Background: Pressure ulcers remain a significant healthcare challenge, particularly in patients with limited mobility. Frequent repositioning is a cornerstone prevention strategy, yet adherence to repositioning schedules remains suboptimal in clinical practice. Visual cues have shown promise in improving compliance with repositioning protocols, but evidence from resource-limited settings is scarce. This study aimed to assess the effectiveness of introducing a turning clock with customised repositioning schedules to prevent pressure ulcer incidence and to promote adherence to a two-hourly repositioning practice in a neurology and stroke rehabilitation unit.Methods: A pre- and post-intervention study was conducted in a 22-bedded neurology and stroke rehabilitation unit at Teaching Hospital Rathnapura. Patients unable to reposition independently were included. Baseline data on pressure ulcer incidence and repositioning adherence were collected over ten months (March–December 2022). Following the implementation of turning clocks in January 2023, similar assessments were conducted for a further 10 months (January–October 2023). Both groups received comparable pressure-redistributing surfaces. Results: The pre-intervention period included 40 patients, with 662 patient-days and 10 pressure ulcer incidents. Post-intervention assessment included 38 patients, with 680 patient-days and 3 pressure ulcer incidents (p<0.001). Adherence to the two-hourly repositioning schedule improved significantly with the turning clock intervention.Conclusion: The implementation of turning clocks significantly reduced the incidence of pressure ulcers and improved the consistency of repositioning practice. This simple, low-cost visual cue intervention shows promising impact on prevention of pressure ulcers in resource-limited settings.
Introduction: Stroke is a leading cause of disability worldwide, with a disproportionate burden in low- and middle-income countries. Health-related quality of life (HRQOL) has emerged as an important outcome for stroke survivors, reflecting both the clinical and social dimensions of recovery. However, data from Sri Lanka remain limited. This study aimed to assess quality of life and its associated factors among stroke survivors attending a tertiary care clinic. Methods: A descriptive cross-sectional study was conducted among 121 adults aged ≥40 years with confirmed stroke who attended outpatient clinics at the Colombo South Teaching Hospital in 2022. Data were collected using an interviewer-administered questionnaire and medical record review. Quality of life was assessed using the Stroke-Specific Quality of Life (SS-QOL) scale. Associations were evaluated using chi-square tests, and variables with p <0.20 were included in multivariable logistic and linear regression models.Results: The mean age was 61.2±10 years, and 61.2% were male. The mean SS-QOL score was 168±28, with 64.5% demonstrating good quality of life. Post-stroke complications were common, with 79.3% reporting at least one complication. In multivariable analyses, employment, marital status, and adequate family and social support were independently associated with higher SS-QOL scores, while the presence of complications was associated with lower scores. Stroke subtype and time to hospital admission were not significantly associated with quality of life. The regression model explained approximately 32% of the variance in SS-QOL scores. The SS-QOL cut-off used to describe “good/poor” quality of life was study-defined and should be interpreted as exploratory.Conclusion: Among stroke survivors in this cohort, quality of life was primarily associated with complication burden, employment, marital status, and perceived family and social support. The cross-sectional design, single-centre setting, and exclusion of patients with severe cognitive or communication impairment limit causal inference and generalisability.
