Navinan M.R.,National Hospital of Sri Lanka |
Rajapakse S.,University of Colombo
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2012
Leptospirosis is a neglected global disease with significant morbidity and mortality. Cardiac complications such as chest pain, arrhythmias, pulmonary oedema and refractory shock have been reported in patients with severe disease. However, the frequency and extent of cardiac involvement in leptospirosis, are under-reported and poorly understood. Multiple factors may contribute to clinical manifestations that suggest cardiac involvement, causing diagnostic confusion. A variety of electrocardiographic changes occur in leptospirosis, with atrial fibrillation, atrioventricular conduction blocks and non-specific ventricular repolarization abnormalities being the most common. Electrolyte abnormalities are likely to contribute to electrocardiographic changes; direct effects on Na+-K+-Cl- transporters in the renal tubules have been postulated. Echocardiographic evidence of myocardial dysfunction has not been adequately demonstrated. The diagnostic value of cardiac biomarkers is unknown. Histopathological changes in the myocardium have been clearly shown, with myocardial inflammation and vasculitis present in postmortem studies. Nonetheless, the pathophysiology of cardiac involvement in leptospirosis is poorly understood. Cardiac involvement, demonstrated electrocardiographically or clinically, tends to predict poor outcome. No specific therapies are available to prevent or treat cardiac involvement in leptospirosis; current management is based on correction of deranged homeostasis and supportive therapy. Evidence suggests that direct myocardial damage occurs in patients with severe leptospirosis, and further studies are recommended to elucidate its pathophysiology, clinical features and contribution to overall prognosis, and to identify appropriate diagnostic investigations and specific therapies. © 2012 Royal Society of Tropical Medicine and Hygiene.
Subasinghe D.,University of Colombo |
Nawarathna N.M.M.,National Hospital of Sri Lanka |
Samarasekera D.N.,University of Colombo
Journal of Gastrointestinal Surgery | Year: 2011
Background: Inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn's disease (CD), which are chronic inflammatory conditions affecting the gastrointestinal tract. There are only few published data on disease characteristics of IBD related to South Asia. Objective: To provide the disease characteristics of the IBD patients who presented to a tertiary care hospital in South Asia. Methods: Patients with an established diagnosis of IBD were identified after a review of their medical records and demographics, and disease characteristics and indications for surgical treatment were analyzed. Results: A total of 184 patients (women = 101, 54. 9%; UC = 153, 83. 2%) were included. Female preponderance was observed for UC (male/female ratio =1:1. 5) and male for CD (male/female = 2:1). Mean age at the time of diagnosis was 36. 3 (range 7-71) years. CD was diagnosed at a significantly younger age than UC (27. 35 ± 10. 22 vs. 38. 14 ± 13. 05 years, p < 0. 0001). CD showed a peak age of onset in the third decade and that for UC was in the fourth decade. The mean duration of IBD was 8. 17 (range 1-28) years. Presenting complaint of the majority (73. 7%) of UC patients was blood and mucous diarrhea and that for CD (77. 4%, 24/31) was left-sided abdominal pain. Only 9. 5% (n = 18) had at least one extra-intestinal manifestation. Among UC patients, 51. 7% (n = 79) had left-sided colitis and panproctocolitis was found in 18. 3% (n = 28). In IBD patients, 14. 1% (n = 26) underwent surgery. Only one patient developed malignancy. Conclusions: The majority of UC patients had left-sided colitis. CD compared to UC was diagnosed at a younger age. However, compared to data reported for some Western countries, extra-intestinal manifestations and malignancy rates were lower. © 2011 The Society for Surgery of the Alimentary Tract.
Ratnayake E.C.,The National hospital of Sri Lanka |
Ratnayake E.C.,National Hospital of Sri Lanka |
Shivanthan C.,The National hospital of Sri Lanka |
Wijesiriwardena B.C.,The National hospital of Sri Lanka
BMC Infectious Diseases | Year: 2012
Background: Dengue is considered one of the most common mosquito borne illnesses in the world. Although its clinical course is usually uneventful, complications have rarely been known to arise. These include neurological manifestations such as neuropathies.Case presentation: We report a middle aged patient from urban Sri Lanka who developed diaphragmatic paralysis secondary to phrenic neuropathy a month after recovering from dengue fever. He was managed conservatively and made a full recovery subsequently.Conclusion: Isolated phrenic nerve palsy causing diaphragmatic paralysis should be considered a recognized complication of Dengue fever. A patient usually gains full recovery with conservative management. © 2012 Ratnayake et al; licensee BioMed Central Ltd.
