A case of fatal acute fatty liver of pregnancy and literature review

AFLP, though rare, is an obstetric emergency which carries a high incidence of maternal and perinatal mortality, despite optimal care. We report a case of a 23-year-old primi mother, who presented to us with vague symptoms of feeling unwell and abdominal pain, was diagnosed with AFLP, and was managed accordingly with the highest level of care available but succumbed a few days into her illness though timely delivery was able to save the baby. By this case report we once again wish to emphasize the value of a timely diagnosis with a high level of clinical suspicion and supportive laboratory investigations including imaging; the need for early termination of pregnancy; and adequate supportive care as the key management options for AFLP. Further, we wish to explore the current treatment options available for AFLP and discuss a few novel therapeutic strategies such as plasma exchange in treating such cases and the pros and cons associated with these treatment modalities

Blistering skin lesion: A new observation of (white scorpion) sting

White scorpion ( Hottentotta tamulus ) stings are an emerging health hazard in northern Sri Lanka and are increasingly recognized particularly during the last decade. The stings are usually harmless; however, fatal cardiovascular sequelae ensues following severe envenomation. It is often difficult to identify this miniature creature and its site of sting due to its nature of habitat and nonspecific local symptoms that develop after the sting. Here, we report a patient who had developed a blistering skin lesion soon after the sting which is not reported in the literature to date by the sting of this particular species. Recognizing it would help the clinicians of this subcontinent to consider scorpion sting as a differential diagnosis for the above presentation in the future

Mechanisms Involving Myocardial Injury in Tropical Stings and Bites

It is known that a number of toxic substances produce myocardial injury by several mechanisms involving interruption of coronary blood flow due to stimulation of clotting mechanism and coronary vasospasm. Number of toxic substances may cause direct myocardial toxicity independent of coronary blood flow. Acute myocardial injury due to stings and bites is a rare entity and not well understood. Here we illustrate a case of myocardial injury due to Russell’s viper envenomation

Erectile dysfunction and associated factors among men with diabetes mellitus from a tertiary diabetic center in Northern Sri Lanka

Abstract Objective Prevalence of erectile dysfunction (ED) in diabetic men is considerably high but it is often underdiagnosed and undermanaged. There were no data available about the prevalence and the risk factors of ED in our region. So a cross-sectional study was conducted to identify the prevalence and associated risk factors of ED in a tertiary care diabetic center in Northern Sri Lanka. Results 326 diabetic male patients between ages 18–60 years were interviewed. Majority (62.9%; 95% CI 57.5–68.0%) of the diabetic patients suffered from ED and 22.4% (95% CI 17.8–26.8%) were found to have severe ED. Most of the patients (98.8%) were not screened or treated for ED. Bivariate analysis showed age above 40, duration of DM (> 5 years), type of diabetes (type 2), having micro-vascular complications, co-existing hypertension, BMI, consuming unsafe level of alcohol and taking beta-blockers were associated with ED at 5% level (P  40 (AOR: 2.13; 95% CI 1.05–4.33), duration of diabetes (AOR: 2.90; 95% CI 1.67–5.01), co-existing hypertension (AOR: 1.8; 95% CI 1.06–3.06), and unsafe level alcohol intake (AOR: 3.14; 95% CI 1.76–5.59) were independent risk factors

Reactivation of latent tuberculosis associated with methotrexate therapy

Tuberculosis is highly prevalent in developing world. Post primary tuberculosis occurs in the setting of depressed immunity commonly affecting the lungs. Reactivation of tuberculosis concomitantly at different non-pulmonary sites is very uncommon. Here we report an immunocompetent male with rheumatoid arthritis presented with reactivation of cutaneous and meningeal tuberculosis while on low dose methotrexate therapy. The case report highlights the fact that the treating clinician should be vigilant enough to suspect reactivation of latent tuberculosis even with non biological disease modifying anti rheumatoid drugs therapy in tropical world

Blood group AB is associated with severe forms of dengue virus infection

Several viral and host factors are believed to contribute to the development of severe forms of dengue such as dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS) following a dengue virus (DENV) infection. The pathogenesis of DHF/DSS is not fully understood, however, host factors like ABO blood groups have been shown to contribute to the severity of DENV infection. The present study investigated the association of blood groups with severity of DENV infection in the northern region of Sri Lanka. The blood-groups of 405 patients positive for DENV NS1 antigen and anti-DENV IgM/IgG were determined using the standard haemagglutination assay recommended by the national blood bank/s. The occurrence of severe dengue in patients with certain blood groups was significantly different (p < 0.001) to those with other blood groups. Patients with AB blood group had more than 2.5 times higher risk of developing DHF than those with other blood groups. On the other hand, patients with blood group O were significantly under represented for DHF relative to the proportion of this blood group in the general population. Thus dengue patients with blood group O appear to have a low risk of developing DHF than those with other blood groups

Epidemiology and factors associated with amoebic liver abscess in northern Sri Lanka

Abstract Background Clinically diagnosed amoebic liver abscess (ALA) caused by Entamoeba histolytica has been an important public health problem in Jaffna district, northern Sri Lanka for last three decades. In order to draw up a control strategy for elimination of this condition, knowledge of its epidemiology and factors associated with this condition in the local context is vital. Methods All clinically diagnosed ALA patients admitted to the Teaching Hospital, Jaffna during the study period were included in the study and the data were collected using an interviewer administered questionnaire. One hundred blood samples from randomly selected toddy (a local alcoholic drink consisting of the fermented sap of the Palmyrah palm) consumers and 200 toddy samples were collected. Toddy samples were cultured in Robinson’s medium to establish the presence of Entamoeba histolytica in the sample. Climatic data and the total toddy sales in the district were obtained from the Meteorological and Excise Departments respectively. A sub group of randomly selected 100 patients were compared with 100 toddy consumers who were negative for E. histolytica antibody to explore the potential risk factors. Results Between July 2012 and July 2015, 346 of 367 ALA patients were enrolled in this study. Almost all patients (98.6%) were males with a history of heavy consumption of alcohol (100%). Almost all (94.2%) were within the age group 31–50 years. None of the cultured toddy samples grew E. histolytica. The monthly incidence of disease peaked in the dry season, matching the total toddy sales in the district. Age, type of alcohol and frequency of drinking were identified as potential risk factors whereas frequency of alcohol consumption and type of alcohol (consuming toddy and arrack) were identified as the independent risk factors. Moreover, the knowledge, attitude and practices towards ALA were poor among participants and the control group. Conclusions Though the number of cases has declined in recent years, ALA still remains as an important public health problem in Jaffna district. The transmission route of E. histolytica leading to ALA has to be further explored. Moreover, greater awareness among the public who are at risk would be beneficial in order to eliminate the disease