Udaya Ralapanawa - Academia.edu (original) (raw)

Papers by Udaya Ralapanawa

Circulation

Introduction: Acute coronary syndrome (ACS) is the leading cause of death worldwide, even higher ... more Introduction: Acute coronary syndrome (ACS) is the leading cause of death worldwide, even higher in South Asian countries. South Asia shows a higher incidence of ACS and an increasing trend of overweight and obesity. Methods: This cross-sectional descriptive study was conducted at the Teaching Hospital Peradeniya, Sri Lanka, among the patients presenting with ACS. An interviewer-administered structured questionnaire was used to collect data and to take anthropometric measurements. They were analysed to obtain the body mass index (BMI) and the waist-hip ratio. Results: A total of 780 patients with ACS were included in the study with a mean age of 60.8 ± 11.3 years. Among them, 316 (40.5%) were females. The mean BMI of females was 25.2 ± 4.4 kg m -2 which was higher than that of males 23.9 ± 3.8 kg m -2 , showing a statistically significant difference (p=0.003). The prevalence of overweight and obesity was 37.6% and 21.2%, respectively, significantly higher than the normal values for ...

Asian Pacific Journal of Health Sciences, Sep 26, 2020

Objectives: Stinging by Asian giant honey bee and hornets is a common environmental hazard leadin... more Objectives: Stinging by Asian giant honey bee and hornets is a common environmental hazard leading to many hospital admissions in Sri Lanka. This study aims to study the social and health impact of flying hymenoptera stings in a region of the central hill country of Sri Lanka. Methodology: The study was carried out at the two base Hospitals in Teldeniya and Rikillagaskada, Sri Lanka. All the patients presented to these hospitals following a wasp or big bee singing, during the period of 2011-2010 were included in the study. Results: There was a total of 80 patients in this study cohort, with 54 (32%) of them being victims of Horne stings and the rest being big bee stings (n = 26, 68%). The mean age of the total group was 45 years (SD = 16). Stings occurrence between 9.00 am and 3.00 pm was more frequent. The majority of the big bee stings (n = 26, 48%) had occurred while working in tea estates, whereas the hornet attacks were frequent around the dwellings (n = 12, 46%), head and neck (n = 72, 90%), upper limbs (n = 48, 60%), chest (n = 28, 35%), and back of the chest (n = 24, 30%) were the commonly involved body regions. Conclusions: Hymenoptera stings have a significant social and health impact in a region of the central hill country of Sri Lanka. Although pain and swelling were the most common adverse effect, life-threatening anaphylaxis was not reported in this study group. Even though electrocardiogram changes were more common among big bee groups, none of them were fatal.

Journal of Medical Case Reports, 2021

Background Rheumatoid arthritis is a common autoimmune disease with many extra-articular manifest... more Background Rheumatoid arthritis is a common autoimmune disease with many extra-articular manifestations. Pure red cell aplasia is a rare manifestation of rheumatoid arthritis and is sparsely documented in the literature, with a variable clinical outcome following immunosuppressive therapy. Case presentation A 63-year-old Sinhalese female presented with transfusion-dependent anemia associated with deforming inflammatory arthritis. She also had leukopenia, right subclavian venous thrombosis, and generalized lymphadenopathy. The diagnosis of rheumatoid arthritis following initial clinical workup and additional blood and bone marrow investigations revealed pure red cell aplasia as a secondary manifestation of rheumatoid arthritis after excluding other secondary causes, such as infections, thymoma, thrombophilic conditions, and hematological malignancy. She responded well to oral prednisolone, cyclosporine A, and hydroxychloroquine, and she attained complete recovery in 2 months. Conclus...

Case Reports in Infectious Diseases, 2020

Introduction. Appendicular tuberculosis is a rare form of extrapulmonary tuberculosis involving t... more Introduction. Appendicular tuberculosis is a rare form of extrapulmonary tuberculosis involving the gastrointestinal tract. Diagnosis of appendicular tuberculosis is difficult due to its atypical presentation. Histological confirmation remains the gold standard in diagnosis. Case Presentation. We report a 37-year-old Sri Lankan male presenting with a diarrheal illness with high fever for 8 days in the background of constitutional symptoms for 1-month duration. He was pale and had moderate amount of free fluid in the abdomen. Inflammatory markers were elevated, and CT abdomen revealed a thickened elongated appendix. Diagnostic paracentesis revealed a lymphocytic transudative ascites. A macroscopically minimally inflammed appendix removed at laparotomy and histology confirmed presence of tuberculous granulomata with caseation. He made an uneventful recovery by the anti-tuberculous therapy. Conclusion. High degree of suspicion is needed in diagnosis of appendicular tuberculosis due to ...

