Guillaine-barre syndrome; a rare complication of melioidosis. a case report.

BACKGROUND: Melioidosis caused by Burkholderia pseudomellei is an infection with protean clinical manifestations. Guillain-Barré syndrome [GBS] associated with melioidosis is very rare. CASE PRESENTATION: A 42-year-old woman with diabetes presented with abdominal pain, vomiting and intermittent fever for one month. Six months before presentation she had recurrent skin abscesses. Three months before presentation she had multiple liver abscesses which were aspirated in a local hospital. The aspirate grew "coliforms" resistant to gentamicin and sensitive to ceftazidime. On presentation she had high fever and tender hepatomegaly. Ultra Sound Scan of abdomen showed multiple liver and splenic abscesses. Based on the suggestive history and sensitivity pattern of the previous growth melioidosis was suspected and high dose meropenem was started. Antibodies to melioidin were raised at a titre of 1:10240. The growth from the aspirate of liver abscess was confirmed as Burkholderia pseudomellei by polymerase chain reaction [PCR]. After a week of treatment, patient developed bilateral lower limb weakness. Deep tendon reflexes were absent. There was no sensory loss or bladder/bowel involvement. Analysis of the cerebro-spinal fluid showed elevated proteins with no cells. There was severe peripheral neuropathy with axonal degeneration. A diagnosis of GBS was made and she was treated with plasmapharesis with marked improvement of neurological deficit. Continuation of intravenous antibiotics lead to further clinical improvement with normalization of inflammatory markers and resolution of liver and splenic abscess. Eradication therapy with oral co-trimoxazole and co-amoxyclav was started on the seventh week. Patient was discharged to outpatient clinic with a plan to continue combination of oral antibiotics for 12 weeks. At the end of 12 weeks she was well with complete neurological resolution and no evidence of a relapse. CONCLUSIONS: Guillaine Barre syndrome is a rare complication of melioidosis and should be suspected in a patient with melioidosis who develop lower limb weakness. Plasmapharesis can be successfully used to treat GBS associated with active melioidosis.

Evaluation of bactericidal effect of three antiseptics on bacteria isolated from wounds.

OBJECTIVE: Antiseptics are widely used in wound management to prevent or treat wound infections due to their proven wound healing properties regardless of their cytotoxicity. The objective of this study was to determine the bactericidal effects of three antiseptics on pathogens known to cause wound infections. METHOD: The study was carried out at a tertiary care hospital and a university microbiology laboratory in Sri Lanka in 2013. The three acids (acetic acid, ascorbic acid and boric acid) in increasing concentration (0.5%, 0.75% and 1%) were tested against bacterial suspensions equivalent to 0.5 McFarland standard. The Bacteria isolates used were isolated from wound and standard strains of Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa. RESULTS: There were 33 (68.8%) Coliforms, 10 (20.8%) Pseudomonas species, and 5 (10.4%) strains of Staphylococcus aureus. Acetic acid at concentration of 0.5% inhibited growth of 37 (77%) and 42 (87.5%) of tested isolates when exposed for 30 and 60 minutes, respectively. However 100% inhibition was achieved at four hours. At a concentration of 0.75%, 40 (83.3%) and 44 (91.7%) were inhibited when exposed for 30 and 60 minutes, respectively, with 100% inhibition at 4 hours. At concentration of 1%, 46 (95.8%) inhibition was seen at 30 minutes and 100% inhibition at 60 minutes. Ascorbic acid, at 0.5% and 0.75 % concentrations, inhibited growth of 45(93.7%) and 47(97.9%) of isolates respectively when exposed for 30 minutes. At these two concentrations, 100% inhibition was achieved when exposed for one hour. At 1% concentration, 100% inhibition was achieved at 30 minutes. Boric acid did not show bactericidal effect at concentrations of 0.5%, 0.75 % and 1%. Pseudomonas species were inhibited at 30 minutes by 0.5% acetic acid. Bactericidal effect against all the standard strains was seen with three acids at each concentration tested from 30 minutes onwards CONCLUSION: Ascorbic acid was bactericidal for all organisms tested within the shortest exposure time at the lowest concentration compared to other two acids. Despite promising bactericidal effects, further studies warrant, as ongoing debates on toxicity of acids on tissue epithelialisation. Application of antiseptics for a shorter duration could overcome this problem without losing bactericidal activity. DECLARATION OF INTEREST: The authors have no conflict of interest and no funding was received for this study.

Knowledge and utilisation of information and communication technology among radiographers in a lower-middle-income country.

