Ceylon Medical Journal最新文献

Cerebral salt wasting (hyponatraemia associated with renal sodium loss and hypovolumia) has been reported secondary to intra-cerebral pathology and following certain infections. Cerebral salt wasting following typhus infection has been reported rarely. We report a case of transient cerebral salt wasting that occurred during the convalescent phase of scrub typhus infection resulting in severe symptomatic hyponatraemia.

The Embryological remnants (ERs) must be removed to achieve a safe and complete 'total' thyroidectomy. Residual ERs, after thyroidectomy, may cause recurrence of the initial pathology. This poses management dilemmas, including a difficult reoperation. Active search and removal of the ERs intraoperatively is essential. Primary overt malignancy is rare in ERs. Literature reports several cohort studies of same. The incidence of a Micropapillary Carcinoma in an ER has not been reported and this brief report describes two patients with Incidental Micropapillary Carcinoma in the Pyramidal lobe, reiterating the need to make removal of ERs the accepted norm in total thyroidectomies.

Background & aim: Maintaining good health in haemodialysis patients is a challenging task that helps to reduce morbidity and mortality. The prevalence of nutrition-related complications is uncertain in Sri Lankan maintenance haemodialysis population. This study was carried out as a baseline study to identify the common nutrition-related complications in maintenance haemodialysis patients.

Methods: A single-centre cross-sectional study was carried out on adult patients on maintenance haemodialysis in a tertiary care centre in the central part of Sri Lanka. Simple random sampling was used, and patients' clinical, anthropometric, body composition via bioelectrical impedance analysis (BIA), laboratory parameters and muscle power were assessed.

Results: We evaluated 114 patients, 87 (76.3%) were males, and the mean age was 52.6 (±12.3) years. Only 9 (7.9%) patients were underweight in the sample population, 77.2% had normal mid-upper arm circumference (MUAC), 81.6% had high muscle mass percentage in BIA analysis, and all patients had normal mid-arm muscle circumference (MAMC). But in 80.5% of patients hand grip power was lower than the cut off for sarcopenia according to EWGSOP2 recommendations. The prevalence of low serum albumin is 33.3% and 60.5% had anaemia. The majority had normocytic normochromic anaemia with high serum ferritin levels. Vitamin D deficiency or insufficiency was 91.2% and electrolyte abnormalities were very common; 57.9% had hypocalcaemia, 61.4% had hyperphosphatemia and all patients had hyperkalaemia.

Conclusions: Muscle mass was preserved in most patients in this population, but the muscle power was significantly low, along with a high prevalence of hypoalbuminaemia, anaemia, vitamin D deficiency or insufficiency, hypocalcaemia, hyperphospatemia and hyperkalaemia.

Introduction: Regional differences in thyroid hormones are noted, especially during pregnancy.

Objectives: Establish reference values for thyroid function tests for Sri Lankan pregnant women and to determine their comparability with regional data; and determine the prevalence of 2. Thyroid Peroxidase (TPO) antibody positivity and 3. Iodine deficiency among pregnant women with uncomplicated clinical history.

Methods: A cross-sectional study conducted in antenatal clinics of a tertiary care maternity center recruited a minimum of 56 women in each trimester in a multistep approach to derive an "ideal-reference population"; Participants with clinically manifested thyroid disease, followed by subjects with sonographically abnormal thyroids and finally those at high risk for thyroid disease as shown by positive TPO levels and urine iodine deficiency were excluded in sequence. Thyroid hormones were measured by chemiluminescence in the ideal reference population. Reference ranges were derived using median and 5th and 95th centiles.

Results: Final sample included 369 women. TSH reference ranges of the first (n=64), second (n=188) and third (n=117) trimesters were 0.014-2.77mIU/L, 0.31-3.2 mIU/L and 0.34-3.4 mIU/L, respectively. TPO antibody level showed a weak but significant correlation with TSH (r=0.10,p 0.021) in the final sample. No significant association was found between urine iodine and thyroid function tests.

Conclusions: TSH reference ranges observed in this study are concordant with the Caucasian reference values more than the regional values. Discrepancies in study methodology, defining and selection of reference population and methods employed in measuring thyroid hormones in different studies may have accounted for these differences.

Introduction: Incidence of non communicable diseases such as diabetes, cardiovascular disease (CVD), several forms of cancer, hypertension, obesity etc is increasing in our country. It is suggested that these diseases can be moderated, in part, by consuming foods that produce a low blood sugar response. It is presumed that kithul treacle is comparable to simple sugars for sweetness, although currently the beneficial effects are not widely known.

Objectives: To assess the chemical composition and glycaemic indices (GI) of kithul treacle and confectionary (aluwa) made using table sugar and kithul treacle.

Methods: Chemical composition was analysed with standard AOAC methods. FAO/WHO guidelines were used to determine the glycaemic responses with glucose as the standard.

Results: The moisture, crude protein, crude fat, total carbohydrate, starch & glucose and total dietary fibre contents of treacle were 28%, 0.3%, 7.9%, 81%, 28% and 2.20% (DM) with negligible ash content. Similarly both aluwa had negligible ash contents. Total carbohydrate (88-89%), fat (2.9%), protein (3.7-4.2%) and total dietary fibre (7.78-8.32%) contents of both aluwa were not significantly different. However, the digestible carbohydrate contents of treacle (67%) and sugar aluwa (59%) were significantly different (p<0.05). The GI of kithul treacle, aluwa made with treacle and sugar were 35, 55 and 63 respectively.

Conclusion: Kithul treacle was categorized as a low GI food whereas both aluwa were categorized as medium GI foods. In comparison to aluwa made with table sugar, the glycaemic response of aluwa made with treacle was lower proving that replacing sugar with treacle leads to lower glycaemic response.

Acquired hepatocerebral degeneration (AHCD) is an acquired, extrapyramidal, neurodegenerative condition, encountered in patients with cirrhosis. It is an uncommon and usually irreversible condition, resulting in widespread cerebral, basal ganglia and cerebellar damage. We describe here four cases of AHCD, with varying presentations, highlighting the need for increased awareness of this condition, to avoid diagnostics delays and unnecessary management.

Abstract: Bone marrow failure (BMF) in children can be idiopathic (70-80%) or inherited. Haematopoietic stem cell transplantation (HSCT) is the only cure for both causes. Allogeneic HSCT requires a suitable donor. Many children will not have a HLA matched sibling or unrelated donor. A haploidentical donor is available for all children as eaazch parent will have at minimum a 50% HLA match. This report of a 7-year old girl with BMF treated with a haplo-HSCT, the first in Sri Lanka, highlights the importance of developing a haploidentical HSCT programme as a potential cure for a disease with a dismal outcome.