Case Reports in Medicine, 2021

Introduction. Kounis syndrome is the concurrence of an acute coronary syndrome (ACS) caused by co... more Introduction. Kounis syndrome is the concurrence of an acute coronary syndrome (ACS) caused by coronary vasospasms, acute myocardial infarctions, or stent thromboses in case of allergic or hypersensitivity reactions. Kounis syndrome is mediated by mast cells that interact with macrophages and T-lymphocytes, causing degranulation and inflammation with cytokine release. It is a life-threatening condition that has many trigger factors and is most commonly caused by medicines. Case Presentation. A 71-year-old male was admitted with a fever of five days’ duration associated with cellulitis, for which he had been treated with clindamycin and flucloxacillin before admission. He was a diagnosed patient with hypertension and dyslipidemia five years ago. After taking the antibiotics, he had developed generalized itching followed by urticaria suggesting an allergic reaction. Therefore, he was admitted to the hospital. After admission, he developed an ischaemic-type chest pain associated with a...

BMC Research Notes, 2018

Objective: This retrospective study was conducted in 2017 with the objective of evaluating the va... more Objective: This retrospective study was conducted in 2017 with the objective of evaluating the value of acute phase peripheral blood parameters in predicting dengue haemorrhagic fever (DHF). Patients, who were admitted to Teaching Hospital Peradeniya between January and August 2017 due to dengue illness, were recruited into this study. Results: A total of 515 patients participated in the study. Among them, 333 were DHF patients while 182 patients were managed as DF. There was a significant difference in mean values of platelets and haemoglobin observed during acute phase in non-leakers compared to the patients who progressed to DHF, while no significant difference was observed for white blood cells, neutrophils, lymphocytes and haematocrit values. A significantly higher mean value was observed in white blood cells and hemoglobin in leakers compared to non-leakers during day 5. Mean day 5 platelet value was significantly lower among leakers compared to non-leakers but no significant difference between haematocrit, neutrophil and lymphocyte values were observed. ROC curve performed for acute phase platelet values and haemoglobin values to gain a predictive value for female and male DHF patients and cut off values with high sensitivity and specificity to predict DHF could be obtained for the platelet count.

BMC Infectious Diseases, 2018

Background: Dengue is a global problem mainly in the tropics. Meticulous clinical management of c... more Background: Dengue is a global problem mainly in the tropics. Meticulous clinical management of cases has reduced the death rate significantly, but large numbers of people still succumb to severe complications of the infection. Presence of myocarditis is often overlooked leading to a poor outcome. Clinical management guidelines of dengue do not stress the importance of myocarditis as a manifestation in dengue infection. Severe hepatic dysfunction also needs emphasis. Case presentation: We present three patients who had come to hospital on the 3rd day of fever. Two of them (case 1 and 3) were in shock on admission and case 2, who was stable on the3 rd day, went into the critical phase and developed shock while in the hospital on the 4 th day. All three had tachycardia on admission that got worse with time. The clinical course was unstable with fluctuations in urine output and deterioration of organ function. Despite frequent monitoring and life support they survived only 2-3 days in hospital. All three patients had myocarditis during the critical phase. In the first case, myocarditis was confirmed by troponin estimation and echocardiogram. In the second and third cases, histopathology confirmed myocarditis. Haemorrhagic necrosis of the liver was found in case 2 and 3 with exponential rise of transaminases. In all three cases, viral RNA was detected in both heart and liver tissues by PCR amplification. Conclusions: We stress that detection of myocarditis and liver involvement in any dengue patient is important from the onset of the illness where treatment should be tailored to prevent development of hypotension. Our findings are novel as PCR and histology are rarely done on tissues of deceased dengue patients in the world. Studies are needed to find therapeutic interventions to reverse cardiac and hepatic dysfunction in dengue infection.

