Age and serum Anti-Mullerian Hormone (AMH) levels as predictors of time to return of menses after chemotherapy.

Chemotherapeutic agents result in the loss of growing follicles, which can manifest as amenorrhoea. Alkylating chemotherapy (AC) is known to be more gonadotoxic than non-alkylating chemotherapy (NAC). Anti-Mullerian Hormone (AMH), an indirect marker of ovarian reserve, and age have been investigated as predictors of ovarian function after chemotherapy, however little is known about the time to return of menses.

Untangling biliary reconstruction in liver transplants for primary sclerosing cholangitis.

Background: Biliary reconstruction technique during liver transplant (LT) for primary sclerosing cholangitis (PSC) remains controversial. This study aimed to evaluate the incidence of biliary complications in patients with PSC having a duct-to-duct (DD) anastomosis or Roux-en-Y hepaticojejunostomy (HJ).

Methods: A retrospective medical record review of patients with PSC undergoing LT at a single center between June 1st, 2000 and December 31st, 2022 was performed.

Direct out-of-pocket expenditure of tuberculosis treatment in intensive phase in Kalutara District, Sri Lanka.

Background: Tuberculosis (TB) is a communicable disease. Financial risk protection is a key target to achieve in end TB strategy. Out-Of-Pocket Expenditure (OOPE) consisted of expenses bore by patients for their illnesses after subtracting third-party payments such as insurance.

The genetic basis of thoracic aortic disease: The future of aneurysm classification?

The expansion in the repertoire of genes linked to thoracic aortic aneurysms (TAA) has revolutionised our understanding of the disease process. The clinical benefits of such progress are numerous, particularly helping our understanding of non-syndromic hereditary causes of TAA (HTAAD) and further refinement in the subclassification of disease. Furthermore, the understanding of aortic biomechanics and mechanical homeostasis has been significantly informed by the discovery of deleterious mutations and their effect on aortic phenotype.

The mismatch between canteen guidelines and their implementation at canteens in medical institutions in Anuradhapura District.

Introduction: The 'Guidelines for a healthy canteen in workplaces' (guidelines) was published in 2013 by the Ministry of Health to improve food choices & healthy eating of working community.

Objectives: To determine the extent of implementation of guidelines in canteens at medical institutions in Anuradhapura District.

Methods: A descriptive cross-sectional study was conducted on random working days in canteens providing all three main meals in medical institutions in Anuradhapura District in August and September 2018.

A rare case of an intramyocardial mesothelial inclusion cyst.

A symptomatic intramyocardial cyst, whilst a rare occurrence, is most effectively investigated using Magnetic Resonance Imaging. Furthermore, following diagnosis it can be effectively treated using a surgical approach.

Metabolic disease and adverse events from immune checkpoint inhibitors.

Objective: Obese and overweight body mass index (BMI) categories have been associated with increased immune-related adverse events (irAEs) in patients with cancer receiving immune checkpoint inhibitors (ICIs); however, the impact of being overweight in conjunction with related metabolic syndrome-associated factors on irAEs have not been investigated. We aimed to evaluate the impact of overweight and obese BMI according to metabolic disease burden on the development of irAEs.

Design And Methods: We conducted a retrospective observational study of patients receiving ICIs at a cancer center.

Hydrodynamic cavitation for scalable exfoliation of few-layered graphene nanosheets.

A scalable manufacturing method for the production of biocompatible fewlayered graphene nanosheets is developed using hydrodynamic cavitation. Scalable exfoliation is induced by employing hydrodynamic cavitation and a serum albumin protein. Unlike acoustic cavitation, the primary means of bubble collapse in hydrodynamic cavitation is caused laterally, thereby separating two adjacent flakes through a shear effect.

Improving the Policy Utility of Cause of Death Statistics in Sri Lanka: An Empirical Investigation of Causes of Out-of-Hospital Deaths Using Automated Verbal Autopsy Methods.

Setting public health policies and effectively monitoring the impact of health interventions requires accurate, timely and complete cause of death (CoD) data for populations. In Sri Lanka, almost half of all deaths occur outside hospitals, with questionable diagnostic accuracy, thus limiting their information content for policy. To ascertain whether SmartVA is applicable in improving the specificity of cause of death data for out-of-hospital deaths in Sri Lanka, and hence enhance the value of these routinely collected data for informing public policy debates.

Protein-assisted scalable mechanochemical exfoliation of few-layer biocompatible graphene nanosheets.

A facile method to produce few-layer graphene (FLG) nanosheets is developed using protein-assisted mechanical exfoliation. The predominant shear forces that are generated in a planetary ball mill facilitate the exfoliation of graphene layers from graphite flakes. The process employs a commonly known protein, bovine serum albumin (BSA), which not only acts as an effective exfoliation agent but also provides stability by preventing restacking of the graphene layers.

Effects of three different mannans on obesity and gut microbiota in high-fat diet-fed C57BL/6J mice.

To compare the effects of three mannans, Konjac glucomannan (KGM), guar gum (GG) and locust bean gum (LBG), on obesity and obesity-related metabolic disorders in mice fed with high-fat diet (HFD), and to investigate the potential modulation of gut microbiota, we performed a 14 week study on C57BL/6J mice fed a HFD with/without mannan supplementation. The results showed that supplementing 8% KGM, GG, and LBG to a HFD dramatically reduced the body weight gain and adipose accumulation, attenuated liver injury, and antagonized glycolipid metabolism and inflammation-related parameters of HFD-fed mice in different degrees. However, only LBG had such roles when the supplement dose was reduced to 2%.

