Browsing by Author "Thadchanamoorthy, V."

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Acute appendicitis during the recovery phase of dengue hemorrhagic fever: two case reports
(BioMed Central, 2022) Thadchanamoorthy, V.; Ganeshrajah, A.; Dayasiri, K.; Jayasekara, N.P.
Background: Dengue fever is one of the most common tropical diseases, with high prevalence in many tropical countries including Sri Lanka. Dengue infection can present from subclinical infection to dengue shock syndrome. Further, the disease also shows a variety of atypical presentations and has been reported to mimic a number of causes of acute abdomen. Case presentation: The authors report two children (a 6-year-old Tamil girl and an 8-year-old Muslim girl) who were diagnosed to have acute appendicitis during the early recovery phase of dengue hemorrhagic fever (DHF) and late recovery period of dengue hemorrhagic fever with platelet count of 92 × 103/cumm and 102 × 103/cumm, respectively. Both children were investigated with abdomen ultrasound as they developed severe abdominal pain and tenderness on palpation during the recovery phase, which was felt to be very unusual. Acute appendicitis was diagnosed in one child, while the other child had a ruptured appendicular abscess. Both children were treated with laparoscopic appendectomy and a 7-day course of intravenous antibiotics. Both children were reviewed in 1 month following treatment and had complete recovery. Conclusion: Although precise pathophysiology and associations of the surgical abdomen with dengue fever remain to be elucidated, there are known factors in dengue fever that can potentially lead to secondary bacterial infections and surgical abdomen. Awareness and increased suspicion by the clinician are paramount to detect such complications early, especially in children who demonstrate unusual clinical features during various stages of dengue infection.
Acute hemolytic crisis complicated with ischemic cardiac injury and methemoglobinaemia following ingestion of naphthalene: a case report
(BioMed Central, 2024-12) Dayasiri, K.; Pathiraja, H.; Thadchanamoorthy, V.
BACKGROUND Naphthalene is an aromatic hydrocarbon that potentially produces methemoglobinaemia but rarely causes hemolysis, especially in children with underlying glucose-6-phosphate dehydrogenase deficiency. Although ingestion of a single moth ball by an older child may not be life threatening, it can be fatal if ingested by a toddler. CASE PRESENTATION A 2-year-old Singhalese boy developed acute severe hemolysis and methemoglobinaemia following ingestion of a mothball. On admission, the patient was ill and pale. The child was tachycardic and tachypnoiec with oxygen saturation of 76% on air. Blood investigations showed significant anemia, elevated reticulocytes, and evidence of hemolysis in a blood picture, along with elevated lactate dehydrogenase and indirect bilirubin. Child also had ST depressions on electrocardiogram examination with negative troponin-I. He was given four packed red blood cell (PRBC) transfusions and was successfully discharged in 3 days time following optimal supportive treatment. A glucose-6-phosphate dehydrogenase assay confirmed the diagnosis of glucose-6-phosphate dehydrogenase deficiency in this child: 0.9 U/gHb (4.0-13.0 U/gHb).CONCLUSION This case report highlights a rare life-threatening presentation of naphthalene ingestion in a child with previously undiagnosed glucose-6-phosphate dehydrogenase deficiency. Ingestion of even a single moth ball can be fatal in vulnerable children given the altered toxicokinetics of naphthalene in children.
Approach to the adolescent with substance use in the acute Setting
(Cureus, Inc., 2021) Sathanantham, S.; Dayasiri, K.; Thadchanamoorthy, V.
ABSTRACT: Psychoactive substance use during adolescence is an emerging challenge to the public health system due to the potential negative impact on the emotional, cognitive, social, physical and academic outcomes of adolescents. An increase in autonomy during adolescence, peer influence and willingness to experiment, lead to taking high-risk decisions subsequently prompting towards substance abuse and alcohol use. Substance use is heterogeneous among adolescents, which differs with availability, perceptions of use and specific drug usage. In adolescents' substance abuse, beyond emergency care, brief counselling with psychosocial assessment and follow up are recommended for successful management. The article reviews the common substances used by adolescents, types of presentations, clinical evaluation of patients and their background, laboratory testing, emergency management and follow up for long-term management. KEYWORDS: adolescent; intoxication; mental health; substance; supportive care.
