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Hewamana S, Skandarajah T, Jayasinghe C, Deshapriya S, Gayashan D, Peiris N, Harischandra M, Gunasena P, Somasundaram G, Srinivasan V, Somiah S, Wickramarathna C, Hewawasam S, Balawardena J, Arseculeratne G, Wadanamby R, Galagoda G, Wijesiriwardana B. Successful Management of Neutropenic Sepsis Is Key to Better Survival of Patients With Blood Cancer in Sri Lanka: Real-World Data From the Resource-Limited Setting. JCO Glob Oncol 2024; 10:e2300412. [PMID: 38484192 PMCID: PMC10954079 DOI: 10.1200/go.23.00412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/25/2023] [Accepted: 02/02/2024] [Indexed: 03/19/2024] Open
Abstract
PURPOSE Sepsis is the main cause of nonrelapse mortality, and there are no published data on applicability of supportive care protocols from high-income countries such as Sri Lanka. The aim of the study was to investigate management and mortality of neutropenic episodes among Hemato-Oncology patients. MATERIALS AND METHODS Retrospective analysis of clinical characteristics, management, morbidity, and mortality of neutropenic Hemato-Oncology patients presented to the Lanka Hospital Blood Cancer Centre from January 1, 2019 to December 31, 2019 was performed. RESULTS A total of 169 neutropenic episodes were identified; 115 (68%) of such episodes were related to chemotherapy. Acute leukemia, lymphoproliferative disorders, and plasma cell disorders accounted for 23%, 69%, and 8% of patients, respectively. The median age of patients who had sepsis was 56 years, whereas that of those who had no sepsis was 53 years (P = .49). The median time to neutropenia was 9 days for those in the sepsis group compared with 8 days in the group that had no sepsis (0.64). The median neutrophil count in the group that had sepsis was 0.06, whereas it was 0.69 in the group that had no sepsis (P ≤ .05). The median time to commencement of antibiotics was 20 minutes. CONCLUSION To our knowledge, this is the only documented study related to outcome and successful applicability of western supportive care protocols to Sri Lankan patients with neutropenia. In this study, we have shown that neutropenic sepsis can be successfully managed in the setting of limited resources with service development, following guidelines and staff training.
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Affiliation(s)
| | | | - Chathuri Jayasinghe
- Department of Statistics, University of Sri Jayewardenepura, Colombo, Sri Lanka
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Gunawardena SA, Dassanayake N, Keerawelle BI, Kanthasamy S, Ranganatha H, Gunawardana JW. The effect of the COVID-19 pandemic on the trends and characteristics of natural and unnatural deaths in an urban Sri Lankan cohort viewed through retrospective analysis of forensic death investigations from 2019 to 2022. Osong Public Health Res Perspect 2023; 14:468-482. [PMID: 38204426 PMCID: PMC10788415 DOI: 10.24171/j.phrp.2023.0175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has had a severe impact on global health. Apart from the disease itself, the strict restrictions and lockdowns enforced to minimize its spread have also substantially disrupted personal and public health. METHODS An analysis of forensic autopsy investigations was conducted between 2019 and 2022 on a selected urban population in Colombo, Sri Lanka, assessing the effects of the COVID-19 pandemic on mortality within these communities. RESULTS During the COVID-19 restrictions, there was a 2.5-fold increase in the total number of deaths, with a significantly higher percentage of female deaths than before. The majority of these deaths were due to cardiovascular causes, while COVID-19-related deaths ranked third overall. The highest proportion of COVID-19 deaths occurred among unvaccinated females. The monthly frequency of deaths from traffic accidents, poisoning, and asphyxiation decreased, while deaths from blunt trauma, sharp trauma, burns, and immersion increased. There was also a rise in blunt homicides and a greater number of femicides during the COVID-19 restrictions than in the pre-pandemic period. A significantly higher percentage of males who received the COVID-19 vaccine died from cardiovascular causes compared to those in the unvaccinated group. CONCLUSION The significant changes in mortality demographics and causes of death within this community during the COVID-19 restrictions underscore the disruption in healthcare, healthseeking behavior, and social interactions during this period. The vulnerability of individuals residing in highly urbanized areas with lower socioeconomic status, particularly women, is brought into sharp focus.
