Admission ultrasonography as a predictive tool for thrombocytopenia and disease severity in dengue infection.

BACKGROUND: Ultrasound (US) is an investigation available in many acute care settings. Thrombocytopenia is a well-described complication of dengue infection and has been shown to correlate with disease severity. The purpose of this study was to assess the utility of admission ultrasonography in predicting thrombocytopenia and disease severity in patients infected with dengue virus. METHODS: Data were collected prospectively on 176 patients (male, n=86; female, n=90) admitted to the Nawaloka Hospital, Sri Lanka with dengue infection between December 2016 and August 2018. All patients had an US scan on admission and disease severity was determined using the World Health Organization 2009 classification. RESULTS: There were 106 (60.2%) cases of dengue with/without warning signs and 70 (39.8%) cases of severe dengue. Patients with an abnormal US on admission were more likely to have severe dengue. Gallbladder wall thickening was the most common US abnormality. Abnormal US findings significantly correlated with more pronounced thrombocytopenia from day 2 of admission. CONCLUSIONS: An abnormal US scan on admission can aid in identification of patients at risk of developing severe dengue and can be used as a novel clinical tool to identify patients at risk of severe thrombocytopenia.

Trans rectal ultra sound guided prostate biopsies: a single centre experience in Sri Lanka.

BACKGROUND: Trans rectal ultrasound guided prostate biopsy (TRUS) was introduced to Sri Lanka in 2002. OBJECTIVES: 1. To study clinicopathological features of males subjected to TRUS biopsy 2. To compare estimation of tumour burden by two methods in carcinoma prostate (CaP). METHODS: 749 symptomatic males subjected to TRUS biopsy over 64 months at a single centre. Information was retrieved from case records. Tumour burden in CaP was calculated as: 1. Calculated tumour burden (CTB)--total percentage tumour in each core/total number of cores 2. Percentage positive biopsy cores (PPBC)--number of positive cores/total number of cores X 100. SPSS 15.0, student's t test and Spearman's rank correlation coefficients were used for statistical analysis. RESULTS: 35.2% had CaP, microacinar in type. 34.88% were poorly differentiated. CaP was frequent among older patients (P<0.00001). The prostate volume in CaP was significantly lower than in the benign group (P<0.05). Prostate specific antigen (PSA) level was significantly higher in CaP (P<0.00001). A 99.6% sensitivity and 4.7% specificity was observed at PSA of 4 ng/ml for detecting CaP. Specificity was 98% at 25.5 ng/ml, with a sensitivity of 44.4%. CTB and PPBC had similar correlations with biochemical/histological parameters of CaP and were strongly correlated (0.786). INTERPRETATION: Males with CaP were older, had higher PSA levels and smaller prostates. A cut off level of PSA >4 ng/ml could be used for directing symptomatic patients for TRUS biopsy to detect CaP, keeping in mind that specificity is 98% only at 25.5 ng/ml. Both CTB and PPBC could be used to calculate tumour burden in TRUS with CaP.

The value of percutaneous nephrostomy; Sri Lankan experience.

OBJECTIVE: To identify the most useful indications for image-guided percutaneous nephrostomy (PCN). DESIGN: Retrospective analysis of immediate outcome of the procedure in 46 patients. SETTING: Department of Radiology, The National Hospital of Sri Lanka, Colombo. PATIENTS: 46 patients on whom 59 PCNs done between June 1995 and August 1996. RESULTS: 57 PCNs were successful and 2 failed. Clinical improvement was observed in all patients with acute obstructive renal failure, pyorenephrosis and fistulae. Benefits were minimal in patients with chronic obstruction and none with terminal malignancy.