Background: Vitamin D deficiency (VDD) is a major global public health problem. Sri Lanka, a tropical island nation located between 6–9°N latitude and receiving year-round ultraviolet B solar radiation, paradoxically has a high burden of VDD, driven by sun-avoidance behaviour, low dietary intake of vitamin D-rich foods, and the absence of national food fortification or supplementation policies. Objectives: To map published data on vitamin D status in Sri Lankan adults, describe the prevalence, determinants, and reported health associations of VDD, compare findings with regional and global data, and identify evidence gaps and locally grounded public health priorities.Methods: A scoping review was conducted following the Arksey and O’Malley framework, using PubMed, Google Scholar, and the Sri Lanka Journals Online database. Studies reporting serum 25-hydroxy vitamin D [25(OH)D] concentrations in Sri Lankan populations were included. Regional and global systematic reviews and meta-analyses were used for comparative analysis. Consistent with scoping methodology, studies were charted descriptively without formal quality appraisal or quantitative synthesis.Results: Reported vitamin D inadequacy ranges from 57.6% among premenopausal women to 90.2% in an urban cohort in Colombo. The most rigorous population-based study found VDD (<50 nmol/L) in 67.6% of adults in Colombo, with women more affected than men (72.6% vs 61.7%). Key determinants included sun avoidance, Fitzpatrick skin types IV–V, low dietary vitamin D intake, and obesity. Sri Lanka reports the lowest pooled VDD prevalence (48%) in South Asia but remains highly deficient in urban settings. Countries with mandatory food fortification achieve substantially lower deficiency burdens.Conclusions: VDD is highly prevalent in urban Sri Lanka, particularly among women and working-age adults. Based on the available evidence, population-level measures, including mandatory fortification of staple foods, promotion of safe sun exposure, public education, and a national surveillance strategy, are priorities in Sri Lanka.
Introduction: Indoor air pollution has become a significant health concern both within households and workplaces. Carpenters face risks from exposure to wood dust, particulate matter, and chemical vapours, which increase their likelihood of developing cardiorespiratory diseases. The objective of this study was to determine the prevalence and associated factors of selected cardiorespiratory symptoms and to measure pulmonary function using peak expiratory flow rate (PEFR) among carpenters in the Moratuwa MOH area.Methods: A community-based cross-sectional analytical study was carried out in 20 randomly selected Grama Niladhari (GN) divisions of Moratuwa from April 2017 to January 2018. Using multistage sampling, 461 carpenters were selected: 443 participated (response rate 96.1%). Data were collected using a pre-tested interviewer-administered questionnaire, a peak flow meter, a bathroom scale, and a measuring board. Statistical analysis included descriptive measures, chi-square testing, and odds ratios with 95% confidence intervals.Results: Out of 443 participants, the most prevalent respiratory symptom during the previous month was cough (61.6%, n=273), followed by sneezing/allergic rhinitis (41.5%, n=184). Prevalence of wheezing was 35.4% (n=157). The most prevalent chronic respiratory symptoms were chronic cough (19.9%, n=88) and chronic phlegm, (18.5% n=82). Out of all participants, 25.3% (n=112) complained of central chest pain. In 24.8% (n=110), the chest pain had eased with rest, and 17.6% (n=76) of the people were diagnosed with hypertension. Of all, 86.9% (n=385) had at least one cardiorespiratory symptom. More than half of the carpenters (60.7%) had PEFR <80% of their predicted value. There was a statistically significant association (p<0.05) between the presence of at least one cardiorespiratory symptom with age, education level, working duration, awareness and practices to prevent dust exposure and family history of cardiorespiratory diseases. Conclusions: Carpenters in Moratuwa exhibited a high prevalence of cardiorespiratory illnesses and reduced lung function, likely due to prolonged exposure to dust. Immediate adoption of proper protective measures was strongly advised.
Rheumatoid arthritis (RA) is the most common chronic inflammatory arthritis, characterised by persistent synovial inflammation, progressive joint damage, and a wide range of extra-articular manifestations. Historically, RA was associated with significant disability and deformities. However, over the past two to three decades, advances in early diagnosis and the introduction of disease-modifying antirheumatic drugs (DMARDs) have transformed disease outcomes. Early recognition of inflammatory arthritis, prompt initiation of DMARD therapy within the “window of opportunity,” and adoption of a treat-to-target strategy have enabled many patients to achieve sustained remission or low disease activity, thereby preventing irreversible joint damage. Consequently, the classical deforming phenotype of RA is now less frequently encountered in clinical practice. Methotrexate remains the cornerstone of therapy, with escalation to combination conventional DMARDs, biologic agents, or targeted synthetic therapies in patients with inadequate response. Furthermore, RA is a systemic disease with significant extra-articular involvement and an increased burden of comorbidities, such as cardiovascular diseases, infections and osteoporosis. Therefore, comprehensive management requires not only control of inflammation but also proactive management of comorbidities and optimisation of overall health. However, delays in referral, under-recognition of early disease and delayed optimisation of DMARD therapy considerably influence patient outcomes. This review summarises the clinical features, diagnostic approach, and contemporary management of RA, and highlights how current strategies have made rheumatoid arthritis without deformities an increasingly attainable goal.
