Teaching Hospital Jaffna Research Articles

A Study on Factors Affecting the Adherence of Medical Nutrition Therapy Amongst Patients with Type 2 Diabetes Mellitus Attending Outpatient Clinics of Teaching Hospital Jaffna, Sri Lanka

A Study on Factors Affecting the Adherence of Medical Nutrition Therapy Amongst Patients with Type 2 Diabetes Mellitus Attending Outpatient Clinics of Teaching Hospital Jaffna, Sri Lanka

Correlation between neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with proteinuria in different stages of chronic kidney disease

Abstract Background Chronic kidney disease (CKD) is a progressive failure of renal function with ongoing systemic inflammation. Inflammatory markers such as neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and proteinuria were documented as independent predictors of CKD progression. Although proteinuria estimated by the protein to creatinine ratio (UPCR) is generally employed to screen the disease progression of CKD, the correlation of NLR and PLR with different stages of CKD is yet to be studied. Consequently, this study strived to find the stage-wise correlation between NLR and PLR with proteinuria in CKD patients. Methods Eighty-five CKD patients with proteinuria who visited the Nephrology Clinic at Teaching Hospital Jaffna, Sri Lanka, were randomly selected and categorized as stages II to IV based on the estimated glomerular filtration rate (e-GFR). Blood samples were collected and subjected to investigate patients’ NLR and PLR. Furthermore, urine protein and creatinine were measured and UPCR was calculated. Participants’ demographic, clinical, and laboratory data were obtained from patients’ clinical registry. Spearman’s rank correlation and receiver operative characteristic (ROC) curve analysis was done, and the p value < 0.05 was considered statistically significant. Results Amongst the total participants, males were predominant (58.8%), with a mean age of 58.1. Severity analysis based on the e-GFR revealed that 17.64%, 18.82%, 29.41%, and 34.11% of CKD patients were in stages II, IIIA, IIIB, and IV, respectively. Stage-wise correlation and ROC curve analysis indicated that NLR and PLR were positively correlated with UPCR in stages IIIA, IIIB, and IV of CKD with more than 80% predictive sensitivity and specificity. Conclusion NLR and PLR can be used as novel predictive markers for monitoring the severity of CKD; however, further large-scale cohort studies of NLR and PLR with serial monitoring and multiple closely spaced measurements are recommended to develop these markers into clinically acceptable markers for CKD progression.

Metabolic derangements and its association with the level of physical activity in obese and overweight children aged 8-14 years at Teaching Hospital, Jaffna

Childhood obesity is a rapidly growing nutritional disorder in children. Metabolic derangements are a common problem encountered in these children. Research has shown the relationship between dietary intake and metabolic derangement. We undertook this study to see the relationship between metabolic derangements and the level of physical activity.We aimed to assess the relationship of metabolic derangements and the level of physical activity among obese and overweight children.A hospital-based descriptive cross-sectional study was done in outpatient Paediatric clinics at the Teaching Hospital Jaffna. Children aged 8- 14 years with BMI above + 1SD were included in this study. The pattern of physical activity was assessed using a Physical Activity Questionnaire-S. Anthropometric measurements were taken using standard procedures and details of the laboratory investigations were obtained from the clinic record done within the immediate past six months.A total of 280 children were included. Nearly two-thirds of children were obese 63.9% (n-178), and 8.6% (n-24) and 2.9% (n-8) of children have impaired glucose and DM respectively; 23.2% (n-64) of the children had equal or more than 90th centile diastolic blood pressure, and 35% (n-98) had equal or more than 90th centile systolic blood pressure and waist circumference. Insufficient physical activity was seen in 44.3% (n-124) and 13.2% (n- 37) of these children had metabolic syndrome.BMI and metabolic derangement showed a statistically significant correlation with the activity level of a child.

