Articles

Introduction: Menarche, the onset of a girl's first menstrual cycle, often introduces menstrual taboos in certain eastern cultures. These taboos may manifest as social isolation, dietary restrictions, and exclusion from religious spaces, which can adversely affect health and promote gender inequality.Case history: A 10-year-old girl developed gastroenteritis while in cultural confinement after reaching menarche. Her parents strictly adhered to traditional customs that limited her interactions with the outside world and deprived her of healthy foods. They believed that her fatigue was a result of hormonal changes associated with menarche. Although her condition worsened over four days, they did not seek medical treatment. The child succumbed upon admission. The autopsy revealed extensive cyanosis in the left hand due to multiple thrombotic occlusions of the brachial vein. Microscopic examination confirmed the presence of brachial venous thrombi. The cause of death was determined to be Multiple Organ Dysfunction Syndrome (MODS) as a consequence of hypovolemic shock.Discussion: Key medico-legal issues in this case include parental negligence and failure to provide medical care under Section 308A of the Penal Code, potentially leading to criminal liability for negligence-related death under Section 298. Violations of the child's rights, protected by the Children and Young Persons Ordinance (CYPO) and the Protection of Children's Rights Act, form the legal framework for child protection in Sri Lanka. The ISD has interviewed family members and collected witness statements from neighbors and teachers, referring the case to the police for further investigation and notifying the National Child Protection Authority for an additional inquiry. Additionally, Sri Lanka is a signatory to the United Nations Convention on the Rights of the Child (UNCRC), which guarantees children's fundamental rights.

Traditional Chinese medicine (TCM) has been used to serve people since antiquity in China, and still has an important role in today’s healthcare. As the outbreak of coronavirus disease 2019 (COVID-19) globally, TCM has played an important role in the fight against COVID-19 in China and other countries. However, scientists outside China doubted TCM. The philosophy of TCM in the description of diseases and the use of herbal medicines is difficult to understand for Western scientists. This article explains the philosophy of TCM using chromatic analogies to make it easily understandable and visually intuitive.

Aim: This study aims to determine the current status for estimation of radiation dose to blood vessels and components from medical imaging procedures.Methodology: A database search on internet via PubMed and Google Scholar was performed to find published papers in estimation of radiation dose to blood vessels and components from medical imaging procedures. Results: Few published papers were found; namely two published papers. Radiation dose to blood vessels and components were assumed to be included in total radiation dose estimation for organ or tissue, without considering different in radiosensitivity. Conclusion: It seems that effect of radiation on blood vessels and components is underestimated, in ICRP 60 and 103 recommendations reports. Recommendation: It is recommended to conduct more studies to estimate radiation dose for blood vessels and components from medical imaging procedures and revise the value of tissue weighting factor for bone marrow.

Objective: Comparison of visual field progression in patients with Primary Open-angle Glaucoma (POAG) and Pseudo Exfoliative Glaucoma (PEXG).Methods and materials: This is a 2-year longitudinal prospective study including 60 glaucomatous eyes with VA CF ≥ 3 m, IOP ≥ 20 mmHg, CDR ≥ 0.6 and those with Shaffer’s grade 3 or above were categorized as POAG along with signs of Pseudo exfoliative material as PEXG.Patients on anti-glaucoma medications and those who have undergone cataract and glaucoma surgeries are also included in this study. 24-2 visual field test was performed using Humphrey Field Analyzer & the progression was assessed based on 3 parameters- Mean Deviation (MD), Visual Field Index (VFI) & Guided Progression Analysis (GPA).Results: The difference in MD & VFI was higher in PEXG (-5.77 dB) (10.88%) than in POAG (-1.56 dB) (7.17%) respectively & was significant statistically (t - test, p = < 0.001). The GPA showed fast progression in 53.30% of cases in PEXG, 13.30% in POAG (Chi-square, p = < 0.001) about 63.30% of POAG & 46.70% of PEXG showed slow- moderate progression, but 23.30% of POAG subjects had no progression.Conclusion: Compared to POAG, the study showed that PEXG had frequent & faster visual field worsening. Therefore, PEXG patients require more stringent management & treatment than those with POAG.

Objectives: Hospitalization following a head injury is associated with high rates of disability that have a strong correlation with depression, anxiety, and low self-esteem. Well-being is related to life satisfaction, quality of life, happiness, personal growth and flourishing, competence, self-acceptance, positive relationships, and autonomy. The well-being of patients and their primary caregivers is important when a patient is left with impaired mobility after neurosurgery. The aim of this study is to examine whether the well-being of patients and their primary caregivers will differ before and after neurosurgery, and whether well-being differs between patients with motor disability (WMD group) and those without, compared to those who are not - NMD group (non-motor disability).Methodology: 123 patients and their main caregivers were recruited. Of these, 62 were in the before neurosurgical group, 31 Patients and 31 caregivers. 61 in the after neurosurgical group, 30 Patients and 31 caregivers, of which there are 16 from WMD group and 15 from NMD. Main outcome measures: Two analyses of Variance (ANOVA) were conducted: for WMD and NMD separately. The results reveal a significant decrease in wellbeing for both, patient and main caregivers, but a stronger decline in well-being was observed among WMD, as indicated by a larger effect size (η² = 0.74) compared to the NMD (η² = 0.38). In addition, no significant effect between group and time of measurement was found, indicating that the decrease in wellbeing was not different among patients compared to their main caregivers. Conclusion: The findings highlight the multifaceted impact of neurosurgery on well-being, particularly for patients who remain with motor disabilities and their primary caregivers.The decline in well-being after neurosurgery highlights the need for improved social support and the importance of developing treatment programs that can help ease the process of coping with these phenomena and provide appropriate support for both patients and their primary caregivers.

