Hypertension Knowledge, Attitude, and Practice in Adult Hypertensive Patients at a Tertiary Care Hospital in Sri Lanka

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 informed by a health care team member. About 74% of them were taking all their prescribed medications. Almost all (95%) patients had checked their blood pressure (BP) during the previous 12 months, and almost the same percentage had visited their doctor for BP checkups every 1–3 months. Conclusion. Our patients were well aware of the importance of regular follow-ups and also knowledgeable about the complications related to HTN. Almost 75% of the patients had optimum drug compliance. It was revealed that forgetfulness was the frequent cause for poor drug compliance

Pituitary macroadenoma presenting as severe hyponatremia: a case report

Abstract Background Hyponatremia is defined as a serum sodium level of less than 135 mEq/L in a patient. Although hyponatremia is not an uncommon laboratory finding, especially in the elderly, hunting for the etiology is a challenging issue for any clinician. The three first-line investigations that are required for further analysis are urine osmolality, serum osmolality, and urinary sodium levels in addition to clinical assessment of volume status. Case presentation A 69-year-old previously well Sinhalese man presented with lethargy, loss of appetite, vomiting, and altered behavior of 1 week’s duration. An examination revealed Glasgow Coma Scale of 13/15 and marginally low blood pressure. Initial serum sodium level was 104 mmol/L, and plasma and urinary osmolalities were 251 mOsm/kg and 305 mOsm/kg, respectively. His urinary sodium level of 158 mmol/L was suggestive of a clinical picture of a syndrome of inappropriate secretion of antidiuretic hormone. Even after correction of hyponatremia with intravenously administered 3% saline, a persistent altered behavior necessitated cerebral imaging that confirmed the presence of pituitary macroadenoma. Meanwhile, his hormone profile showed very low serum cortisol and low free tetraiodothyronine levels. An ultrasound scan of his abdomen affirmed the presence of normal adrenal glands. With intravenously administered hydrocortisone and orally administered levothyroxine replacement, he showed marked clinical improvement that supported the diagnosis of hypopituitarism. Conclusion Hyponatremia in the elderly is not an uncommon presentation. However, etiological diagnosis is a challenging task as there are multiple overlapping differential diagnoses

A case report of dengue haemorrhagic fever during the peripartum period: challenges in management and a case of vertical dengue transmission

Abstract Background Incidence of Dengue infection is on the increase in Sri Lanka with it being associated with significant maternal and neonatal morbidity in pregnancy. Case presentation A 33-year-old pregnant woman at 38 weeks of gestation, presented with acute onset of fever, was later diagnosed with Dengue illness. Due to the emergence of warning symptoms and signs and rapidly dropping platelet count, the baby was delivered by urgent caesarian section. She went into the critical phase during the postoperative period and due to concealed bleeding, required blood transfusion. On the 5th day of life, the neonate was also diagnosed with possible dengue by vertical transmission and required blood and PLT transfusions for recovery. Conclusions This case report illustrates how a high index of suspicion, early diagnosis, close monitoring, timely intervention and critical consideration of physiological changes of pregnancy when interpreting clinical situation, led to achieving a successful outcome