Human Papillomavirus-Associated Oral Squamous Cell Carcinoma Among Adults Living in South-Central Asia: A Systematic Review.

Human papillomavirus (HPV) related oral cancers are increasing and are associated with sexual risk behaviours. An increase in the incidence of oral cancer has been observed in South-central Asian countries. The objective was to systematically review the evidence on the association of HPV and oral squamous cell carcinoma (OSCC) among adults living in South-central Asia. We searched multiple databases and reference lists of relevant articles in December 2018. Quality assessment of the selected articles were done using the Newcastle-Ottawa quality assessment scale. Thirteen out of 150 articles met the eligibility criteria. Most studies were from India (10/13) followed by Pakistan (2/13) and Bangladesh (1/13). Half (7/13) of the studies found a positive association between HPV with OSCC. HPV 16, HPV 18 and HPV 16/18 were found to be the most common types implicated in HPV infection associated with OSCC. Moreover, buccal mucosa was the most common site of oral cancer. The review found equivocal evidence in relation to the association of HPV with oral squamous cell carcinoma among people living in South Asia.

Sri Lankan Sloth Bear (Melursus ursinus inornatus) Attacks on Humans.

The sloth bear (Melursus ursinus) is an omnivore that has been reported around most parts of South Asia. Although rare, sloth bear attacks can inflict potentially life-threatening injuries. This cross-sectional study analyzed 10 patients who had been mauled by sloth bears and who presented to rural hospitals in the Anuradhapura district of Sri Lanka between 2015 and 2019. All of the patients were male farmers. The human-bear encounters occurred in the jungle during the daytime. Ten victims sustained multiple soft tissue and bone injuries, mainly to the face and arms. The injuries ranged from minor abrasions to extensive deep lacerations and bone fractures. All of the patients were managed in the tertiary care hospital by multidisciplinary surgical teams. Sloth bear-inflicted wounds must be treated as major trauma. There is a need to formulate guidelines and train medical officers in managing animal-inflicted injuries in Sri Lanka.

Penetrating Injuries Following Spotted Deer Axis axis ceylonensis Attack.

The spotted deer Axis axis is a Cervidae mammal that lives in most parts of Southeast Asia. Spotted deer attacks on humans are scarcely reported in the literature and are a rare phenomenon. A 31-y-old man was attacked by an unprovoked male spotted deer while supervising maintenance inside a deer enclosure. The victim received deep lacerations in the lower limbs and puncture wounds in the chest and abdomen. The victim made a full recovery after prompt management at a tertiary care hospital. The potential factors leading to this uncommon attack are discussed.

Qualitative and quantitative dermatoglyphics of chronic kidney disease of unknown origin (CKDu) in Sri Lanka.

BACKGROUND: Dermatoglyphics has been used widely in fields of medicine as a non-invasive diagnostic tool and an early assessment of risk for certain medical conditions. It reflects disturbances in fetal development during early prenatal weeks 14-22 when fingerprints develop. Dermatoglyphic asymmetry has been used to measure developmental instability during a specific period of human fetal development. Thus, the present study was planned to investigate whether digital and palmar dermatoglyphics of chronic kidney disease of unknown origin (CKDu) patients in Sri Lanka are different from healthy people. METHODS: A case control study was carried out among CKDu patients (90 males, 90 females) from a CKDu endemic area and gender-matched two control groups; one group from a CKDu endemic region (90 males, 90 females) and another group from a CKDu non-endemic region (90 males, 90 females). Dermatoglyphics were obtained using photographic methods. Both qualitative and quantitative dermatoglyphic variables were defined and analyzed according to standard criteria. Both directional (DA) and fluctuating asymmetry (FA) were assessed. RESULTS: Several qualitative dermatoglyphic variables had significant association with CKDu. The triradii a1 variable was less evident in palms of CKDu cases in both genders when compared to both control groups. The FA of pattern discordance (right vs left hands) between CKDu cases and control group were significant in several digits. The FA of the ridge count was found significant in several digits, and also significant for A-B ridge count and total ridge count. CONCLUSION: Based on these results, it is proposed that the mechanisms responsible for the development of CKDu might be associated with those responsible for FA observed in CKDu patients. Accordingly, a diagnostic tool based on FA could be developed for predicting risk prior to the development of CKDu.

