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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Coagulopathy and fibrinolysis following the bite of a hump-nosed viper (Hypnale hypnale)(Oxford University Press, 1996) Premawardena, A.P.; Seneviratne, S.L.; Jayanthi, S.; Gunatilake, S.B.; de Silva, H.J.No abstract availableItem Postdischarge outcomes of COVID-19 patients from South Asia: a prospective study(Royal Society of Tropical Medicine and Hygiene, 2022) Abeysuriya, V.; Seneviratne, S.L.; de Silva, A.P.; Mowjood, R.; Mowjood, S.; de Silva, T.; de Mel, P.; de Mel, C.; Wijesinha, R.S.; Fernando, A.; de Mel, S.; Chandrasena, L.Background: Coronavirus disease 2019 (COVID-19) may cause clinical manifestations that last for weeks or months after hospital discharge. The manifestations are heterogeneous and vary in their frequency. Their multisystem nature requires a holistic approach to management. There are sparse data from the South Asian region on the outcomes of hospital-discharged COVID-19 patients. We assessed the posthospital discharge outcomes of a cohort of Sri Lankan COVID-19 patients and explored the factors that influenced these outcomes. Methods: Data were prospectively collected from patients who were discharged following an admission to the Nawaloka Hospital, Sri Lanka with COVID-19 from March to June 2021. At discharge, their demographic, clinical and laboratory findings were recorded. The patients were categorised as having mild, moderate and severe COVID-19, based on the Sri Lanka Ministry of Health COVID-19 guidelines. Following discharge, information on health status, complications and outcomes was collected through clinic visits and preplanned telephone interviews. A validated (in Sri Lanka) version of the Short Form 36 health survey questionnaire (SF-36) was used to assess multi-item dimensions health status of the patients at 1, 2 and 3 mo postdischarge. Results: We collected data on 203 patients (male, n=111 [54.7%]). The level of vaccination was significantly associated with disease severity (p<0.001). Early recovery was seen in the mild group compared with the moderate and severe groups. At 3 mo, on average 98% of mild and 90% of moderate/severe patients had recovered. Based on the SF-36, physical functioning dimensions, role limitation due to physical and emotional health, energy/ fatigue, emotional well-being, social functioning, pain and general health were significantly different in the moderate/severe vs mild COVID-19 groups at 1, 2 and 3 mo postdischarge (p<0.05). Twenty-three patients developed complications, of which the most common were myocardial infarction with heart failure (n=6/23; 26.1%), cerebrovascular accident (n=6/23; 26.1%) and respiratory tract infections (n=3/23; 13.01%) and there were six deaths. Conclusions: In our cohort, receiving two doses of the COVID-19 vaccine was associated with reduced disease severity. Those with mild disease recovered faster than those with moderate/severe disease. At 3 mo posthospital discharge, >90% had recovered.Item Combination of cycle threshold time, absolute lymphocyte count and neutrophil:lymphocyte ratio is predictive of hypoxia in patients with SARS-CoV-2 infection(Royal Society of Tropical Medicine and Hygiene, 2022) Abeysuriya, V.; Seneviratne, S.L.; de Silva, A.P.; Mowjood, R.; Mowjood, S.; de Silva, T.; de Mel, P.; de Mel, C.; Chandrasena, L.; Wijesinha, R.S.; Fernando, A.; de Mel, S.Background: There is currently no clinically validated biomarker to predict respiratory compromise in sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Cycle threshold time (Ct), absolute lymphocyte count (AL) and neutrophil:lymphocyte ratio (NLR) have been previously evaluated for this purpose. We hypothesized that the combination of these parameters at presentation may be predictive of hypoxia (oxygen saturation <92%). Methods: Data were collected on 118 patients with SARS-CoV-2 infection between May 2020 and April 2021. Demographics, clinical parameters and laboratory and radiological investigation results were recorded. Respiratory compromise (RC) was defined based on symptoms and signs, hypoxia and chest X-ray abnormalities. Results: RC occurred in 61 (51.7%) of patients. The Ct, AL and NLR at median day 3 of illness were significantly different between patients with and without RC (Ct, RC vs not: 19.46±2.64 vs 22.62±3.37, p=0.0001; AL, RC vs not: 531.49±289.09 vs 764.69±481.79, p=0.0001; NLR, RC vs not: 3.42±0.75 vs 2.59±0.55, p=0.0001). Receiver operating characteristics analysis showed that a Ct <19.9, AL <630.8×103/μL and NLR >3.12 at median day 3 of symptoms was predictive of hypoxia on day 7 of illness (area under the curve 0.805, sensitivity 96.7%, specificity 69.1%). The predictive value for the parameters combined was significantly superior to their individual predictive power. Conclusions: Ct, AL and NLR used in combination on day 3 of symptoms are predictive of hypoxia on day 7 of SARS-CoV-2 illness.Item The Impact of empirical hydrocortisone therapy on clinical outcomes in dengue fever: A retrospective chart review(Oxford University