Is the rise in childhood obesity rates leading to an increase in hospitalizations due to dengue?

Background: Obesity and diabetes are known risk factors for severe dengue. Therefore, we sought to investigate the association of obesity with increased risk of hospitalization, as there is limited information.

Methods And Findings: Children aged 10 to 18 years (n = 4782), were recruited from 9 districts in Sri Lanka using a stratified multi-stage cluster sampling method.

Large epidermoid cyst of the spleen causing massive splenomegaly: A case report.

Splenic cysts are uncommon and are classified as primary cysts or secondary cysts based on the presence or absence of an intact epithelial lining, respectively. Epidermoid cysts have an epithelial lining of stratified squamous epithelium and have been reported in normal and intra-pancreatic accessory spleens. An 18-year-old girl presented with a symptomatic, uncomplicated splenic cyst causing massive splenomegaly and symptoms due to mass effect.

Severe hyponatraemia due to high output external biliary drainage corrected with bile refeeding: A case report.

Hyponatraemia is an uncommon complication of external biliary drainage. We report on a 62-year-old male with hilar cholangiocarcinoma who developed refractory severe hyponatraemia despite sodium replacement during preoperative external biliary drainage. Nasojejunal bile refeeding restored sodium levels to normal.

Delay in diagnosis to treatment and impact on survival of gastric adenocarcinoma in a low income setting without screening facility.

The treatment modality of gastric adenocarcinoma (GCA) depends on the stage of the disease at the clinical presentation. Long delays are probably an unfavorable factor for the patient's prognosis. A prospective longitudinal, study involving 145 consecutive GCA was conducted at the National Hospital of Sri Lanka (NHSL).

Parenchymal-sparing hepatectomy for multiple bilobar colorectal liver metastases in a Jehovah's witness: a case report.

Parenchymal-sparing hepatectomy (PSH), though technically challenging, is emerging as a choice of treatment for colorectal liver metastases (CRLM). PSH in Jehovah's witness (JW) patients, for whom transfusion is not an option, involves complex surgical and medicolegal issues. A 52-year-old JW male with synchronous, multiple, bilobar liver metastases from a rectal adenocarcinoma was referred following neoadjuvant chemotherapy.

A model for analysis of antibiotic usage in low-income settings.

Objectives: Quantification of antibiotic usage is an important component of antimicrobial stewardship programmes. We aimed to estimate institutional antibiotic usage and costs using methodology and metrics applicable to low-income settings without electronic health records.

Methods: The DDD per 100 patient-days (DDDs/100 PDs) of antibiotics used in a calendar year was calculated retrospectively from ward registers and inpatient drug records in general surgical wards of a tertiary hospital.

Intrahepatic gallbladder duplication mimicking a hepatic cyst: A case report.

Gallbladder duplication is a rare anomaly of the biliary tree. Implications of misdiagnosis include unwarranted surgery and morbidity such as when liver resections are done suspecting cystic intraductal papillary neoplasm of the bile duct. The use of appropriate imaging, when suspected, facilitates diagnosis and avoids adverse surgical outcomes.

Human epidermal growth factor receptor-2 gene expression positivity determined by silver in situ hybridization/immunohistochemistry methods and associated factors in a cohort of Sri Lankan patients with gastric adenocarcinoma: a prospective study.

Objective: Positive human epidermal growth factor 2 (HER2) expression and its predictive clinicopathological features remain unclear in Sri Lankan gastric cancer (GC) patients. Here, we aimed to determine GC HER2 status predictors by analyzing associations between clinicopathological features and HER2 expression using immunohistochemistry (IHC) and silver in situ hybridization (SISH).

Methods: During this 4-year prospective study, clinicopathological data were collected from participants in the National Hospital of Sri Lanka.

Infarct Like Necrosis of Colorectal Liver Metastasis Without Chemotherapy: A Rare Phenomenon.

Usual type necrosis (UN) and infarct like necrosis (ILN) occur in CRLMs. ILN is a rare form of necrosis in colorectal liver metastases which is usually seen following chemotherapy. De novo occurrence of ILN is a very rare phenomenon.

Multi-system : A tale of destruction form lung to eye.

, found in the gastrointestinal flora is a causative agent of hospital-acquired infections. Although isolated organ infections are common, reports of multi-system involvement are rare. We report on a susceptible patient presenting with disseminated infection with concurrent multi-organ disease involving the lung, liver, prostate and eye.

Adenosquamous Carcinoma of the Distal Common Bile Duct: A Case of a Rare Type of Cholangiocarcinoma.

Introduction: Adenosquamous carcinoma (ASC) is a rare subtype of the conventional adenocarcinoma of the bile duct. The clinico-pathological characteristics of this entity are poorly understood partly due to its rarity.

Case Summary: A 67-year-old ASA II male presented with obstructive jaundice subsequently complicated by cholangitis.

Idiopathic gross dilatation of the pancreatic duct with exocrine insufficiency in a patient with type 1 neurofibromatosis.