BMC research notes, Jan 8, 2015

Meticulous fluid management is the mainstay of treatment in dengue fever that is currently govern... more Meticulous fluid management is the mainstay of treatment in dengue fever that is currently governed by consensus guidelines rather than by strong research evidence. To examine this issue we audited the fluid requirement of a cohort of adult patients with dengue fever (DF) and dengue haemorrhagic fever (DHF) in a tertiary care clinical setting. This retrospective cohort study was conducted from July 2012 to January 2013 in Teaching Hospital, Peradeniya, Sri Lanka. Adult patients with confirmed dengue infection managed according to the national and WHO guidelines were included. Their fluid requirement was audited once data collection was over in both DF and DHF groups. Out of 302 patients, 209 (69%) had serological confirmation of dengue infection, comprising 62 (30%) patients gone into critical phase of DHF. Mean age of the DHF group was 30 years (range 12-63 years) and included more males (n = 42, 68%, p < 0.05). Their mean duration of fever on admission and total duration of fev...

International Journal of Hypertension

Objective. Hypertension (HTN) remains a major risk factor for cardiovascular diseases globally. D... more Objective. Hypertension (HTN) remains a major risk factor for cardiovascular diseases globally. Despite considerable improvement in increasing awareness, treatment, and control of HTN, undiagnosed and uncontrolled HTN remains a major public health challenge. Our focus was on studying the knowledge, attitude, and practice regarding HTN in adult hypertensive patients at a tertiary care hospital in Sri Lanka. Methodology. A descriptive study on knowledge, attitude, and practice of hypertensive patients on antihypertensive medications attending the hypertensive clinic was carried out from January 2016 to June 2016 at THP. Results. The study was on a total of 371 hypertensive patients comprising 253 (68.2%) females and 118 (31.8%) males. Among the total participants, 12 (3.2%), all females, had never been to school. About half of them (47.7%) had not even reached GCE (ordinary level). More than two-thirds (77%) of the study population were aware of the complications of HTN as they were i...

Asian Pacific Journal of Health Sciences, Sep 27, 2020

Objective: Elevation of serum liver transaminase is common during dengue infection. A group of de... more Objective: Elevation of serum liver transaminase is common during dengue infection. A group of dengue patients was studied to determine the relationship between the elevation of liver transaminases in dengue fever (DF) and dengue hemorrhagic fever (DHF). Methodology: This study was conducted to assess the predictive value of liver enzymes for DHF. During the dengue epidemic of 2017, all data pertaining to 601 dengue patients were collected in a systematic manner for purposes of conducting an analysis on the predictive value of serum levels of liver transaminase for DHF. Six hundred one patients were categorized into DF and DHF, according to the World Health Organization 2009 Dengue Management Guidelines. The data were collected retrospectively. Results: There were significant differences between aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels among DF and DHF patients, not only on day 5 of the critical phase but also during the acute febrile phase. The area under the ROC curve at the acute febrile phase for AST was 0.7, but in ALT, it was 0.6. However, the area under the ROC curve was 0.70, which indicates that AST at the acute febrile phase is a good indicator of the leaking tendency. According to the coordinate points of the curve, leaking can be predicted with a sensitivity of 72% and a specificity of 60% at an AST value of 59.5. Conclusion: The AST value of 59.5 at the acute febrile phase can be used to predict DHF. However, patients who have significantly elevated transaminase levels during the acute febrile phase have a higher tendency to develop DHF.

International Journal of Clinical Case Reports and Reviews, 2021

Introduction Acetaminophen-induced liver injury is the most common cause of acute liver failure, ... more Introduction Acetaminophen-induced liver injury is the most common cause of acute liver failure, where multiple ingestions or a delay in the presentation may lead to a poor prognosis. N-acetylcysteine (NAC) is the conventional antidote used to treat acute acetaminophen toxicity, and plasmapheresis can be used as an adjunct, though there are no systematic studies to prove its effectivity. Case Presentation An 18-year-old girl was admitted with reduced responsiveness for one day with a few episodes of diarrhea. On admission, she was febrile and had a GCS of 10/15, otherwise normal neurology. She had marked right hypochodrial tenderness, deep icterus, and a pulse of 120 beats per minute, with a blood pressure of 80/50 mmHg; fluid resuscitation with inotropic support was done. Initial investigations revealed severe metabolic acidosis, hemoglobin of 9.5 g/dL, white blood cell count 13,500/mm3, and platelet 119,000 per µL. The prothrombin time (PT) international normalized ratio (INR) was...

