BackgroundAcute Coronary Syndrome (ACS) is one of the leading causes of death worldwide and studies have shown higher mortality rates and premature death in South Asian countries. The occurrence and effect of risk factors differ by type ofACS.Epidemiological studies in the Sri Lankan population are limited.MethodsThis is a cross sectional descriptive study conducted at the Teaching Hospital Peradeniya, Sri Lanka among patients presenting with ACS. Data was collected by an interviewer administered structured questionnaire and epidemiological patterns and risk factors were analyzed.ResultsThe sample of 300 patients had a mean age of 61.3+/− 12.6 and male sex showed higher association with all three type of ACS compared to female with a P value of 0.001. This study showed higher mean age of 62.2 ± 11.4 years amongst unstable angina (UA) patients and 61.9 ± 14.5 years amongst non ST elevation myocardial infarction (NSTEMI) patients compared to 59.2 ± 11.2 years for ST elevation myocardial infarction (STEMI) patients with no significant statistical difference (P = 0.246). Approximately 55.8% STEMI patients, 39.8% UA and 35.5% NSTEMI patients were smokers indicating a significant association between smoking and STEMI (P = 0.017). Nearly 54.5% STEMI, 35.4% UA and 32.7% NSTEMI patients consumed alcohol and there was a very strong association between alcohol consumption and STEMI (P = 0.006). Almost 51.8% NSTEMI patients, 47.8% UA patients and 29.9% STEMI patients had hypertension(HT) (P = 0.008) indicating significant association of HT with UA and NSTEMI. About 33.6% UA patients and 30.0% NSTEMI patients had DM whilst only 22.1% of STEMI patients had DM of no significance (p = 0.225). Around 15.0% patients with UA, 25.5% with NSTEMI and 11.7% with STEMI had dyslipidemia (P = 0.032). There was a very strong association between a past history of ACS or stable angina with NSTEMI and UA (P = 0.001).ConclusionSmoking and alcohol abuse are significantly associated with STEMI.Patients with NSTEMI or Unstable Angina had higher rates of hypertension and were more likely to have a history of ACS or stable angina than STEMI patients. Patients with NSTEMI were more likely than patients with STEMI or UA to have dyslipidemia.
BackgroundVitamin B12 deficiency is often diagnosed with hematological manifestations of megaloblastic macrocytic anemia, which is usually the initial presentation. Neurological symptoms are often considered to be late manifestations and usually occur after the onset of anemia. Sub acute combined cord degeneration, which is a rare cause of myelopathy is however the commonest neurological manifestation of vitamin B12 deficiency.Case presentationWe present a case of a 66 year old Sinhalese Sri Lankan female, who is a strict vegetarian, presenting with one month’s history suggestive of Sub-acute combined cord degeneration in the absence of haematological manifestations of anaemia. Her Serum B12 levels were significantly low, after which she was treated with hydroxycobalamine supplementation, showing marked clinical improvement of symptoms, with normalization of serum B12 levels. Hence, the diagnosis of vitamin B12 deficiency was confirmed retrospectively.ConclusionVitamin B12 deficiency could rarely present with neurological manifestations in the absence of anaemia. Therefore a high index of suspicion is necessary for the early diagnosis and prompt treatment in order to reverse neurological manifestations, as the response to treatment is inversely proportionate to the severity and duration of the disease.
BackgroundAdvanced life support (ALS) and cardio pulmonary resuscitation, provided at the right time is essential for improving mortality in medical emergencies. Accurate knowledge and skills on this regard, in all medical personals is an essential part of medical education and it should be up to date with varying protocols. The aim of this study is to assess the knowledge and attitudes among the undergraduate medical students and medical officers in the Teaching Hospital Peradeniya and provide suggestions to improve the training programme on ALS.MethodsA standardized self-administered questionnaire regarding knowledge and attitudes on ALS was filled by 4th and final year medical students, and medical officers, and the data was analyzed.ResultsThere were 411 eligible candidates and of them 130 (31.6 %) were 4th year medical students, 221 (53.8 %) were final year medical students and 60 (14.6 %) were medical officers. Of the medical officers, only 15.8 % indicated that the internship training was adequate to handle an emergency confidently. Approximately 45 % of the medical officers and 34.6 % of the final year medical students were confident of saving lives with their current ALS knowledge. However, only 22 % of 4th year medical students were confident in saving the life of a patient.ConclusionsOverall, just over 10 % of participants demonstrated inadequate ALS knowledge scores. A significantly higher proportion of final year medical students had good knowledge, compared to medical officers and 4th year students. Only one-third of participants were confident in saving a life with their current ALS knowledge. Nearly all participants thought that the ALS course should be reevaluated frequently.
BackgroundSri Lanka has a high suicide rate, with more than 40 % of poisoning admissions due to overdose of drugs with Paracetamol being the commonest. Data regarding cardiotoxicity to paracetamol is very minimal though hepatotoxicity following poisoning is well studied. Paracetamol cardiotoxicity has rarely been clinically significant and may have well been overlooked. The possibility that paracetamol overdose might be directly cardiotoxic has been the subject of a few reports. Unexplained deaths and electrocardiographic changes associated with paracetamol poisoning have also been reported in which cardiac origin cannot be clearly ruled out. Although some studies state that paracetamol poisoning has no direct cardiotoxic effect, electrocardiographic changes due to metabolic derangement of hepatotoxicity have been shown in certain studies. Thus, we conducted this study to assess in detail the cardiotoxic effect of paracetamol poisoning.MethodsThis is a cross sectional descriptive study done on those with confirmed paracetamol poisoning. Serum paracetamol levels, Electrocardiogram, Echocardiogram, troponin I, and other basic investigations were done.ResultsParacetamol ingestion is more common among teenagers and the young population in Sri Lanka. Although several cases of paracetamol poisoning induced cardiotoxicity has been described in the past, this study demonstrated no electrocardiographic, echocardiographic or cardiac biomarkers changes of myocardial toxicity.ConclusionThough literature review support cardiotoxicity following paracetamol poisoning, our study does not provide enough evidence for this. Continuous cardiac monitoring, serial troponin and echocaediogram assessment would be voluble adjunct in its management. Further experiments and research in this subject would be useful with a larger number of samples to further evaluate this important problem.
BackgroundEwing sarcoma is a primary bone neoplasm, which is a high grade aggressive small round blue cell tumour, and is currently recognized as a part of the Ewing family of tumours. It is the most lethal bone tumor, and is a rare malignant bone tumor accounting for 10% of all primary bone tumors, and 6% of malignant bone tumors. It has an average annual incidence of 3 per 1 million, found almost exclusively in Caucasians. It commonly occurs in long bones and pelvis but rarely involves the scapula. 85% of cases have metastasis within 2 years of diagnosis, rarely involving the meninges.Case presentationWe report a case of a 25 year old Sinhalese Sri Lankan female, presenting with a 1 day history of bilateral lower limb weakness and urinary incontinence. She had a sensory level with flaccid paralysis of lower limbs and a painless bony lump in the left dorsal scapula. Investigations showed scapular primary Ewing sarcoma giving rise to spinal intradural metastasis. For the best of our knowledge this is the first reported case of a scapular Ewing sarcoma with spinal intradural metastasis presenting with lower limb paralysis.ConclusionIntradural spinal metastasis of Ewing sarcoma presenting with lower limb weakness, without a history of pain, though rarely, can be the first presentation, and can rapidly progress to brainstem involvement and death.
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