Objective To audit the process of stroke care. Design Retrospective case record evaluation using an audit package designed by the Royal College of Physicians of London.
Tuberculous meningitis in adults: a prospective study at a tertiary referral centre in Sri Lanka S A C U Gunawardhana, S C Somaratne, M A H Fernando, P S Gunaratne(Index words: tuberculous meningitis, clinical presentation, magnetic resonance imaging, Sri Lanka) AbstractIntroduction Central nervous system tuberculosis is the most severe form of extrapulmonary TB and it is associated with a substantial morbidity and mortality.Objectives To describe the demographic profile, clinical features, laboratory and imaging results of a cohort of adult patients with TBM (Tuberculous meningitis).Methods This study encompasses a prospective analysis of all adult cases of TBM diagnosed from 1st January 2010 to 31st December 2011 in the Neurology unit 2, National Hospital of Sri Lanka. Consensus case defini-
Introduction: Oral cancer is the commonest cancer among Sri Lankan males for decades.Objectives: To describe the sex difference in site specific cancers in oral cavity and to analyse the incidence trends according to sex, sites and age category of oral cancer in Sri Lanka between 2005 and 2019 Methods: Data on oral cancers were obtained from National Cancer Registry, Sri Lanka (NCR-SL) from 2005 to 2019. Sex difference for lip, tongue and mouth cancers were analysed. Analysis was performed with Joinpoint Trend Analysis Software on age standardized incidence rate (ASR) to examine the trends in sites, sex and age group categories over a 15-year period.Results: Data ofa total of31 919 oral cancer patients (males: 24 982; 78.3%; females: 6937; 21.7%) were analysed.All three site specific sub types showed a higher incidence in males than females. ASR has increased over the 15-year period in both sexes. The proportional increase in incidence was higher for males (1.9-fold increase with ASR; 9.8 to 18.9, average annual percentage change (AAPC) of5.4; 95% CI: 4.1, 6.7) than females (1.55-fold increase with ASR; 2.9 to 4.5,AAPC of3.l; 95% CI: 1.8, 4.5; p<0.001 fortrend). A statistically significant increasing trend was detected in all three types according to anatomical sites and in both sexes with a higher proportional increase in lip cancers (AAPC ofl0.5; 95%CI: 5.9, 15.3 in males;AAPC of6.9; 95%CI: 1.5, 12.6 in females;p<0.05 fortrend).An increasing trend in ASR was detected for all age categories. The rate was higher in less than 40 years age groups in both sexes (AAPC of 6.5; 95%CI: 3.3, 9.8 in males;AAPC of7.8; 95%CI: 3.4, 12.4 infemales;p<0.05 for trend). Conclusions & Recommendations:The incidence of oral cancer in Sri Lanka has shown an increasing trend with a greater propor t ional rise in males. It showed a higher incidence in males than females in all three subtypes. Structured prevention, screening and early detection programmes have to be planned to reduce the burden of oral cancer in Sri Lanka.
Background: Exclusive breastfeeding (BF) up to six months is recommended in Sri Lanka because it is known to be the best food for the infants and it provides vast benefits to the mother as well. Since exclusive BF rates decline with the advancing age of the baby, it is quite obvious that mothers face difficulties in BF.Objective: To describe the factors associated with difficulties in BF in mothers with neonates attending selected lactation management centres in the Colombo district. 2 . A study in the United States found a 25% increase in mortality among non-breast fed infants 3 . A study in Sri Lanka showed about 16% incidence of breast and nipple abnormalities in primigravida women and around 92% of them exclusively breast fed with support 4 . A study in a rural area in Sri Lanka found that 32% of the babies less than 3 months of age were on formula milk, and that difficulty in BF was a significant factor in starting formula feeding 5 . Method
Introduction: Dengue is an arboviral infection, transmitted from person to person via mosquito vectors. Dengue transmission is affected by rainfall, temperature, humidity and wind speed. These climate variables are changing as a result of anthropogenic climate change, and it is expected that this will affect the incidence of dengue. This scoping review explored the impacts on dengue transmission of variation in these climate variables in 12 Asian countries located in South- and South-East Asia regions. Methods: The protocol developed by the Joanna Briggs Institute was followed for this scoping review. Articles were found using the PubMed, Scopus, and Embase databases, as well as grey literature. Studies conducted in India, Bangladesh, Bhutan, the Democratic Republic of Korea, Indonesia, Maldives, Myanmar, Nepal, Thailand, Sri Lanka, and Timor Leste and published in English between 2002 and 2022 were included. An extensive literature search was conducted in February and March, 2022. A modified checklist designed for assessing the quality of ecological studies was used to assess the quality. Following quality assessment, ninety articles were included in the review. Results: The initial search yielded 1912 articles. After the duplicates were removed, 983 were identified as potentially relevant. Following the exclusion of 729 articles by two reviewers, 254 articles were subjected to full text screening. Thereafter, 90 articles were selected for the review that strictly met the inclusion criteria. Although the results were mixed, we found that dengue transmission decreases in temperature extremes. Dengue transmission increases with heavy rainfall, with a 1- 3-month lag. Humidity was also found to be related to dengue transmission. Other factors found to be associated with dengue transmission include the hours of sunshine and wind speed. Conclusion: There is a complex relationship between changing climate parameters and dengue incidence in Asia. This reflects the complex ecology of vector-borne diseases and suggests that the impact of changes in climate variables on dengue transmission may vary according to local climate and other factors.