Recommendation to diagnose male factor infertility based on routine semen analysis results

It is apparent that sperm parameters like concentration, motility and morphology are not definitive/adequate fertility measures as sperm is a heterogeneous mixture, and sperm quality is determined by only what is visible in the microscopic field. Objective was to assess the quality variation among different aliquots of an ejaculate and present a concept that may allow interpreting the results in such a way as to determine the clinical usefulness of the semen analysis more accurately.A laboratory-based cross-sectional study was conducted at Teaching Hospital Jaffna’s Semiology laboratory from July to September 2023 after obtaining Institutional Ethical Review committee approval, analysing 102 semen ejaculates collected through masturbation. The sample was analysed using a Makler counting chamber, and Data was analysed using SPSS version 24, with statistical significance set at P< 0.05.The three different aliquots obtained from the same ejaculate revealed no significant difference from each other for all three variables like Concentration (P=0.957), Progressive Motility (P=0.810) and Motility (P=0.832). Similarly, the mean and fifth percentile plus 95% confidence level were not significantly different (P= 0.782, P= 0.328, P= 0.370).When using the Makler counting chamber, the mean value calculated from one aliquot per ejaculate counted on three strips of ten squares should be acceptable, and at least two different ejaculates should be analysed when interpreting the results based on World Health Organization (WHO, 2021) reference limits.

Association between baseline characteristics of carpal tunnel syndrome and its relation to psychometric properties of the Boston carpal tunnel questionnaire

Objectives: Carpal tunnel syndrome (CTS) generally causes functional disabilities and consequently develops socioeconomic burdens for individuals and our community in the long run. The negative consequences are more recorded in developing nations. Therefore, early addressing the disorder is essential to eliminate the negative impacts on any health-care system. Methods: This descriptive cross-sectional study was conducted on patients with CTS attending the professorial surgical clinics at Teaching Hospital Jaffna. The demographic and clinical presentation while a self-reported Boston Carpal Tunnel Questionnaire (BCTQ) was used to assess the severity of symptoms and functional status of the wrist and hand. Results: This study involved 63 respondents whose mean age and body mass index were 55.4 ± 12.4 years and 25.6 ± 3.1, respectively. The larger proportion was female (74.6%) and the majority’s civil status was married (90.5%). Menial and skilled jobs were 46.6% and 31.7%, respectively, whereas the remaining were professionals. The right-hand dominance was 93.7%, although 57.1% had the right hand affected. There was a significant association (r = 0.739 and P = 0.0001) between the clinical tests and the severity of symptoms score. Conclusion: This study outcomes of CTSs severity and functional status with the BCTQ recommend that this tool and its scales indicate the association between CTSs baseline characteristics and impairments resulting from CTS in the clinical context.

Manual Vacuum Aspiration Versus Expectant Management for First Trimester Miscarriage: A Randomized Controlled Trial.

Background Miscarriage is one of the common problems encountered in pregnancy. The treatment modalities are expectant, medical, and surgical management. This study compared the effectiveness and safety of manual vacuum aspiration (MVA) with expectant management for first trimester miscarriage. Method This randomized controlled trial was conducted in Teaching Hospital Jaffna, Jaffna, Sri Lanka, and 134 eligible patients with first trimester spontaneous miscarriage were randomized to expectant management (67) and MVA (67). Those allocated to expectant management were managed expectantly for up to two weeks, and those allocated to MVA underwent aspiration under a paracervical block in the ward. The primary outcome was complete evacuation of the uterus, and the secondary outcomes were duration of bleeding, duration of pain, level of pain, need for the second procedure, cervical or uterine injuries, and patient satisfaction. Results Of the 134 eligible women, seven were lost to follow-up and 127 were analyzed. The MVA was superior in achieving complete evacuation compared to expectant management (95.2% vs. 70.3%; p ≤ 0.001). Notably, in both groups, complete evacuation was more readily achievable in incomplete miscarriage than in missed miscarriage. Duration of bleeding (mean days, 1.6 vs. 4.3; p ≤ 0.0001), duration of pain (mean days, 1.0 vs. 4.2; p ≤ 0.0001), and the need for additional surgical procedure in the form of dilatation and curettage (4.8% vs. 29.7%; p ≤ 0.001) were lower in MVA. Patient satisfaction was higher in the MVA group than in the expectant group (93.7% vs. 65.6%; p ≤ 0.001). No statistically significant differences were observed between the groups in terms of blood transfusion and infection. There wasn't any incidence of cervical damage or uterine perforation. Conclusion MVA is an effective and safe treatment method for first trimester miscarriage with higher patient satisfaction.