Close Encounter With a Prickly Soccer Ball: An Injury From an Indian Crested Porcupine.

The Indian crested porcupine, Hystrix indica, is a large rodent with the unique feature of long quills. These quills are an integral part of its defense mechanism against predators. Injuries resulting from human contact with quills may cause pain, bleeding, and swelling. Quill-related injuries are common among animals such as dogs, cats, and some wild animals. The mechanism of injury, consequences, and management of injuries to humans from H indica quills are rarely described. In this report, we describe the injuries and management of a man who sustained injury from H indica quills.

Freshwater Catfish Envenoming in a Tropical Country.

OBJECTIVE: Freshwater catfish are known to cause painful stings in humans. Stings usually cause mild envenomation and, in some instances, can lead to severe secondary bacterial infections. Sri Lanka is a tropical country where catfish stings are not rare. However, presenting signs and symptoms, complications, and management options are scarce in the literature. METHODS: A retrospective, descriptive, cross-sectional study was conducted by reviewing patient records in the university surgical units and surgical clinic in the teaching hospital in Anuradhapura, Sri Lanka, during 2015. RESULTS: Ten patients presented to the hospital following catfish stings. The common presenting features following stings were severe pain, swelling, and lymphadenopathy followed by cellulitis. Late complication such as tenosynovitis were also observed. CONCLUSIONS: Routine procedures are sufficient to reduce further complications. However, people who are at high risk of encountering catfish, and travelers visiting tropical countries, should be aware of the possibility of stings and take necessary precautions.

Pharmacology education and antibiotic self-medication among medical students: a cross-sectional study.

OBJECTIVE: Pharmacology teaches rational prescribing. Self-medication among medical students is recognised as a threat to rational prescribing. Antibiotic self-medication could cause antibiotic resistance among medical students. We aimed to find an association between pharmacology education and antibiotic self-medication. RESULTS: Overall, 39% [(110/285) 95% CI 32.9-44.3] of students were found to have antibiotic self-medication. The percentage for antibiotic self-medication progressively increased with the year of study. The percentage of antibiotic self-medication was significantly high in the "Formal Pharmacology Education" group (47%-77/165) in comparison to the "No Formal Pharmacology Education" group (28%-33/120) (P = 0.001032). Overall, the most common self-prescribed antibiotic was amoxicillin (56%-62/110).

Regulation of herbal medicine use based on speculation? A case from Sri Lanka.

Chronic Kidney Disease of Unknown aetiology is a significant public health problem in Sri Lanka. The final report by the WHO mission recommended regulation of herbal medicines containing aristolochic acid, which is an established nephrotoxin. The use of Complimentary and Alternative Medicine (CAM) has a history of more than 2500 years in Sri Lanka. Aristolochia species are rarely used in Ayurveda and traditional medicine in Sri Lanka. Before regulating the analysis of herbal preparations using Aristolochia, collecting data from CAM practitioners regarding the use of Aristolochia is necessary. Analysis of Ayurveda pharmacopeia shows the doses used are negligible and some preparations are used for external applications.

The status of dermatoglyphics as a biomarker of Tel Hashomer camptodactyly syndrome: a review of the literature.