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Affiliation(s)
- Sameera Anuruddha Gunawardena
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
- Department of Pathology, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Nishani Dassanayake
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | - Shivasankarie Kanthasamy
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Hasini Ranganatha
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Jayani Wathsala Gunawardana
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
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Hewamana S, Gunasena P, Jayasinghe C, Skandarajah T, Harischandra M, Abeyaratne S, Ekanayake L, Somasundaram G, Somiah S, Srinivasan V, Arseculeratne G, Perera N, Fernando J, Faiz M, Munasinghe N, Mowlana A, Deshapriya S, Mawathakubura S, Wickramarathna C, Wijewickrama A, Jayawardena P, Perera E, Peiris N, Paranawithane S, Perera C, Kariyawasam C, Munasinghe S, De Silva C, Wadanamby R, Galagoda G, Lin TT, Wijesiriwardena B, Balawardena J. Response and Survival Estimates of Patients With Plasma Cell Myeloma in a Resource-Constrained Setting Using Protocols From High-Income Countries: A Single-Center Experience From Sri Lanka. JCO Glob Oncol 2022; 8:e2100352. [PMID: 35772042 PMCID: PMC9276119 DOI: 10.1200/go.21.00352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
There is a significant disparity in global cancer care and outcome between countries. Progress in the treatment of symptomatic plasma cell myeloma (PCM) in high-income countries is not seen in low- and middle-income countries. Is it possible to set up dedicated hemato-oncology centers and use protocols from high-income countries in a resource-constrained setting? It is possible to successfully apply treatment and supportive care protocols in the correct setting of dedicated hemato-oncology centers. Patients with plasma cell myeloma were treated with thalidomide- and/or bortezomib-containing regimens adapted from high-income countries. After a median follow-up of 40.6 months (range, 35.2-59.07 months), the median overall survival (OS) was 84.2 months (95% CI, 60.87 to NA) and the 5-year estimated OS was 65%, comparable to parameters in phase III randomized trials in high-income countries.![]()
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Affiliation(s)
- Saman Hewamana
- Clinical Haematology Unit, Lanka Hospitals, Colombo, Sri Lanka
- Asiri Surgical Hospital, Colombo, Sri Lanka
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Chandu De Silva
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | | | - Thet Thet Lin
- Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
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Gadsden T, Downey LE, Vilas VDR, Peiris D, Jan S. The impact of COVID-19 on essential health service provision for noncommunicable diseases in the South-East Asia region: A systematic review. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 1:100010. [PMID: 35769108 PMCID: PMC9069231 DOI: 10.1016/j.lansea.2022.04.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background COVID-19 has had a profound impact on the health systems of the 11 countries of the WHO South East Asia Region. We conducted a systematic review of studies that used quantitative and comparative approaches to assess the impact of the pandemic on the service provision of four noncommunicable diseases (NCDs) (cancer, cardiovascular disease, chronic respiratory diseases, and diabetes) in the region. Methods A systematic search was conducted in PubMed, Embase, MedRxiv, and WHO COVID-19 databases in December 2021. The quality of studies was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist and the ROBINS-I risk of bias tool. A narrative synthesis was conducted following the 'synthesis without meta-analysis' reporting guidelines. Findings Two review authors independently screened 5,397 records with 31 studies included, 26 which were cross-sectional studies. Most studies (n=24, 77%) were conducted in India and 19 (61%) were single-site studies. Compared to a pre-pandemic period, 10/17 cancer studies found a >40% reduction in outpatient services, 9/14 cardiovascular disease found a reduction of 30% or greater in inpatient admissions and 2 studies found diagnoses and interventions for respiratory diseases reduced up to 78.9% and 83.0%, respectively. No eligible studies on the impact of COVID-19 on diabetes services were found. Interpretation COVID-19 has substantially disrupted the provision of essential health services for NCDs in the WHO South East Asia Region, particularly cancer and cardiovascular disease. This is likely to have serious and potentially long-term downstream impacts on health and mortality of those living with or at risk of NCDs in the region. Funding This work was supported by the WHO Sri Lanka Country Office.
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Affiliation(s)
- Thomas Gadsden
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Laura E Downey
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- School of Public Health, Imperial College London, London, United Kingdom
| | - Victor Del Rio Vilas
- World Health Organization (WHO) South East Asia Regional Office (SEARO), New Delhi, India
| | - David Peiris
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, Australia
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Bergin ART. Insights Into the Demands on a Clinical Oncologist in Sri Lanka. JCO Glob Oncol 2022; 8:e2100429. [PMID: 35230874 PMCID: PMC8887938 DOI: 10.1200/go.21.00429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Alice R T Bergin
- Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3010, Australia
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