australia and the Brazilian Ministry of Health; TRIDENT ClinicalTrials.gov number, NCT02699645; Australian New Zealand Clinical Trials Registry number, ACTRN12616000327482.).