S. W. Gnanathayalan, T. Peranantharajah, N. Rajendra, A. Arasalingam
We present a rare case of bilateral anterior cerebral artery (ACA) territory infarction with akinetic mutism, quadriparesis and frontal lobe release signs along with limbic dysfunction mimicking a basilar artery thrombosis. The etiology was thrombosis of the anterior communicating artery with propagation or embolism of the thrombus to both A2 segments of the anterior cerebral artery and restricted or absent blood flow in the branches arising from the A2 and A3 segments causing extensive infarction. We also aim to review the anatomy of the ACA to understand localization of lesions.
{"title":"Bilateral anterior cerebral artery thrombosis - a mimicker of basilar artery thrombosis: a case report","authors":"S. W. Gnanathayalan, T. Peranantharajah, N. Rajendra, A. Arasalingam","doi":"10.4038/jmj.v33i1.127","DOIUrl":"https://doi.org/10.4038/jmj.v33i1.127","url":null,"abstract":"We present a rare case of bilateral anterior cerebral artery (ACA) territory infarction with akinetic mutism, quadriparesis and frontal lobe release signs along with limbic dysfunction mimicking a basilar artery thrombosis. The etiology was thrombosis of the anterior communicating artery with propagation or embolism of the thrombus to both A2 segments of the anterior cerebral artery and restricted or absent blood flow in the branches arising from the A2 and A3 segments causing extensive infarction. We also aim to review the anatomy of the ACA to understand localization of lesions.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"106 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122316099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hospital admissions due to non-coronavirus disease 2019 (nonCOVID-19) respiratory diseases decreased in Teaching Hospital Jaffna following social distancing, other public health measures (face mask wearing) and due to lock down implemented by authorities in 2020.
{"title":"Impact of non–Coronavirus -2019 (Non–COVID-19) respiratory disease hospital Admissions: a single centre experience","authors":"R. M. M. Seelarathna, N. Rajeshkannan, T. Kumanan","doi":"10.4038/jmj.v33i1.118","DOIUrl":"https://doi.org/10.4038/jmj.v33i1.118","url":null,"abstract":"Hospital admissions due to non-coronavirus disease 2019 (nonCOVID-19) respiratory diseases decreased in Teaching Hospital Jaffna following social distancing, other public health measures (face mask wearing) and due to lock down implemented by authorities in 2020.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122527455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We present a 65 year old female patient presented with acute onset of severe left sided abdominal pain associated with a tender intra-abdominal lump over the left flank. An abdominal ultrasonography revealed an ectopic spleen in left flank and a CE-CT scan of abdomen confirmed the wandering spleen with torsion of vascular pedicle at the hilum. She underwent splenectomy. Wandering spleen is an uncommon clinical entity. Review of literature was made on different clinical presentations, diagnostic evaluation, treatment options, and clinical outcomes of patients with wandering spleen and discussed in this case report.
{"title":"A female patient with painful abdominal lump- torsion of wandering spleen","authors":"S. Rajendra","doi":"10.4038/jmj.v33i1.126","DOIUrl":"https://doi.org/10.4038/jmj.v33i1.126","url":null,"abstract":"We present a 65 year old female patient presented with acute onset of severe left sided abdominal pain associated with a tender intra-abdominal lump over the left flank. An abdominal ultrasonography revealed an ectopic spleen in left flank and a CE-CT scan of abdomen confirmed the wandering spleen with torsion of vascular pedicle at the hilum. She underwent splenectomy. Wandering spleen is an uncommon clinical entity. Review of literature was made on different clinical presentations, diagnostic evaluation, treatment options, and clinical outcomes of patients with wandering spleen and discussed in this case report.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126128443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Congenital diaphragmatic hernia is a defect in the fetal diaphragm, allowing the contents of the abdominal cavity to protrude into the thorax. It is characterized by varying degree of pulmonary hypoplasia associated with decrease in cross sectional area of pulmonary vasculature. The case report presents an incidental finding of a congenital diaphragmatic hernia at an age of two years and four months, emphasizing the increased importance of thorough clinical examination that may lead you to an important incidental diagnosis.
