Manifestations and outcomes of leptospirosis during local outbreaks in high endemic districts of Sri Lanka: A retrospective multi-center study

Objective: To determine the clinical presentations and disease outcomes of suspected and confirmed cases of leptospirosis from 3 high endemic districts of Sri Lanka, during outbreaks reported between 2013 and 2017. Methods: The retrospective multi-center study was carried out during 2013-2017 in 5 selected hospitals representing 3 high endemic districts in Sri Lanka. Clinically suspected leptospirosis patients were recruited according to the Communicable Disease Epidemiology Profile Sri Lanka, WHO. Leptospirosis was confirmed by either single microscopic agglutination test titre 1: 400 or by positive polymerase chain reaction (PCR) test result. Results: Out of 372 clinically suspected cases, 29.00% were confirmed as leptospirosis cases by either microscopic agglutination test (50.00%) or positive polymerase chain reaction (52.77%) and 12.90% were presumptively identified as leptospirosis. Clinical symptoms (headache, vomiting, jaundice and dyspnoea) and variations in haematological parameters (haemoglobin, platelet count) and biochemical parameters (serum creatinine, serum urea, serum bilirubin and C-reactive protein) were associated with confirmed leptospirosis (P<0.05). Acute kidney injury, meningitis, myocarditis, pulmonary haemorrhage and acute liver failure was seen among 21.30%, 12.04%, 6.48%, 6.48%, 5.56%, respectively with 4.63% fatality among the leptospirosis confirmed patients. The sensitivity, specificity, positive predictive value and negative predictive value of the case definition of Ministry of Health, Sri Lanka were 96.29%, 9.09%, 31.13%and 85.71%, respectively, when benchmarked against either positive polymerase chain reaction or microscopic agglutination test as the gold standard. Conclusions: Acute kidney injury is the predominant complication observed among the leptospirosis confirmed patients. However, pulmonary haemorrhage is predominantly associated with mortality. The case definition of Ministry of Health, Sri Lanka is found to have higher sensitivity and enabled the screening of all probable cases of leptospirosis.

Manifestations and outcomes of leptospirosis during local outbreaks in high endemic districts of Sri Lanka: A retrospective multi-center study

Objective: To determine the clinical presentations and disease outcomes of suspected and confirmed cases of leptospirosis from 3 high endemic districts of Sri Lanka, during outbreaks reported between 2013 and 2017. Methods: The retrospective multi-center study was carried out during 2013-2017 in 5 selected hospitals representing 3 high endemic districts in Sri Lanka. Clinically suspected leptospirosis patients were recruited according to the Communicable Disease Epidemiology Profile Sri Lanka, WHO. Leptospirosis was confirmed by either single microscopic agglutination test titre 1: 400 or by positive polymerase chain reaction (PCR) test result. Results: Out of 372 clinically suspected cases, 29.00% were confirmed as leptospirosis cases by either microscopic agglutination test (50.00%) or positive polymerase chain reaction (52.77%) and 12.90% were presumptively identified as leptospirosis. Clinical symptoms (headache, vomiting, jaundice and dyspnoea) and variations in haematological parameters (haemoglobin, platelet count) and biochemical parameters (serum creatinine, serum urea, serum bilirubin and C-reactive protein) were associated with confirmed leptospirosis (P<0.05). Acute kidney injury, meningitis, myocarditis, pulmonary haemorrhage and acute liver failure was seen among 21.30%, 12.04%, 6.48%, 6.48%, 5.56%, respectively with 4.63% fatality among the leptospirosis confirmed patients. The sensitivity, specificity, positive predictive value and negative predictive value of the case definition of Ministry of Health, Sri Lanka were 96.29%, 9.09%, 31.13%and 85.71%, respectively, when benchmarked against either positive polymerase chain reaction or microscopic agglutination test as the gold standard. Conclusions: Acute kidney injury is the predominant complication observed among the leptospirosis confirmed patients. However, pulmonary haemorrhage is predominantly associated with mortality. The case definition of Ministry of Health, Sri Lanka is found to have higher sensitivity and enabled the screening of all probable cases of leptospirosis.

Development Of Clinical Pathway For Non-Surgical Management Of Chronic Periodontitis

@#The vast range of treatment protocols available for non-surgical management of chronic periodontitis can affect the consistency of clinical decision-making for dentists. This is further compounded by the different case definitions for periodontitis used in various clinical studies. The aim of this paper is to describe the steps taken leading to an expert consensus of periodontitis case definition followed by the development of a clinical pathway for managing chronic periodontitis. To assist reaching a consensus on a standard case definition of periodontitis for clinical research, a roundtable discussion was held involving 13 dental specialists and researchers from universities and the Ministry of Health. Participants discussed clinical experiences in identifying periodontitis and related issues based on scientific evidence. A further expert panel discussion consisting of 8 periodontists was conducted at another session to review current management practices and evidence-based practices available from the literature and generated a clinical pathway for non-surgical management of periodontitis. The case definition derived from the roundtable discussion recognises differentiation of selected clinical parameters and their thresholds as well as the extent and severity of the periodontitis. As for the newly developed clinical pathway, experts collectively defined the appropriate goals to satisfy the multidimensional needs of the patients which are translated into detailed elements of care, including the sequence of events of patients at each dental visit over time. The agreed case definition will facilitate selection and recruitment of cases for clinical studies while the clinical pathway can be used to reduce variations between clinicians.

