Browsing by Author "Premawardana, N.P."

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Gloriosa superba poisoning mimicking an acute infection- a case report
(BioMed Central, 2015) Premaratna, R.; Weerasinghe, M.S.; Premawardana, N.P.; de Silva, H.J.
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 4 days 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.
Pulmonary arterial hypertension in thalassaemia patients- does splenectomy and disease severity increase the risk?
(Sri Lanka Medical Association, 2011) Premawardana, N.P.; Nandasiri, A.S.D.; Ranaweera, A.G.R.M.A.; Nishad, A.A.N.; Silva, D.P.S.I.; Premawardhena, A.P.
INTRODUCTION AND OBJECTIVES: Pulmonary arterial hypertension (PAH) has been described in patients with thalassaemia. A causative association with splenectomy has been postulated. Our previous observations differed from this. We aimed to study these factors in our patients. METHODS: Pulmonary artery pressure (PAP) and other data of thaiassaemics attending the Thalassaemia Unit, Ragarna were studied using clinic records. PAP was measured using trans-thoracic 2D echocardiography. Four categories were separately analysed: thalassaemia major (TM) with splenectomy (A) and without (B), thalassaemia intermedia (TI) with splenectomy (C) and without (D). PAH was defined as PAP over 25 mm Hg. RESULTS: A total of 74 patients were studied, 60 (81%) with TM and 14 (19%) with TI. 25 of TMs (41%) and 10 of TIs (71%) had splenectomy (p <0.05). Mean ages (SD) of TM and TI were 20.71(8.4) and 32.6 (13.3) years respectively. Those of categories ABCD were 20.9 (7.4), 20.7 (9.1), 27 (9.6) and 46 (12.3) years. A total of 16 (21.6%) of all patients had PAH (95% CI13.8-32.3). This included 13 (21.7%) TM patients and three (21.4%) with TI (p-0.98). The prevalence of PAH was 17.1% (95 CI 8.4-33.5) in splenectomised thalassaemia patients and 25.6% (95% CI 16.5-43.8) in non splenectomised patients (p= 0.37), and in categories A,B,C,D were 16%, 23%, 20% and 25% respectively. Mean of PAP of splenectomised with PAH is 39 mmHg (SD=4.5) and in non splenectomised with PAH was 34.9 mmHg (SD=5.3) (p=0.8). CONCLUSIONS: PAH is a significant complication in patients with thalassaemia. However the severity of disease nor the splenectomy status were found to be causatively linked in our study.
Zinc supplementation in chronic kidney disease of unknown aetiology in Sri Lanka: a pilot study. (ZisCKDu-P)
(Ceylon College of Physicians, 2020) Abeysundara, P.K.; Nishad, N.; de Silva, S.T.; Dassanayake, R.T.; Galabada, D.P.; Jayawardane, U.G.W.; Premawardana, N.P.; Kumara, G.M.S.S.; Dilani, P.M.; Herath, H.M.T.D.; Wijesinghe, P.S.
INTRODUCTION: It was hypothesized that the antioxidant properties of zinc retard the progression of chronic kidney disease of unknown etiology in the North Central Province of Sri Lanka. METHODS: The pilot study was a randomized, placebo-controlled, single blinded, parallel group, single-center clinical trial with two arms (Z and P) and a 1:1 allocation ratio. Participants in group Z (n=20) received 60 mg of elemental zinc daily, in the form of zinc sulfate, and group P (n=21) received a starch tablet per day. Clinical, hematological parameters and kidney function were measured at the baseline and following three months of the intervention. RESULTS: A total of 86 CKDu patients were screened; only 35 males and 6 females were selected. Mean age and estimated glomerular filtration rate of the study population were 51.2±6.2 years and 38.9±8.8 mL/min/1.73 m2 respectively. At the end of three months there was non-significant increase in urine protein creatinine ratio (Z arm: 65±54 vs. 82± 86 mg/mmol; P=0.46, P arm: 72.4±113 vs. 120± 209 mg/mmol; P=0.36) and non-significant decline in estimated glomerular filtration rate (Z arm: 40.9±10.4 vs. 39.7±9.2 mL/min/1.73 m2; P=0.31, P arm: 37.1±6.8 vs. 36.4±10 mL/min/1.73m2; P=0.31) in both groups. Body mass index was significantly reduced (23±4 vs. 22.7± 3.9 kg/m2; P=0.01) and diastolic blood pressure was significantly increased (78±6 vs. 86±10 mmHg; P=0.001) in the placebo arm. Haemoglobin levelshowed a decline in the study group; 0.33±1 g/dl, while there was an increase in the placebo group, 0.34±0.7 g/dl, (P=0.02). There were no major side effects. CONCLUSIONS: The change of urine protein: creatinine ratio and estimated glomerular filtration rate did not show a significant difference between the two groups. A future trial should test effectiveness of same dose of zinc for a similar duration of time in a larger sample. Extended follow-up of the study subjects for one year after the intervention would be useful to assess the long-term effects of zinc on kidney function and side effects.