Detection of clarithromycin‑resistant Helicobacter pylori strains in a dyspeptic patient population in Sri Lanka by polymerase chain reaction‑restriction fragment length polymorphism.

Aim: The aim of this study was to investigate the proportion of common clarithromycin‑resistant mutation types present in the 23S ribosomal ribonucleic acid (rRNA) gene of H. pylori strains in Sri Lanka. Settings and Design: The study was a cross‑sectional, descriptive study where 76 dyspeptic patients who were required to undergo endoscopy examination were included. The study was carried out at a Teaching Hospital in Sri Lanka. Subjects and Methods: In‑house urease test and polymerase chain reaction (PCR) amplification of the glmM gene of H. pylori was performed to confirm the H. pylori infection. Analysis of point mutations in 23S rRNA gene strains were performed by PCR‑restriction fragment length polymorphism (RFLP). Results: Of the 16 urease‑positive biopsies, 94% (n = 15) were positive by PCR using the glmM primer. All H. pylori strains yeilded a point mutation at A2142G site of the 23S rRNA gene, while A2143G mutation was not detected. Conclusions: For the first time in Sri Lanka, we reported predominance of A2142G point mutation associated with claritromycin resistance of H. pylori in a Sri Lankan population.

The cost of diabetic foot conditions.

OBJECTIVES: To estimate the cost of management of diabetic foot ulcers and the standards of foot-care practices. METHODS: Patients admitted with diabetic foot ulcers (DFU) to the University Surgical Unit, Colombo South Teaching Hospital during 6 months were audited. Costs were obtained from the Medical Supplies Division, Central Blood Bank, Director General of Laboratory Services and 3 leading private hospitals. RESULTS: 144 (4.3% of admissions) diabetic patients occupied 10.1% of hospital beds. Average stay was 10.9 days. 55 daily-paid workers lost Rs.1076.36 for each admission. Each family has spent Rs.1811.60. The State has spent Rs.14 936 during the hospital stay of each patient. Majority of 61.8%, DFUs started as preventable minor trauma. 48% knew the importance of foot-care but practices remained poor. Worst affected were the patients followed up at peripheral units. Only 11.1% feet were completely assessed by a doctor. CONCLUSIONS: DFUs have a serious impact on patients and the State. Standards of foot-care remain poor among patients. A well planned foot-care program will be highly cost-effective.

Adolescent pregnancies--is the outcome different?

OBJECTIVE: To compare the obstetric complications and mode of delivery between adolescent pregnancies and pregnancies of women over 20 years. DESIGN: A prospective study of all pregnant mothers delivered at General Hospital, Anuradhapura during a period of two years from January 1993. SUBJECTS: 1600 pregnant adolescents and 14699 pregnant women over 20 years. RESULTS: The percentage of adolescent pregnancies during this period was 9.8%. The incidence of pregnancy induced hypertension among adolescent women was 2.3% and 2.2% in women over 20 years. The still birth rate was 2.4% in adolescent pregnancies and 2.2% in women over 20 years. The incidence of breech presentation was 2.2% in both groups. There was a statistically significant difference (P < 0.001) in the incidence of low birth weight among live births between adolescents (33.6%) and women over 20 years (22.7%). Adolescent women had a caesarean section rate of 7% and a forceps delivery rate of 2.3% compared to 11.4% and 2.0% in mothers over 20 years, a statistically significant difference. CONCLUSIONS: Adolescent women were not at an increased risk for pregnancy induced hypertension, still birth or breech presentation. The incidence of low birth weight and normal vaginal delivery were significantly higher among adolescent women.

Ketamine as an anaesthetic agent for tubal sterilisation.

OBJECTIVE: In most developing countries there is a dearth of qualified anaesthesiologists to administer general anaesthesia for tubal sterilisation. This study was done to determine whether ketamine could be safely used by non-specialist doctors as an anaesthetic for open tubal ligation. METHOD: A retrospective observational study of 4851 tubal sterilisations done under ketamine anaesthesia. All patients were given diazepam 0.1 mg/kg body weight intravenously followed by intravenous ketamine 2 mg/kg body weight slowly over one minute. All sterilisations were performed by Pomeroys method by a specialist or a senior house officer with specialist supervision. RESULTS: There were no major adverse reactions such as cardio-respiratory arrest following administration of ketamine. Hallucinations and transient psychotic sequalae were a common occurrence during the postoperative period. In 96% of patients the procedure was pain free. CONCLUSION: Ketamine given by non-specialist doctors can be recommended in carefully selected patients when there is a dearth of qualified anaesthesiologists for tubal sterilisations.

The Stamy procedure: a retrospective analysis of clinical outcome in stress incontinence.

OBJECTIVE: To review the clinical outcome of treatment by the modified Stamy procedure in 26 patients with genuine stress incontinence. DESIGN: A retrospective study of women with stress incontinence who underwent a modified Stamy procedure over a 2-year period between January 1991 and January 1993, of postoperative complications and the success rate three months after surgery. SUBJECTS: Twenty-six women presenting with symptomatic stress incontinence. INTERVENTIONS: All patients underwent a modified Stamy procedure. They were reviewed in the gynaecology clinic after three months. MAIN OUTCOME MEASURES: All patients were assessed by clinical examination for postoperative complications, subsequent voiding difficulties, and for recurrence or persistence of incontinence. RESULTS: The most common complications were retention of urine (23%), infection (19%), postoperative persistent pain (12%), urge incontinence (8%) and primary haemorrhage requiring transfusion (4%). The stress incontinence was subjectively cured in 81% and objectively cured in 72% when examined at three months postoperatively. CONCLUSIONS: Modified Stamy procedure is a useful operation for women with stress incontinence and it is associated with a low incidence of postoperative complications.

A retrospective evaluation of early carcinoma of the cervix treated surgically in a Provincial General Hospital.

OBJECTIVE: To assess the safety of Wertheim-Meigs hysterectomy for stage I and IIA carcinoma of the cervix performed at a Provincial General Hospital in Sri Lanka. DESIGN: A retrospective analysis of 16 cases managed from January 1992 to March 1993. SETTING: Provincial General Hospital in Sri Lanka. PATIENTS AND METHODS: Patients with either stage I or IIA carcinoma of the cervix were subjected to Wertheim-Meigs hysterectomy. All patients opted for surgery over radiotherapy when given the choice. Complications within the first 60 days were retrospectively analysed. RESULTS: Immediate operative mortality was nil, although two patients had massive haemorrhage during surgery. Injury to the pelvic colon occurred in one patient. Post-operative pyrexia (n = 16), persistent oozing from suction drains (n = 4), prolonged ileus (n = 6) and bladder dysfunction (n = 4) were the immediate post-operative complications. Average post-operative stay in the hospital was 12 days. CONCLUSIONS: Early carcinoma of the cervix treated by Wertheim-Meigs hysterectomy carries a low incidence of immediate post-operative mortality and morbidity when performed with the resources available at a Provincial General Hospital.