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  1. Fulltext Severe pulmonary leptospirois associated with high fatality rate: an autopsy series in Galle, southern Sri Lanka
    Ruwanpura R, Rathnaweera A, Hettiarachchi M, Dhahanayake K, Amararatne S
    Med J Malaysia, 2012 Dec;67(6):595-600.
    PMID: 23770952
    INTRODUCTION: According to statistical unit of the Karapitiya Teaching Hospital, Galle, the main tertiary care institution of the Southern Province serving approximately three million population, in 2008, there were 459 patients with clinical diagnosis of leptospirosis, with 25 fatalities, 21 out of which were referred for autopsy examination.

    OBJECTIVES: The present study to study and correlate pathological changes in deaths associated with pulmonary form of leptospirosis with clinico-diagnostic aspects of the infection.

    METHOD: There had been 21 leptospirosis related autopsy examinations performed at forensic medicine unit of the Karapitiya Teaching Hospital from January to December 2008. The clinical, laboratory and autopsy findings of these cases were recorded in detail and analyzed.

    RESULTS: The characteristic autopsy feature of all these cases was a moderate to severe pulmonary haemorrhage in association with hepato-renal, myocardial and cerebral lesions. The histology of the lung tissues in most cases showed extensive alveolar haemorrhages, hyaline like deposits, neutrophilic infiltrations, swollen septa with congested blood vessels.

    CONCLUSION: Severe pulmonary complications are mostly responsible for all fatalities due to leptospirosis in our series. Though there are no reliable clinical indicators that suggest probability of developing pulmonary haemorrhages, we emphasize that respiratory functions and haematological parameters need to be closely monitored in all hospitalized patients with leptospirosis for early detection and prevention of haemorrhagic complications.
  2. Discordance in exclusive breastfeeding between maternal recall and deuterium dose-to-mother technique during the first 6 months of infants: A multi-country study in Asia
    Winichagoon P, Pongcharoen T, Fadjarwati T, Winarno E, Karim NA, Purevsuren E, et al.
    Eur J Clin Nutr, 2024 Feb;78(2):135-140.
    PMID: 37838807 DOI: 10.1038/s41430-023-01353-0
    PURPOSE: This study aimed to assess the agreement in EBF between maternal recall and the dose-to-mother (DTM) technique.

    METHODS: Indonesia, Malaysia, Mongolia, Pakistan, Sri Lanka, Thailand, and Vietnam participated in the study. A total of 207 and 118 mother-infant pairs were assessed at 3 and 6 months of child's age. Using a standardized questionnaire, mothers were asked to recall child feeding during the previous 24 h, at 3 and 6 months. Those recalled to be EBF proceeded to be assessed using DTM technique. Non-milk oral intake (NMOI) cutoff of 86.6 g/d was used to classify EBF.

    RESULTS: According to DTM, 66% of infants were EBF at 3 months, while only 22% were EBF at 6 months. At 3 months, the overall % agreement between maternal recall and DTM method was 68%, kappa 0.06 (95% CI: 0.07-0.20), and at 6 months, the % agreement was only 21%, kappa -0.031 (95% CI -0.168 to 0.107). Human milk intakes were similar at 3 months and 6 months when expressed as g/d, but decreased when expressed as g/kg/d, with a large variation within and between countries; Pakistan being the lowest.

    CONCLUSION: This study showed there were declining levels of EBF from 3 to 6 months in the participating countries from Asia and the agreement between maternal recall and DTM technique to classify EBF was low. To ensure that the DTM technique can be more widely used in evaluating breastfeeding promotion programs, consensus on the appropriate NMOI cutoff and simplification of the DTM protocol is necessary.

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