{"title":"Congenital Diaphragmatic Hernia presenting as recurrent respiratory tract Infections","authors":"Manori Prasadani, M. G. Sathiadas","doi":"10.4038/jmj.v33i1.122","DOIUrl":"https://doi.org/10.4038/jmj.v33i1.122","url":null,"abstract":"Congenital diaphragmatic hernia is a defect in the fetal diaphragm, allowing the contents of the abdominal cavity to protrude into the thorax. It is characterized by varying degree of pulmonary hypoplasia associated with decrease in cross sectional area of pulmonary vasculature. The case report presents an incidental finding of a congenital diaphragmatic hernia at an age of two years and four months, emphasizing the increased importance of thorough clinical examination that may lead you to an important incidental diagnosis.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122342823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Metronidazole has many unique properties such as possessing antibacterial as well as anti-protozoal activity, very minimal resistance rate, acceptable safety profile and market longevity. Metronidazole has remained as the recommended drug in the treatment of any form of amoebiasis caused by Entamoeba histolytica since its inception almost half a c entury ago. Anaphylaxis which limits the use of many antibacterial agents is hardly reported with metronidazole accounting for its favourable safety profile. Owing to its low-cost, it is considered affordable and economically accessible in developing countries which are mainly affected by amoebiasis. Its pharmacokinetic properties considered are its asset as well as drawback. For example, good bioavailability and good tissue penetration allows metronidazole to be used as oral dosage form in many indications and responsible for its efficacy in many extra-intestinal amoebiasis. However, inhibition of hepatic drug metabolizing enzymes is responsible for some significant drug interactions, and disulfiram like effect with alcohol. Unlike many other antimicrobial agents which were discovered much later, metronidazole has withstood the problem of antimicrobial resistance. Even some longer acting agents have been developed in the recent past, metronidazole remains the drug of first choice for amoebiasis documenting very high cure rate with minimal need for other treatment modalities.
{"title":"Metronidazole for Amoebiasis: A tale of more than half a century","authors":"T. Kumanan, V. Sujanitha, S. Ranganathan","doi":"10.4038/jmj.v33i1.116","DOIUrl":"https://doi.org/10.4038/jmj.v33i1.116","url":null,"abstract":"Metronidazole has many unique properties such as possessing antibacterial as well as anti-protozoal activity, very minimal resistance rate, acceptable safety profile and market longevity. Metronidazole has remained as the recommended drug in the treatment of any form of amoebiasis caused by Entamoeba histolytica since its inception almost half a c entury ago. Anaphylaxis which limits the use of many antibacterial agents is hardly reported with metronidazole accounting for its favourable safety profile. Owing to its low-cost, it is considered affordable and economically accessible in developing countries which are mainly affected by amoebiasis. Its pharmacokinetic properties considered are its asset as well as drawback. For example, good bioavailability and good tissue penetration allows metronidazole to be used as oral dosage form in many indications and responsible for its efficacy in many extra-intestinal amoebiasis. However, inhibition of hepatic drug metabolizing enzymes is responsible for some significant drug interactions, and disulfiram like effect with alcohol. Unlike many other antimicrobial agents which were discovered much later, metronidazole has withstood the problem of antimicrobial resistance. Even some longer acting agents have been developed in the recent past, metronidazole remains the drug of first choice for amoebiasis documenting very high cure rate with minimal need for other treatment modalities.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130667507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The COVID 19 pandemic questioned the continuous and comprehensive management of chronic illness. The new health guidelines and limited resources challenged primary care centers in their service delivery. A new local guideline become a timely need to overcome the challenges. This article is briefly narrating the local guidelines which was prepared by the University Family Health Center, Kondavil.
