The Quest for Understanding Cutaneous Leishmaniasis in Northern Province,Sri Lanka:An Analysis of Clinical Data From the District General Hospital,Vavuniya

The study aimed to examine the clinical and epidemiological patterns of cutaneous leishmaniasis(CL)in patients attending the Dermatology Unit,District General Hospital in Vavuniya,Sri Lanka.A total of 77 patients clinically suspected for CL were interviewed through a structured questionnaire,and skin-lesion samples were obtained between January 2016 and January 2017.The definitive diagnosis of CL was made through microscopic identification of smears,histopathological examination of biopsies and kDNA PCR.Treatment modalities were chosen based on the location of the lesions on the body and complexity of the lesions.Of 77 suspected patients,68 were confirmed for CL,with a mean age of 34.6(±12.7)years,and included 54 males(79.4%)and 14 females(20.6%).Being a male was a significant risk factor(P=0.032,OR=4.82)associated with CL.Lesions were observed mainly on the exposed areas of the body,of which the forearm(22.1%)was the most commonly affected site.Single lesions(75.0%)and ulcerated nodules with central crust(39.7%)were the prominent features among the infected group.The age group of 21–40 years was significantly associated with healing lesions(P=0.028,marginal effect=0.55).However,a significant negative relationship was detected between ulcerated nodular lesions and lesion healing(P=0.0436,marginal effect=−0.375).Males are at higher risk of CL.Early diagnosis and specific treatment,along with preventive measures such as protective clothing and sand fly repellents,can limit the spread of the disease.There is a need for a comprehensive approach to prevent and control the transmission of CL.

The Principles of Insulin Management of Type 2 Diabetes Mellitus

Insulin therapy is an integral part of the pharmacological management of Type 2 diabetes mellitus. Guidelines recommended insulin therapy for those patients with suboptimal glycaemic control despite optimal medical treatments. Studies show that insulin therapy with the human and regular insulins improve glycaemic control, reduce the chronic complications, and inevitably improve patient’s quality of life. The new analogue insulin has a better safety profile and efficacies, and has been shown to achieve better outcomes and patient’s acceptability compared with the human and regular insulins. The diabetic guidelines also recommend the intensity of insulin therapy in a personalised glycaemic control strategy based on the patient’s profiles and their preferences. However, the guidelines do not recommend any standardised approach to the principles of insulin initiation, titration, and monitoring. This review summarises the essential principles of insulin initiation, titration, and monitoring in Type 2 diabetes mellitus.

Prevalence of Undernutrition among Children Aged 6 - 59 Months in the Municipality of Toucountouna (Benin) in 2017

Introduction: Undernutrition is a public health problem in the world and especially in developing countries. According to the demographic and health survey with multiple indicators of Benin IV (DHS-MICS-IV), the prevalence of acute undernutrition (AU), chronic undernutrition (CU) and that of underweight (UW) was 16%, 45% and 21%, respectively. The objective of this work was to determine the prevalence of undernutrition in children aged 6 to 59 months in the municipality of Toucountouna in 2017. Materials and Methods: This was a descriptive cross-sectional study with two-stage cluster random sampling, composed of 390 children aged 6 to 59 months, living in the municipality of Toucountouna for at least six months. The study variables were: socio-demographic, economic, behavioral, socio-sanitary and anthropometric. Data were entered and analyzed using Epi-info 7.2 software. Results: 203 out of 390 children included, were boys (sex ratio of 1.08). The mean age of the children was 28.70 ± 11.79 months. The prevalence of AU, CU and UW was 10.26%, 31.54% and 11.79%, respectively. Conclusion: The results of this study showed that efforts remain to be made in terms of undernutrition and other surveys could identify the determinants linked to this situation in the locality for the effective implementation of prevention.

腮腺肿瘤超声弹性图技术的评价与诊断

腮腺肿瘤超声弹性图技术的评价与诊断 摘要超声为腮腺病变诊断的一线影像检查方法,然而,单凭超声检查不能鉴别良性与恶性病变。由于细针针吸细胞学活检（FNAC）结果正确率并非100%,而腮腺部分/全部切除又有面神经麻痹与Frey综合征的危险,能鉴别肿瘤良恶性的影像技术具有重大价值。超声弹性图为一新的影像技术,

Faecal pyruvate kinase isoenzyme type M2 for colorectal cancer screening:A meta-analysis