Wijewickrama E.S.,National Hospital of Sri Lanka
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia | Year: 2013
Acute renal failure (ARF) is a well-recognized complication of paroxysmal nocturnal hemoglobinuria (PNH). The predominant mechanism is intravascular hemolysis resulting in massive hemoglobinuria ARF. We report a case of acute tubular necrosis (ATN) developed in the absence of overwhelming evidence of intravascular hemolysis in a 21-year-old man with anemia, who was eventually diagnosed to have PNH. The patient presented with rapidly deteriorating renal functions in the background of iron deficiency anemia, which was attributed to reflux esophagitis. There was no clinical or laboratory evidence of intravascular hemolysis. Renal biopsy revealed ATN with deposition of hemosiderin in the proximal tubular epithelial cells. Diagnosis of PNH was confirmed with a positive Ham's test and flow cytometry. Our case emphasizes the need to consider ATN as a possible cause for ARF in patients suspected to have PNH even in the absence of overwhelming evidence of intravascular hemolysis.
Nazar A.L.,National Hospital of Sri Lanka
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia | Year: 2014
We report the case of a 45-year-old chronic smoker who presented with acute paraplegia occurring during coitus and subsequently developed acute renal failure (ARF) requiring dialysis. He had absent peripheral pulses in the lower limbs with evidence of acute ischemia. Doppler study showed dissecting aneurysm of thoracic aorta, thrombotic occlusion of the distal aorta from L1 level up to bifurcation and occlusion of the right renal artery by a thrombus that was confirmed by magnetic resonance imaging of the spine. He was not subjected to any vascular intervention as his lower limbs were not salvageable due to delay in the diagnosis. Post-coital aortic dissection and aortic dissection presenting with acute paraplegia and ARF are very rare. This is probably the first case report with post-coital acute aortic dissection presenting with paraplegia and ARF. This case emphasizes the importance of a careful examination of peripheral pulses in patients presenting with ARF and paraplegia.
Ekanayaka R.A.I.,National Hospital of Sri Lanka
BMJ Case Reports | Year: 2014
Cyanosis is an ominous physical sign indicating significant cardiac or respiratory disease. However, bluish discolouration mimicking cyanosis could occur in methaemoglobinaemia. The clinical implications being very different, it is important that the aetiology of bluish discolouration of tissues is correctly identified. A case is reported where the antianginal agent nicorandil was identified as the most likely cause for methaemoglobinaemia. Copyright 2014 BMJ Publishing Group. All rights reserved.
Gunawardhana S.A.A.I.,National Hospital of Sri Lanka
Sri Lankan Journal of Anaesthesiology | Year: 2012
Background Recent guidelines on preoperative fasting recommend 2 hours for clear fluids and 6 hours for solids in most elective surgical patients 1,2. Despite this contemporary practice varies widely across the country. This study evaluates the knowledge, current practices and compliance with guidelines. Method This was a cross-sectional study. Data was obtained from patients attending for elective surgeries in NHSL during July 2010 and from junior anaesthetists, intern medical officers (IMO) and nurses of surgical wards. ASA practice guideline was the standard of assessment. Results 235 patients and 118 healthcare workers were included. The mean duration of fasting was 13.86 hours (range 8 - 18) for solids and 12.68 hours for liquids (4 - 18). All junior anaesthetists and 64.3% of IMOs had above satisfactory level of knowledge. Nurses had below satisfactory knowledge. Only 58.3% of anaesthetists and none of the nurses or IMOs have adhered to guidelines. 81% patients stated that they would refuse a meal at 2 am but 66% would have appreciated a cup of tea 2 hours before surgery. Conclusion Patients undergoing routine surgery fast for unnecessarily long periods. Failure of implementation of guidelines is mainly due to inadequate knowledge and poor attitude among ward staff. More pragmatic approach is needed to assure that fasting instructions are consistent with the ASA guidelines and that patients understand and comply with these directives.