Press, 2020) de Mel, S.; Thilakawardana, B.U.; de Mel, P.; de Silva, A.P.; de Mel, C.; Chandrasena, L.; Seneviratne, S.L.; Abeysuriya, V.BACKGROUND: The role of steroids in dengue infection (DI) remains uncertain. METHODS: A retrospective chart review was conducted on patients ≥18 y of age diagnosed with DI based on positivity for dengue non-structural antigen 1 or immunoglobulin M between October 2017 and November 2018. RESULTS: Hydrocortisone was administered to 106 of 406 patients. DI with warning signs occurred in nine patients (9.5%) in the steroid cohort and eight patients (2.5%) in the non-steroid group. The incidence of severe DI, bleeding and admission duration were similar between the groups. CONCLUSIONS: Our study shows no significant benefit of empirical steroids in DI. KEYWORDS: clinical outcomes; corticosteroids; dengue.Item Familial thrombocytopaenia in three male siblings(Sri Lanka Medical Association, 2017) Amarasena, P.; Premawardhena, A.P.; Herath, H.R.B.M.; Seneviratne, S.L.INTRODUCTION & OBJECTIVES: Familial thrombocytopaenia is uncommon. Specific molecular defects have been identified in some families. We describe three male siblings with thrombocytopaenia and other immune related findings. The parents are healthy and non-related. METHODS: Clinical and investigative findings were obtained from the brothers and their parents. RESULTS: Case 1: A 15 year old male presented with spontaneous ecchymotic patches and oral mucosal bleeding. Platelet count was 1000/mm3, mild hepatomegaly was present on ultrasonography and IgA was raised. As the response to IV methyl-prednisolone was poor, IVIG, prednisolone and azathioprine were used. He has had recurrent RT infections and as his latest platelet counts are suboptimal, Rituximab is being considered. Case 2: A 19 year old male was found to have thrombocytopaenia whilst being investigated for a large scalp haematoma aged 2 years. He had been treated with oral prednisolone and needed pulse IV dexamethasone. Presently he is off steroids and the platelet count is 54000/mm3. Serum IgM is reduced and IgA is raised. He has chronic bilateral lower limb eczema, an atrio-fascicular accessory pathway and gets recurrent RT infections. Case 3: A 12 year old male had fever, cervical lymphadenopathy and hepatosplenomegaly aged 3 years. He then developed AIHA and thrombocytopaenia. The thrombocytopaenia persisted and was treated with prednisolone and cyclosporine. Aged 9 years, he developed SLE and a year later, class IV lupus nephritis was found on renal biopsy. CONCLUSION: An AR or XR genetic cause is likely in this family. The identification of the exact molecular defect may help with selecting appropriate medications to target abnormal immune pathways.Item Outcome of management of yellow oleander poisoning in a Base Hospital setting(Sri Lanka Medical Association, 2001) Seneviratne, S.L.; de Silva, C.E.; Fonseka, M.M.D.; Gunatilake, S.B.; de Silva, H.J.Abstract AvailableItem Outcome of envenomation due to snake bite during pregnancy(Sri Lanka Medical Association, 2001) Seneviratne, S.L.; de Silva, C.E.; Fonseka, M.M.D.; Gunatilake, S.B.; de Silva, H.J.Abstract availableItem Post mortem findings in yellow oleander poisoning(Sri Lanka Medical Association, 2001) Seneviratne, S.L.; de Silva, C.E.; Fonseka, M.M.D.; Gunatilake, S.B.; de Silva, H.J.INTRODUCTION: Death from yellow oleander poisoning (YOP) is mainly due to cardiac toxicity caused by its effect on the conducting system leading to bradyarrhythmias. Whether other organ systems are involved in YOP is not clear. No post-mortem studies of death due to YOP have been documented. OBJECTIVE: To study post-mortem (PM) abnormalities following YOP. METHODS: Post-mortems were performed on patients with YOP who died after admission to Base Hospital, Polonnaruwa (BHP), over a 20 month period from January 1998 to August 1999. Written consent was obtained from relatives for the PM examination. RESULTS: Thirty seven PMs were performed during the study period. There were 21 males and the age range was from 13 to 70 years. Twenty three patients died within 24 hours of admission while ten and two died on the 2" and 3rd days respectively. Two patients died after 72 hours of hospital stay. Almost all subjects (35) had myocardial and pericardial haemorrhages. Congested kidneys were found in 24 (64.8%) while nine had a congested liver. Cerebral oedema was found in 16(43.2%). No abnormalities were found in the lungs and other intra- abdominal organs. CONCLUSION: Deaths occur early in fatal YOP. Myocardial and pericardial haemorrhages were seen in almost all PMs and could have resulted from cardio-pulmonary resuscitation, at least in some patients. PM abnormalities seen in kidneys and brain were probably secondary to hypoperfusion following cardiac arrhythmias. YOP does not seem to cause direct damage to organ systems other than the heart. Further work needs to be done to determine the effects of YOP on the cardiac conducting tissue.Item 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.Item 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.