Background: Patient-reported experience measures (PREMs) are essential for assessing healthcare quality, yet evidence from Sri Lanka remains limited. This study aimed to evaluate patient satisfaction and experiences among female inpatients on a medical ward and to identify factors associated with satisfaction.Methods: A cross-sectional study was conducted among 184 female patients admitted for ≥24 hours to a medical ward in a tertiary care hospital in Sri Lanka from January 22nd to February 22nd, 2025. Data were collected using an interviewer-administered questionnaire adapted from validated international PREMs tools. Descriptive analysis and logistic regression were conducted to identify factors associated with willingness to recommend the hospital.Results: The mean age was 58.1 years (SD 17.43) with a mean hospital stay of 3.4 days (SD 2.03). Most patients (71.2%) reported no delay in admission, and 85.3% received a bed immediately. While 50.5% rated the ward as “very clean”, 20.7% reported toilet facilities as grossly inadequate. Regarding dining facilities, 83.2% reported no designated eating area and 72.8% reported the absence of handwash gels. Satisfaction scores were high for doctors (9.35/10, SD 1.84), nurses (9.21/10, SD 1.78) and junior staff (8.60/10, SD 2.34). Overall, 61.3% would recommend the hospital. Univariate analysis showed a significant association between willingness to recommend and satisfaction rates with health staff, cleanliness, and rest, while multivariate logistic regression showed toilet cleanliness as the only independent predictor (OR = 0.51, p = 0.046)Conclusions: While clinical care provided by healthcare staff received high satisfaction scores, significant improvements are required in infrastructure, sanitation and dining facilities to enhance the patient experience and satisfaction.
Spontaneous subcutaneous emphysema (SSE) is an uncommon condition characterised by the presence of air within the subcutaneous tissues in the absence of trauma or surgical intervention. It usually results from alveolar rupture due to elevated intra-alveolar pressure. We report a previously healthy 16-year-old man who presented with fever, cough, and sudden-onset diffuse chest pain during an influenza-like illness. Clinical examination revealed palpable crepitus over the neck and upper chest. Chest radiography and contrast-enhanced computed tomography demonstrated extensive cervical and thoracic subcutaneous emphysema, associated with a pneumomediastinum, in the absence of an underlying structural lung disease. Reverse transcriptase polymerase chain reaction (RT-PCR) testing of a throat swab confirmed Influenza A H1N1 infection. The patient was treated conservatively with oseltamivir, supplemental oxygen, analgesia, and close observation, resulting in complete clinical and radiological resolution within seven days.This case highlights a rare manifestation of Influenza A infection in an adolescent. Severe coughing associated with influenza may markedly increase intra-alveolar pressure and precipitate alveolar rupture leading to pneumomediastinum and SSE. Although usually self-limiting, SSE may occasionally progress to serious complications including tension pneumothorax and airway compromise. Early recognition and appropriate imaging are therefore important for excluding life-threatening complications and guiding conservative management.