INTRODUCTION: Understanding the current ICT-related experience is essential for planning and effectively implementing quality healthcare services. Hence, this study aims to assess the knowledge and utilisation of ICT among radiographers in Sri Lanka. METHODS: A descriptive cross-sectional study was conducted among 590 practicing radiographers in Sri Lanka. Data was collected through a postal survey using a structured self-administered questionnaire. The questionnaire consisted of three sections: socio-demographic characteristics, existing knowledge of ICT, and utilisation of ICT applications and facilities. RESULTS: A total of 416 radiographers returned the questionnaire giving a response rate of 70.5%. Considering the overall ICT knowledge, 24.0% of the respondents possessed good knowledge, while 54.3% and 21.6% reported having fair and poor knowledge, respectively. The knowledge of ICT was significantly associated with gender, age, level of education, duration of service, and previous ICT training experience (p < 0.05). Digital radiography and electronic patient record (EPR) systems were used by 8% and 17.8% of respondents, respectively. Inadequate ICT facilities (56.7%) were identified as the most significant challenge for radiographers to use ICT. CONCLUSIONS: The majority of the respondents in this study had a fair knowledge of ICT, and this knowledge was significantly associated with certain demographic factors. Further, it was found that access to certain ICT applications, such as digital radiography and EPR systems, is limited. Hence, this study highlighted the importance of providing systematic, comprehensive and regular ICT training programmes and improving access to ICT facilities for radiographers. IMPLICATIONS OF PRACTICE: The study provides insight into the significance of improving ICT literacy among radiographers in the field. In addition, the findings may draw policymakers' attention to improving radiographers' access to the latest technologies.

Online learning during the COVID-19 pandemic: Perceptions of allied health sciences undergraduates.

INTRODUCTION: The purpose of this study was to determine the perceptions of Allied Health Sciences undergraduates towards online learning during the COVID 19 outbreak. METHODS: A cross-sectional study was conducted with undergraduates of the Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka. A self-administered online questionnaire consisted of four sections to evaluate demographic information; details of online learning; perspectives and challenges on online learning were used for data collection. RESULTS: A total of 518 responses were received from the five disciplines of radiography (32.8%), nursing (24.9%), medical laboratory sciences (18.2%), pharmacy (14.5%), and physiotherapy (9.7%), resulting in a 76.4% response rate. The majority preferred smartphones (73.2%) for online access, and Zoom is the most utilized online communicating platform (72.8%). The overall respondent's perception score ranged from 9 to 27 (Positive ≥ 18, Neutral = 18, Negative ≤ 18) with a mean (SD) of 20.4 (4.0). Even though the majority (59.7%) agreed that online learning is more comfortable to communicate than conventional learning, most respondents (48.3%) have a negative perception towards offering practical and clinical-based subjects online. Poor internet connections (67.0%) and the lack of electronic devices (53.3%) were the most significant challenges encountered during online learning. CONCLUSION: The majority of the students have a positive perception towards online learning. Online learning appears to be an efficient learning strategy when students have equal access to online facilities. IMPLICATIONS FOR PRACTICE: Although the allied health undergraduates faced several challenges, they demonstrated their versatility and acceptance of the online learning strategy during the COVID-19 pandemic. Therefore a well-structured online learning programme will be beneficial for students to continue their studies during a pandemic.

Many pitfalls in diagnosis of acute intermittent porphyria: a case report.

BACKGROUND: Acute intermittent porphyria is a rare autosomal dominant disorder caused by a deficiency of the enzyme, hydroxymethylbilane synthase. Recognition of acute neurovisceral attacks can be difficult due to the nonspecific nature of symptoms. CASE PRESENTATION: We report a case of 33-year-old male patient who presented with recurrent episodes of severe abdominal pain, nausea, vomiting, constipation and numbness of bilateral lower limb extremities. These nonspecific neurovisceral attacks were subject to medical and surgical misdiagnoses of acute appendicitis, sinus tachycardia, renal calculi, drug-induced acute interstitial nephritis and two episodes of partial intestinal obstruction. The sixth acute attack raised the suspicion of an acute porphyria. Watson and Schwartz test was positive for porphobilinogen in urine. Mutation analysis by DNA sequencing of the extracted DNA of the proband revealed a previously reported missense mutation, c.517C>T encoding p.R173W in the HMBS gene, confirming the diagnosis of Acute Intermittent Porphyria. Four out of five family members who underwent targeted mutation analyses were mutation-positive. CONCLUSION: The most common clinical presentation of Acute Intermittent Porphyria is abdominal pain with neurovisceral manifestations which are common to several medical, psychiatric and surgical pathologies. This leads to underdiagnosis and misdiagnosis of this disorder, incorrect management, and severe complications. Therefore, a high index of suspicion and awareness of front line laboratory investigations are important for diagnosis. Definitive diagnosis enables implementation of strategies to prevent acute attacks, and also triggers genetic testing and genetic counseling of at-risk family members.

Adaptation of archaeological techniques in forensic mass grave exhumation: the experience of 'Chemmani' excavation in northern Sri Lanka.

There have been several mass grave excavations in Sri Lanka during the period of 1995 to 1998. Excavation of mass graves in the Chemmani area of northern peninsula of the country took place in September 1999, after about 5 years of the incident. Six graves with 1 to 6 bodies in each were identified and excavated in accordance with archaeological methods modified to suit the requirements of forensic exhumations. The experience gathered from excavation of those sites revealed the importance of archaeological methods in mass grave exhumations. For the first time in our forensic history, services of archaeologists and soil experts were used in the Chemmani exhumation. Their knowledge was found useful in locating the pit, pedestalling, and collection of human remains without causing any damage and artefacts, and in recording of the data.

Problems seen in two cases of illegal adoption.

Illegal adoption procedures may lead to many medical and legal problems. Two case reports are used to illustrate some of these. The present Sri Lankan law in relation to these aspects is discussed.