Button battery ingestion in a child: is it always necessary to perform urgent endoscopy
(Batticaloa Medical Association, 2023) Dayasiri, K.; de Abrew, G.; Thadchanamoorthy, V.
Epidemiological patterns and trends of paediatric snakebites in Sri Lanka
(Biomed Central, 2024-12) Dayasiri, K.; Caldera, D.; Suraweera, N.; Thadchanamoorthy, V.; Hettiarachchi , M.; Denipitiya, T.; Bandara, S.
OBJECTIVES This study aimed to analyse the epidemiological patterns of paediatric snake bites in Sri Lanka over a 4-year period (2020-2024).METHODS A multi-centre, retrospective observational study was conducted from June 2020 to June 2024 across nine governmental hospitals in seven provinces of Sri Lanka. Data were collected based on 757 children presenting with snake bites. The snake bites were analysed based on age, gender, and seasonal variations. Data on the type of snake involved, geographic variations and the temporal trends in snake bite occurrences were also analysed.RESULTS The mean age of the 757 children recruited to the study was 10.3 years (SD-5.00, range-0.1-17 years). Males (57.7%) were significantly more affected than females (42.3%) (p < 0.05). Visual identification confirmed the snake species in 58.4% of cases. The hump-nosed viper (16.7%), Russell's viper (14.7%), and common krait (12.9%) were the most common medically important snakes identified in the study. Seasonal peaks in snake bites occurred in May-July and November-December. An increasing trend in snake bite incidence was noted over the first three years, with a slight decline in the final year.CONCLUSION Paediatric snake bites in Sri Lanka show significant age, gender, and seasonal patterns. Targeted public health interventions are needed to mitigate the impact on children.
Epidemiology of acute poisoning among children in urban Sri Lanka: the experience of two tertiary care hospitals in Colombo district
(The Jaffna Medical Association, 2023) Dayasiri, K.; Thadchanamoorthy, V.; Jansz, M.; Dassanayake, S.; Anand, G.
Acute poisoning in children is an important public health problem and one of the leading causes of emergency department admissions following childhood injuries. Although most paediatric ingestions are accidental, children are at a higher risk for serious complications following ingestion of a similar toxic dose compared to adults. The current study evaluated the recent patterns and trends in acute poisoning among children in two tertiary care centers in urban Sri Lanka: Lady Ridge Hospital for Children, Colombo and North Colombo Teaching Hospital, Ragama. Out of 200 cases, the majority were between 1-5 years and male children outnumbered female children. The most common poisons included kerosene oil, paracetamol and “Good Luck” plants. Complication rate was low, and no mortalities were reported. Deliberate poisoning accounted for 1% of total poisonings. The current trends in poisoning among children living in urban Sri Lanka showed decreasing incidence of pesticide poisonings and increasing incidence of pharmaceutical poisonings and poisoning with ornamental plants.
Expanded dengue syndrome presenting with acute liver failure, acute kidney injury, pancreatic involvement, coagulopathy, and multiple intracranial hemorrhages in a young child: a case report
(BioMed Central, 2022) Thadchanamoorthy, V.; Dayasiri, K.