With the rising trend of prostate cancer, where does northern Sri Lanka stand? A cohort study from a tertiary care centre.

Introduction: Prostate cancer is the second most common cancer among males all over the world in 2020. As per the global cancer observatory 1, 414, 259 (7.3%) cases were diagnosed in 2020 worldwide. The study aims to analyse the variations in demographic and clinico-pathological characteristics of prostate cancer in the Northern Province.
 Methods: This is a cross-sectional descriptive institution-based study that recruited all the prostate cancer patients who were treated at the Teaching hospital, Jaffna from August 2019 to August 2022. Data were extracted retrospectively from the clinic records of the patients as well as histopathology documents.
 Results: A total of 141 diagnosed patients at Teaching Hospital Jaffna were analysed. The mean age of the sample was 70.11± 8.43 years. Out of 141 patients, 30.49% were diagnosed to have localized disease and 26.24% and 43.26% with locally advanced and metastatic disease respectively. Out of those who had localized disease 68.5% were managed with radiotherapy, 23.25% with active surveillance and 11.6% with radical prostatectomy. The mean value of PSA was 70.11±8.4. The majority 97.2% had small acinar adeno carcinoma as histology. As per the D’Amico classification system for prostate cancer, 2.83% belonged to low-risk category and 80.1% belonged to high-risk category.
 Conclusion: There is a rising trend in the incidence of prostate cancer in Sri Lanka over the recent past. Most of the cases are advanced at the initial presentation. It implies the need for screening programmes with PSA in near future to detect cancer at early stages, implementation of cancer awareness programmes as practised in Western countries and strict adherence to national guidelines on management and referral pathways.

Retrospective analysis of a single unit experience in laparoscopic cholecystectomy in Northern Sri Lanka during the Covid-19 pandemic

Introduction: Laparoscopic cholecystectomy is a surgical procedure that removes a diseased gallbladder for various indications. It is preferred over open cholecystectomy due to fewer complications and early recovery. However, it carries different operative and postoperative complications. In addition, the availability of resources and skillful surgeons limits its use worldwide. Analysing the experience of laparoscopic cholecystectomy will enhance the training and skills and improve the surgical outcome.
 Methods: All the laparoscopic cholecystectomies done from July 2020 to July 2022 were analysed retrospectively. 
 Results: This study included eighty-seven surgeries with patients ages 8 to 84 years (mean 51.76 ±17.15). Male patients were 32.2% and females 67.8%. The indication for laparoscopic cholecystectomy was symptomatic gallstone disease in 72.4% acute/chronic cholecystitis in 14.9%, distal CBD stones in 5.7%, Gall bladder polyp in 3.4%, biliary colic in 18.4%, cholangitis in 1.2%, obstructive jaundice in 1.2% and pyocele in 1.2%. ERCP was performed by the surgeons of the same unit to manage 6.8% of the cases preoperatively and 2.2% post-operatively. Intra-operative difficulty or problems was seen in 24.13% of the cases, which included adhesions with adjacent organs in 14.9%, difficult identification of Calot's triangle in 3.4%, bile spillage 6.8% and abnormally distended gall bladder, adhered deep into the liver, and double gallbladder in 1.2% each. 1.2% of the cases needed conversion to open. Postoperative complications were noted in 20.68% of cases. 3.4% had Clavian Dindo grade I complications.
 Conclusion: Professorial unit Teaching hospital Jaffna is performing laparoscopic cholecystectomies even in the presence of limited resources. The outcomes were comparable with the international standards published up to date.