Background: Peritonitis remains a major complication of peritoneal dialysis (PD) and is linked to technique failure, catheter loss, and mortality. The International Society for Peritoneal Dialysis (ISPD) 2022 recommends keeping peritonitis rates at ≤0.40 episodes per patient-year and culture-negative rates below 15%. Clinical audit is essential for assessing adherence to these standards and identifying areas for quality improvement.Methods: This retrospective clinical audit included all adult patients receiving PD in Nephrology Unit 3 at the National Hospital of Sri Lanka from 01 January 2025 to 31 December 2025. Peritonitis episodes were identified from clinical and microbiological records. Patient-years were calculated based on PD exposure during the audit period. Outcomes assessed included organism distribution, relapse frequency, catheter removal, fungal peritonitis, insertion-related peritonitis, mortality, and the proportion of patients remaining peritonitis-free. Findings were compared with ISPD 2022 guideline targets and international registry benchmarks.Results: Twelve patients (7 females, 5 males; mean age 54.8 years) contributed 7.24 patient-years at risk. Thirteen episodes of peritonitis were recorded, corresponding to a peritonitis rate of 1.80 episodes per patient-year, substantially exceeding ISPD 2022 recommendations. Culture-negative peritonitis accounted for 30.8% of episodes. Coliform organisms and Corynebacterium species each accounted for 23.1% of infections, followed by Pseudomonas spp. (15.4%) and Acinetobacter (7.7%). No cases of fungal peritonitis were observed.Three episodes met ISPD 2022 criteria for relapse (23.1%). Catheter removal occurred in two episodes (15.4%), and one death was associated with peritonitis. Five patients (41.7%) remained peritonitis-free during the audit period. Two episodes (22.2% of catheter insertions) were classified as catheter insertion-related peritonitis. Conclusion: This clinical audit found that peritonitis and culture-negative rates substantially exceeded ISPD 2022 targets, with relapse rates above registry benchmarks and a low proportion of peritonitis-free patients. These findings highlight the need for targeted infection-prevention strategies and optimisation of microbiological practices. However, the small cohort size and limited patient-years at risk mean that the calculated rates should be interpreted cautiously. A structured quality-improvement initiative, followed by re-audit, is planned.
Acute kidney injury (AKI) poses a significant health challenge in Sri Lanka, affecting both community and hospitalised populations with distinct epidemiological patterns. This review provides evidence-based guidance on recognising, managing, and preventing AKI, emphasising the unique disease patterns and resource considerations relevant to local practice. Since community-acquired causes account for 80% of AKI cases in low- and middle-income countries, understanding tropical infections, environmental toxins, and socioeconomic factors is crucial for effective management.
Chronic kidney disease (CKD) affects approximately 10% of the global population and represents a major health challenge with significant cardio-vascular morbidity and mortality. This review provides an update on evidence-based management strategies for non-dialysis-dependent CKD. Key advances include the widespread adoption of sodium-glucose cotransporter-2 (SGLT2) inhibitors across the CKD spectrum, introduction of non-steroidal mineralocorticoid receptor antagonists such as finerenone, and refined approaches to CKDassociated complications, including anaemia and mineral bone disorders. Contemporary management emphasises early detection through systematic screening, aggressive cardiovascular risk modification, combination nephroprotective therapies, and timely preparation for kidney replacement therapy. The integration of novel therapeutic agents with established treatments offers unprecedented opportunities to slow disease progression and improve patient outcomes through multi-disciplinary, team-based care approaches.
Falls are a common and serious complication among individuals with diabetes mellitus (DM), particularly those with diabetic peripheral neuropathy (D-PN). Multiple impairments in neuromuscular, sensory, and cognitive systems may contribute to increased fall risk in this population. The study aimed to identify key risk factors for falls among older adults with diabetes and to develop a multi-domain fall risk model that integrates screening and explanatory variables for clinical application.A prospective cohort study was conducted among community-dwelling adults aged 50-70 years with DM for over 5 years, and participants were followed for 6 months to record fall incidence. Group comparisons and multivariate analyses were carried out to identify significant screening and explanatory predictors.Participants with D-PN demonstrated significantly poorer muscle strength, reaction time, balance, and sensory function compared with non-neuropathic and control groups. Female gender and a history of previous falls were the strongest predictors for screening. Quadriceps strength and tandem balance emerged as key explanatory factors. The final model, comprising five risk variables: diagnosed neuropathy, poor contrast vision, reduced knee strength, impaired balance, and slow walking speed, showed a graded increase in fall incidence from 0% (1 factor) to 83% (five factors).A simple, multi-domain fall risk model can effectively identify individuals with diabetes at high risk of falling, supporting targeted screening and preventive interventions in clinical practice.