Noncompliance of treatment among tuberculosis patients in intensive phase at Kalutara District of Sri Lanka.

Background: Tuberculosis (TB) is an ancient disease and remains to be a public health problem all over the world. Noncompliance of treatment among TB patients affect the control of disease, leading to increased burden of the disease, mortality, drug resistant and relapse. Assessing the factors associated with noncompliance of TB treatment will be useful to reduce the noncompliance and burden.

Emergency cardiac surgery for patients on NOACs in the NOAC era - Perspective.

Excessive bleeding is an important cause of morbidity and mortality after cardiac surgery. Bleeding after cardiac surgery is multifactorial. Adherence to the proverbial 6 Ps remains the cornerstone of any strategy for management of postoperative bleeding after cardiac surgery.

Hypertensive Crisis in Pregnancy with COVID19: Confirmed with rt-PCR for Nasopharyngeal Swab.

The novel coronavirus has already spread across the geographical borders to 213 countries and self-governing territories. However, the effect of SARS-CoV-2 infection on pregnant mothers is still poorly understood and sparsely documented. Here, we present a case of a primi mother, who presented with diarrheal episode and proceeded to a hypertensive crisis and placental abruption with rt-PCR (nasopharyngeal swab) confirmed for COVID19.

Protocol for establishing a child and adolescent twin register for mental health research and capacity building in Sri Lanka and other low and middle-income countries in South Asia.

Introduction: Worldwide, 10%-20% of children and adolescents experience mental health conditions. However, most such disorders remain undiagnosed until adolescence or adulthood. Little is known about the factors that influence mental health in children and adolescents, especially in low and middle-income countries (LMIC), where environmental threats, such as poverty and war, may affect optimal neurodevelopment.

Critical Care Junior Doctors' Profile in a Lower Middle-income Country: A National Cross-sectional Survey.

Background And Aims: Retention of junior doctors in specialties such as critical care is difficult, especially in resource-limited settings. This study describes the profile of junior doctors in adult state intensive care units in Sri Lanka, a lower middle-income country.

Materials And Methods: This was a national cross-sectional survey using an anonymous self-administered electronic questionnaire.

Closing the theory to practice gap for newly qualified doctors: evaluation of a peer-delivered practical skills training course for newly qualified doctors in preparation for clinical practice.

Purpose: The Good Intern Programme (GIP) in Sri Lanka has been implemented to bridge the 'theory to practice gap' of doctors preparing for their internship. This paper evaluates the impact of a 2-day peer-delivered Acute Care Skills Training (ACST) course as part of the GIP.

Study Design: The ACST course was developed by an interprofessional faculty, including newly graduated doctors awaiting internship (pre-intern), focusing on the recognition and management of common medical and surgical emergencies.

Capacity building for critical care training delivery: Development and evaluation of the Network for Improving Critical care Skills Training (NICST) programme in Sri Lanka.

Objectives: To deliver and evaluate a short critical care nurse training course whilst simultaneously building local training capacity.

Research Methodology: A multi-modal short course for critical care nursing skills was delivered in seven training blocks, from 06/2013-11/2014. Each training block included a Train the Trainer programme.

Fusarium agapanthi sp. nov., a novel bikaverin and fusarubin-producing leaf and stem spot pathogen of Agapanthus praecox (African lily) from Australia and Italy.

This study was conducted to characterize a novel Fusarium species that caused leaf and stem spot on Agapanthus praecox (Agapanthus, African lily) in northern Italy and leaf rot and spot on the same host in Melbourne, Australia. Formally described as Fusarium agapanthi, this pathogen was analyzed using phenotypic, phytopathogenic, secondary metabolite, molecular phylogenetic and genomic data. Five strains were characterized, including one isolated in 1999 from symptomatic A.

Capacity-building of the allied health workforce to prevent and control diabetes: Lessons learnt from the National Initiative to Reinforce and Organize General Diabetes Care in Sri Lanka (NIROGI Lanka) project.

In 2008, to tackle the exponential rise in the clinical burden of diabetes that was challenging the health systems in Sri Lanka, a shift in focus towards patient-centred care linked with community health promotion was initiated by the National Initiative to Reinforce and Organize General Diabetes Care in Sri Lanka (NIROGI Lanka) project of the Sri Lanka Medical Association. Specific training of "diabetes educator nursing officers" (DENOs), field staff in maternal and child health, footwear technicians, and health promoters from the community, was instituted to improve knowledge, skills and attitudes in the area of control and prevention of diabetes. This article highlights some of the activities carried out to date with the allied health workforce and volunteer community.

Quality of inpatient care in public and private hospitals in Sri Lanka.

Objective: To compare the quality of inpatient clinical care in public and private hospitals in Sri Lanka.

Methods: A retrospective, cross-sectional comparison was done of inpatient quality, in a sample of 11 public and 10 private hospitals in three of 25 districts. Data were collected for 55 quality indicators from medical records of 2523 public and 1815 private inpatient admissions.

Nursing intensive care skills training: a nurse led, short, structured, and practical training program, developed and tested in a resource-limited setting.

Purpose: To assess the impact of a nurse-led, short, structured training program for intensive care unit (ICU) nurses in a resource-limited setting.

Methods: A training program using a structured approach to patient assessment and management for ICU nurses was designed and delivered by local nurse tutors in partnership with overseas nurse trainers. The impact of the course was assessed using the following: pre-course and post-course self-assessment, a pre-course and post-course Multiple Choice Questionnaire (MCQ), a post-course Objective Structured Clinical Assessment station, 2 post-course Short Oral Exam (SOE) stations, and post-course feedback questionnaires.