Occurrence of Spinal Masqueraders in a Urolithiasis Clinical Context

Objective: The purpose of this study is to provide the occurrence of urolithiasis that closely mimicked the somatic nature in the subjective, objective findings and reduction of symptoms with an analgesic. Methods: This study was carried out in a genitourology clinic, Teaching Hospital Jaffna, Sri Lanka for a three months period. The socio-demographics, BMI, and clinical presentation of pain were collected. Results: This study recruited 84 patients, whose mean age was 50.5 ± 15.6 years and the median was 51 years. There were almost two folds male participants (64.3%) and considering the BMI, overweight was the most significant at 52.3% while obesity and underweight were (9.6%) and (5.3%) respectively remain was ideal. The majority (84.5%) had comorbidities including diabetes, hypertension, and dyslipidemia although many had combined them. The subjective clinical presentation was mostly pain and dysuria although the somatic nature of pain complaint was significantly dominated by lower back pain (56%), flank pain (21.4%), loin to groin pain (10.7%), and uretic colic pain (11.9%) despite the uretic colic pain pattern. Conclusion: This can help clinicians to rule out an important aspect of visceral pathologies similar to musculoskeletal clinical presentation to rule in the visceral etiologies that primary symptoms generator.

Assessment of parents’ or guardians’ satisfaction of in-patient health care provided to their children in a single unit at a tertiary care hospital

Patient satisfaction surveys help to measure the staff performance, and it guides to improve the patient retention rate by providing high quality services to the patients. This study was carried out to assess the parents’ or guardians’ satisfaction of in-patient health care provided to their children and to identify the factors associated with satisfaction. This prospective cross-sectional study was carried out in the Professorial Paediatric Unit, Teaching Hospital Jaffna. A Sample of 165 parents were interviewed by using a questionnaire. The level of satisfaction was marked by 5-point Likert scale. Data was analysed using SPSSvs 20. Chi square was used to check the association. Out of the total 165 study participants 93.5% were mothers, 44.8% were in the age group of 31-40 years, and 56.2% studied between grade 6 to grade 11. The mean age of the children was 4.23 years (±3.75) and mean duration of hospital stay was 3.64 days (±2.4). The mean global satisfaction score was 4.93(±0.24), The mean score for the communication with nursing officers and medical officers were 4.85 and 4.87 respectively. For satisfaction of the environment the mean score for cleanliness around the bed and cleanliness of the bathroom were 4.72 and 4.47 respectively. The satisfaction negatively correlated with the educational level of the parents X2 (4, N=165) 16.408, p=0.003, and duration of the hospital stay X2 (3, N=165)1=2.237 p=0.007.

Knowledge on inquest and cause of death– A study among doctors at teaching hospital Jaffna

An inquest is the procedure for investigating sudden deaths in Sri Lanka, a fact-finding exercise rather than a fault-finding inquiry. Giving the correct Cause of Death (COD) is essential from both legal and statistical points of view. Doctors have an important role in both inquest and COD. This study aims to assess the knowledge of inquest and COD among doctors of various hierarchy levels at the teaching hospital, Jaffna. A descriptive cross-sectional study was conducted through systematic random sampling. The questionnaire was distributed and collected in small groups at convenient times with adequate instructions. The total number of participants was 137, among which 44 were consultants, 45 were medical officers, and 48 were intern house officers. Sixty-two subjects had experience more than ten years. Considering the inquest, 37%(N=50) had good, and 61%(N=83) had average knowledge regarding the procedure, 43%(N=58) had good, and 54%(N=73) had average knowledge regarding indications; More than half of the doctors (52%, N=71)) had good, and 29%(N=39) had average knowledge about the doctor’s role in inquest procedure. Regarding COD, 47%(N=64) had good knowledge, while 37%(N=50) had average knowledge. Designation and experience showed a significant association (p-value<0.05) with the overall understanding of inquest, where consultants had good scores. Gender did not significantly correlate with the overall knowledge of inquest and COD. Since a considerable proportion of doctors have average knowledge or below regarding inquest and COD, this is high time to make feasible interventions to upgrade the knowledge among doctors.