{"title":"Chronic illness management in COVID 19 era: An experience from primary care center","authors":"K. Rubavinoth, S. Kumaran","doi":"10.4038/jmj.v33i1.119","DOIUrl":"https://doi.org/10.4038/jmj.v33i1.119","url":null,"abstract":"The COVID 19 pandemic questioned the continuous and comprehensive management of chronic illness. The new health guidelines and limited resources challenged primary care centers in their service delivery. A new local guideline become a timely need to overcome the challenges. This article is briefly narrating the local guidelines which was prepared by the University Family Health Center, Kondavil.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128203134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chylous ascites is characterised by the accumulation of lymphatic fluid in the peritoneal cavity. It is a rare presentation of liver cirrhosis; it can be the initial presentation or can occur in the course of the disease. Although in developing countries the main causes were tuberculosis and filariasis, this is the case of chylous ascites due to non alcoholic liver cirrhosis. In the present case the chylous ascites was an incidental finding, and it was well responded to initial conservative management. With the next six months of follow up it was noted that the patient was in remission. This case showed that if there is no great suspicion of malignancy the invasive diagnostic investigations are not needed and treating the underlying condition is the crucial step in the management.
{"title":"Conservatively managed spontaneous chylous ascites in a non alcoholic cirrhotic patient – case report and literature review","authors":"Anne D. D. Joseph, V. Sujanitha, T. Kumanan","doi":"10.4038/jmj.v33i1.121","DOIUrl":"https://doi.org/10.4038/jmj.v33i1.121","url":null,"abstract":"Chylous ascites is characterised by the accumulation of lymphatic fluid in the peritoneal cavity. It is a rare presentation of liver cirrhosis; it can be the initial presentation or can occur in the course of the disease. Although in developing countries the main causes were tuberculosis and filariasis, this is the case of chylous ascites due to non alcoholic liver cirrhosis. In the present case the chylous ascites was an incidental finding, and it was well responded to initial conservative management. With the next six months of follow up it was noted that the patient was in remission. This case showed that if there is no great suspicion of malignancy the invasive diagnostic investigations are not needed and treating the underlying condition is the crucial step in the management.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121256459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Population aging and multiple pathology among older people have increased medicines use in elderly. Aim of this study was to evaluate chronic illnesses and polypharmacy and to determine factors associated with polypharmacy among hospitalized elderly at Teaching Hospital-Jaffna. This was a cross sectional, descriptive study. Elderly and polypharmacy were defined as ≥65years and concomitant use of ≥6 medications for ≥1 month respectively. Data were collected from bedhead-tickets of 288 elderly patients using data extraction sheet. Chi-squared and paired t-test were performed to determine the level of significance and unadjusted odd ratios were calculated to determine the association between polypharmacy and common chronic illnesses. A p value Mean age was 72 (SD±6.2) and majority were males (53.5%). Relatively higher proportion, 58.7% (n=169) of patients had polypharmacy. Seven chronic illnesses were prevalent in >10% of the patients. Lipid-modifying (80.9%) and antithombotic agents (76.4%) were the top two subgroups prescribed to elderly. Polypharmacy was substantially increased with increasing number of chronic illnesses (p This study concluded that polypharmacy was common among hospitalized elderly and increases with hospitalization. There was increased tendency to prescribe antithrombotic and lipid-modifying agents. These findings indicate the need for medication reconciliation and review in elderly patient. Further studies targeting wider population are needed to determine the appropriateness of polypharmacy in elderly.