Background: Dengue is a mosquito-borne viral infection that typically occurs in tropical and subtropical countries. The clinical manifestations of dengue infection range from an asymptomatic subclinical course to severe dengue shock syndrome. Besides, dengue can affect any organ in the body and can present with atypical manifestations. Case presentation: We report a 6-year-old previously healthy Tamil child who had dengue complicated with multiorgan involvement. She initially presented with high fever, headache, body aches for 5 days, blood and mucus diarrhea, hematuria, and right knee joint swelling for 2 days. Dengue NS1 antigen was positive on day 2 of febrile illness. She was managed symptomatically in the local hospital for 3 days and transferred to the tertiary care hospital for further management. She was eventually diagnosed as having dengue hemorrhagic fever complicated with multiorgan involvement including acute liver failure, pancreatic involvement, coagulopathy, arthritis, acute kidney injury, and multiple intracranial hemorrhages. The constellation of disease manifestations was identified as expanded dengue syndrome. She was managed with fresh blood, platelet, and cryoprecipitate transfusions and intravenous antibiotics in addition to renal and liver support in the intensive care unit. On day 14 of illness, she deteriorated while on the ventilator and died due to multiple intracranial hemorrhages. Conclusion: The reported child with dengue hemorrhagic fever developed several unusual presentations such as acute liver and renal failure, disseminated intravascular coagulopathy, pancreatic involvement, and multiple intracranial hemorrhages, which form part of expanded dengue syndrome. In the seriously unwell child, it is important to look for unusual complications actively to improve outcomes.
Impact of covid-19 on the education and health of schooling children in Sri Lanka; A multi-provincial study
(Sri Lanka College of Paediatricians, 2022) Dayasiri, K.; Thadchanamoorthy, V.; kankananarachchi, I.; Umasankar, N.; Dassanayake, S.; Gunasekara, S.; Mettananda, S.
Metatropic dysplasia; A case report.
(Batticaloa Medical Association, 2023) Dayasiri, K.; Thadchanamoorthy, V.
Parental knowledge, attitudes and practices regarding safe handling and disposal of alcohol-based hand sanitizers and surface disinfectants in urban Sri Lanka
(Ethiopian Pediatric Society, 2024) Dayasiri, K.; Pathiraja, H.; De Soyza, E.K.N.; Thadchanamoorthy, V.; Dassanayaka, S.J.S.
INTRODUCTION Hand sanitizers were increasingly used in most households during the COVID-19 pandemic. This study aimed to assess knowledge and practices regarding the safe handling and disposal of alcohol-based hand sanitizers and surface disinfectants in urban Sri Lanka.METHODS A cross-sectional study was performed including parents of children admitted to North Colombo Teaching Hospital for a period of one year in August 2021. Data were collected regarding parental knowledge about the safe handling and disposal of hand sanitizers, and their health hazards by paediatric post-graduate trainees. All data were analyzed using SPSS 17.0. Chi-square test was used to find the association of overall knowledge and attitude scores with potential sociodemographic determining factors.RESULTS A total of 153 parents were recruited. The majority of mothers (126, 82.4%) and fathers (133, 86.9%) had attended up to secondary school. Approximately 113(73.9%) parents believed that pre-school children were the most vulnerable for accidental ingestion of sanitizers and 40 parents (26.1%) did not believe that sanitizer solutions can be accidentally inhaled by toddlers. Only 132 parents (86.2%) knew how to disinfect their home premises safely and 29 parents (18.9%) didn’t know how to store cleaning products safely. Overall, lower knowledge scores correlated with lower maternal education (p<0.05) and lower socio-economic status (p<0.05). The gender (p = 0.06) and age of the parent (>35 years versus <35 years) (p = 0.21) did not show a significant association. Attitude scores positively correlated with parental education (p<0.002) and socio-economic status (p<0.03). The gender (p = 0.12) and age of the parent (>35 years versus <35 years) (p = 0.07) did not show a significant association.CONCLUSION Overall knowledge and attitude scores in parents were associated with education level of parents and the level of socio- economic status. Gender and parental age did not show a significant association.
Prospective analysis of ventilated patients in the Paediatric Medical Intensive Care Unit of Lady Ridgeway Hospital
(Sri Lanka College of Paediatricians, 2012) Thadchanamoorthy, V.; de Silva, S.; Sarathchandra, J.; Kumarendran, B.
