Thilak Jayalath

Translation and validation of patient-practitioner orientation scale in Sri Lanka

Background: Practice of family medicine and patient centeredness does not get the deserved attention in clinical practice and teaching in Sri Lanka. Non-availability of tools for assessment of patient centeredness deters the process of curricular development and research. The Patient-Practitioner Orientation Scale (PPOS) is a self-administered tool that assesses patient-centeredness in both health care professionals and patients. This study has translated and validated the PPOS to Sinhala language. Methods: Translation and cross-cultural adaptation were carried out using forward and backward translation method. The psychometric properties of a pretested new Sinhala version of PPOS (PPOS-Sinhala) was tested in a convenience sample of 1367 patients and health professionals. Temporal stability was tested in a sub-sample of 140 individuals. The comparability of the PPOS scores and association with sex and level of education with those reported for Western populations were examined to establish construct validity. Results: The sample included 543 medical students, 67 doctors, 335 allied health students and 422 patients. Cronbach′s alpha for these groups ranged from 0.48 to 0.53 for sharing, 0.42 to 0.53 for caring, and 0.62 to 0.65 for total score. Intraclass correlation coefficients of 0.56, 0.6, and 0.4 were observed for the Total, Sharing, and Caring sub-scales, respectively. PPOS scores did not vary significantly for men and women. Health professionals exhibited higher scores than patients. Age was negatively associated and education level was positively associated with PPOS. Discussion: PPOS-Sinhala is stable, sufficiently valid and reliable to evaluate patient centeredness among Sinhala speaking health care professionals and patients. Lower internal consistency is found for a few items in the instrument which requires further development. PPOS scores and their correlates for this Sri Lankan population were more similar to that found in other populations in this region than for scores and correlates found in the US.

Fatal Massive Pulmonary Hemorrhage in Dengue Infection

Background: Pulmonary hemorrhage is a very rare complication of dengue infection. This condition presenting with hemoptysis has been reported in 1.4% of dengue infections. However, major hemorrhage is unusual except when associated with profound or prolonged shock. In contrast although this case showed no features of plasma leakage, it resulted in massive pulmonary hemorrhage leading to death. Case Presentation A 17 year old previously healthy Sri Lankan, Sinhalese male presented with a 5 day history of fever. On admission he was ill looking and the hematocrit was 44.8%. He was treated in the High Dependency Unit with close monitoring and was started on normal saline 100 ml per hour and showed improved blood pressure and hematocrit value of 41.5% with the initial chest X-ray and ultrasound on abdomen showing no fluid leakage. But within a few hours he developed sudden onset of hemoptysis and respiratory distress, and an urgent chest X-ray taken showed a patchy right sided middle lobe opacity with no pleural effusion. Death occurred following failed resuscitation and the post mortem revealed massive pulmonary hemorrhage. Conclusion Pulmonary hemorrhage in dengue infection has rapid progression associated with high mortality. Thus, a high index of suspicion is needed for diagnosis.

Value of peripheral blood count for dengue severity prediction

ObjectiveThis retrospective study was conducted in 2017 with the objective of evaluating the value of acute phase peripheral blood parameters in predicting dengue haemorrhagic fever (DHF). Patients, who were admitted to Teaching Hospital Peradeniya between January and August 2017 due to dengue illness, were recruited into this study.ResultsA total of 515 patients participated in the study. Among them, 333 were DHF patients while 182 patients were managed as DF. There was a significant difference in mean values of platelets and haemoglobin observed during acute phase in non-leakers compared to the patients who progressed to DHF, while no significant difference was observed for white blood cells, neutrophils, lymphocytes and haematocrit values. A significantly higher mean value was observed in white blood cells and hemoglobin in leakers compared to non-leakers during day 5. Mean day 5 platelet value was significantly lower among leakers compared to non-leakers but no significant difference between haematocrit, neutrophil and lymphocyte values were observed. ROC curve performed for acute phase platelet values and haemoglobin values to gain a predictive value for female and male DHF patients and cut off values with high sensitivity and specificity to predict DHF could be obtained for the platelet count.

Regulation and Metabolic Functions of White Adipose Tissue Stearoyl-CoA Desaturase

White adipose tissue (WAT) has important dual energy-storage and endocrine functions, which become deranged in obesity, contributing to the pathogenesis of inflammatory metabolic disorders such as type-2 diabetes. Humans express SCD1 in WAT, and rodents express both SCD1 and SCD2 in this tissue. WAT SCD expression is regulated by hormones, cytokines, and nutritional status. Leptin, estrogen, and tumor necrosis factor-alpha reduce its expression, while insulin and ghrelin increase it. In humans, hypercaloric or high-carbohydrate diets stimulate WAT SCD expression, while caloric restriction suppresses it. Fatty acids have differential effects on WAT SCD expression with polyunsaturated fatty acids (PUFAs) having an inhibitory effect and saturated fatty acids (SFAs) having a stimulatory effect. Interestingly, effects of peroxisome proliferator-activated receptor gamma agonists are species-specific. WAT SCD plays an important role in modulating metabolic functions. Its expression positively correlates with body weight and insulin resistance. Although germline SCD1 deletion protects mice from diet-induced obesity and insulin resistance, adipose-specific SCD knockout does not provide these protective effects. Therefore, it is likely that WAT SCD upregulation in obesity is an adaption to increased availability of carbohydrates and SFAs. However, since palmitoleate and oleate, two major products of the desaturation reaction catalyzed by this enzyme, regulate inflammatory responses, WAT SCD also appears to be important in modulating adipose tissue inflammation in obesity. In conclusion, SCD is an important enzyme for triglyceride storage of WAT, which has additional functions in regulating metabolism and inflammation, especially in conditions of expanded fat mass.