Additional file 2: Figure S2. Discriminatory function of day 3 platelet count and haemoglobin con... more Additional file 2: Figure S2. Discriminatory function of day 3 platelet count and haemoglobin concentration in predicting progression into dengue haemorrhagic fever among male dengue patients. Area under the curve was 0.70 for platelets and 0.40 for haemoglobin. A cut off value with high sensitivity and specificity to predict DHF could be obtained from our sample.

Additional file 1: Figure S1. Discriminatory function of day 3 platelet count and haemoglobin con... more Additional file 1: Figure S1. Discriminatory function of day 3 platelet count and haemoglobin concentration in predicting progression into dengue haemorrhagic fever among female dengue patients. Area under the curve was 0.71 for platelets and 0.50 for haemoglobin. A cut off value with high sensitivity and specificity to predict DHF could be obtained from our sample.

BackgroundThe cardiovascular risk profile and adverse events following acute coronary syndrome (A... more BackgroundThe cardiovascular risk profile and adverse events following acute coronary syndrome (ACS) differ between the Sex, indicating the importance of studying the sex differences in factors associated with ACS.MethodsA cross-sectional descriptive study was performed among ACS patients presented to Teaching Hospital Peradeniya. An interviewer-administered prevalidated questionnaire was used to collect data, and analysis was done. ResultsA total of 789 patients were included, consisting of 40.4% females. The mean age of females (62.17±11.06) was higher than males (59.80±11.24) (p=0.004), and in females, the mean age for unstable angina (60.5±10.5) was lower than NSTEMI (63.8±12.5) (p=0.022) and STEMI (64.0±9.2) (p=0.026). The male-female composition for unstable angina (46.3% vs 53.7%) and STEMI (75.8% vs 24.2%) showed varied proportions. The mean BMI (24.95±4.40 kg m-3 vs 23.77±3.88 kg m-3) (p=0.008) and obesity (21.6% vs 13.8%) (p=0.048) was higher in females. Overweight (9.4% v...

Background: Fibromuscular dysplasia (FMD) is a rare, medium-sized arteriopathy affecting less tha... more Background: Fibromuscular dysplasia (FMD) is a rare, medium-sized arteriopathy affecting less than 7% of the population. It affects predominantly young women of childbearing age. Stroke caused by fibromuscular dysplasia of the carotid artery is uncommon and reported to range between 0.6% by angiography and 1.1% by autopsy. Case Presentation: A 35-year-old mother of two children, previously well, was admitted to our hospital with right-sided spastic hemiparesis with upper motor neuron type facial nerve palsy. Non-contrast CT (NCCT) brain on admission revealed left-sided middle cerebral arterial territory infarction with possible hemorrhagic transformation with midline shift. She had progressive neurological features where NCCT brain in 24 hours showed an increase in the size of the hemorrhage. Magnetic resonance imaging (MRI) of the brain, including angiogram of neck vessels, revealed acute dissection of the left internal carotid artery with acute thrombosis, left frontoparietal hemo...

Background Haemophagocytic Lymphohistiocytosis (HLH) is an uncommon systemic inflammatory clinica... more Background Haemophagocytic Lymphohistiocytosis (HLH) is an uncommon systemic inflammatory clinical syndrome associated with numerous conditions and a rare complication of dengue associated with significant mortality and morbidity even with appropriate treatment. The outcome is further poor if the diagnosis is delayed or left untreated. Therefore a high degree of clinical suspicion is paramount in the diagnosis of HLH, especially in an atypical presentation of dengue infection. Case Presentation A 17-year-old boy with a non-significant past medical history admitted with a four-day history of fever, headache, nausea, vomiting, and loose stool. On admission, he was hemodynamically stable and managed as serologically confirmed dengue fever. On the 5th day of fever, he entered the critical phase, which was uncomplicated except for high fever spicks. Even after the critical phase was over, he had ongoing high fever spicks, hepatosplenomegaly with persistent thrombocytopenia, neutropenia a...

