Purpose: To validate a Sinhalese version of the VFQ-25 vision related quality of life assessment tool for use in Sri Lankan populations. Methods: An instrument validation study was conducted at the National Eye Hospital, Colombo. All consenting patients with diabetic retinopathy who attended the clinics during the period of data collection were recruited until the expected sample size was met. Expert review of the translated questionnaire was done by a consultant vitreoretinal surgeon and a specialist in ophthalmological research. Patient responses were used to assess internal consistency, inter-rater and test-retest reliability and construct validity. Content validity was ensured by expert review. Results: 71 patients participated in the study of whom a majority were males (53.5%) and the mean age was 57.68 (+/- 9.429) years. The mean logMAR binocular single vision (BSV) and Eastermann scores were 0.803 (+/- 0.630) and 79.27 (+/- 21.95) respectively. A high level of internal consistency as well as inter-rater and test-retest reliability overall and for each subscale was demonstrated, with an overall Cronbach alpha value of 0.953 for internal reliability. The overall score correlated with best corrected visual acuity (BCVA) of the better eye, BSV and Eastermann score demonstrating good construct validity. Conclusion: The developed Sinhalese version of the VFQ-25 was proven to be a valid and reliable tool. It is the first ever complete vision related quality of life questionnaire to be validated for use in a Sri Lankan setting and will be of immense benefit to clinicians and academics for future studies.
Introduction: Kidney transplantation is the optimal treatment for patients with end-stage kidney disease (ESKD). However, the shortage of donor organs remains a major limitation. The use of kidneys from paediatric deceased donors is one strategy to expand the donor pool. En bloc dual kidney transplantation (EBKT), in which both kidneys are transplanted together with the donor aorta and inferior vena cava, has been developed to overcome concerns related to small renal mass and vascular complications.Case series: We report three cases of en bloc dual kidney transplantation from paediatric deceased donors performed in Sri Lanka. Donor ages ranged from three to seven years (mean age 5.25 years), with body weights between 12 kg and 14.5 kg (mean weight 13.25 kg). The grafts were transplanted into adult recipients with end-stage renal disease. In all cases, the donor aorta and inferior vena cava were anastomosed to the recipient's external iliac vessels. Two recipients demonstrated immediate graft function, while one developed transient acute tubular necrosis with subsequent recovery. All recipients were discharged with satisfactory graft function.Conclusion: This case series demonstrates that en bloc dual kidney transplantation from paediatric donors is a feasible and safe option with favourable early graft outcomes. It may represent a valuable strategy to expand the donor pool in resource-limited settings such as Sri Lanka.
Judicial mental health and well-being is an issue of increasing importance globally. Research globally suggests that an increasing preponderance of burnout, traumatic stress, alcohol abuse, etc are secondary to occupation related stressors. These factors are worse in Sri Lanka where additional stressors such as political interference, resource insufficiency and administrative shortfalls exist. This policy report describes some of the international steps taken to promote judge well-being (including the Nauru Declaration) and recommends policy changes that may improve the well-being of Sri Lankan judicial officers through the interplay of medicine and judicial administration.