AIM:To present a critical discussion of the efficacy of the faecal pyruvate kinase isoenzyme type M2(faecal M2-PK) test for colorectal cancer(CRC) screening based on the currently available studies.METHODS:A literature search in PubMed and Embase was conducted using the following search terms:fecal Tumor M2-PK,faecal Tumour M2-PK,fecal M2-PK,faecal M2-PK,fecal pyruvate kinase,faecal pyruvate kinase,pyruvate kinase stool and M2-PK stool.RESULTS:Stool samples from 704 patients with CRC and from 11 412 healthy subjects have been investigated for faecal M2-PK concentrations in seventeen independent studies.The mean faecal M2-PK sensitivity was 80.3%;the specificity was 95.2%.Four studies compared faecal M2-PK head-to-head with guaiacbased faecal occult blood test(gFOBT).Faecal M2PK demonstrated a sensitivity of 81.1%,whereas the gFOBT detected only 36.9% of the CRCs.Eight independent studies investigated the sensitivity of faecal M2-PK for adenoma(n = 554),with the following sensitivities:adenoma < 1 cm in diameter:25%;adenoma > 1 cm:44%;adenoma of unspecified diameter:51%.In a direct comparison with gFOBT of adenoma > 1 cm in diameter,47% tested positive with the faecal M2-PK test,whereas the gFOBT detected only 27%.CONCLUSION:We recommend faecal M2-PK as a routine test for CRC screening.Faecal M2-PK closes a gap in clinical practice because it detects bleeding and nonbleeding tumors and adenoma with high sensitivity and specificity.

Bile peritonitis due to intra-hepatic bile duct rupture

Generalized biliary peritonitis is a serious intra-abdominal emergency. Most of them occur due to duodenal ulcer perforation and rapidly evolve into bacterial peritonitis due to contamination by gut organisms and food. In this situation, recognition of the pathology and its treatment is straightforward and is usually associated with a good outcome. There are a few unusual causes of biliary peritonitis, of which rupture of the biliary tree is one.We describe a rare case of biliary peritonitis due to rupture of an intra-hepatic biliary radical. Unusual causes of peritonitis do interrupt our daily routine emergency surgical experience. Rapid recognition of the presence of peritonitis, adequate resuscitation, recognition of operative findings, establishment of biliary anatomy, and performance of a meticulous surgical procedure resulted in a good outcome.

Antimicrobial susceptibility and serotypes of Neisseria meningitidis and Streptococcus pneumoniae in Sri Lanka:Experience from the National Reference Laboratory

Objective:To determine the antimicrobial susceptibility and serotypes of Neisseria(N.)meningitidis and Streptococcus(S.)pneumoniae in Sri Lankan patients.Methods:We retrospectively analyzed 11 blood culture specimens from suspected patients with invasive meningococcal disease and 26 S.pneumoniae clinical isolates.We tested 6 antimicrobials against N.meningitidis and 12 antimicrobials against S.pneumoniae.Meningococcal serogroup was determined by realtime PCR and Quellung serotyping was used for pneumococcal analysis.Results:N.meningitidis serogroup B was the most common in this study.Intermediate-susceptibility to penicillin was seen in 75.0%(6/8)of strains.Susceptibility to ciprofloxacin,levofloxacin and cotrimoxazole was 62.5%(5/8),62.5%(5/8)and 87.5%(7/8),respectively.Excellent susceptibility was seen in cefotaxime and meropenem.In S.pneumoniae,the most common serotype was 19F in both invasive and non-invasive pneumococcal diseases.The majority of strains showed multidrug resistance.Penicillin non-susceptibility in non-meningeal strains were 13.6%and all meningeal strains were penicillin resistant.Erythromycin was highly resistant in both groups.Amoxicillin showed excellent susceptibility in non-invasive pneumococcal diseases strains.Linezolid,levofloxacin and vancomycin showed 100.0%susceptibility in all pneumococcal isolates.Conclusions:Implementation of vaccines should be considered,especially for children and high-risk populations.This may contribute to reducing pneumococcal and meningococcal invasive disease burden and help prevent emergence of antimicrobial resistant strains.

Can palliative radiotherapy influence prostate-specific antigen response in patients with castrate-resistant prostate cancer treated with systemic therapy(chemotherapy or abiraterone)?——a report of three cases

Palliative radiotherapy(pRT) is primarily employed for palliation of bone pain in patients with castrate-resistant prostate cancer(CRPC). However, evidence that p RT influences prostate-specific antigen response in patients with CRPC on systemic therapy is lacking. We describe three cases of CRPC progressing after treatment with docetaxel(n=2) and abiraterone(n=1), who responded unusually after p RT for bone pain with the development of a significant biochemical response and restoration of response to systemic therapy. The possibility of p RT influencing metastatic disease in CRPC has not been previously reported, and raises the possibility of radiation-induced modulation of anti-tumor immune response mechanisms that may play a role in the restoration of response to systemic treatment.

Acute Respiratory Distress Syndrome Following Anaphylactic Shock—“A Deadly Duel”—Case Report and Literature Review

A 58-year-old Asian female developed acute respiratory distress syndrome (ARDS) following anaphylactic shock. Several similar cases have been reported in the literature, attributed to the pathophysiological mechanisms of anaphylaxis or interestingly, the treatment itself;adrenaline, majority of the latter being related to administration of supra-therapeutic doses. According to our clinical experience, the possibility of ARDS should be considered in patients who develop unexplainable hypoxaemia following anaphylactic shock. This case report discusses the pathophysiology of ARDS both in anaphylaxis and following epinephrine treatment and key aspects of management of ARDS with a main focus on the role of high flow oxygen, diuretics and anxiolytics. The importance of avoiding drug administration errors is also highlighted.