Introduction: Oesophageal cancer (OC) is the seventh most common cancer in men and the 13 th in women worldwide. Of the two histological types, the most common is squamous cell carcinoma (SCC) while adenocarcinoma (AC) is increasing dramatically in affluent nations. According to the National Cancer Registry, Sri Lanka (NCR-SL), the age standardized incidence rate (ASR) for mal es was 9 .4 per 100 000 population while it was 5 .3 for females in 2019. Objectives:To describe the pattern of crude incidence rates (CR), age-specific incidence rates and ASR ofOC by sex, by age group and by the two main histological types (SCC &AC) in Sri Lanka from 2005 to 2019 Methods: Data already available in the NCR-SL maintained by the National Cancer Control Programme (NCCP) were extracted directly to calculate CR, age-specific incidence rates and ASR for the period during 2005-2019. Trend analysis was done using Joinpoint Trend Analysis Software (version 4.9). Av erage annual percentage changes (AAPC) were described with 95% confidence interval (CI).Results: There were 22 63 7 OC cases reported in Sri Lanka over the period of 2005 to 2019. Squamous cell carcinoma accounted for 18 546 (81.9%) of cases and 2 469 (18.1 % ) were AC. The AAPC ofage-specific incidence of OC for the 2005-2019 period was statistically significant for both age groups: 0-49 age group was 5.4 (95% CI: -1.3, 9.7) and 7.2 (95% CI: 3.8, 10.8) for the 50 years and above age group. TheAAPC ofASR ofOC in Sri Lankafrom 2005 to 2019 was 4.71 (95% CI: 3.5, 6.0). Tbe AAPC among males was 4.71, which was statistically significant (p<0.05). Tbe AAPC of CR ofSCC was 6.36 (95% CI: 3.4, 9.4) and 9.14 (95% CI: 9.3, 12.0) for AC. Both values were statistically significant (p<0.05).Conclusions & Recommendations: The ASR was higher among males compared to females. It was higher in the 50 years and above age group compared to 0-49 years. The CR ofSCC remains higher compared to AC. Yet, theAAPC is higher in AC. Further comprehensive studies should be conducted to identify the aetiology of different types ofOC.
Introduction:There is a dearth of information available on baseline data on the pattern of childhood cancers in Sri Lanka. Objectives:To describe the pattern of childhood cancer in Sri Lank a from 2005 to 2019 Methods: Data of all newly diagnosed childhood cancer patients ( age group 0-19) during 2005-2019 included in the National Cancer Registry, Sri Lank a (NCR-SL) were analysed. Data were categorized according to the frequency of childhood cancers in different age groups, sex, and types of tumours using the International Classification of Childhood Cancer, and incidence rates of childhood cancer were analysed.Results: Dur i ng the 15 years studied, 10 276 childhood cancer cases have been reported out of338 866 cancer patients, accounting for 3% of all cancers. Incidence was slightly higher among males, and the male to female ratio was 1.1: 1. Children in the 0-4-year age category accounted for 32% (n = 3295) of the burden followed by 15-19 age group (n = 3021; 29 .4% ). The lowest frequency (n = 1961; 19 .1 % ) was seen in the 10-14-year age group.The age-standardized incidence rate of childhood cancer was observed to have increased significantly from 2005-2019, with an average annual percent change (AAPC) of3 .0 (95% CI: 1.1, 4.9). The increase was significant in early life (0-4 and 5-9 age groups). Haematological malignancies accounted for 43.2 % of all childhood cancers. Among children aged 0-14, the first three leading cancers were leuk aemia, central nervous system tumours, and l ym phomas, whereas, in the 15-19-year age group, other malignant epithelial neoplasms & malignant melanomas were the leading types of cancers, followed by leukaemia and l ym phoma.Conclusions & Recommendations: Childhood cancer incidence rates are increasing in Sri Lanka in parallel with global statistics. A significant increase in childhood cancer cases is observed in early ages of life (0-4 and 5-9 age groups) with a slight male preponderance in all ages.
0https :// orcid.org/0000-0001-8 903-9961Introduction: Studies carried out on the incidence oflung cancer in the world and Southeast Asia region have shown varying trends. This is the first study in Sri Lanka after 2010 on trends oflung cancer. Objectives:To describe the trends in lung cancer incidence and patterns in Sri Lanka Methods: All newly diagnosed 'tr achea bronchus and lung' cancer patients in Sri Lanka during 2005-2019 included in the National Cancer Registry, Sri Lanka (NCR-SL) were analysed. Crude incidence rates (CR) and age standardized incidence rates (ASR) were compared using the Joinpoint regression program.Results: Data of 19 815 trachea bronchus and lung cancer patients (males = 15292; 77.17%) were analysed. The joinpoint regression analysis observed a linear increasing trend of CR andASR oflung cancer from 2005-2019. The proportional increase was higher for females (average annual percentage change (AAPC) ofCR = 8.5 andASR = 6.16) than males (AAPC ofCR = 5 .4 andASR = 3 .48) and the increase was statistically significant for both sexes.Conclusions & Recommendations: In Sri Lanka, the incidence oflung cancer has shown an increasing trend with a greater proportional rise in females. Although the increase could be partially explained by indoor air pollution, the rise could be due to other unknown factors, which warr ants detailed studies on lung cancer in Sri Lanka.
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