Rationale: Pulmonary Arterial Hypertension (PAH) is a progressive vascular remodeling disease with elevated pulmonary vascular resistance that is lethal. While therapeutic progress was recently made with endothelin, nitric oxide, and prostacyclin pathway-based therapy for the treatment of PAH, the disease is currently incurable with a high cost of morbidity and mortality. Sotatercept, a new activin receptor IIA-Fc fusion protein, may prove to be a game-changer as a therapeutic agent for the treatment of PAH by regulating the growth factor signaling aberration of PAH.Methods: It is a narrative review of evidence for the drug Sotatercept for Group 1 PAH from a systematic literature search for clinical trials, mechanism studies, and regulatory data up to 2024. Pivotal clinical trials such as PULSAR, SPECTRA, STELLAR, and ZENITH were evaluated for efficacy, safety, and comparative results.Results: Sotatercept is a TGF-β family member ligand trap that rebalances activin/BMP signaling to target vascular remodeling. Clinically, striking effects were shown with exercise (40.8 m improvement in STELLAR 6MWD), pulmonary hemodynamics (PVR reduction of 146-240 dyn·s·cm-5 in PULSAR), as well as clinical measures (76% reduction of composite morbidity/mortality through ZENITH). On the background with an acceptable drug safety profile of predominantly hematologic effects, as well as injection site reaction, benefits were achieved. Comparison with analyses implies at least similar, if superior in some dimensions, efficacy of current PAH therapies.Conclusion: Sotatercept is a new therapeutic option for PAH as the first drug to act on the activin/BMP pathway. With its strong effect on several clinically relevant end points, it is a “fourth pillar” of PAH therapy. Clinical trials will determine its place in the algorithm, ascertain other combinations, and potentially identify its utility for other types of pulmonary hypertension.

Post-COVID pulmonary fibrosis has emerged as a significant long-term complication among survivors of severe SARS-CoV-2 infection. This review highlights the underlying pathophysiology, diagnostic modalities, and recent advances in the diagnosis and management of post-COVID pulmonary fibrosis. As global cases of COVID-19 continue to evolve, understanding and addressing this emerging chronic respiratory condition is critical for long-term patient care.

Introduction: Bronchoscopy could lead to local spread of pre-existing infection, spread of infection from one patient to another if the bronchoscope is disinfected inadequately, or, isolation of microorganisms from bronchoscopic specimens in a patient who is clinically not infected, i.e., pseudo-infection. This study is one such investigation of an outbreak of bronchoscopic pseudo-infections in a tertiary care hospital.Materials and methods: Bronchoalveolar lavage (BAL) samples were inoculated onto MacConkey Agar and 5% Sheep Blood Agar and incubated at 37 °C overnight. The growths obtained on culture media were processed for identification and antimicrobial susceptibility on Vitek 2 Compact as per manufacturer’s instructions. To investigate the outbreak, 5 mL - 10 mL of sterile water was flushed through the channels of disinfected bronchoscope and collected in a sterile container. The samples were centrifuged and inoculated onto MacConkey Agar and 5% Sheep Blood Agar. The growths obtained were further processed similarly as the BAL samples were processed. Environmental swabs collected from the bronchoscopy unit were also processed as the procedure mentioned above.Results: Bronchoalveolar lavage of 3 patients in a period of 1 week were contaminated with multidrug resistant Klebsiella pneumoniae. Two out of five bronchoscope fluid samples were also contaminated with Klebsiella pneumoniae. Among the swabs collected from bronchoscope unit, Klebsiella pneumoniae was isolated from the detergent box of the endowasher. Conclusion: The risk of propagation of infection via a bronchoscope can be evaded by proper reprocessing and improving the sterilization practices. 

Touch DNA, the minute quantities of DNA deposited through skin contact, has become a valuable tool in forensic investigations. However, the recovery of touch DNA from non-porous surfaces remains a challenging task, requiring optimized collection and extraction techniques to maximize DNA yield, because non-porous surfaces have smooth, non-absorbing material properties. This review explores various non-porous surfaces such as glass, plastic, and metal, analyzing their impact on DNA recovery efficiency. Different collection methods, including swabbing, tape lifting, scrubbing, and vacuum collection methods, are evaluated to determine their effectiveness in retrieving minute amounts of DNA from these surfaces. Through a comparative analysis of existing studies, this paper identifies which collection methods work best for different non-porous surfaces and why choosing the right technique matters. Factors such as surface type, environmental conditions, and collection technique performed, time duration, and so on can affect DNA recovery, making it crucial to use the most effective approach. This review also emphasizes the need for standardized protocols to ensure consistent and reliable results in forensic investigations. Having clear guidelines can reduce errors, improve DNA analysis, and make touch DNA analysis more reliable in forensic investigations. By focusing on these aspects, this study aims to contribute to the ongoing efforts in refining touch DNA recovery strategies.

Polymer Electrolyte Membrane Fuel Cells (PEMFCs) operating in Dead-Ended Anode (DEA) mode present a promising alternative to traditional flow-through systems by simplifying design and reducing costs. However, their efficiency and durability are challenged by transient phenomena such as water accumulation, nitrogen buildup, and carbon corrosion throughout operation. This review investigates the dynamic behavior of DEA PEMFCs under dynamic operating states, aiming to improve their efficiency. By analyzing purge cycle optimization and transient response characteristics, we identify strategies to mitigate hydrogen loss, maintain voltage stability, and extend stack lifetime. The key findings indicate that precise purge scheduling and effective water management are critical for optimizing performance, with dynamic models providing insights into time-dependent processes. This study underscores the potential of DEA PEMFCs for high-efficiency applications provided transient effects are effectively managed.