Beneficial Effects of Non-chemically Grown Traditional Rice/Rice Based Functional Food(NGTRF)in Nutritional Management of Nafld and Diabetes Mellitus

Non-communicable diseases(NCDs)are commonly associated with non-alcoholic fatty liver/non-alcoholic fatty liver disease(NAFL/NAFLD)for which no drugs or specific food are available either to control or to cure.We encounter promising results with NGTRF in nutritional Management of NAFLD and diabetes.Objective is to compare the effect of using NGTRF over routine western management(RWM)and Hela Nila Wedakama(HNW)patients with NCD,including metabolic syndrome,are prescribed NGTRF(produced by Hela Suwaya)and followed up.The five therapeutic categories are(1)RWM alone;(2)NGTRF alone;(3)NGTRF+RWM(in Galle);(4)NGTRF+RWM(in Gampaha);(5)NGTRF+RWM+HNW.According to clinical,biochemical and radiological profiles,majority of categoroes 2,3,4 and 5 are either controlled or cured effectively and sustainably compared to category 01.Preliminary evidence shows that effectiveness and sustainability of prescribing NGTRF is better.According to“Hela Suwaya”knowledge,genetic basis of food(conventional vs.traditional)and agronomic practices should be strongly considered while prescribing food.Traditional rice grown with toxin free Hela Suwaya“Hela Govithena”technology improves the micronutrient,prebiotic,probiotic and antioxidant profiles of food.Agrochemical farming reduces these parameters by reducing soil pH and biota.Functional foods produced by Hela Suwaya post-harvest food technology(such as rice-based porridge)will further improve these nutritional profiles.The resulting optimization of the disturbed liver function is the key factor behind this beneficial effect on whole NCD spectrum.This is observed as cured or reduced NAFL/NAFLD.We have already planned controlled clinical trials for further confirmation.Proper food-based intervention is therefore strongly suggested.

A Case of Benign Chondroblastoma of Anterior Mandible and Review of Literature: A Very Rare Presentation

Benign chondroblastoma of mandibular bone is an extremely rare tumor. Although 9 cases have been reported in the mandibular condyle in the English literature, to the best of our knowledge this is the first case originated from anterior mandible in a 31-year-old male.

Microglandular hyperplasia-like mucinous adenocarcinoma of the endometrium: A rare case report

BACKGROUND Microglandular hyperplasia(MGH)is a proliferation of endocervical glands,related to estrogen stimulation,mainly occurring in the reproductive age group.The differential diagnosis includes endometrial adenocarcinoma with MGH-like pattern(MGA),a distinction that may be particularly problematic in curettage specimen.CASE SUMMARY A 57-year-old,postmenopausal woman was admitted in our hospital for surgical treatment.She had been diagnosed with a uterine leiomyoma,after complaints of irregular vaginal bleeding.She underwent dilatation and curettage(D&C)and subsequent total abdominal hysterectomy with bilateral salpingo-oophorectomy.D&C were compatible with MGA.Histologically,a proliferation of small glands,without intervening stroma,with mucin production,accumulation of neutrophils in the gland lumen and stroma,mild nuclear atypia and rare mitoses,were seen.In the hysterectomy specimen,the endometrium was thickened,but without apparent tumor formation.On microscopic examination,a residual similar adenocarcinoma was seen in the isthmus and more conventional-of endometrioid and mucinous type,in the rest of the endometrium.CONCLUSION MGH-like proliferation with mild cytologic atypia,detected in the endometrial curettage specimen of a postmenopausal woman,should alert pathologists for MGA of the endometrium.VIM,p16,PAX-2,CD10 and CD34 may help in the differential diagnosis.

Scarlett McNally:运动是一剂灵丹妙药

可预防的不良健康问题(ill-health)造成人力、劳动力和财务成本对英国经济来说就像定时炸弹。虽然预期寿命的延长是个好消息,但预测显示,未来平均每名成年人将需要10年的社会照护(social care)。因为20世纪80年代的房地产暴利掩盖了当今的社会照护成本,决策者可能无法掌握这一挑战的真正规模。我们的后代——以及未来的政府——不会再有这种缓冲。

World Federation of Acupuncture-Moxibustion Societies(WFAS)Clinical Practice Guideline on Acupuncture and Moxibustion:Gastroesophageal Reflux Disease(GERD)recommendation summaries

The Clinical Practice Guideline on Acupuncture and Moxibustion:Gastroesophageal Reflux Disease(GERD)(WFAS 007.9-2023),officially released by the World Federation of Acupuncture-Moxibustion Societies(WFAS)on October 9,2023,represents the inaugural acupuncture and moxibustion clinical practice guideline dedicated to GERD globally.This guideline outlines its purpose,scope,target audience,and relevant environments,along with detailing the acupuncture and moxibustion treatment methodology for GERD,as well as the guideline development process and recommendations.This article specifically emphasizes the recommendations of the guideline,highlighting the crucial importance of both the dissemination and adherence to this guideline to standardize acupuncture and moxibustion treatments for GERD.Such standardization plays a pivotal role in the advancement and widespread utilization of acupuncture and moxibustion in the management of GERD.