Background Patients with HIV infection often develop multiple complications and comorbidities, in... more Background Patients with HIV infection often develop multiple complications and comorbidities, including malignancies and opportunistic infections. The association of HIV infection with typhoid fever remains unclear, though there is a clear risk of typhoid in HIV infected persons. Therefore, the diagnosis of typhoid should be considered in HIV infected individuals, mainly when they present with severe ulcerative diarrhoea. Case Presentation A 38-year-old gentleman presented with fever with significant weight loss and anorexia for eight months. He had worked abroad in a middle east country and had recently returned to Sri Lanka. On examination, he was thinly built with a BMI of 18 kg/m2. The initial full blood count revealed lymphopenia, anaemia and thrombocytopenia. He also had mild hyponatremia. His HIV Ag/Ab combo assay became positive, and he was found to have a low CD4 count. While on antiretroviral therapy, he developed nausea, vomiting and diarrhoea while continuing the preexi...

Ceylon Medical Journal, 2018

Introduction Understanding the diurnal variation of blood pressure (BP) is important in the manag... more Introduction Understanding the diurnal variation of blood pressure (BP) is important in the management of hypertension. Objectives Primary objectives of the study were to analyse the pattern of nocturnal BP in patients with essential hypertension who are already on treatment. Methodology Cross-sectional descriptive study was conducted at cardiology unit Teaching Hospital Kandy, in 2015, in patients referred from the hypertensive clinic at Teaching Hospital Peradeniya. A consecutive sample of 100 essential hypertensives aged >18 years with stage I to III hypertension were included. Patients with a history of previous ischemic heart disease or cerebro-vascular events were excluded. Twenty-four-hour ambulatory blood pressure monitoring was performed in all patients after complete clinical evaluation. Results Sample size was 100. Mean age was 60.86 ± 8.73 years. Twenty eight were male. In the sample 32 had normal dipping patterns. Out of the 68 with abnormal dipping, 45 had sub-optimal dipping, 19 had reverse dipping and 4 had extreme dipping. There were 72 patients with nocturnal hypertension, of them 29 (39.7%) had isolated nocturnal hypertension. Conclusion A high prevalence of abnormal dipping, nocturnal hypertension and isolated nocturnal hypertension among our sample of patients with essential hypertension. Therefore, it is important to increase awareness and to consider ambulatory blood pressure monitoring to detect these abnormal nocturnal blood pressure variations.

Clinical and Experimental Hypertension, 2018

Background: Hypertension (HT) is identified as a highly prevalent cardiovascular risk factor and ... more Background: Hypertension (HT) is identified as a highly prevalent cardiovascular risk factor and also as a separate disease entity, leading to significant mortality and morbidity. The rate of HT is increasing worldwide with a faster rate identified in developing countries. Thus, it is important to evaluate epidemiological patterns of chronic HT in a developing country like Sri Lanka. Methodology: This is a cross-sectional descriptive study conducted at the Teaching Hospital Peradeniya, Sri Lanka, to assess symptoms and risk factors among patients with chronic HT. Results: In a cohort of 266 chronic hypertensives, the mean values for age of population, age of onset, and duration of HT, respectively, are 63, 45, and 8 years. At presentation, 24.8% were asymptomatic. The commonest presentation at diagnosis was dizziness accounting for 33.8% cases, followed by chest pain, headache, loss of consciousness, and shortness of breath accounting for 7.5%, 13.5%, 2.6%, and 4.5%, respectively. Approximately 36.5% of patients had a positive family history. Fathers of 7.1% patients, mothers of 19.2%, and both parents of 10.2% patients had HT. 38.7% of patients had one or more siblings with HT. 34.6% had diabetes mellitus. Conclusion: Symptoms of those with HT are mostly nonspecific and should be considered as possible warning signs prior to the development of sinister complications of the disease. Family history of HT with affected siblings, or one of the parents, was, observed in more than one-third of patients. Early screening and prevention of modifiable risk factors are important in these patients to prevent debilitating complications.