INTRODUCTION: Tel Hashomer camptodactyly syndrome is a rare disease and only a few cases have been reported. Dermatoglyphics potentially provide relevant phenotypic biomarkers that were initially noted as a vital clinical feature of this disease. Dermatoglyphics possibly can indicate growth disturbances that took place during early fetal development at the time when epidermal ridges were being formed into discernable patterns. Consequently, these intrauterine effects might well have occurred in association with the expression of the Tel Hashomer camptodactyly syndrome. Therefore, this review was undertaken to provide, as far as we know, the first attempt to broadly assess dermatoglyphic features that are connected with the Tel Hashomer camptodactyly syndrome. If a developmental association between dermatoglyphics and Tel Hashomer camptodactyly can be firmly established, this would probably document that Tel Hashomer camptodactyly disease has its origins during the early fetal period. METHODS: A systematic literature search was conducted using articles from PubMed (Medline), POPLINE, Trip Database, Cochrane Library, and gray literature up to 31 March 2015. The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS: Fourteen relevant publications were included in the review. There were 23 cases of patients with Tel Hashomer camptodactyly syndrome that were described in these published articles. We reviewed the dermatoglyphics of 21 available cases out of all of the published and electronically available cases of Tel Hashomer camptodactyly. Eight cases reported whorls to be the most common digital pattern with an expected rise of ridge count. Two cases show significantly high frequencies of arch patterns. Further, there were increased numbers of palmar creases, along with abnormal flexion creases or other palmar dermatoglyphic abnormalities reported in all cases. CONCLUSION: This review highlighted the desirability of thoroughly observing and recording dermatoglyphic features when reporting on future patients with Tel Hashomer camptodactyly syndrome, in conjunction with carrying out modern molecular methods.

Situation of Sri Lanka, where autochthonous malaria is no longer a problem, and other infections dominate, such as dengue, leptospirosis and rickettsioses.

PURPOSE OF REVIEW: Sri Lanka achieved a major milestone in communicable disease control in 2012 by reporting zero incidence of autochthonous malaria. However, reduction of malaria was associated with concurrent increase of several tropical diseases. This review looks into the time trends and epidemiology of these communicable diseases in Sri Lanka. RECENT FINDINGS: Reduction of malaria cases coincides with an increase of dengue, leptospirosis and rickettsioses in Sri Lanka. Although the case fatality rate of dengue has reduced and maintained below 1%, leptospirosis in clinical management is questionable. Despite having national focal points for control and prevention, these emerging diseases are completely out of control. Whether the holding back of vector control activities of malaria after a successful control programme is having an effect on emergence of other vector-borne diseases should be studied. SUMMARY: The communicable disease control programme in Sri Lanka should be further strengthened with availability of proper and rapid diagnostic facilities. Malaria control could not be considered as a great achievement due to the fact that other emerging infectious diseases are replacing malaria.

Drug utilization, prescription errors and potential drug-drug interactions: an experience in rural Sri Lanka.

BACKGROUND: Prescription writing is a process which transfers the therapeutic message from the prescriber to the patient through the pharmacist. Prescribing errors, drug duplication and potential drug-drug interactions (pDDI) in prescriptions lead to medication error. Assessment of the above was made in prescriptions dispensed at State Pharmaceutical Corporation (SPC), Anuradhapura, Sri Lanka. METHODS: A cross sectional study was conducted. Drugs were classified according to the WHO anatomical, therapeutic chemical classification system. A three point Likert scale, a checklist and Medscape online drug interaction checker were used to assess legibility, completeness and pDDIs respectively. RESULTS: Thousand prescriptions were collected. Majority were hand written (99.8 %) and from the private sector (73 %). The most frequently prescribed substance and subgroup were atorvastatin (4 %, n = 3668) and proton pump inhibitors (7 %, n = 3668) respectively. Out of the substances prescribed from the government and private sectors, 59 and 50 % respectively were available in the national list of essential medicines, Sri Lanka. Patients address (5 %), Sri Lanka Medical Council (SLMC) registration number (35 %), route (7 %), generic name (16 %), treatment symbol (48 %), diagnosis (41 %) and refill information (6 %) were seen in less than half of the prescriptions. Most were legible with effort (65 %) and illegibility was seen in 9 %. There was significant difference in omission and/or errors of generic name (P = 0.000), dose (P = 0.000), SLMC registration number (P = 0.000), and in evidence of pDDI (P = 0.009) with regards to the sector of prescribing. The commonest subgroup involved in duplication was non-steroidal anti-inflammatory drugs (NSAIDs) (43 %; 56/130). There were 1376 potential drug interactions (466/887 prescriptions). Most common pair causing pDDI was aspirin with losartan (4 %, n = 1376). CONCLUSION: Atorvastatin was the most frequently prescribed substance. Fifteen percent of the prescriptions originate from government sector. SLMC registration number and trade names were seen more in prescriptions originating from the private sector. Most prescriptions were legible with effort. NSAIDs were the commonest implicated in drug class duplication. Fifty three percent of prescriptions have pDDI.

