Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Sural nerve involvement in patients with acute inflammatory demyelinating polyneuropathy variant of Guillain-Barre syndrome with sural sparing at initial presentation(Association of Sri Lankan Neurologists, 2023) Munasinghe, H.; Gunasekara, S.; Gunarathne, K.; Senanayake, B.; Mohotti, S.; Weerakoon, T.; Wanniarachchi, S.; Ravindra, S.; Ponnamperuma, M.; Wijayawardhana, S.INTRODUCTION: Neurophysiological testing is a valuable tool in the diagnosis of Guillain-Barre syndrome (GBS). Sural sparing is a usual feature of acute inflammatory demyelinating polyneuropathy (AIDP) type GBS. However, sural involvement has been reported in later stages of GBS. It is important to identify patterns of sural nerve involvement to differentiate GBS from its mimickers and to stage the disease. This research aimed to detect the pattern of sural nerve involvement in AIDP-GBS cases with normal electrophysiological responses in the sural nerve at the beginning. OBJECTIVES: To determine the location and timing of sural nerve involvement in AIDP-GBS. METHODS: This prospective follow up study included diagnosed cases of AIDP-GBS with preserved bilateral sural responses. Nerve conduction and somatosensory evoked potentials (SSEP) were done on admission and weekly thereafter for four consecutive weeks. The last evaluation was done four weeks after the fourth study. RESULTS: All patients (100%) showed normal distal sural responses over the initial four weeks of follow up. They continued to remain normal up to eight weeks in eight patients (53.3%). Two patients had gradual prolongation of their sural SSEP on consecutive studies. One of them had gradual reduction of sural sensory nerve action potential and nerve conduction velocity along with the prolongation of sural SSEP latencies. The difference of SSEP latency increments in the left sural nerve of these two patients was statistically significant (p<0.05). The right sural SSEP latency difference was not significant. CONCLUSION: Sparing of the distal sural sensory response was demonstrated in 100% of AIDP-GBS cases during the first four weeks of follow up. More than 50% of the cohort demonstrated preserved sural sensory responses for eight weeks from the initial presentation. Two out of fifteen patients showed statistically significant proximal sural sensory pathway involvement with increasing SSEP latencies. This finding suggests that in some patients, the sural sensory pathway may get affected at its proximal segments or at the central nervous system before the distal nerve is affected.Item 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.Item Neutropenic patient presented with subcutaneous nodules(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) de Silva, S.H.C.K.; Jayasekera, P.I.; Wanigasooriya, S.; Gunasekara, S.BACKGROUND: Fusarium spp. is the second most-common mold infection in immunocompromised patients. Disseminated fusariosis is life-threatening and the outcome is influenced by the host’s immune status. Mortality ranges from 50-80%. Prolonged and profound neutropenia is a major risk factor. We report the first case of disseminated fusariosis with Fusarium aquaeductuum in Sri Lanka. CASE REPORT: A 5 1/2 year old boy with acute lymphoblastic leukemia (ALL) after completing chemotherapy was admitted with a relapse after 6 months. On admission he was asymptomatic. But the absolute neutrophil count was 650/L. He was started with IV vancomycin and IV ciprofloxacin empirically. While on those two antibiotics for 11 days, fever spikes appeared and meropenem and IV fluconazole were added. Fever continued and after 2 days he developed multiple painful subcutaneous nodules about 2cm in radius, mainly on limbs. Blood culture was positive for branching fungal filaments and it was later identified as Fusarium aquaeductuum.IV amphotericin B (conventional) was started and oral voriconazole was added after 2 days and both were continued for a total of 2 weeks after negative repeat blood cultures. CONCLUSIONS: Our patient was started on amphotericin B, with high clinical suspicion. Voriconazole was added due to initial poor response and positive repeat blood cultures. Although the mortality rate following disseminated fusariosis ranges 50% to 80%, with timely management our patient fully recovered.