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A prospective study on ablative therapy for small renal masses (SRM) at a tertiary care centre in Sri Lanka

2026-01-01T00:00:00Z

Title: A prospective study on ablative therapy for small renal masses (SRM) at a tertiary care centre in Sri Lanka Authors: Kiritharan, K.; Sangavi, S.; Nivetha, M.; Thishanthini, V.; Neeranjali, P.; Sripandurangana, R.; Priyatharsan, K.; Varothyan, S.; Jeyanthan, B.A.D.; Mayuran, M.; Brammah, R.T.; Gowribahan, T.; Theepan, J.M.M.; Vinothika, S.; Jenil, A.A.; Balagobi, B. Abstract: Introduction: Renal cell carcinoma (RCC) is the fourteenth most common malignancy. Improved cross-sectional imaging has increasedthe identification of small renal masses (SRMs), resulting in a change in care to nephron sparing techniques such as microwave ablation (MWA). This study evaluated the patient characteristics, tumor features, and early outcomes of imageguided MWA for SRMs in a tertiary care environment in Sri Lanka Methodology: This prospective observational study was carried out in a tertiary care hospital between April 2023 and May 2024. Consecutive patients with biopsy—proven T1a SRMs (≤4 cm) who underwent curative percutaneous MWA following multidisciplinary team (MDT) evaluation, were included. Clinical, radiological, histological, and renal function data were obtained. The outcomes included technical success, complications, recurrence, and changes in renal function. Results: Twelve patients (mean age 52.1 ±13.19 years; 83.33% male) underwent MWA with a mean follow-up of 28.63 months until April 2026. Hypertension was the most common comorbidity, and 75% of lesions were incidentally detected. Clear cell RCC was the most common histological subtype (66.67%), followed by oncocytoma (16.67%). Technical success was achieved in all cases, with 83.33% required a single ablation session. Only two minor complications (16.67%) (Clavien-Dindo grades I and II) were recorded. Renal function was preserved, with no evidence of local recurrence or distant metastasis during follow-up. Conclusion: Image-guided MWA revealed great technical success, acceptable safety, and effective short-term oncological management while maintaining renal function, indicating that it is a potential nephron-sparing alternative for selected SRMs in resource-limited settings.

Adverse Effects of Antisizure Medications Among Adults with Epilepsy at Teaching Hospital, Jaffna

2026-01-01T00:00:00Z

Title: Adverse Effects of Antisizure Medications Among Adults with Epilepsy at Teaching Hospital, Jaffna Authors: Yalini, G.; Rajasekaran, T.; Keshavaraj, A.; Navaratinaraja, T.S. Abstract: Background: Antiseizure medications (ASMs) are the cornerstone of epilepsy management. However, adverse effects (AEs) associated with ASMs may affect adherence and, thereby, the control of epilepsy. This study aimed to evaluate the treatment pattern and adverse effects of ASMs among adults with epilepsy who are being followed up at Teaching Hospital, Jaffna. Methods: A descriptive cross-sectional study was conducted among adult patients receiving ASMs for ≥3 months at the neurology outpatient clinic, Teaching Hospital, Jaffna. Eligible participants were recruited using consecutive sampling over a 4-month period. Data were collected using a pretested interviewer-administered questionnaire developed by the investigators based on the literature. The questionnaire captured sociodemographic and clinical characteristics, ASM use, and self-reported adverse effects. Logistic regression was performed to determine the factors associated with adverse effects. A p ≤ 0.05 is considered statistically significant. Results: Data from 213 participants were analysed. The mean age was 36.3 ± 0.92 years, and the majority (52%) were males. Focal seizure (n=129, 60.6%) was the most common type. Nearly two-thirds (64.8%) received dual or polytherapy, and older (first-generation) ASMs were predominantly prescribed (74.5%). Only one-third (34%) were seizure-free for ≥ 2 years. A total of 333 AEs were reported in 146 participants (prevalence 68.5%; mean 1.6 per patient). Common AEs included sedation (27%), memory impairment (24%), and dizziness (21%). Advancing age (AOR 4.3; 95% CI: 1.87–10.29; p<0.001), late onset of epilepsy (AOR 0.35; 95% CI: 0.14–0.87; p=0.023), and polytherapy (AOR 2.7; 95% CI: 1.4–5.3; p=0.003) were significantly associated with AEs. Valproic acid and clobazam were significantly associated with sedation (p<0.001 and p=0.003, respectively) and dizziness (p=0.013 and p=0.006, respectively), while carbamazepine was significantly associated with memory impairment (p=0.022). Among those who experienced AEs, one-fourth required switching ASMs. Carbamazepine was the most commonly replaced ASM, and levetiracetam was the most common alternative. Conclusion: Older antiseizure medications and polytherapy were commonly prescribed, and adverse events were frequent. Larger studies are needed to evaluate current prescribing practices and develop strategies to optimise epilepsy care.

