Kounis syndrome is associated with mast cell activation resulting in acute coronary syndrome secondary to an allergic insult. Various drugs such as antibiotics, analgesics, and environmental exposures such as bee, wasp sting, and poison ivy are known to induce Kounis syndrome. A 68-year-old man admitted with a cobra bite on both hands to emergency care unit and sustained cardiorespiratory arrest. Electrocardiogram, taken 6 hours after the cardiac arrest, showed ST elevations in leads V2 to V5 suggestive of anterior ST elevation myocardial Infarction (STEMI). Serum Troponin was 10 ng/ml (control= <0.5). Serum IgE levels were significantly high (19155IU/ml, baseline 100). 2-Dimensional echocardiogram showed anterior and apical-septal hypokinesia with left ventricular ejection fraction of 30-35%. Coronary angiogram was normal. He remained hypotensive requiring inotropic and vasopressor support during ICU stay. This was a case of Kounis syndrome leading to cardiogenic shock secondary to Cobra (naja naja) bite. This is the only reported case of cobra bite causing Kounis syndrome and cardiogenic shock. Identification of the cause of myocardial infarction in snake envenomation is useful in the management as some of the drugs like adrenaline, morphine, and beta blockers may worsen the clinical syndrome if it is due to Kounis syndrome.

BackgroundSpinal muscular atrophies (SMAs) are a group of disorders characterized by degeneration of the anterior horn cells in the spinal cord and motor nuclei in the lower brainstem. It is transmitted by autosomal recessive inheritance and most of these conditions are linked to SMN gene. Even if the clinical picture is mainly dominated by the diffuse muscular atrophy, some patients can also show atypical clinical features such as myoclonic epilepsy (“SMA plus”), which may be related to other genes. In particular, the association of SMA and progressive myoclonic epilepsy (PME) has been previously described.Case presentationWe present a case of two brothers with late onset SMA associated with a unique form of non progressive myoclonic epilepsy without cognitive impairment or ataxia. They had identical clinical and electrophysiological features.ConclusionsThe association of SMA with myoclonic epilepsy may constitute a separate and genetically independent syndrome with unique clinical and electrophysiological findings. Collection of similar cases with genetic studies is needed to define the phenotype clearly and to identify new genes and molecular pathogenetic mechanisms involved in this condition.

Introduction:Buddhist-derived meditation is a well-known phenomenological practice that enhances overall wellbeing of individuals. However, broad-and less-rigorous criteria in recruiting suitable meditation practitioners affect the reliability of results obtained through meditation research.Objectives: To develop an instrument to identify skilled meditators among meditation practitioners, in order to use it in scientific research including medical research conducted to understand the physiological, psychological, social, and environmental effects of meditation Methods: Extensive literature reviews, interviews and focus group discussions with experts in a number of related fields were utilized in developing the instrument. Judgmental validation of the generated items was ensured through establishing their face, content and consensual validity. Internal consistency reliability and factor structure of the scale were explored to analyse its psychometric properties. Cut-off marks were determined to develop a scoring system for the instrument.Results: Twenty-five items were categorized under five sections (A, B, C1, C2, D) that addressed six factors: duration of the meditation practice, details of the meditation practice, peripheral awareness, stable attention, and alertness and emotional stability. Three further qualitative items were added under section E. An exploratory factor analysis process resulted in a two-factor structure between the Likert-scale items as theoretically expected. Scores to identify 'skilled meditators' were determined as: Section C1>7 (fall-back score; 7-9, ideal score; 10-12), Section C2>14 (fall-back score; 14-16, ideal score; 17-20) and Section D>25 (fall-back score; 25-29, ideal score; 30-35). Conclusions & Recommendations:The overall findings reveal the UoC-IISM to be a valid and reliable tool to be used in identifying skilled meditators, among meditation practitioners, for scientific research in the Sri Lankan context. The instrument explores six factors through its 28 items and the importance of using a combination of these factors is discussed.

Amyloidosis is a rare disease characterised by the deposition of insoluble extracellular fibrillar proteins in various tissues of the body. The pattern of manifestation is organ dependent and also on whether the disease is localised or systemic, primary or secondary. Primary systemic amyloidosis is a disease of adulthood. In reported cases, the mean patient age of onset is 65 years. We report a case of a young adult who presented with jaundice and leg oedema which ultimately found to have granulomatous hepatitis and nephrotic syndrome secondary to systemic amyloidosis. The purpose of this case report is to reiterate the importance of a high index of suspicion in considering amyloidosis in such presentations regardless of the presenting age.

Background: Buddhist-derived meditation is a well-known phenomenological practice that enhances overall well-being of individuals. However, broad and less-rigorous criteria in recruiting suitable meditation practitioners affect the reliability of results obtained through meditation research. Therefore, we aimed at developing an instrument to identify and recruit skilled meditators to be used in work conducted to understand the physiological, psychological, social, and environmental effects of meditation.Methods: Extensive literature reviews, interviews and focus groups with experts in the field of meditation were utilized in developing the instrument. Judgmental validation of the generated items was ensured through establishing their face, content and consensual validity. Internal consistency reliability and factor structure of the scale was explored to analyze its psychometric properties. Cut-off marks were determined in order to develop a scoring system for the instrument.Results: Twenty five items were categorized under five sections (A, B, C1, C2, D) that addressed six factors: duration of the meditation practice, details of the meditation practice, peripheral awareness, stable attention, alertness, and emotional stability. Three further qualitative items were added under section E. An exploratory factor analysis process resulted in a two-factor structure between the Likert scale items as theoretically expected. Scores to identify ‘skilled meditators’ were determined as: Section C1>7 (fall-back score; 7-9, ideal score; 10-12), Section C2>14 (fall-back score; 14-16, ideal score; 17-20) and Section D>25 (fall-back score; 25-29, ideal score; 30-35).Conclusion: An instrument named, “The Colombo Intake Interview to identify skilled meditators for scientific research (CIISMR)”, consisting of 28 items exploring six factors that identify a “skilled meditator” was developed and validated to the Sri Lankan context. The importance of using a combination of these six factors is discussed.