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Biomedical subjects

H J de Silva

Publications and source records attributed to H J de Silva.

At least 19 recordsLinked to original sources
PubMed1994

Delayed cerebellar ataxia complicating falciparum malaria: a clinical study of 74 patients.

We report the clinical features of 74 patients with delayed cerebellar ataxia (DCA) following falciparum malaria, who were prospectively followed up at two centres. This unusual complication has an acute onset, with signs suggesting a predominantly midline cerebellar lesion without any evidence of cerebral involvement. There was a delay of a median 13 days between the onset of fever and the onset of ataxia. DCA has a good prognosis, with spontaneous and complete recovery within 3 months. In our opinion, it is an example of a post-infective neurological syndrome possibly mediated via an immune mechanism.

Acute Disease↗
PubMed1994

Optimum dose of olsalazine for maintaining remission in ulcerative colitis.

To evaluate the optimum dose of olsalazine for maintaining remission in ulcerative colitis, 198 patients in remission for more than three months were randomly assigned to receive 0.5 g, 1.0 g, or 2.0 g/day for 12 months. A dose-ranging effect was detected in the per protocol analysis, with remission rates of 60% (0.5 g), 70% (1.0 g), and 78% (2.0 g) (p = 0.03, trend in proportions). The higher dose was most effective in patients with proctitis (90% remission on 2 g/day, p = 0.03) or those in remission for less than 12 months before the trial (88% remission on 2 g/day, p = 0.0006). There was little dose-ranging effect in patients with extensive colitis or those in remission for more than 12 months. Diarrhoea necessitated treatment withdrawal in 12%. The optimal dose of olsalazine for maintaining remission in ulcerative colitis is 1 g/day. For patients with proctitis or recent relapse, 2 g/day may be preferable, although the dose seems to be less important in patients with more extensive disease or those in long term remission.

Aminosalicylic Acids↗
PubMed1994

Absence of anti-Purkinje cell antibodies in patients with cerebellar ataxia following falciparum malaria.

Immunological mechanisms have been implicated in the pathogenesis of delayed cerebellar ataxia following falciparum malaria (DCA). We tested serum and CSF samples obtained from 39 Sri Lankan patients with DCA for the presence of antibodies (Ab) directed against cerebellar Purkinje cells by an immunofluorescence (IF) technique and Western blot analysis. For the IF test 7 mu thick frozen sections of histologically normal cerebellum obtained at post mortem were used. Proteins obtained from crude preparations of Purkinje cells isolated from the cerebellum were used for Western blot analysis. Sera obtained from patients known to have antineuronal antibodies associated with cerebellar degenerations and paraneoplastic disorders (anti-Hu and anti-Yo Ab) and sera from normal blood donors served as positive and negative controls, respectively. All serum and CSF samples obtained from patients with DCA were negative for Ab directed against cerebellar Purkinje cells. Humoral mechanisms are, therefore, unlikely to be important in the pathogenesis of this delayed complication of falciparum malaria.

Adolescent↗
PubMed1994

Intestinal parasitoses in the Kandy area, Sri Lanka.

The prevalence of intestinal protozoa and geohelminths was assessed among two diverse populations in the Kandy area: adults attending medical outpatients clinics at the Teaching Hospital Peradeniya, and pre-school children in low-cost housing areas within the Kandy Municipality. In addition to a brief history and examination, a fresh stool sample was obtained and examined by direct smears in saline and iodine, and by formol-ether concentration. The children's stool samples were also examined for Cryptosporidium by cold Ziehl-Neelsen staining. A total of 192 stool samples from the adult outpatients (101 males, age range 15-82 years, mean 51.4 years) and 354 samples from the pre-school children (age range 1-72 months, mean 30 months) were examined. Entamoeba histolytica was not seen in any of the samples; Giardia cysts and Cryptosporidium oocysts were seen in three and one sample respectively from the pre-school children. The overall prevalence of geohelminth infections was 21.3% among the adults and 24.5% among the children. Ascaris lumbricoides was the predominant species in both populations. Comparison of the rate of intestinal parasite infection among 37 adult patients patients with non-specific abdominal complaints, with the rate among 37 matched controls with no abdominal complaints showed no significant difference (16% and 19% respectively). This suggests that the presence of abdominal pain or diarrhea was unrelated to the presence of intestinal parasites in the adult study population. Although the techniques used were not highly sensitive, the absence of E. histolytic probably reflects a true decline in the prevalence of this parasite in Sri Lanka.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Hypokalaemic periodic paralysis in central Sri Lanka.

We describe 14 Sinhalese male patients with hypokalaemic periodic paralysis (HPP). The age at onset was between 10 and 32 years. Each paralytic episode lasted from 6 to 48 hours (except in one patient who had an attack lasting 5 days). The frequency of attacks varied from 8 to 10 per month in one patient to only 2 attacks over a period of 16 years in another. Four patients (28.6%) had a family history of the disease. Hypokalaemia (serum potassium 1.5 to 3 mmol/l) was documented during an attack in 11 patients. No cause for hypokalaemia was evident in any of them. Investigations including EMG, thyroid hormone level and skeletal muscle histology were within normal limits between episodes. All the patients responded well to treatment with potassium supplementation, alone or with acetazolamide.

