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Sri Jayewardenepura Kotte, Sri Lanka

Gooneratne I.K.,Institute of Neurology | Weeratunga P.,University Medical Unit | Caldera M.,Institute of Neurology | Gamage R.,Institute of Neurology
Practical Neurology | Year: 2014

Gloriosa superba, a flowering plant widespread in South and Southeast Asia, is implicated in many cases of self-poisoning. Colchicine is concentrated in the seeds and tubers and this mediates its toxicity. We describe a 28-year-old woman who developed delayed encephalopathy after eating G superba tubers. MR scan of brain showed bilateral symmetrical T2 basal ganglia hyperintensities in the caudate and lentiform nuclei. The delay in onset of encephalopathy is attributable to a direct-effect colchicine, probably mediated through its effect on microtubular transport. © 2014 BMJ Publishing Group Ltd. All rights reserved.

Fernando S.D.,University of Colombo | Herath S.,National STD AIDS Control Programme | Rodrigo C.,University Medical Unit | Rajapakse L.,University of Colombo
Indian Journal of Sexually Transmitted Diseases | Year: 2012

Introduction: Trichomoniasis is a relatively neglected area of research in Sri Lanka. Given the number of infections observed, an analysis of sociodemographic characteristics of patients would be valuable in prevention. Materials and Methods: Data were collected from 359 newly registered women at a tertiary level sexually transmitted diseases clinic over a period of 18 months. Trichomoniasis was diagnosed by culture of vaginal swabs collected from the posterior fornix. Results: The prevalence of trichomoniasis in the sample was 7.2%. Of those who tested positive for trichomoniasis, 76% were in the age group of 21-45 years, 68% were married and living with a spouse and 60% were unemployed. A diagnosis of Trichomoniasis was associated with being married (OR, 1.6; CI, 0.56-4.41), age over 33 years (OR=1.3, CI, 0.55-2.9), being employed (OR, 1.3; CI, 0.56 - 2.94), having an education of less than ten years at school (OR, 3.0; CI 1.28-7.26) and not using condoms during the last sexual act (OR 2.0, CI 0.84-4.86). The risk was less among commercial sex workers (OR, 0.3, CI: 0.14-0.85), those with multiple sexual partners (OR, 0.2; CI; 0.073-0.408) and women reporting extramarital sexual relationships (OR, 0.3; CI, 0.128-0.733). Conclusions: Education on safe sex and recognition of symptoms is currently targeted at high risk groups such as commercial sex workers. Extending these programmes to the rest of the community will further reduce the risk of transmission of trichomonas.

Fernando T.,University of Colombo | Rodrigo C.,University of Colombo | Samarakoon L.,University Medical Unit | Navinan M.R.,University of Colombo | And 3 more authors.
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2013

Background: Cardiac involvement is known to occur in leptospirosis, however, data on the significance of electrocardiographic and echocardiographic findings is very limited. Methods: Electrocardiographic and echocardiographic changes were studied in serologically confirmed patients with leptospirosis. Results: Of 22 patients, 45% (10) had cardiac symptoms; 59% (13) had abnormalities on the ECG; 90% (9/10) of patients with cardiac symptoms had at least one electrocardiographic abnormality. Echocardiographic abnormalities were seen in 41% (9). Clinical and echocardiographic evidence of myocarditis was seen in two patients, but left ventricular function was preserved. Conclusions: Echocardiographic changes may be useful in identifying patients with myocarditis in leptospirosis, especially in symptomatic patients. © Royal Society of Tropical Medicine and Hygiene 2013. All rights reserved.

Premaratna R.,University of Kelaniya | Weerasinghe M.S.,University Medical Unit | Premawardana N.P.,University Medical Unit | de Silva H.J.,University of Kelaniya
BMC Pharmacology and Toxicology | Year: 2015

Background: Gloriosa superba (GSb) is a highly poisonous plant and its toxicity is due to anti-mitotic effects of constituents such as colchicine and gloriosine on rapidly proliferating cells. Poisoning is known to cause very rapid and severe clinical manifestations due gastro intestinal, neurological, cardiac and bone marrow toxicity. Case presentation: A young male presented with an acute onset febrile illness associated with diarrhoea, confusion, haematuria and aggressive behavior of 4days duration. He developed subconjunctival haemorrhages, bleeding gums, neck stiffness, bilateral papilloedema, tender hepatomegaly and features suggestive of subacute intestinal obstruction. He had progressive reduction in white cell counts, platelets and derrangements in liver functions. The illness mimicked acute severe leptospirosis or dengue. On day 9 of illness he started to loose his hair and was totally alopecic by day 14. At this stage of illness, possibility of GSb poisoning was suspected. He admitted the act of self harm after repeated questioning. Conclusion: His presentation mimicked an acute severe tropical febrile illness such as leptospirosis or dengue until he started to loose his hair. Therefore we feel that Clinicians practicing in tropical setting where Gloriosa superba is endemic should be aware of its clinical presentations and should always consider the possibility of ingestion of Gloriosa superba when the patient has pancytopenia and develops shedding of hairs which results in total alopecia in a case of unexplained gastroenterocolitis, rather investigating. © 2015 Premaratna et al.

Arambewela M.H.,University Medical Unit | Sumanathilaka M.R.,University Medical Unit | Pathirana K.D.,University Medical Unit | Bodinayaka C.K.,University Medical Unit
The Ceylon medical journal | Year: 2013

Acute hypokalemic periodic paralysis (HPP), a clinical syndrome characterised by acute systemic weakness and low serum potassium (K+), is a rare but treatable cause of acute limb weakness. Hypokalemia can be caused by K+ loss via the kidneys or extra renal routes mainly the gut, or due to transcellular potassium shifts where extracellular K+ will move into the cell. In the latter situation, although there is hypokalaemia, there is no deficit of K+ in the body. The main causes for intracellular shift of K+ are familial hypokalemic periodic paralysis, thyrotoxic periodic paralysis, barium poisoning, insulin excess and alkalosis. Although the association between thyrotoxicosis and HPP is known, HPP with hypothyroidism is extremely rare. We report a case of hypokalemic periodic paralysis associated with hypothyroidism and neuromyotonia.

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