Introduction: Methamphetamine use is an emerging public health concern in Sri Lanka, yet there is limited qualitative understanding of the psychosocial and cognitive factors underlying its initiation, continuation, and barriers to abstinence.Objectives: To explore the lived experiences of metha-mphetamine users in Sri Lanka, focusing on pathways to initiation, drivers of use, barriers to cessation, and perceived treatment needs.Methods: A qualitative study was conducted among 37 individuals attending substance use and psychiatric services at the National Hospital of Sri Lanka. Participants were recruited using purposive sampling, and in-depth semi-structured interviews were conducted until data saturation was achieved. Data were analysed using reflexive thematic analysis following Braun and Clarke’s framework. Measures to ensure trustworthiness included investigator triangulation, reflexivity, and systematic theme development.Results: Three overarching themes were identified: socially mediated initiation, perceived functional enhancement and psychological reinforcement, entrapment, harm, and barriers to abstinence. Initiation was largely socially mediated, driven by peer influence, curiosity, and emotional distress. Continued use was reinforced by perceived functional enhancement, including improved energy, productivity, and sexual performance, despite progressive psychological and physical harm. A transition from initial euphoria to paranoia, low mood, and functional decline was commonly described. Persistent cognitive distortions, including beliefs in self-medication and functional benefits, contributed to ongoing use. Barriers to abstinence included craving, motivational ambivalence, social influences, and easy availability. Misconceptions regarding treatment, including the use of other subs-tances, were also evident.Conclusions: Methamphetamine use in Sri Lanka is sustained by a complex interplay of social exposure, psychological vulnerability, and cognitive distortions regarding perceived benefits. Addressing these factors requires culturally appropriate psychoeducation, early identification, and expansion of evidence-based psychosocial interventions within existing addiction treatment services.
Introduction: Although many maternal morbidities are documented, the true extent of certain conditions, particularly postpartum musculoskeletal disorders, remains unclear due to challenges in measurement, absence of standardized criteria, and limitations of health records in developing countries with weak information systems.Objective: This research aims to ascertain the prevalent types of postpartum musculoskeletal morbidity and to explore the association between musculoskeletal morbidity and demographic characteristics, antenatal care visits and supplementation, and postpartum complications.Methods: Conducted a descriptive cross-sectional study, the research employing a consecutive sampling method, including all consenting mothers, resulting in 230 participants. Data collection utilized an interview-administered questionnaire and musculoskeletal morbidity percentages calculated using a standardized musculoskeletal questionnaire tool employing a consecutive sampling method, including all consenting mothers, resulting in 230 participants.Results: The findings indicate that 80.4% of mothers experienced musculoskeletal morbidity, with a majority (84.0%) falling within the 25-29 age range. Over half of the mothers (62.6%) had a parity of 2 to 4. Musculo-skeletal issues reported included muscle pain (79.4%) and joint pain (70.4%), with lower back pain being the most prevalent (71.3%). Mothers faced challenges in daily activities (11.7%), walking (12.2%), breastfeeding (5.2%), and (4.3%) sleeping trouble due to these musculo-skeletal morbidities. No statistically significant relation-ship was found between BMI and musculoskeletal morbidity.Conclusions: This study underscores a notable inci-dence of postpartum musculoskeletal morbidity. There is no statistical association between musculoskeletal morbidity and demographic variables, antenatal care visits, and supplementations. However, a significant association was observed between postpartum compli-cations and morbidity. More multicenter studies are warranted including confounding variables like genetic predisposition and pre-existing musculoskeletal conditions.
Concurrent presence of pulmonary arterial (PAT) and venous thrombosis (PVT) is an extremely rare entity as there is not much evidence in the literature. PVT is frequently associated with lung transplant or surgery. We describe two cases of idiopathic concurrent PAT and PVT with a literature review to highlight the difficulties of management and evaluation of these cases.First case describes a young female presented with lower limb venous thrombosis with subsequent course of PAT and PVT. Despite extensive investigations, no underlying cause was identified. Second case was a middle-aged female with recurrent pulmonary arterial and a new PVT. Both patients were initiated on lifelong anticoagulation therapy due to the recurrent nature and severity of their disease.This case series highlights the challenges associated with management and evaluation of this rare clinical entity. Further research is needed for better understanding of the underlying mechanisms and optimal treatment.
