Journal/Magazine Articles

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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine

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    Pathogenesis of liver involvement during dengue viral infections
    (Oxford University Press, 2006) Seneviratne, S.L.; Malavige, G.N.; de Silva, H.J.
    The dengue virus can infect many cell types and cause diverse clinical and pathological effects. We describe clinical and experimental observations that suggest that liver involvement occurs during dengue infections, and we outline the possible role played by host immune responses in this process.
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    Detection and management of alcohol misuse by General Practitioners
    (Sri Lanka Medical Association, 2003) Gurugama, N.P.; Seneviratne, S.L.; Peiris, D.T.S.; de Silva, H.J.
    INTRODUCTION: Alcohol misuse and related problems are common in Sri Lanka. The appropriateness of the primary care setting in dealing with alcohol misuse is well recognised, and general practitioners (GPs) constitute an important first contact setting. METHODS: One hundred and fifty randomly selected GPs practising in the Colombo and Gampaha districts were given a questionnaire to assess how they detect and manage alcohol misuse, and their attitudes towards persons who misuse alcohol. RESULTS: Seventy per cent of GPs responded [74 male; mean age 42 years (SD 6.7)]. Our results suggest that although a majority (81%) of GPs were frequently confronted with problems related to alcohol misuse, their efforts to detect the problem and knowledge regarding risk limits of alcohol consumption were poor. Only 25.7% had even heard of CAGE and MAST questionnaires. The majority of GPs felt inadequately trained to deal with alcohol misuse, but only a few made any self-directed efforts to improve their knowledge and skills regarding its management or referred their patients for specialised care. Participation in preventive programmes was minimal, and many GPs expressed negative attitudes towards persons misusing alcohol. CONCLUSIONS: The ability of general practitioners to detect and alcohol misuse appears to be inadequate.
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    Envenoming due to snake bite during pregnancy
    (Oxford University Press, 2002) Seneviratne, S.L.; de Silva, C.E.; Fonseka, M.M.D.; Pathmeswaran, A.; Gunatilake, S.B.; de Silva, H.J.
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    Yellow oleander poisoning in Sri Lanka: outcome in a secondary care hospital
    (SAGE Publishing, 2002) Fonseka, M.M.D.; Seneviratne, S.L.; de Silva, C.E.; Gunatilake, S.B.; de Silva, H.J.
    Cardiac toxicity after self-poisoning from ingestion of yellow oleander seeds is common in Sri Lanka. We studied all patients with yellow oleanderpoisoning (YOP) admitted to a secondary care hospital in north central Sri Lanka from May to August 1999, with the objective of determining theoutcome of management using currently available treatment. Patients with bradyarrhythmias were treated with intravenous boluses of atropine and intravenous infusions of isoprenaline. Temporary cardiac pacing was done for those not responding to drug therapy. During the study period 168 patients with YOP were admitted to the hospital (male:female = 55:113). There were six deaths (2.4%), four had third-degree heart block and two died of undetermined causes. They died soon after delayed admission to the hospital before any definitive treatment could be instituted. Of the remaining 162 patients, 90 (55.6%) patients required treatment, and 80 were treated with only atropine and/or isoprenaline while 10 required cardiac pacing in addition. Twenty-five (14.8%) patients had arrhythmias that were considered life threatening (second-degree heart block type II, third-degree heart block and nodal bradycardia). All patients who were treated made a complete recovery. Only a small proportion of patients (17%) admitted with YOP developed life-threatening cardiac arrhythmias. Treatment with atropine and isoprenaline was safe and adequate in most cases
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    Neuroleptic malignanat syndrome without fever: a report of three cases
    (BMJ Publishing Group, 2000) Peiris, D.T.S.; Kuruppuarachchi, K.A.L.A.; Weerasena, L.P.; Seneviratne, S.L.; Tilakaratne, Y.T.; de Silva, H.J.; Wijesiriwardena, B.
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    Juvenile myoclonic epilepsy : a study in Sri Lanka
    (Elsevier-W.B. Saunders, 2000) Gunatilake, S.B.; Seneviratne, S.L.
    Juvenile myoclonic epilepsy (JME) has a distinct clinical profile. Often JME is not recognized, with the result that proper treatment is not instituted, leading to poor control of seizures. This study is an attempt to identify the factors that contribute to the delay in diagnosing this condition. During a period of 3 years 40 patients (21 females) with JME were identified and all were included in a prospective follow-up study. The age range was 12-58 years. Twenty-seven patients (67%) had already seen at least one specialist; however, diagnosis had not been made despite the presence of characteristic features. The duration of delay in diagnosis varied from months to years with a mean of 11 years. Myoclonic jerks were the most characteristic feature, but only six volunteered this information spontaneously. The response to treatment with sodium valproate was excellent, although only three were taking it when first seen. As a result of treatment with other drugs all patients were having recurrent seizures. The main reasons for the delay in diagnosis found in our study were that the physicians were unaware of the condition, the occurrence of myoclonic jerks were overlooked either because the patients were not directly questioned about them or because the patients did not volunteer the information.