Pancreatic duct dilatation occurs in conditions including chronic pancreatitis, pancreatic carcinoma and intraductal papillary mucinous neoplasms. Although several pancreatic benign and malignant tumours have been reported in association with type 1 neurofibromatosis, an association with gross pancreatic duct dilatation or ectasia has not been previously published. We report on a patient with type 1 neurofibromatosis found to have idiopathic gross pancreatic duct dilatation and exocrine insufficiency.

Double gallbladder-intraoperative finding at laparoscopic cholecystectomy: Literature review.

Duplication of the gallbladder is a rare entity. It is often appreciated at surgery and has a higher propensity for complications and conversion to open surgery. We report a case of laparoscopic recognition and removal of a duplicated gallbladder opening into the bile duct through separate cystic ducts, in a young male presenting with biliary colics.

Right hepatectomy with a cholangiojejunostomy and hepaticojejunostomy for unilobar Caroli's syndrome.

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Acute Gastrointestinal Bleed from a Gastrointestinal Stromal Tumour Impersonating an Arteriovenous Malformation of the Jejunum.

Gastrointestinal stromal tumours (GIST) are neoplasms which originate from the mesenchymal tissue of the gastrointestinal tract. We report on a GIST presenting with acute gastrointestinal bleeding that mimicked an arteriovenous malformation (AVM) on imaging and at surgery. A 61-year-old female presented with a short history of melaena and severe anaemia.

Seeking the unseen: Localization and surgery for an occult sporadic insulinoma.

Insulinomas are rare pancreatic neuroendocrine tumours and the commonest cause for endogenous hyperinsulinaemic hypoglycemia. Small tumours are not easily detected by conventional cross-sectional imaging making localization prior to surgical removal a challenge. Selective arterial calcium stimulation is an invaluable adjunct to localization in such circumstances.

Total Pancreatectomy for Malignant Intraductal Papillary Mucinous Neoplasm (IPMN) Complicated by Gastropancreatic Fistulae.

Background: Intraductal papillary mucinous neoplasms (IPMN) of the pancreas complicated by fistula formation to adjacent organs are an uncommon phenomenon. We present an IPMN of the pancreas with malignant transformation and multiple fistulae to the stomach and duodenum. .

Acute kidney injury due to high-output external biliary drainage in a patient with malignant obstructive jaundice: a case report.

Background: Persistent high output is a rare but potentially serious complication of percutaneous biliary drainage.

Case Presentation: A 68-year-old Sinhalese woman with a palliative self-expanding metal stent placed for an inoperable hilar cholangiocarcinoma presented with worsening obstructive jaundice. Ultrasonography showed intrahepatic duct dilatation with the self-expanding metal stent in situ.

Betel chewing among bus drivers in Jaffna district.

Objective: To assess the prevalence, pattern and sociocultural factors associated with betel chewing among bus drivers in Jaffna district.

Methodology: Cross-sectional study was conducted among 423 registered drivers using an interviewer administered questionnaire from March to April 2014.

Results: All were males.

Nonhealing scrotal ulceration-an unusual manifestation of TB epididymo-orchitis: case report and review of literature.

The clinical presentation of genitourinary tuberculosis (TB) may be variable and a high index of suspicion is required for a timely diagnosis, especially in endemic areas. Recurrent scrotal ulcers associated with epididymo-orchitis even without other constitutional symptoms should alert the clinician of a possible diagnosis of TB.

Palliative end ileostomy and gastrojejunostomy for a metastatic distal transverse colonic malignancy complicated by a proximal duodenocolic fistula: a case report.

Background: Fistulae between the colon and upper gastrointestinal tract are distressing and uncommon complications of malignancies involving this region. We report a case of a middle-aged man with a locally advanced and metastatic distal transverse colon malignancy who presented with a duodenocolic fistula proximal to the primary tumor and underwent palliative surgery.

Case Presentation: A 50-year-old Sri Lankan man presented to our hospital with a history of feculent vomiting of 1 week's duration preceded by worsening constipation and abdominal fullness of 2 months' duration.

Human Epidermal Growth Factor Receptor-2 in Sri Lankan Gastric Carcinoma Patients with Clinicopathological Association and Survival.

Background: HER2 protein expression indicates adverse prognosis in gastric adenocarcinoma (GCa). GCa HER2 positivity ranges from 10 to 22.8%.

Gastric fundal heterotopic pancreas mimicking a gastrointestinal stromal tumour (GIST): a case report and a brief review.

Background: Heterotopic pancreas is a rare congenital condition characterised by pancreatic tissue lacking vascular or anatomic communication with the normal pancreas. Most cases of ectopic pancreas are asymptomatic. The preoperative diagnosis of this condition is difficult.

Space-time clustering characteristics of dengue based on ecological, socio-economic and demographic factors in northern Sri Lanka.

The aim of the present study was to identify geographical areas and time periods of potential clusters of dengue cases based on ecological, socio-economic and demographic factors in northern Sri Lanka from January 2010 to December 2013. Remote sensing (RS) was used to develop an index comprising rainfall, humidity and temperature data. Remote sensing data gathered by the AVNIR-2 instrument onboard the ALOS satellite were used to detect urbanisation, and a digital land cover map was used to extract land cover information.