Dermatoglyphics in kidney diseases: a review.

Kidney diseases are becoming a major cause of global burden with high mortality and morbidity. The origins of most kidney diseases are known, but for some the exact aetiology is not yet understood. Dermatoglyphics is the scientific study of epidermal ridge patterns and it has been used as a non-invasive diagnostic tool to detect or predict different medical conditions that have foetal origin. However, there have been a limited number of studies that have evaluated a dermatoglyphic relationship in different kidney diseases. The aim of this review was to systematically identify, review and appraise available literature that evaluated an association of different dermatoglyphic variables with kidney diseases. This review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The PubMed(®) (Medline), POPLINE, Cochrane Library and Trip Database and grey literature sources such as OpenGrey, Google Scholar, and Google were searched to earliest date to 17 April 2014. Of the 36 relevant publications, 15 were included in the review. Of these studies, there are five case reports, seven case series and three comparative studies. Possible association of dermatoglyphics with Wilms tumor (WT) had been evaluated in two comparative studies and one case series that found fewer whorls and a lower mean total ridge count (TRC). Another study evaluated adult polycystic kidney disease (APCD) type III that revealed lower TRC means in all cases. All other case series and case reports describe dermatoglyphics in various kidney disease such as acro-renal-ocular syndrome, potter syndrome, kabuki makeup syndrome, neurofaciodigitorenal syndrome, syndactyly type V, ring chromosome 13 syndrome, trisomy 13 syndrome and sirenomelia. It is evident that whorl pattern frequency and TRC have been used widely to investigate the uncertainty related to the origin of several kidney diseases such as WT and APCD type III. However, small sample sizes, possibly methodological issues, and discrepancy in the make up between cases and control groups limits interpretation of any significant findings. Future studies with proper protocol, adequate cases, and control groups may provide stronger evidence to resolve uncertainty related to the aetiology of kidney diseases.

Exertional heat stroke in a young military trainee: is it preventable?

BACKGROUND: Heat stroke is a life-threatening condition with exertional heat stroke occurring frequently among soldiers and athletes. Because of its common occurrence, many military trainees practice preventive measures prior to any activity requiring severe exertion. Although it is said to be common in practice, different presentations of heat stroke are scarcely described in literature. CASE PRESENTATION: We describe a case of an exertional heat stroke in a 23-year-old male Sinhalese soldier who developed early changes of renal failure, liver failure and rhabdomyolysis. The patient initially presented with convulsions, delirium and loss of consciousness to an outside health care facility before being transferred to our institution. CONCLUSION: It is clear that heat stroke does occur in military trainees while preventive strategies are being practiced. It is important for those who provide healthcare to soldiers to provide proper advice on how to identify impending heat stroke prior to any exercises resulting in severe physical exertion. Further, treating physicians should educate all military trainees about preventive strategies.

Dermatoglyphics in hypertension: a review.

Hypertension is a major contributor to the global burden of disease and mortality. A major medical advancement would be a better means to ascertain which persons are at higher risk for becoming hypertensive beforehand. To that end, there have been a number of studies showing that certain dermatoglyphic markers are associated with hypertension. This association could be explained if the risk toward developing hypertension later on in life is somehow connected with fetal development of dermatoglyphics. It would be highly valuable from a clinical standpoint if this conjecture could be substantiated since dermatoglyphic markers could then be used for screening out individuals who might be at an elevated risk of becoming hypertensive. The aim of this review was to search for and appraise available studies that pertain to the association between hypertension and dermatoglyphics.A systematic literature search conducted using articles from MEDLINE (PubMed), Trip, Cochran, Google scholar, and gray literature until December 2014. Of the 37 relevant publications, 17 were included in the review. The review performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement.This review showed a fairly consistent finding of an increased frequency of whorl patterns along with a higher mean total ridge count in digital dermatoglyphic results in hypertensive samples compared to controls. However, it was imperative to discuss several limitations found in the studies that could make this association as yet unsettled.