Adolescent↗
PubMed1993

A scale to assess severity in organophosphorus intoxication: POP scale.

We have developed a clinical scale to assess severity or organophosphorus (OP) intoxication. Five common clinical manifestations of OP poisoning have been selected as parameters, each to be assessed on a 3 point scale varying from 0-2. Poisoning can then be graded as mild (score 0-3), moderate (score 4-7) or severe (score 8-11) when the patient first presents. The scale was validated using two consecutive series of 173 patients with OP poisoning. Correlations between the scores obtained on admission and three outcome variables, namely, death, the need for ventilatory support and the dose of atropine required in the first 24 hours after admission were significant. We believe that this scale would assist in grading severity of OP intoxication at first contact and help in predicting possible outcome.

Bradycardia↗
PubMed1993

Viral hepatitis complicating pregnancy--a five year hospital based retrospective study.

Limited data are available on viral hepatitis (VH) complicating pregnancy from Sri Lanka. We retrospectively studied all pregnant and non-pregnant women of child bearing age, who were admitted with VH to the Teaching Hospital Peradeniya between January 1987 and December 1991. During this period, there were 187 cases of icteric VH among non-pregnant women of child bearing age, but only 10 cases among pregnant women (hospital incidence of 0.35 cases of VH per 1000 pregnancy related admissions). Two of the 10 (case fatality 20%) pregnant women died of causes related to VH compared with only 3 of the 187 (1.6%) non-pregnant women (p < 0.001), giving a relative risk of death due to VH in pregnant women of 12.5 (95% confidence limits 1.8-85.6). The perinatal case fatality rate due to VH was 20%. VH complicating pregnancy does not appear to be a common cause of hospital admission, but pregnancy makes death due to VH more likely. VH complicating pregnancy also results in a high perinatal mortality.

Adolescent↗
PubMed1993

Chloramphenicol resistant typhoid fever.

We report a patient with typhoid fever caused by a strain of Salmonella typhi which was resistant to chloramphenicol. This is the first documentation of chloramphenicol resistant Salmonella typhi in Sri Lanka.

Adult↗
PubMed1992

Does pralidoxime affect outcome of management in acute organophosphorus poisoning?

Acute organophosphorus (OP) poisoning is usually treated with atropine plus cholinesterase reactivators such as oximes, but controlled trials to assess the efficacy of oximes in OP poisoning have not been done. A period when the acetyl cholinesterase reactivator pralidoxime chloride was not available in Sri Lanka gave us the opportunity to compare atropine alone for treatment of moderate to severe OP poisoning (21 patients) with atropine plus pralixodime (24 patients). Outcome, as assessed clinically, was similar in the two groups. These results cast doubt on the necessity of cholinesterase reactivators for treatment of acute OP poisoning.

Adolescent↗
PubMed1992

A two-year follow-up study of alcohol dependent men rehabilitated at a special unit in a developing country.

Two hundred and thirty-four alcohol dependent men who had all failed to improve after previous hospital-based interventions were admitted to an intensive 6-week residential rehabilitation programme conducted at a special unit in Sri Lanka. Outcome was assessed at 2 years post-treatment, and 36% of dependent persons remained totally abstinent. During an extended period of follow-up (mean 39.2 months) a significant association was found between abstinence and having a life partner, stable family support, a higher income and regular employment. However, there was no significant association between abstinence and age, duration of alcohol dependence, level of education or type of employment. Although the majority of alcohol dependent persons did not benefit from the programme, our results compare favourably with those of similar studies done in developed countries.

Adult↗
PubMed1992

Central retinal artery occlusion associated with migraine.

We report a case of central retinal artery occlusion associated with migraine. Although this association is rare, the importance of early diagnosis, and the long-term management of this form of complicated migraine are briefly discussed.

Adult↗
PubMed1991

Clinical and functional outcome after restorative proctocolectomy.

Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has been carried out on 88 patients since 1982. Three different pouch designs (J, S and W) were used. Ten pouches had to be removed. Detailed analysis was performed on 61 patients (J = 23, S = 15, W = 23) whose pouches had been functioning for at least 6 months. There was no significant difference in surgical complications before or after ileostomy closure between pouch designs but the hospital stay was greater after construction of an S pouch (P less than 0.05). There were no significant differences in stool frequency, degree of continence or urgency between the three types. Twelve patients with J pouches required antidiarrhoeal medication compared with only one with S and five with W pouches. Only seven patients with S pouches could defaecate spontaneously compared with 22 with W pouches and all patients with J pouches (P less than 0.001). Twenty-five of 29 patients who had preservation of the anal transition zone had perfect continence compared with 23 of 32 with a mucosal proctectomy (P = n.s.). Pouchitis occurred in 13 patients, all of whom had ulcerative colitis. In a subgroup of 23 patients, pouch evacuation was assessed scintigraphically. There was no difference in pouch capacity or total volume evacuated, but spontaneous evacuation was better in J and W pouches compared with S pouches.

Adult↗