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    Suicide in Sri Lanka: Points to ponder
    (Sri Lanka Medical Association, 2000) de Silva, H.J.; Kasturiaratchi, N.; Seneviratne, S.L.; Senaratne, D.C.; Molagoda, A.; Ellawala, N.S.
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    Use of antivenom serum in snake bite: a prospective study of hospital practice in the Gampaha district
    (Sri Lanka Medical Association, 2000) Seneviratne, S.L.; Opanayaka, C.J.; Ratnayake, N.S L.A.; Sarathkumara, K.E.; Sugathadasa, A.M.; Weerasuriya, N.; Wickrama, W.A.S.S.; Gunatilake, S.B.; de Silva, H.J.
    OBJECTIVE: To record current practices in hospital management of snake bite, especially with regard to use of antivenom serum (AVS). METHODS: Management of all snake bite victims admitted to the four main hospitals of the Gampaha district was prospectively studied during a 5-month period. A pretested data collection sheet was used. Relevant information was obtained from patients, accompanying persons, medical staff and hospital records. RESULTS: 466 patients (M:F = 7:3; 402 adults and 64 children) were admitted following snake bite during the study. The offending snake was identified in 357 (76.6 percent) cases [172 (36.9percent) by examining the dead snake, 185 by identification of the snake in a photograph]. 273 (76.5 percent) of the 357 admissions were due to hump nosed viper bite. AVS was given to 184 (39.5 percent) patients, including 99 (36.3 percent) with hump nosed viper bite. A sensitivity test of AVS was used in all 184 patients. Premedication with hydrocortisone and/or antihistamines before AVS infusion was given to 89 patients. Acute adverse reactions to AVS occurred in 102 (55.4 percent) patients given AVS. There was no significant difference in the rate of reactions whether premedication was given or not. CONCLUSION: Precise identification of the offending snake was not possible in many instances. Practices that are of no benefit in the treatment of snake bite are still widely used. Acute adverse reactions to AVS are common, and neither hydrocortisone nor antihistamines seem to be of benefit as prophylaxis. Evidence based management guidelines, especially with regard to AVS therapy, are urgently required.
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    Sympathy towards patients
    (Royal College of Physicians of London, 1999) Seneviratne, S.L.; Gunatilake, S.B.; Dassanayake, D.; Adhikari, A.; de Silva, H.J.
    No abstract available
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    Anorectal physiology and transit in patients with disorders of thyroid metabolism
    (Blackwell Scientific Publications, 1999) Deen, K.I.; Seneviratne, S.L.; de Silva, H.J.
    BACKGROUND: Data on anorectal physiology in patients with disordered thyroid metabolism are lacking. This prospective study was performed to evaluate anorectal physiology in patients with either hyperthyroidism and diarrhoea, or hypothyroidism and constipation in order to assess slow transit in hypothyroid patients. METHODS: Thirty patients with hypothyroidism and constipation (24 females, median age 59 years, range 23-80) and 20 patients with hyperthyroidism and diarrhoea (12 females, median age 46 years, range 36-62) were evaluated by anal manometry, rectal balloon sensation and whole-gut transit markers. Data were compared with anorectal physiology and whole-gut transit in 22 healthy controls (13 females, median age 51 years, range 24-65). RESULTS: In the hypothyroid patients, maximum resting pressure (MRP) and maximum squeeze pressure (MSP) were similar to controls (patients, median MRP 55 mmHg (18-98); controls, median MRP 41 mmHg (20-105) and patients, median MSP 83 mmHg (39-400); controls, median MSP 88 mmHg (30-230); P 0.05 for both resting and squeeze pressures). In hyperthyroid patients, median MRP and MSP were significantly lower than controls (patients, MRP 33 mmHg (8-69); controls MRP 41 mmHg (20-105) P = 0.04 and patients, MSP 60 mmHg (26-104); controls, MSP 88 mmHg (30-230); P = 0.03). Threshold sensation for impending evacuation in hypothyroid patients was significantly higher than controls, while in hyperthyroid patients, threshold sensation was significantly lower compared with controls. Maximum tolerable rectal volumes in hypothyroid patients was significantly lower compared with controls, while no significant difference was found between maximum tolerable rectal volumes in hyperthyroid patients and controls. Prevalence of delayed whole-gut transit in both hypothyroid and hyperthyroid patients was similar to controls. Furthermore, 33 percent of hypothyroid patients and 40 percent of hyperthyroid patients experienced symptoms of bowel dysfunction prior to the onset of their thyroid disorder. CONCLUSIONS: Patients with altered thyroid function and bowel dysfunction demonstrated abnormalities of anal manometry and rectal sensation.