A real-world study of BBIBP-CorV vaccine effectiveness in a Sri Lanka rural province.

Objective: Real-world studies assessing the effectiveness of the BBIBP-CorV vaccine in low and middle-income countries are limited. We evaluated the BBIBP-CorV vaccine's effectiveness in reducing COVID-19 symptomatic disease, hospitalisation, severe disease, and mortality during the third wave of the pandemic in Sri Lanka. Methods: We conducted a test-negative case-control study in North Central Province from May 2021 to February 2022. Evidence of vaccination was obtained from the national registry. The PCR-positive patients were cases, while negative individuals were controls. Adjusted vaccine effectiveness (aVE) was computed for fully, partially, and non-vaccinated groups in reducing symptomatic disease, hospitalisation, severe disease, and mortality. Results: Our study involved 3305 cases and 3418 controls. The overall aVE for preventing PCR-positive infection in fully vaccinated was 30·8 % (95 % CI:17·9-41·6). In fully vaccinated over 60 years, the overall aVE was 72·3 % (95 % CI: 49·7-84·8). Full vaccination with BBIBP-CorV is effective in reducing hospitalisation, severe COVID-19 disease, and death, with aVE rates of 70·3 % (95 % CI: 57·9-79·0), 88·9 % (95 % CI: 81·8-93·2), and 92·3 % (95 % CI: 84·8-96·1) respectively. Conclusion: Individuals who have received two doses of the BBIBP-CorV vaccine are protected against hospitalisation, severe COVID-19 disease, and death. Duration of protection against hospitalisation, severe COVID-19, and fatal COVID-19 sustained at least 121 days, with no sign of waning during that time.

Scleredema Diabeticorum: A Rare Metabolic Connective Tissue Manifestation of Type 2 Diabetes Mellitus Causing External Restrictive Lung Disease.

Scleredema diabeticorum (SD) is a rare metabolic connective tissue manifestation of diabetes mellitus (DM). SD commonly manifests in male patients with poorly controlled prolonged DM with obesity. In SD, the skin gets stiffened, thickened, and leathery in texture with a peau d'orange appearance commonly involving the posterior aspect of the neck and chest wall. Extensive chest wall skin involvement restricts lung movement, causing external restrictive lung disease and hypoventilation. In this case report, we present a 50-year-old male patient with poorly controlled type 2 DM for 10 years, complicated with established diabetic microvascular complications and extensive involvement of SD over the back of the neck and chest with external restrictive lung disease.

Rapid Recovery of Acute Respiratory Distress Syndrome in Scrub Typhus, With Pulse Methylprednisolone and Therapeutic Plasma Exchange.

Acute respiratory distress syndrome (ARDS) is an atypical presentation of scrub typhus infection with associated high morbidity and mortality compared to uncomplicated scrub typhus infection. Here we report an otherwise healthy 41-year-old female patient admitted with moderate ARDS secondary to scrub typhus infection who gained comparatively rapid recovery within 72 hours following intravenous methylprednisolone pulse (MPP) therapy with therapeutic plasma exchange (TPE), suggesting a beneficial role of MPP and TPE in the treatment of ARDS secondary to scrub typhus infection. To our knowledge, this is the first case report regarding the use of MPP therapy and TPE in a patient with ARDS due to scrub typhus infection.

Demographic, exposure, clinical, biochemical and diagnostic data of febrile patients recruited for the largest field study on leptospirosis in Sri Lanka.

This dataset includes data from febrile patients recruited for a large hospital-based study in Sri Lanka from 2016 to 2019. The variables include primary socio-demographic data, exposure data, clinical data, biochemical and investigation data. Some of these data are available as serial data from admission to discharge daily. Microscopic agglutination test, quantitative PCR of whole blood, urine and serum and culture isolation was performed to diagnose the patients with leptospirosis.

Bites by snakes of lesser medical importance in a cohort of snakebite patients from rural Sri Lanka.

Reporting of snakebite is poor in areas where they are most common. Comparatively, bites by snakes of high medical importance are likely to be documented than snakes of lesser medical importance. This study aims to describe the demographic, epidemiological and, clinical data of patients who were presented during a 49-month study period to a tertiary care center in rural Sri Lanka following authenticated bites by snakes of lesser medical importance. Of the total of 2362 confirmed snakebite patients during the study period, 517 (22%) presented with the offending snake specimen. Of them, 76 (15%) were identified as snakes of lesser medical importance and were included in this study. There were 41 (54%) females. The median ages of females and males were 35 and 43 years respectively. Most patients (86%) were bitten indoors or at home gardens. More than half of them were bitten between 1800 and 0000 h. Most bites (54%) had occurred to the ankle or below. The patients were bitten by 12 species of colubrids, one pythonid (Python molurus), and one viperid (Trimeresurus trigonocephalus). The snake species that caused the most-number of bites was the Trinket snake (Coelognathus helena) (n = 15). Three species of wolf-snakes, Lycodon aulicus, L. anamallensis, and L. striatus were responsible for 12, 11, and 5 bites respectively. Most of the patients (55%) presented to the local hospital and subsequently transferred to the study hospital for further management. None of the patients developed systemic envenoming and five developed mild local pain and swelling. Fifty-six (74%) patients were discharged on the following day, while 18 (24%) were discharged on the third day. There is a need to educate medical personnel working the peripheral hospital on how to identify medically lesser important snakes to avoid unnecessary transfers.

Hyponatraemia and seizures in Merrem's hump-nosed pit viper (Hypnale hypnale) envenoming: a case report.

BACKGROUND: Hump-nosed pit vipers (Genus: Hypnale) are medically important snakes in Sri Lanka and South India. Merrem's Hump-nosed pit viper (Hypnale hypnale) frequently leads to potentially fatal envenomings in Sri Lanka and India. Venom-induced consumption coagulopathay (VICC), local envenoming and acute kidney injury (AKI) are the commonest effects of the envenoming by this snake. CASE PRESENTATION: We report a previously unreported presentation of H. hypnale envenoming, with an isolated urinary salt loss leading to moderate hyponatraemia resulting seizures. The patient was treated with careful fluid and electrolyte management. No antivenom is currently available for H. hypnale envenoming. CONCLUSION: In the absence of any evidence of venom induced consumptive coagulopathy, acute kidney injury and cerebral haemorrhage, we hypothesize that this effect is likely due to the presence of a natriuretic peptide in H. hypnale venom, similar to the natriuretic peptides identified in few other snake venoms.

Hoffmann syndrome: a case report.

Hoffmann syndrome is a rare form of hypothyroid myopathy in adults characterized by presence of muscle weakness, stiffness and pseudohypertrophy. We report a 39 year old male with primary hypothyroidism diagnosed at childhood and not on regular thyroxine therapy who presented with fatigue, cold intolerance, constipation, exertional breathlessness, progressive proximal muscle weakness and swelling of the legs for one year. Examination revealed pseudohypertrophy of calf muscles with marked symmetrical proximal upper and lower limb weakness. His TSH and Creatine phosphokinase (CPK) levels were significantly elevated and electromyography (EMG) was compatible with myopathic disorder. After institution of thyroxine therapy his weakness improved markedly and pseudohypertrophy regressed in two months. We report this case because of its rarity.