Shivanthan M.C.,National Hospital of Sri Lanka |
Ratnayake E.C.,National Hospital of Sri Lanka |
Wijesiriwardena B.C.,National Hospital of Sri Lanka |
Somaratna K.C.,National Hospital of Sri Lanka |
Gamagedara L.K.G.K.,National Hospital of Sri Lanka
BMC Infectious Diseases | Year: 2012
Background: Dengue fever is an endemic illness in the tropics with early and post infectious complications affecting multiple systems. Though neurological sequelae including mononeuropathy, encephalopathy, transverse myelitis, polyradiculopathy, Guillain-Barre syndrome , optic neuropathy and oculomotor neuropathy have been reported in medical literature, the abducens nerve despite its notoriety in cranial neuropathies in a multitude of condition due to its long intracranial course had not been to date reported to manifest with lateral rectus paralysis following dengue.Case presentation: A previously well 29 year old male with serologically confirmed dengue hemorrhagic fever developed symptomatic right lateral rectus palsy during the critical phase of the illness, which persisted into convalescence and post convalescence with proven deficit on Hess screen. Alternate etiologies were excluded by imaging, serology and electrophysiology.Conclusions: The authors detail the first reported case of abducens nerve palsy complicating dengue fever in a previously healthy male from Sri Lanka. In a tropical country with endemic dengue infections, dengue related abducens neuropathy may be considered as a differential diagnosis in cases of acquired lateral rectus palsy after dengue fever. © 2012 Shivanthan et al.; licensee BioMed Central Ltd.
Hannadige H.,National Hospital of Sri Lanka
Sri Lankan Journal of Anaesthesiology | Year: 2015
A superficial cervical plexus block was performed following general anaesthesia for a thyroidectomy to provide intraoperative and post-operative analgesia. The patient suffered a transient motor weakness and numbness on both upper limbs following the procedure which lasted about 12hrs. There were no residual neurological effects. © 2015, College of Anaesthesiologists of Sri Lanka. All rights reserved.
Perera I.A.C.L.,National Hospital of Sri Lanka
Sri Lankan Journal of Anaesthesiology | Year: 2012
Background: Venous thromboembolism (VTE) is an important cause of mortality and morbidity in critical care patients. This is as a result of high prevalence of VTE risk factors in this group of patients including physical inactivity, immobilization, vascular injury and / or hypercoagulable state. The effect of these risk factors are cumulative. VTE may progress into thrombophebitis or pulmonary embolism (PE) with increased mortality and morbidity and have enormous economic issues. But the risk of VTE and its prevention have been poorly characterized in this population. Evidence based thromboembolic prophylaxis guidelines are also not widely available for these critically ill patients. The main objectives of this audit were to determine the presence and the type of the risk factors and the prophylaxis given in patients admitted to five adult intensive care units (ICU) in National Hospital Sri Lanka (NHSL). Method: This audit was carried out from 1 st to 31 st of March 2011 in five critical care units in NHSL. Confidentiality was maintained. Data was obtained with the use of pre formed data collection forms, filled by post graduate trainees in anaesthesiology. Results: There were a total of 90 patients, 53% male and 47% female, and 40% were in the 30-40 year age group. Majority (49%) of the patients were admitted to ICU following surgery. 35 patients (38.9%) had at least 2 risk factors for VTE. 39 patients (43.3%) had received VTE prophylaxis. 51 patients (56.6%) did not get any prophylaxis against VTE. 43.3% were given only pharmacological prophylaxis and 33.3% were offered both pharmacological and mechanical prophylaxis. Enoxaparin 40mg daily was used as the drug of choice in majority of the patients irrespective of their body weight. Pharmacological VTE prophylaxis for the postoperative patients was started 8-12 hours after admission in the majority. Conclusion: We found an under usage of VTE prophylaxis on at risk patients in intensive care units at NHSL. We would like to highlight the importance of having institutional guidelines on VTE prophylaxis and improving the awareness on VTE among the ICU staff.