Analysis of Antibiotic Consumption by AWaRe Classification at Teaching Hospital, Jaffna: A Retrospective Study

2026-01-01T00:00:00Z

Title: Analysis of Antibiotic Consumption by AWaRe Classification at Teaching Hospital, Jaffna: A Retrospective Study Authors: Yalini, G.; Meenadchisundaram, P.; Amarasingam, S.; Nithiyananda, S.; Navaratinaraja, T.S. Abstract: Background: Antibiotic resistance is a major global health challenge, leading to adverse health outcomes and increased healthcare costs. In response to this growing threat, the World Health Organization (WHO) introduced the Access, Watch, and Reserve (AWaRe) classification of antibiotics in 2017 as a surveillance tool, recommending that at least 60% of total antibiotic consumption should be from the Access group. This study aimed to analyse antibiotic consumption at Teaching Hospital, Jaffna, according to the WHO AWaRe classification from 2018 to 2022. Methods: A retrospective analysis of systemic antibiotic consumption was conducted at the Teaching Hospital, Jaffna, from 2018 to 2022. Antibiotic supply data were obtained from the hospital pharmacy database. Antibiotics were classified into Access, Watch, and Reserve groups according to the 2021 WHO AWaRe classification. Trends in antibiotic consumption were assessed using percent change for Access and Watch categories over a period of five years, taking 2018 values as the baseline, and between consecutive years. Antibiotic consumption was summarised by AWaRe category, and changes over time were evaluated by comparing percentages with the 2018 baseline and across consecutive years. Results: Throughout the five-year period, consumption of Access group remained above the WHO-recommended target of 60%, accounting for 68.1%, 72.3%, 76.4%, 67.9%, and 70.1% of total antibiotic consumption in 2018–2022, respectively. The corresponding proportions of Watch group were 31.7%, 27.4%, 23.1%, 31.4%, and 29.0%, while Reserve group contributed 0.01%, 0.01%, 0.04%, 0.03%, and 0.01%, respectively. The Access-to-Watch ratio remained consistently above 2 throughout the study period. An increasing trend in the proportion of Access group was observed except in 2021, when it declined from 76.4% to 67.9% with a reciprocal increase in the Watch group from 23.1% to 31.4%. Conclusion: The proportion of Access group remained above the WHO-recommended target of 60% throughout the study period. Routine monitoring of antibiotic consumption using hospital supply data could support surveillance of prescribing patterns and inform antimicrobial stewardship strategies in resource-limited settings.

Consumption of systemic antibiotics in a tertiary care hospital in Northern Sri Lanka: a five-year trend analysis

2026-01-01T00:00:00Z

Title: Consumption of systemic antibiotics in a tertiary care hospital in Northern Sri Lanka: a five-year trend analysis Authors: Yalini, G.; Pavithra, M.; Saranya, A.; Nithiyananda, S.; Thiyahiny, S.N. Abstract: Background Surveillance of antimicrobial consumption helps to understand the pattern of antibiotic utilisation and plays an essential role in tackling antimicrobial resistance. However, a lack of an established surveillance system is a major challenge in combating antimicrobial resistance in low- and middle-income countries (LMICs). This study aimed to determine the pattern of systemic antibiotic consumption at the Teaching Hospital, Jaffna, using the World Health Organization (WHO) methodology for surveillance of antimicrobial consumption. Methods A descriptive study of systemic antibiotic consumption was conducted at the Teaching Hospital, Jaffna, from 2018 to 2022. Supply data were analysed using the Anatomical Therapeutic Chemical (ATC)/defined daily dose (DDD) methodology. Antibiotic consumption volume was expressed in DDD, while outpatient and inpatient consumption rates were expressed as DDD/100 patients and DDD/100 admissions, respectively. The AWaRe (Access, Watch, and Reserve) classification and Drug Utilisation-90% (DU90%) were used to assess consumption patterns. Trends were assessed using curve estimation analysis. The Wilcoxon signed-rank test and Friedman test were performed to determine the significance of changes between years and over five years, respectively. A p value ≤ 0.05 was considered statistically significant. Results Compared with 2018, overall antibiotic consumption showed a declining trend except in 2019. Oral antibiotics accounted for more than 80% of total consumption, and amoxicillin/clavulanic acid remained the most commonly consumed antibiotic. Access antibiotics accounted for over 70% of total consumption, with an Accessto- Watch ratio > 2 throughout the study period. The DU90% segment remained largely consistent, comprising 11–12 antibiotics. Curve estimation analysis showed non-linear trends in Access and Watch antibiotic consumption. Despite the decline in total antibiotic consumption, the inpatient antibiotic consumption significantly increased in 2021 compared with 2020 (p < 0.001). Conclusion Analysis of antibiotic supply data showed that the overall pattern of antibiotic consumption remained consistent over a five-year period despite the changes that occurred during the COVID-19 pandemic. Establishing routine monitoring of antibiotic consumption using available data sources in hospitals provides basic information and insights into the problems. These findings could help to plan strategies to improve the antibiotic utilisation in LMICs.