Development Of Clinical Pathway For Non-Surgical Management Of Chronic Periodontitis

The vast range of treatment protocols available for non-surgical management of chronic periodontitis can affect the consistency of clinical decision-making for dentists. This is further compounded by the different case definitions for periodontitis used in various clinical studies. The aim of this paper is to describe the steps taken leading to an expert consensus of periodontitis case definition followed by the development of a clinical pathway for managing chronic periodontitis. To assist reaching a consensus on a standard case definition of periodontitis for clinical research, a roundtable discussion was held involving 13 dental specialists and researchers from universities and the Ministry of Health. Participants discussed clinical experiences in identifying periodontitis and related issues based on scientific evidence. A further expert panel discussion consisting of 8 periodontists was conducted at another session to review current management practices and evidence-based practices available from the literature and generated a clinical pathway for non-surgical management of periodontitis. The case definition derived from the roundtable discussion recognises differentiation of selected clinical parameters and their thresholds as well as the extent and severity of the periodontitis. As for the newly developed clinical pathway, experts collectively defined the appropriate goals to satisfy the multidimensional needs of the patients which are translated into detailed elements of care, including the sequence of events of patients at each dental visit over time. The agreed case definition will facilitate selection and recruitment of cases for clinical studies while the clinical pathway can be used to reduce variations between clinicians.

Cumulative Trauma Disorders Among Shipyard Workers and Application of Baseline Checklist for Risk Assessment / 대한산업의학회지

Cumulative trauma disorders were surveyed in a cross-sectional study of 100 male ship yard workers and 43 male office workers. And baseline checklist for risk assessment of cumulative trauma disorders was applicated in a ship making process. Cases of cumulative trauma disorders were defined using physical examinations and electronic diagnostic methods. Data on demographics, individual factors (medical condition), work organization and psychosocial aspects of work were obtained by questionnaire. Association between the above factors and cumulative trauma disorders were assessed by multiple logistic regression models. 29(29 %) participants of male shipyard workers and 4(9.2 %) study subjects of male office workers met our case definitions for cumulative trauma disorders. The myofascial pain syndrome of neck muscles(12 % of participants) and carpal tunnel syndrome(5 % of participants) were the major two medical conditions in shipyard workers. The odds of male shipyard workers for cumulative trauma disorders to male office workers was 3.15 after adjustment of age(95 % C.I. :2.25-5.44). And the variables such as duration of present job, HIVD condition, and surges in workload were associated at least one of the cumulative trauma disorders in the final models (p<0.05) . This study indicates that work related upper extremity musculoskeletal disorders are relatively common among shipyard workers, and shows that the psychosocial factors is not likely to be related to the occur rences of these disorders in heavy workers. Also we developed baseline checklist for risk assessment of cumulative trauma disorders. The checklist was unique in that its expected users were industrial hygienists and occupational healthing nurses who did not have much ergonomic background and in that it was targeted to Korean workers in various types. As the first application of the checklist, shipyard workers were evaluated.

Cumulative Trauma Disorders Among Shipyard Workers and Application of Baseline Checklist for Risk Assessment / 대한산업의학회지

Cumulative trauma disorders were surveyed in a cross-sectional study of 100 male ship yard workers and 43 male office workers. And baseline checklist for risk assessment of cumulative trauma disorders was applicated in a ship making process. Cases of cumulative trauma disorders were defined using physical examinations and electronic diagnostic methods. Data on demographics, individual factors (medical condition), work organization and psychosocial aspects of work were obtained by questionnaire. Association between the above factors and cumulative trauma disorders were assessed by multiple logistic regression models. 29(29 %) participants of male shipyard workers and 4(9.2 %) study subjects of male office workers met our case definitions for cumulative trauma disorders. The myofascial pain syndrome of neck muscles(12 % of participants) and carpal tunnel syndrome(5 % of participants) were the major two medical conditions in shipyard workers. The odds of male shipyard workers for cumulative trauma disorders to male office workers was 3.15 after adjustment of age(95 % C.I. :2.25-5.44). And the variables such as duration of present job, HIVD condition, and surges in workload were associated at least one of the cumulative trauma disorders in the final models (p<0.05) . This study indicates that work related upper extremity musculoskeletal disorders are relatively common among shipyard workers, and shows that the psychosocial factors is not likely to be related to the occur rences of these disorders in heavy workers. Also we developed baseline checklist for risk assessment of cumulative trauma disorders. The checklist was unique in that its expected users were industrial hygienists and occupational healthing nurses who did not have much ergonomic background and in that it was targeted to Korean workers in various types. As the first application of the checklist, shipyard workers were evaluated.