Determinants of mortality and impact of therapy in patients with leptospirosis admitted for intensive care in a Sri Lankan hospital--a three year retrospective study.

INTRODUCTION: Leptospirosis is a disease of epidemic proportions in Sri Lanka. There is paucity of data on the determinants of mortality and impact of therapy in patients with leptospirosis admitted to critical care settings in endemic territories. METHODOLOGY: This retrospective cross-sectional study was performed in patients with serologically confirmed leptospirosis admitted to the intensive care unit of the General Hospital, Kalutara from January 2011 to April 2014. Associations between socio-epidemiological, clinical and laboratory parameters and patient mortality were examined. RESULTS: Forty-five patients were included. The mean age was 49.11(SD = 16.95) and majority (92%) were male. Percentage mortality was 44.4%. Patient mortality was associated with age > 40 (p = 0.012), symptoms of uremia (p = 0.017), evidence of CNS involvement (p = 0.039), presence of oliguria (p = 0.002) and anuria (p = 0.014), presence of multi-organ dysfunction syndrome (MODS) (p < 0.001), CRP > 96 (p = 0.036), platelet count < 20,000 (p = 0.045), Potassium > 5.0 (p = 0.05), metabolic acidosis with pH < 7.2 (p = 0.03), INR > 2 (p = 0.037) and requirement of mechanical ventilation (p < 0.001). Cox regression analysis revealed MODS and potassium > 5 to be independently associated with mortality. CONCLUSIONS: A high mortality rate is noted. The presence of MODS and serum potassium concentration > 5.0 was independently associated with mortality in this retrospective study of patients with confirmed leptospirosis in a critical care setting.

Economic valuation of a mangrove ecosystem threatened by shrimp aquaculture in Sri Lanka.

Mangrove ecosystems in Sri Lanka are increasingly under threat from development projects, especially aquaculture. An economic assessment is presented for a relatively large (42 ha) shrimp culture development proposed for the Rekawa Lagoon system in the south of Sri Lanka, which involved an extended cost-benefit analysis of the proposal and an estimate of the "total economic value" (TEV) of a mangrove ecosystem. The analysis revealed that the internal benefits of developing the shrimp farm are higher than the internal costs in the ratio of 1.5:1. However, when the wider environmental impacts are more comprehensively evaluated, the external benefits are much lower than the external costs in a ratio that ranges between 1:6 and 1:11. In areas like Rekawa, where agriculture and fisheries are widely practiced at subsistence levels, shrimp aquaculture developments have disproportionately large impacts on traditional livelihoods and social welfare. Thus, although the analysis retains considerable uncertainties, more explicit costing of the environmental services provided by mangrove ecosystems demonstrates that low intensity, but sustainable, harvesting has far greater long-term value to local stakeholders and the wider community than large shrimp aquaculture developments.

Serum cholesterol concentrations in parasuicide.

OBJECTIVE: To evaluate whether people who have committed parasuicide have low serum cholesterol concentrations. METHOD: All subjects admitted to the University Medical Unit, Ragama after parasuicide from 1.3.96 to 31.1.97 were matched for age, sex, presence of diabetes and arterial hypertension, substance abuse, body mass index and socioeconomic status with controls. Venous blood samples for cholesterol estimation were collected from parasuicides within 24 hours of admission. RESULTS: Analysis was done on 168 parasuicide patients [males 74; mean age for males 24 years (SD 6.2), females 19 years (SD 3.3)] and 168 matched controls. Of the parasuicide subjects, 33 had a psychiatric illness and 135 were considered to have impulsive personalities. The serum cholesterol level in parasuicide patients was not significantly different from that in controls. CONCLUSIONS: This study, the first from a developing country, did not show an association between low serum cholesterol concentrations and parasuicide.

Maternal comprehension of two growth monitoring charts in Sri Lanka.

OBJECTIVE: To investigate the maternal comprehension of two different growth charts and to identify the group of mothers with poor comprehension. DESIGN: An experimental prospective study. SETTING: A child welfare clinic at the De Soysa Hospital for Women, Colombo, Sri Lanka. SUBJECTS: 932 mothers were studied regarding their interpretation of the type of growth chart their infants had been allocated. A total of 413 mothers interpreted the 'road-to-health' chart and 519 mothers interpreted the revised chart. A validated scoring system was used to assess comprehension. The two groups of mothers were comparable. RESULTS: 62.4% (324) mothers who interpreted the revised chart had good comprehension. Only 20.6% (85) mothers had similar comprehension with the road-to-health chart. Education up to or beyond grade 8 in school significantly improved comprehension. CONCLUSION: The design of the growth chart has a powerful effect on maternal comprehension of growth patterns. Length of schooling rather than literacy alone is a marker of a comprehending mother. The policy implications of these findings are that governments and agencies may need to redesign parent held growth charts to achieve better comprehension by mothers.