Hepatocellular carcinoma (HCC) is a growing public health concern in Sri Lanka. While the incidence is lower than in other Asian countries, it is on the rise. In this point-of-view article, we describe the hidden burden of disease, unique characteristics and associations of HCC in Sri Lanka.We conducted a selective literature search across electronic databases (PubMed, MEDLINE, Embase, and Cochrane Library) to identify relevant publications on HCC in Sri Lanka. Original, descriptive, epidemiological studies and relevant systematic reviews were included. We excluded randomised controlled trials, narrative reviews, evidence-based clinical practice guidelines and expert consensus statements.In Sri Lanka, HCC primarily affects men at age 64 years at diagnosis. Most cases occur in individuals with underlying cirrhosis. Non-alcoholic cryptogenic cirrhosis is the major risk factor. At diagnosis, most HCCs were in an intermediate or advanced stage, often presenting as single large tumours with significant blood vessel invasion. TACE was the most common treatment offered. The overall survival remains limited to less than 2 years.
Introduction: Renal cell carcinoma (RCC) is known to spread along the veins. However, secondary deposits from RCC growing along the veins are not reported. This case report describes a patient who presented with right upper limb swelling due to RCC spreading along the subclavian vein (SCV) and the superior vena cava (SVC) from a secondary deposit on the rib.Case: A 59-year-old male presented with swelling of the right upper limb. He had RCC seven years ago and underwent radical nephrectomy. A computerised tomographic (CT) scan showed an osteolytic solid mass of 6 cm * 7 cm on the body of the first rib. The tumour was extending into the SCV and the SVC. There was no evidence of recurrence at other sites. The patient underwent an en bloc excision of the tumour with the ribs and the SCV. The SCV was repaired with a polyester graft. The histology confirmed a metastasis from the clear cell RCC. The patient made an uneventful recovery.Discussion and conclusions: At the time of diagnosis, about 33% of the patients with RCC have metastasis. After the surgery, about 30% to 50% of the patients develop recurrences. Studies have shown that wide local excision of the isolated metastasis with a negative margin (metastasectomy) results in improved survival. Excision is followed by adjuvant therapy. Therefore, this case indicates that patients who develop RCC should be followed up for long periods to detect late recurrences. Wide local excision of the isolated metastasis results in improved outcomes.
Biotinidase deficiency (BD) is a rare, autosomal recessive disorder associated with neurological and skin-related consequences, resulting from impaired biotin recycling. Eight children diagnosed with BD between 2013 and 2023 were included. All were identified based on the clinical features of BD, with no established newborn screening programme in place. Clinical features, laboratory investigations, and variant analysis data were collected and analysed retrospectively. This study aimed to examine genotypic and phenotypic variations of BD in the Sri Lankan population. We identified six genotypic variants, including four novel variants in the biotinidase gene. Genotype did not significantly influence phenotypic variations. While the most common clinical findings were consistent with the literature, this cohort presented with some rare features such as developmental regression, hypertonia, spasticity, dystonic reactions, and hyperreflexia. In contrast to other studies, patients in our cohort showed marked improvement in cognitive impairment, developmental regression, and visual and hearing defects, with minimal residual impairments upon initiating biotin treatment. Patients who were diagnosed and commenced treatment earlier responded better compared to those who experienced delayed diagnosis and exhibited some residual impairment. Therefore, a newborn screening programme for BD should be established in Sri Lanka to enable early diagnosis and prevent symptomatic cases of BD.