Cerebral venous sinus thrombosis is an uncommon cerebrovascular disorder with diverse presentations, often affecting young women in the peripartum period due to hypercoagulability. Inflammatory bowel disease is a recognised prothrombotic condition, although the coexistence of cerebral venous thrombosis is exceedingly rare. We describe a 27-year-old primiparous woman who is one month postpartum, presenting with a generalised tonicclonic seizure. Imaging revealed a frontal lobe venous haemorrhage with superior sagittal sinus thrombosis. Her history was notable for intermittent bloody, mucoid diarrhoea since late pregnancy. Postpartum sigmoidoscopy showed severe colitis with obscured vascular pattern, mucosal granularity, shallow ulcers, and spontaneous bleeding, while histopathology confirmed ulcerative colitis. She was anticoagulated for venous thrombosis and achieved remission of colitis with corticosteroid therapy. This case illustrates the unusual intersection of obstetric physiology, systemic inflammation, and gastrointestinal disease. It emphasises the importance of considering inflammatory bowel disease in postpartum women presenting with thrombotic complications and gastrointestinal symptoms.
Migraine is a complex neurological disorder charac-terised by recurrent headaches, often accompanied by a range of sensory and autonomic symptoms. While vascular theories once dominated, recent evidence highlights the predominant role of the central nervous system in originating migraine pain. The current consensus emphasises the central roles of trigemino-vascular pathways, brainstem regions, and diencephalic nuclei in migraine pathogenesis. Key neurotransmitters, including monoamines such as serotonin, dopamine, and norepinephrine, as well as neuropeptides such as calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating polypeptide (PACAP), are pivotal in mediating pain transmission within these pathways.Premonitory phase symptoms like food cravings, yawning, and mood changes are linked to central nervous system alterations and precede the headache phase. The aura phase, characterized by gradual onset symptoms such as scotomas and paraesthesia, is attributed to cortical spreading depression, a wave of self-propagating neuronal depolarisation followed by transient cortical hypo-perfusion, underscoring its neuronal basis.The transition to chronic migraine involves dys-function in top-down pain modulation and sen-sitization of the trigeminal system, leading to central sensitization. Peripheral sensitization and molecular mechanisms involving CGRP, Serotonin (5-HT), and PACAP further contribute to migraine chronification. Additionally, oestrogen modulates pain pathways through its effects on the µ-opioid system and neurotransmitters such as serotonin as well as its regulatory action on CGRP. This multifaceted interplay of circuits, neuropeptides, and hormonal influences determines the complex pathophysiology of migraine, providing avenues for targeted therapeutic interventions.
Dumping syndrome refers to symptoms and signs that occur after eating in patients who have under-gone gastric bypass or gastrectomy. The symptoms can also occur as complications of oesophageal surgery and, rarely, in the absence of surgery. The prevalence of dumping syndrome after bariatric surgery varies widely, ranging from about 20% to over 75% depending on the surgery type, definition, and diagnostic criteria used. There are two main presentations: early dumping and late dumping syndrome. Early dumping syndrome comprises both gastrointestinal and vasomotor symptoms, triggered by the rapid emptying of a large amount of hyperosmolar food into the small intestine, leading to rapid fluid shifts from the plasma into the bowel and excessive secretion of gastrointestinal vasoactive peptides, causing vasodilation and increased gastric motility. This phase usually occurs within the first hour of food intake. In contrast, late dumping symptoms are of reactive hypoglycaemia due to rapid absorption of glucose, causing reactive hyperinsulinemia, which usually manifests 1-3 hours following a meal. While many patients experience mild symptoms that improve with diet, between 1% and 5% may have severe symptoms. Management of dumping syndrome often needs multiple measures. However, management can be challenging in some patients and may lead to intractable symptoms. Adopting a dumping diet is the first step in the management. Those who do not respond well to dietary modification may benefit from pharmacological treatment with acarbose or somatostatin analogues. Patients resistant to dietary and pharmacological measures may be considered for surgical intervention, but the outcome of surgery is not predictable.
