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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 An unusual presentation of caudothalamic haemorrhage as fever in a term neonate(Perinatal Society of Sri Lanka, 2024-11) Wickramaarachchi, W.M.S.K.K.; Jayalath, A.G.I.U.; Randeny, S.; Mettananda, S.No abstract availableItem Methotrexate-induced leukoencephalopathy presenting as acute-onset limb weakness in a child: A case report(BioMed Central, 2024) Pathiraja, H.; Abrew, G.D.; De Silva, L.; Fernando, S.; Randeny, S.; Mettananda, S.BACKGROUND Methotrexate is an essential medicine used to treat childhood malignancies including acute lymphoblastic leukemia. Neurotoxicity manifesting as leukoencephalopathy is an important adverse effect of methotrexate. Methotrexate-induced leukoencephalopathy classically demonstrates sub-acute-onset neurological manifestations that include learning disability, progressive dementia, drowsiness, seizures, ataxia, and hemiparesis. These are rare in children and are generally reported following intrathecal or intravenous use of methotrexate. In contrast, acute onset neurotoxicity with oral use of methotrexate is very rare. We report a 10-year-old boy presenting with acute onset limb weakness and neurological signs due to methotrexate-induced leukoencephalopathy following oral methotrexate.CASE PRESENTATION A 10-year-old Sri Lankan boy presented with fever and headache for 5 days and difficulty in walking for 2 days. He was unable to stand unaided on admission, and his parents complained of repetitive, involuntary extension movements involving the right upper limb. He is a child diagnosed with acute lymphoblastic leukemia who was on treatment for a relapse with daily oral dexamethasone and mercaptopurine, weekly oral methotrexate and folinic acid, and once every two weeks intrathecal vincristine. On examination, he had dystonic movements of the right upper limb and hypotonia and reduced muscle power (grade 3/5) of the left upper and lower limbs proximally and distally. The muscle power of the right side was grade 4 (out of 5). Tendon reflexes were diminished in all four limbs, and the plantar response was flexor bilaterally. The child had dysmetria and intension tremors on both sides. T2-weighted magnetic resonance imaging of the brain revealed symmetrical high signal intensities with diffusion restriction involving bilateral putamen, subcortical areas, and deep white matter, suggesting treatment-related neurotoxicity due to methotrexate-induced leukoencephalopathy. Oral methotrexate was discontinued. He showed gradual improvement in limb weakness and other neurological signs following treatment with intravenous folinic acid, aminophylline, dexamethasone, and oral dextromethorphan.CONCLUSION This case report describes a patient with rapidly progressing methotrexate-induced leukoencephalopathy following oral methotrexate. It highlights that the risk of neurotoxicity persists even with the oral use of methotrexate; therefore, the prescribers should be vigilant of this uncommon side effect.Item Spondylometaphyseal dysplasia in a 2-year-old Sri Lankan girl(The Sri Lanka Collage of Paediatricians, 2024) Madawala, P.; Lokuhewage, C.; Bandara, S.; Randeny, S.; Mettananda, S.No abstract availableItem Kagami-Ogata syndrome: a case report(BioMed Central, London, 2022) Suriapperuma, T.; Randeny, S.; Mettananda, S.Background: Kagami-Ogata syndrome is a rare genetic imprinting disorder involving the 14q32.2 genomic location of chromosome 14. The estimated incidence is less than 1 per 1 million. Here we report a male neonate with Kagami-Ogata syndrome presenting with severe respiratory distress requiring mechanical ventilation since birth. Case presentation: A Sri Lankan male neonate born at term via caesarean section to a mother with type 1 diabetes mellitus and hypothyroidism developed respiratory distress immediately after birth. On examination, the baby had facial dysmorphism with a hirsute forehead, full cheeks, flat nasal bridge, elongated protruding philtrum, and micrognathia. His chest was small and bell shaped, and he had severe intercostal and subcostal recessions. His abdominal wall was lax and thin, with evidence of divarication of the recti. Bowel peristalsis was easily visible through the abdominal wall. The chest x-ray showed narrowing of the rib cage with crowding of the ribs in a "coat-hanger" appearance. The coat-hanger angle was 32°, and the mid-to-widest thoracic diameter was 68%. On the basis of facial dysmorphism, chest and anterior abdominal wall abnormalities, coat-hanger appearance of the rib cage, increased coat-hanger angle, and reduced mid-to-widest thoracic diameter, a clinical diagnosis of Kagami-Ogata syndrome was made. Owing to severe respiratory distress, the baby required intubation and ventilation immediately after birth. He was ventilator-dependent for 3 weeks; however, he was successfully weaned off the ventilator on day 22 after several failed extubation attempts. At 3-month follow-up, he had generalized hypotonia and mild global developmental delay. His developmental age corresponded to 2 months. Conclusions: We report a patient with Kagami-Ogata syndrome presenting with respiratory distress immediately after birth. This case report highlights the importance of being aware of this rare condition, which could present as severe respiratory distress in term and preterm newborns. A positive diagnosis could avoid unnecessary treatment and aid in accurate prognostication.Item Multisystem inflammatory syndrome in children: A Sri Lankan case series(Sri Lanka College of Paediatricians, 2021) Sandakelum, U.; Samararathna, R.; Pathiraja, H.; de Silva, L.; Balasubramaniam, R.; de Abrew, G.; Adihetty, D.; Fernando, M.; Randeny, S.; Mettananda, S.No Abstract AvailableItem Knowledge and expectations of parents regarding the role of antibiotic treatment of upper respiratory tract infections - a survey among parents attending a tertiary care institution with a sick child(Sri Lanka Medical Association, 2006) Premaratna, R.; Rajindrajith, S.; Mettananda, C.; Balasooriya, H.; Fonseka, J.; Randeny, S.; de Silva, H.J.INTRODUCTION: Parents' knowledge and expectations regarding antibiotics contribute for antibiotic misuse inpaediatric practice. METHODS: Parents of children suffering from URTI, attending the OPD and Professorial Paediatric Unit of the Teaching Hospital, Ragama, were interviewed for knowledge, attitudes and practices during URTI pre-tested questionnaire by doctors from February to July 2005. Results: 235 parents (230 mothers) mean age 31.9 years (SD: 7.33) participated in the study. The level of education was; below grade 5:11 (4.7%), Grade 5-10: 142 (60.4%), grade 10-12:71 (30.2%) and higher education: 11 (4.7%). Of the 235,201 (85.1%) identified antibiotics as a component of treatment. However only 11 (4.7%) knew that antibiotics were against bacterial infections; 212 (90.3%), 189 (80.8%), 176 (75%), 165 (70.4%), 130(55,4%), 77 (32.8%) and55 (23.6%) identified them as treatment for cough, fever, phlegm, cold, sore throat, ear ache and headache either alone or combination. 116 (49.3%) and 119 (50.3%) thought that antibiotic treatment was important to cure the illness or for early recovery respectively. The expectation of being given an antibiotic for an URTI (always, 75%, 50% and 25% of the time and never) was 28 (12%), 39 (17%), 23 (10%), 119 (51%) and 23 (10%) respectively. Twenty (8.5%) had requested an antibiotic when it had not been prescribed; 12(60%) from apharmacy and 8 (40%) from the doctor. 172 (73%) claimed to complete the full course of treatment, while 18 (7.8%) kept the 'excess' antibiotics for future use. CONCLUSIONS: Knowledge, expectations, demand and self medication with antibiotics seems to be low among parents in our population.