White scorpion (<em>Hottentotta tamulus</em>) sting induced autonomic hyperactivity and myocardial ischemia in a child

Scorpion bite is one of the common emerging toxicological problems in Jaffna peninsula of Northern Sri Lanka. Majority of the patients have an uncomplicated course, but some people may have severe systemic envenomation and life-threatening cardiovascular events. This case report is of a child admitted to Paediatric professorial unit, Teaching Hospital Jaffna following white scorpion (Hottentotta tamulus) bite. Subsequently he developed myocardial ischemia. There was no literature available in paediatric population with myocardial ischemia following sting of Hottentotta tamulus.

Depression, Disability, and Cognitive Impairment Among Elders With Medical Illnesses Attending Follow-Up Clinics at a Tertiary Care Hospital in Northern Sri Lanka.

The rising proportion of the elderlyis increasingly affected by non-communicable diseases. Despite an abundance of literature suggesting that elders with medical conditions are more vulnerable to depression, disability, and cognitive impairment, these tend to go unnoticed and unaddressed. This study describes the prevalence and correlates of depression, disability, and cognitive impairment among elders with medical illnesses attending follow-up clinics in a tertiary care hospital in northern Sri Lanka. This descriptive cross-sectional study was carried out among 122 elders (≥60 years) attending medical clinics at Teaching HospitalJaffna. Depression, disability, and cognitive impairment were assessed by the 15-item Geriatric Depression Scale, 12-item World Health Organization Disability Assessment Schedule 2.0, and Montreal Cognitive Assessment, respectively. Student's T-Test, ANOVA, and correlation coefficient were used in analyzing data using Statistical Package for Social Sciences 25 (SPSS-v25) (IBM, New York, United States). The mean age of the participants was 68.3 years (SD=5.70); 58 (47.5%) were males and 64 (52.5%) were females. Prevalence of depression was 44.3% (95% CI=35.5-53.1), while disability was 95.9% (95% CI=92.4-99.4) and cognitive impairment was 80.3% (95% CI=73.2-87.4). Depression was significantly associated with gender (p=0.013), marital status (p=0.019), and living arrangement (p<0.001). Cognitive impairment was significantly associated with education level (p=0.045), and disability was associated with education level (p=0.008) and marital status (p=0.027). Among the study participants, only 12 (9.8%) had previously sought professional help for depression, disability, or cognitive impairment. Depression, disability, and cognitive impairment are common among the elderly attending medical clinics in Teaching HospitalJaffna, and are, in most cases, unaddressed.

A descriptive study to analysis the ureteral length in adult population

Purpose: The ureteral stent is an essential in various urological procedures. Therefore, choosing an ideal ureteral stent is central to minimizing the incidence of stent related complications. This study aim was to identify the average length of ureteral in adult population as it would help to opt for optimal stenting according to the variability of age and gender. Materials and methods: It was a descriptive cross-sectional study at Teaching Hospital Jaffna and underwent to analysis the average length of ureteral among adults based on their CT urogram. This study was approved (Reg.No:S01/07/2021) on 30 September 2021 by the Ethics Review Committee of Teaching Hospital Jaffna and the patient informed written consent was received. A total number of 69 patients had been ordered for computed tomography urogram consecutively in last 4 months from 1st October 2021to 31st January 2022. All ureterals with pathological conditions were excluded from this study. The actual and linear lengths were calculated by using the Radiant DICOM viewer 3.2.3. Results: The gender distribution was men 69.6% and women 30.4%. Fifty seven (49.6%) were right ureterals and fifty eight (50.4%) were left ureterals. The average length of ureteral right and left were 23.03 (±3.15) cm and 23.48 (±3.17) cm respectively. The average length of right ureteral in male was 23.03 (±2.85) cm and left was 23.64 (±3.16) cm while it was estimated in female right 23.03 (±3.82) cm and left 22.98 (±3.26) cm. The multiple linear regressions showed that there is a no linear relationship between the ureteral length and age or gender. Conclusion: The average actual length of ureteral of Jaffna adult population is 23.03 (±3.15) cm in right and 23.48 (±3.17) cm in left. The median ureteral length is 23.26 (±3.15) cm. Therefore, it is prudent to use 24cm ureteral stent to Sri Lankan population.