Gitelman syndrome is an autosomal recessive salt-wasting tubulopathy affecting the distal convoluted tubule, characterised by hypokalaemia, metabolic alkalosis, hypomagnesaemia, hypocalciuria, and secondary hyperreninemic hyperaldosteronism, mimicking the effects of chronic thiazide diuretic use. Although hypocalcaemia is uncommon, it can occur due to hypomagnesaemiainduced suppression of parathyroid hormone (PTH) secretion, leading to functional hypoparathyroidism. Symptomatic hypocalcaemia and tetany are extremely rare presentations of Gitelman syndrome.We report a 30-year-old man who presented with transient loss of consciousness and muscle cramps. He had experienced similar episodes over the preceding year, accompanied by perioral numbness and salt cravings. He had previously been diagnosed with primary hypoparathyroidism based on persistently low serum parathyroid hormone (PTH) levels despite calcium supplementation. Examination revealed carpopedal spasms and a positive Chvostek sign.Laboratory investigations revealed hypokalaemia, metabolic alkalosis, hypomagnesaemia, hypocalciuria, and elevated renin and aldosterone levels, consistent with Gitelman syndrome and hypocalcaemia. Treatment with intravenous calcium, magnesium, and potassium resulted in symptom resolution. Due to persistent hypokalaemia, spironolactone was added. Genetic testing confirmed mutations in SLC12A3 consistent with Gitelman syndrome.This case highlights the importance of evaluating serum magnesium in patients with unexplained or treatment-refractory hypocalcaemia. Magnesium deficiency can mimic hypoparathyroidism by suppressing PTH secretion and impairing the end-organ responsiveness to PTH. The combination of hypokalaemia, hypomagnesaemia, and hypocalciuria is characteristic of Gitelman syndrome and should prompt further evaluation, including genetic.
Mycoplasma pneumoniae is a common respiratory pathogen that causes a wide range of clinical manifestations, from mild upper respiratory tract infections to severe atypical pneumonia. Besides its pulmonary involvement, it can cause several extra-pulmonary complications. Among these, dermatological manifestations such as Stevens-Johnson syndrome, erythema multiforme, and toxic epidermal necrolysis are well recognised. Reactive infectious mucocutaneous eruption is a relatively rare but notable manifestation. This case report describes a 35-year-old man who developed mucosal lesions involving the ocular, oral, and genital areas after a prodrome of respiratory symptoms. Laboratory tests confirmed a high antibody titre of Mycoplasma pneumoniae. While initial antibiotic therapy improved the respiratory symptoms, mucosal involvement persisted, necessitating the use of systemic corticosteroids, which led to a significant clinical improvement. This case highlights the importance of timely recognition and correct management of this uncommon manifestation of mycoplasma infection.
Takotsubo cardiomyopathy is a transient cardiac condition often triggered by sudden, severe emotional or physical stress. Although initially regarded as benign, thromboembolic complications occur in about 12% of patients, with cerebral infarction reported in up to 9.5% of cases. We describe a 57-year-old woman with hypertension who developed takotsubo cardiomyopathy following physical assault with chest trauma. She presented with chest pain and altered consciousness and was initially treated for acute coronary syndrome. Her coronary angiography was normal, and takotsubo cardiomyopathy was diagnosed based on characteristic echocardiographic features. The patient then developed an acute embolic stroke affecting both sides of the middle cerebral artery territory, requiring anticoagulation therapy. This case underscores the potentially serious thromboembolic complications of TC and highlights the importance of early recognition, appropriate consideration of anticoagulation, and multidisciplinary management. The clinical challenge of balancing bleeding and thrombotic risks in acute TC requires personalised decision-making and close monitoring.