OBJECTIVE: To determine the characteristics and outcome of ventilated patients in the paediatric medical intensive care unit (PICU) of Lady Ridgeway Hospital for Children (LRH), Colombo. DESIGN: Prospective descriptive study METHOD: The study population consisted of all ventilated paediatric patients admitted to PICU, LRH from 1st March to 31st August, 2009. The factors studied included demographic profile (age, sex, residence, transfer), length of stay on ventilator, indication for ventilation, details of organ dysfunction and the final outcome. RESULTS: There were 152 patients ventilated over the study period of six months. Seventy three were under one year of age. Male to female ratio was 1.17:1. A significant proportion (n=105) were from the Western province. Eighty five patients were transferred from medical wards of LRH. Median duration of ventilation was six days (IRQ 4-10). Indications for ventilation included respiratory problems (85), neurological disorders (13), cardiac causes (5), hepatic problem (1) and miscellaneous diseases (48) including 32 from dengue syndromes. There were 42 deaths among ventilated patients giving an overall mortality rate of 27.6%. Multi-organ dysfunction syndrome (MODS) on admission accounted for 81% of the deaths. Bronchopneumonia (16) and dengue haemorrhagic fever (12) were the main underlying causes of death. Thirty two (21%) had anaemia while in the PICU, 15 of them having anaemia on admission. Nosocomial infection was present in 17 (11%) patients. Children transferred from other provinces had a higher risk of death than those from the Western province (OR=1.5, 95% CI: 0.7 – 3.3). CONCLUSIONS: MODS on admission accounted for 81% of the deaths. Bronchopneumonia and dengue haemorrhagic fever were the main underlying causes of death. Children transferred from other provinces had a higher risk of death compared to those from the Western province
A rare case of abrupt onset vascular lump in the newborn; neonatal kaposiform haemangioendothelioma
(Batticaloa Medical Association, 2023) Dayasiri, K.; de Abrew, G.; Samaraweera, S.; Thadchanamoorthy, V.
Two cases of “Rusty pipe syndrome”; a potential barrier for establishment of breastfeeding
(Batticaloa Medical Association, 2023) Vijayakumar, V.; Dayasiri, K.; Thadchanamoorthy, V.; Gunathilake, M.D.A.S.
Unexplained Tachypneoa and severe metabolic acidosis in a three-month-old child: A rare presentation of beta-ketothiolose deficiency
(Cureus, 2022) Thadchanamoorthy, V.; Dayasiri, K.
Beta-ketothiolase (mitochondrial acetoacetyl-CoA thiolase, T2) deficiency is a rare inborn error of metabolism that is characterized by impaired metabolism of ketones and isoleucine. The condition is inherited as an autosomal recessive disorder. Herein, we present a child with T2 deficiency from Mahaoya, Eastern Province, Sri Lanka. This three-month-old child presented with fever, difficulty in breathing, and irritability for one day and was subsequently found to have severe metabolic acidosis with positive ketone bodies in urine. His blood glucose was normal. Metabolic screening showed increased urinary excretion of 2-methyl-3-hydroxybutyrate (2M3HB), 2-methyl acetoacetate (2MAA), and tiglylglycine (TIG). He was diagnosed to have beta-ketothiolase deficiency based on biochemical studies. Genetic studies were not done due to financial constraints in the family. Severe metabolic acidosis was successfully managed with intravenous sodium bicarbonate infusion. T2 deficiency would be a differential diagnosis in children with unsolved ketoacidosis. Children with T2 deficiency have a better outcome if detected and managed early. The reported patient had age-appropriate growth and development at the latest follow-up at three years eight months while he has been on oral carnitine and bicarbonate.
Ventilated patients in the Paediatric medical intensive care unit of Lady Ridgeway hospital: an audit
(Sri Lanka Medical Association, 2011) Thadchanamoorthy, V.; de Silva, S.; Sarathchandra, J.; Kumarendran, B.
INTRODUCTION AND OBJECTIVES: To analyse the outcomes related to ventilated paediatric patients admitted to paediatric ICU (PICU) in Lady Ridgeway Hospital (LRH). METHODS: This clinical audit recruited consecutive 292 patients admitted to PICU of LRH in 2Q09. The patients who admitted for