{"title":"Chronic illnesses and polypharmacy in elderly patients: A hospital-based study in Northern Sri Lanka","authors":"S. N. Thiyahiny, T. Kumanan, R. Surenthirakumaran","doi":"10.4038/jmj.v33i1.117","DOIUrl":"https://doi.org/10.4038/jmj.v33i1.117","url":null,"abstract":"Population aging and multiple pathology among older people have increased medicines use in elderly. Aim of this study was to evaluate chronic illnesses and polypharmacy and to determine factors associated with polypharmacy among hospitalized elderly at Teaching Hospital-Jaffna. This was a cross sectional, descriptive study. Elderly and polypharmacy were defined as ≥65years and concomitant use of ≥6 medications for ≥1 month respectively. Data were collected from bedhead-tickets of 288 elderly patients using data extraction sheet. Chi-squared and paired t-test were performed to determine the level of significance and unadjusted odd ratios were calculated to determine the association between polypharmacy and common chronic illnesses. A p value Mean age was 72 (SD±6.2) and majority were males (53.5%). Relatively higher proportion, 58.7% (n=169) of patients had polypharmacy. Seven chronic illnesses were prevalent in >10% of the patients. Lipid-modifying (80.9%) and antithombotic agents (76.4%) were the top two subgroups prescribed to elderly. Polypharmacy was substantially increased with increasing number of chronic illnesses (p This study concluded that polypharmacy was common among hospitalized elderly and increases with hospitalization. There was increased tendency to prescribe antithrombotic and lipid-modifying agents. These findings indicate the need for medication reconciliation and review in elderly patient. Further studies targeting wider population are needed to determine the appropriateness of polypharmacy in elderly.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115548584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Kumara, T. Peranantharajah, A. Narani, B. Thangarajah, S. Narayanapillai
Patients who develop Systemic Lupus Erythematous (SLE) at or after the age of 50 years are considered as late-onset SLE. In this case report, we present a case of class IV Lupus Nephritis in a 60-year-old lady with newly diagnosed SLE. This lady presented with generalized edema and reduced urine output and found to have active urinary sediment, rising serum creatinine, positive ANA and dsDNA and hypocomplementemia. Renal biopsy proved diffuse proliferative glomerulonephritis (Lupus Nephritis – class IV). She was treated with methyl prednisolone and cyclophosphamide as the induction regime. Then treatment was continued according to Euro- Lupus Protocol. She showed clinical and biochemical improvement.
{"title":"A case of Systemic Lupus Erythematosus with class IV nephritis in a 60 year old female","authors":"D. Kumara, T. Peranantharajah, A. Narani, B. Thangarajah, S. Narayanapillai","doi":"10.4038/jmj.v33i1.123","DOIUrl":"https://doi.org/10.4038/jmj.v33i1.123","url":null,"abstract":"Patients who develop Systemic Lupus Erythematous (SLE) at or after the age of 50 years are considered as late-onset SLE. In this case report, we present a case of class IV Lupus Nephritis in a 60-year-old lady with newly diagnosed SLE. This lady presented with generalized edema and reduced urine output and found to have active urinary sediment, rising serum creatinine, positive ANA and dsDNA and hypocomplementemia. Renal biopsy proved diffuse proliferative glomerulonephritis (Lupus Nephritis – class IV). She was treated with methyl prednisolone and cyclophosphamide as the induction regime. Then treatment was continued according to Euro- Lupus Protocol. She showed clinical and biochemical improvement.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"118 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126724413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Auto immune Hepatitis (AIH) with cholestatic jaundice is a rare entity. AIH is characterized by inflammatory changes in liver with the presence of circulating auto antibodies and hyperglobulinemia. Here we report a case of 67-years-old lady who presented with Acute autoimmune hepatitis with cholestatic jaundice with early accurate diagnosis and early initiation of corticosteroids recovered successfully. Even though it is very rare AIH should not be overlooked in patients with cholestatic jaundice without viral/drug induced hepatitis.
{"title":"Autoimmune hepatitis with cholestasis; An uncommon presentation in elderly","authors":"A. Nimalan, S. Sivansuthan","doi":"10.4038/jmj.v33i1.125","DOIUrl":"https://doi.org/10.4038/jmj.v33i1.125","url":null,"abstract":"Auto immune Hepatitis (AIH) with cholestatic jaundice is a rare entity. AIH is characterized by inflammatory changes in liver with the presence of circulating auto antibodies and hyperglobulinemia. Here we report a case of 67-years-old lady who presented with Acute autoimmune hepatitis with cholestatic jaundice with early accurate diagnosis and early initiation of corticosteroids recovered successfully. Even though it is very rare AIH should not be overlooked in patients with cholestatic jaundice without viral/drug induced hepatitis.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"97 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124059407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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