Vasoactive Intestinal Peptide-Secreting Pancreatic Neuroendocrine Tumor: A Case Report

A 36-year-old female with chronic watery diarrhea and persistent hypokalemia for more than eight months duration eventually being diagnosed as vasoactive intestinal peptide tumor (VIPoma) clinically and histologically is presented here. The patient achieved complete recovery after starting octreotide, a somatostatin analog. She underwent a distal pancreatectomy along with the removal of the tumor at Teaching Hospital Jaffna for the permanent cure.

Clinicopathological profile of urological malignancies at Teaching Hospital in Jaffna Peninsula of Northern Sri Lanka

Urological malignancies remains significant health hazards over the years. Prostate cancer is the commonest cancer in male worldwide. There have been various studies done in other parts of Sri Lanka to establish the characteristics of urological malignancies. But the data from Jaffna is lacking. This study was a retrospective cross-sectional study. Data of all histologically proven urological malignancies of Teaching Hospital Jaffna (THJ) between 1st of January 2018 and 1st of June 2021 were analyzed. The most commonly identified urological malignancy was prostate carcinoma (62.3%, n=101) with mean age of 71.6 years. 98% were adeno carcinoma. 59.4% had stages equal or more than T3 and 41.6% had Gleason score of 8 or more. 59.4% of the patients presented with metastatic prostatic carcinoma. Bladder malignancies were seen in 27.8% with the mean age of 68.6 years. Male to female ratio was 5:1, 97.7% were primary urothelial malignancies. 80% were organ confined disease. 57.8% were high grade and 35.5% were muscle invasive. Nearly 6.2% of the patients were diagnosed with renal carcinoma and mean age was 53.9 years. The male to female ratio was 2:3. 80% were clearcell renal cell carcinoma, 70% were localized.Eighty percentage diagnosed cancers had stage equal or less than T2. Nearly 3.7% of the patients had penile cancers. All of them were squamous cell carcinoma while 66.7% diagnosed cancers had stage equal or less than T2. Prostate carcinoma was the most common urological malignancy identified in this study. Most of the renal and penile carcinoma was diagnosed at early stages in contrast with bladder and prostate carcinoma.

Impact of Covid 19 preventive measures on hospital admission due to respiratory illness in children at Professorial Paediatric unit Teaching Hospital Jaffna

Respiratory diseases are common causes of hospital admission in children. Droplet transmission is the primary route of transmition in respiratory infections. The objective was to assess the burden of respiratory diseases on hospital admission of children during this Covid 19 pandemic and to assess the impact of Covid 19 preventive measures on it. An institutional based retrospective descriptive study based on secondary data was carried out at Professorial Paediatric unit Teaching hospital Jaffna. The data was extracted from the electronic patient management system. All the records of children who were primarily diagnosed with respiratory disease during the period of June 2020 to May 2021 were extracted. This data was compared with that of 2017. The total hospital admission has reduced from 4127 to 1049 during the pandemic. There was a significant decrease in total hospital admission during the covid 19 pandemic compared to before the pandemic {t (11.488) = 8.015 p&lt;0.001}. Similarly, there was a significance decrease in the admissions due to respiratory diseases during the covid 19 pandemic {t(11.355) =5.982 p&lt;0.001}. The percentage of respiratory admission has significantly reduced during the pandemic {t(21.997) =5.173 p&lt;0.001}. Hospital admission due to respiratory illness has significantly reduced when compared to total admission during this pandemic. This may be attributed to social distancing, wearing mask and good hand hygiene.

Impact of non–Coronavirus -2019 (Non–COVID-19) respiratory disease hospital Admissions: a single centre experience

Hospital admissions due to non-coronavirus disease 2019 (nonCOVID-19) respiratory diseases decreased in Teaching Hospital Jaffna following social distancing, other public health measures (face mask wearing) and due to lock down implemented by authorities in 2020.

A study on knowledge, attitude and practices towards the COVID-19 pandemic among the non-COVID-19 patients at Outpatient Department in a Teaching Hospital, Northern Sri Lanka.

