Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Outcomes of breast abscesses during lactation: a retrospective study(Sri Lanka college of Obstetricians & Gynaecologists, 2023) Abeysuriya, V.; Dodampahala, S.H.; Chandrasena, L.INTRODUCTION: During breastfeeding one of the most common problems which can encounter is breast abscess. Our retrospective study aimed to assess the outcomes of breast abscesses among a cohort of lactating mothers. METHODS: A single-centre retrospective study was carried out. Randomly selected 2000 medical records of mothers, referred as outpatients and hospitalized from 2002 to 2022 were retrieved. There were 32 breastfeeding mothers with breast abscesses. The diagnosis of lactational breast abscess was made by documented signs of a localized inflammatory, palpable breast lump confirmed with an ultrasound findings. From the retrieved database, data on maternal, perinatal, and breastfeeding features, ultrasound scan reports, methods of interventions and outcomes and microbiological testing reports were evaluated. Ethics Committee Approval was received from Nawaloka Research and Education Unit. No conflict of interest. RESULTS: The mean age of the 32 patients was 28.7 ± 5.7 years. There were 85% primiparous and 15% multiparous. Exclusive breastfeeding at diagnosis was present in 20/32 (63%). Most of the women developed breast abscesses during the initial 40 days (36.3 ± 1.4 days) after delivery. The majority of 26/32 (81.3%) of the breast abscesses were <5cm in diameter in the ultrasound examination. The majority of the patients 28/32 (87%) underwent ultrasound-guided aspiration while on antibiotic coverage according to the standard clinical guidelines. Four patients had repeated ultrasound-guided aspiration. Four patients who had abscesses >5cm, with overlying skin necrosis underwent incising and drainage. None of the patients developed mammary fistulae or sinuses. All of the incision and drainage abscesses were healed within 3 to 5 weeks with repeated wound dressings. Ninety-one percent of the cultures revealed S. aureus positive. None of the patients stops breastfeeding during the acute phase.CONCLUSION: Our retrospective study showed that needle aspiration may be performed, regardless of the size of the breast abscesses in most instances.Item Death of a child following a superstitious ritual of exorcism(Elsevier, 2022) Thivaharan, Y.; Dias, V.; Edirisinghe, A.; Kitulwatte, I.D.G.Introduction: Diseases, especially those related to the psyche produced by demons, are an accepted belief in many communities. This paper elaborates on the death of a child, a victim of an exorcism ritual, and calls for adequate awareness and preventive measures. Case report: The deceased, a 9-year-old child, was taken by her mother to an exorcist to ’expel a demon from her body. The exorcist caned the child for two days while giving ’water’ to drink. On the second day, the child lost consciousness and was pronounced dead on admission. On direct questioning, it was revealed that the child had been made to consume some medicinal syrups forcefully by the mother and the exorcist. The autopsy revealed multiple abrasions, tram-line contusions and burns on the body. There was mottling and consolidation in the lungs. Blood-stained secretions were found in the trachea, bronchi, and stomach. Musculoskeletal dissection revealed subcutaneous haemorrhages and muscular contusions over the buttocks and limbs. Histology revealed evidence of well-established aspiration pneumonia. There was no other significant pathology, especially no evidence of acute kidney injury due to rhabdomyolysis. Toxicological analysis was negative for common poisons, therapeutic drugs, and heavy metals. The cause of death was concluded as aspiration pneumonia in a child subjected to physical violence. Conclusion: With the forceful feeding of the syrup, the child can have aspiration, resulting in aspiration pneumonia. At the same time, it appears that even after the child became symptomatic, she had not been brought for medical treatment but had continued with the same exorcistic therapy. While the caregivers become responsible for the child’s death, the lessons to be learnt are enormous. Thus, banning such practices against children is a need of the hour.