ABSTRACT
INTRODUCTION: Research over the last decade has recognized left ventricular hypertrophy as a risk factor for major cardiovascular events including stroke. While cardiac magnetic resonance imaging is the best modality to quantify left ventricular hypertrophy, echocardiographic calculation of left ventricular mass index is a reasonable alternative. METHODS: We carried out a hospital based prospective study to identify the prevalence of left ventricular hypertrophy, assessed using echocardiography, in patients presenting with ischaemic strokes. This is the first study that attempted to quantify this issue in a cohort of Sri Lankan patients. The study was carried out in the National Hospital of Sri Lanka over a period of 6 months. RESULTS: A total of 55 patients (44 males, 80%) (mean age: 62.3, range: 48-82 years) with ischaemic strokes were studied. Of them, only 38 could be mobilized to measure the height and weight to calculate the left ventricular mass index. Of the rest, only one person had the electrocardiographic criteria for left ventricular hypertrophy. Of the 38 patients evaluated, 29 (76.3%) had left ventricular hypertrophy while 19 (50%) had severe hypertrophy. DISCUSSION AND CONCLUSIONS: The rates of left ventricular hypertrophy reported in similar studies in other countries vary between 25-62%. Given the high prevalence of left ventricular hypertrophy reported in this study and its recognition as a risk factor for stroke recently, together with the availability of effective treatment for risk reduction, the cost effectiveness of population screening should be evaluated. Further studies are planned in this regard.
ABSTRACT
Chikungunya outbreaks occurred in the central province, Sri Lanka in 2006. This community-based study reports the epidemiology and the natural history of the infection from an affected village. Of the 199 families and 1001 individuals in the village, 159 (80%) and 513 (51%) were affected, respectively, comprising 237 (46%) males with peak incidence at 40-50 years. The acute illness caused polyarthritis in 233 (46%), and of them 230 (98%) progressed to chronic arthritic disability (CAD). Of the CAD patients, 102 (44%) had recovered in 141 days (range 30-210 days) from the disability state whilst 128 (56%) had persisting disability which lasted 12, 24, and 36 months in 41 (17.8%), 22 (9.5%), and 14 (6.1%) individuals, respectively. Carpal tunnel syndrome (CTS) manifested in 110 (21%). Females showed preponderance for complications over males: acute arthritis 147 versus 86, P = 0.001; CAD 136 versus 84, P = 0.029; CTS 88 versus 22, P = 0.001; relapses 105 versus 68, P = 0.001. Chikungunya was highly communicable and caused lasting crippling complications.
ABSTRACT
A sixty year old male presented with dark urine, symptomatic anaemia and peripheral gangrene following cold exposure. Investigations revealed that he had haemolysis and serological evidence of recent Epstein Barr virus infection. Although acrocyanosis is commonly associated with cold agglutinin disease, gangrene is a rare complication. Management of secondary cold agglutinin disease is mainly supportive.
ABSTRACT
Copper sulphate ingestion (accidental or deliberate) is a rare form of poisoning usually limited to the Indian subcontinent. Though the rates are on the decline, it is essential that physicians are aware of its lethal complications and management strategies. The main complications of copper sulphate ingestion include intravascular haemolysis, methaemoglobinaemia, acute kidney injury and rhabdomyolysis. The lethal dose can be as small as 10 grams. We have explored the complications of acute copper sulphate poisoning with examples from two case presentations. We also recommend measures for prevention of such events.