Background:Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2) has infected millions of people all over the world and Sri Lanka is not an exception for the impact of Coronavirus Disease (COVID-19). As there are no effective therapeutic agents at present and newly developed vaccines are not freely available for many countries, preventive measures such as handwashing, social distancing, and respiratory etiquette are key to control of spread. The effective implementation of these measures depends on public knowledge and attitude towards COVID-19 and adherence to key practices.Methods:This is a cross-sectional study conducted among 500 non-COVID-19 patients who attended the Outpatient Department (OPD) of the Teaching Hospital Jaffna, Sri Lanka. Knowledge, attitude and practices (KAP) was assessed through a self-administered questionnaire and analysis was performed by using SPSS 26.Results:The majority were females (67.8%) and the mean age of the participants was 36.9 (range: 15–85). Most of the participants were homemakers. Two hundred and twenty-two patients (44.4%: 40.1–48.8) showed a suboptimal knowledge score regarding COVID-19. The males, age above 65, were significantly associated with low knowledge score (P < 0.05). Similarly, a significant proportion (36.4%: 32.3–40.7) showed a suboptimal attitude score but the majority of the participants have adopted positive behaviours such as frequently washing hands (88.4%) and wearing masks in appropriate places (91.6%). The major sources for information regarding COVID-19 among the participants were the news media (54.0%) followed by social media (23.2%).Conclusion:As a significant proportion of the participants showed a poor knowledge score and gaps in specific aspects related to COVID-19, the primary care physicians have a significant role to play to improve community knowledge by educating specific groups such as the males and elderly by using appropriate news media and social media platforms.

Hormone receptor status, Her 2- neu amplification and their correlation with prognostic indices in patients with invasive ductal carcinoma of breast in Jaffna

Knowing the tumour biology can help to stratify patients for prognostic and therapeutic purposes. Expression of estrogen and progesterone receptors (ER, PR), amplification of human epidermal growth factor receptor 2 (Her 2 neu), size and histological grading of tumour , axillary lymph node state and NPI ( Nottingham Prognostic Index) are well established parameters that have influence on prognosis and treatment of breast carcinoma. It is an institutional based retrospective cross sectional analytic study.181 female patients who underwent primary mastectomy and axillary clearance for invasive ductal carcinoma of breast in Teaching Hospital Jaffna from 2014 to 2018 were included in this study.ER/PR status and amplification of Her 2 neu in the infiltrating ductal carcinoma of breast and the prognostic indices were recorded. SPSS was used for statistical analysis and correlation between the receptor status and prognostic indices were calculated using Spearman’s correlation, chi-square and Kruskal- Wallis tests. Of the 181 patients with invasive ductal carcinoma of breast, 132 patients (72.9%) were above 45 years old. A total of 87 patients had ER + (48.1%), 76 had PR + (41.9%) and, 62 had Her 2-neu + (34.3%). The mean ages of patients with expression of ER, PR and Her 2-neu amplification were 56.43, 54.36 and 52.95 years respectively. Triple negative tumour was found in 38 patients (21%). NPI 1 indicating good prognosis, NPI 2 with moderate and NPI 3 with poor prognostic categories were seen in 57 (31.5%), 74 (40.9%) and 50 (27.6%) patients respectively. Stage T2 sized tumour was identified in 88 patients (48.6%).A total of 110 patients (60.8%) had grade 2 tumours. 89 patients (49.1%) had axillary lymph node involvement. Statistically significant correlation was found between the expression of ER and PR (Spearman’s correlation coefficient (r) = 0.136, p value &lt; 0.0001). Statistically significant inverse correlation existed between the expression of hormone receptors (ER&amp;PR) and Her 2-neu amplification (chi square=12.93, p value &lt; 0.0001). Kruskal-Wallis test revealed statistically significant association between the expression of ER and the favourable NPI groups and also with low grade tumours ((p value 0.046 and 0.006) and a statistically significant association between Her2-nue amplification and axillary lymph node involvement (p value = 0.0001).