Background: Antimicrobial resistance is a major public health problem that threatens economic security, puts health at risk, and jeopardises global progress towards the Sustainable Development Goals. Limited data exist regarding burden, risk factors, treatment, and health outcomes of infections due to carbapenem-resistant gram-negative bacteria (CR-GNB) in Sri Lanka. Methods: A case-control study was conducted among patients admitted to a tertiary care hospital in Southern Province, Sri Lanka, from September 2019 to January 2020. Laboratory-based surveillance was performed using routine clinical samples of urine, blood, sputum, pus, and sterile fluid received by the clinical microbiology laboratory to identify cases (CR-GNB isolates) and controls (carbapenem-susceptible GNB isolates). Entero-bacteriaceae, Pseudomonas spp, and Acinetobacter spp. were included. Results: Of 4176 positive cultures during the study period, 1472 (35.2%) were Enterobacteriaceae, 301 (7.2%) were Pseudomonas spp., and 148 (3.5%) were Acinetobacter. Of all 1921 GNB isolates, carbapenem resistance in Acinetobacter, Enterobacteriaceae and Pseudomonas were 79.7%, 19.2% and 13.0% respectively. In a subset of 143 patients in whom the case-control study was performed, 75 patients had CR-GNB positive cultures, and the median age was 58.0 years, and 62.7% were males. In logistic regression, none of the sociodemo graphic or clinical factors explored was independently associated with carbapenem resistance. Nevertheless, patients infected with CR-Acinetobacter had a significantly higher mortality rate (OR 3.72: 95%CI 1.15-12.25; p=0.03). Conclusions: We identified a high prevalence of carbapenem resistance among GNB in Sri Lanka. Further studies are needed to elucidate the risk factors and outcomes of CR-GNB infections specific to the Sri Lankan context.
Introduction: Determining the epidemiological characteristics and clinical and radiological predictors of different types of radiolucent urinary stones is important in the Sri Lankan setting, where routine stone analysis is not freely available. Method: This was a prospective, multi-centre study involving a sample of patients having radiolucent urinary stones. It was conducted in four urology units in Colombo over one year, starting fromAugust 2019. A urinary stone that was not recognisable in plain X-ray KUB was considered a radiolucent stone. The diagnosis of the stone was made by non-contrast computerised tomography (NCCT KUB). Chemical analysis of the stones was carried out using Fourier-transform infrared spectroscopy (FTIR) technology. Results: A total of 71 patients were included. The male-to-female ratio was 3:1, and the average age was 48 years. Forty-three (60.5%) stones were uric acid stones, while 26 (36.7%) were calcium oxalate monohydrate stones. There was one calcium oxalate dihydrate stone and one apatite stone (1.4% each). In multivariate analysis, advanced age, unilateral stone location and low radiodensity were associated with uric acid stones. A radiodensity of 548 HU or lower in the NCCT KUB was predictive of a uric acid stone with 96.2% sensitivity and 76.4% specificity. Conclusion: The majority of radiolucent stones in our study are uric acid stones. The presence of a stone with a radiodensity of 548 HU or lower in the NCCT KUB is predictive of a uric acid stone. Calcium oxalate monohydrate stones constitute a significant proportion of radiolucent stones in Sri Lanka.
Introduction: Clean intermittent catheterisation (CIC) is the preferred bladder emptying method for neurogenic bladder, with UTIs being a common issue in this population. Objectives: To determine the incidence, the bacterial agents and the risk factors associated with UTI among children undergoing CIC. Method: This descriptive cross-sectional study was conducted at the Neurogenic Bladder Clinic, Lady Ridgeway Hospital, Colombo, Sri Lanka, from November 2021 to March 2022. Clinical data were collected from 73 children (53% boys) with neurogenic bladder on CIC and having no UTI at recruitment, via interviewer interviewer-administered questionnaire. A catheterised urine sample was obtained for culture and antibiotic sensitivity testing at recruitment. During the 3-month follow-up, participants were monitored weekly via telephone for UTI symptoms, with symptomatic patients reassessed. Results: The median age of the children was 9 years (range 0.75-19 years), and 84% had congenital neural tube defects. CIC was performed with nasogastric tubes (62%) or CIC catheters (48%), reused for 1 and 4 weeks, respectively. At recruitment, 55% had asymptomatic bacteriuria, but only 12% developed symptomatic UTI during the 3 months (infection rate: 1.02 per 1000 patient days). Escherichia coli was the most common UTI pathogen. UTI was significantly associated with CIC by caregiver and the use of prophylactic antibiotics. Conclusions: The incidence of UTI in children with neurogenic bladder performing CIC was low, even with catheter reuse. Escherichia coli was the most common pathogen. Symptomatic UTI was significantly associated with prophylactic antibiotic use and caregiver administered CIC.
