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Daniel C, Enghard P, Ratnatunga N, Wijetunge S, Wazil A, Zwiener C, Barth JA, Chandrajith R, Klewer M, Eckhardt KU, Amann K, Freund P, Premarathne S, Pushpakumara W, Nanayakkara N. Early Ultrastructural Changes in Biopsies From Patients With Symptomatic CKD of Uncertain Etiology. Kidney Int Rep 2023; 8:642-657. [PMID: 36938087 PMCID: PMC10014386 DOI: 10.1016/j.ekir.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/01/2023] Open
Abstract
Introduction Although the investigation of chronic kidney disease of uncertain etiology (CKDu) has identified many possible influencing factors in recent years, the exact pathomechanism of this disease remains unclear. Methods In this study, we collected 13 renal biopsies from patients with symptomatic CKDu (Sym-CKDu) from Sri Lanka with well-documented clinical and socioeconomic factors. We performed light microscopy and electron microscopic evaluation for ultrastructural analysis, which was compared with 100 biopsies from German patients with 20 different kidney diseases. Results Of the 13 Sri Lankan patients, 12 were men (92.3%), frequently employed in agriculture (50%), and experienced symptoms such as feeling feverish (83.3%), dysuria (83.3%), and arthralgia (66.6%). Light microscopic evaluation using activity and chronicity score revealed that cases represented early stages of CKDu except for 2 biopsies, which showed additional signs of diabetes. Most glomeruli showed only mild changes, such as podocyte foot process effacement on electron microscopy. We found a spectrum of early tubulointerstitial changes including partial loss of brush border in proximal tubules, detachment of tubular cells, enlarged vacuoles, and mitochondrial swelling associated with loss of cristae and dysmorphic lysosomes with electron-dense aggregates. None of these changes occurred exclusively in Sym-CKDu; however, they were significantly more frequent in these cases than in the control cohort. Conclusion In conclusion, our findings confirm the predominant and early alterations of tubular structure in CKDu that can occur without significant glomerular changes. The ultrastructural changes do not provide concrete evidence of the cause of CKDu but were significantly more frequent in Sym-CKDu than in the controls.
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Affiliation(s)
- Christoph Daniel
- Department of Nephropathology, Institute of Pathology, Friedrich–Alexander Universität, Erlangen-Nuremberg, Erlangen, Germany
| | - Philipp Enghard
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin, Berlin, Germany
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Sulochana Wijetunge
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - A.W.M. Wazil
- Nephrology and Kidney Transplant Unit, National Hospital, Kandy, Sri Lanka
| | - Christian Zwiener
- Environmental Analytical Chemistry, Department of Geosciences, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Johannes A.C. Barth
- Department of Geography and Geosciences, Friedrich–Alexander-Universtiät Erlangen-Nuremberg, GeoZentrum Nordbayern, Erlangen, Germany
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
| | - Monika Klewer
- Department of Nephropathology, Institute of Pathology, Friedrich–Alexander Universität, Erlangen-Nuremberg, Erlangen, Germany
| | - Kai-Uwe Eckhardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin, Berlin, Germany
| | - Kerstin Amann
- Department of Nephropathology, Institute of Pathology, Friedrich–Alexander Universität, Erlangen-Nuremberg, Erlangen, Germany
| | - Paul Freund
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin, Berlin, Germany
| | | | | | - Nishantha Nanayakkara
- Nephrology and Kidney Transplant Unit, National Hospital, Kandy, Sri Lanka
- Correspondence: Nishantha Nanayakkara, Center for Research, National Hospital Kandy, Kandy, Sri Lanka.
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Badurdeen Z, Ratnatunga N, Abeysekera T, Wazil AWM, Rajakrishna PN, Thinnarachchi JP, Welagedera DD, Ratnayake N, Alwis APD, Abeysundara H, Kumarasiri R, Taylor R, Nanayakkara N. Randomized control trial of prednisolone and doxycycline in patients with acute interstitial nephritis of unknown aetiology. Trials 2023; 24:11. [PMID: 36600250 DOI: 10.1186/s13063-022-07056-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Patients presenting with acute interstitial nephritis (AIN) of unknown aetiology, probably the earliest presentation of chronic kidney disease of unknown aetiology (CKDu), have been treated with oral prednisolone and doxycycline by physicians in Sri Lanka. This trial assessed the effectiveness of prednisolone and doxycycline based on eGFR changes at 6 months in patients with AIN of unknown aetiology. METHOD A randomized clinical trial with a 2 × 2 factorial design for patients presenting with AIN of unknown aetiology (n = 59) was enacted to compare treatments with; A-prednisolone, B-doxycycline, C-both treatments together, and D-neither. The primary outcome was a recovery of patients' presenting renal function to eGFR categories: 61-90 ml/min/1.73m2 (complete remission- CR) to 31-60 ml/min/1.73m2 (partial remission- PR) and 0-30 ml/min/1.73m2 no remission (NR) by 6 months. A secondary outcome was progression-free survival (not reaching < 30 ml/min/1.73m2 eGFR), by 6-36 months. Analysis was by intention to treat. RESULTS Seventy patients compatible with a clinical diagnosis of AIN were biopsied for eligibility; 59 AIN of unknown aetiology were enrolled, A = 15, B = 15, C = 14 and D = 15 randomly allocated to each group. Baseline characteristics were similar between groups. The number of patients with CR, PR and NR, respectively, by 6 months, in group A 3:8:2, group B 2:8:3 and group C 8:5:0 was compared with group D 8:6:1. There were no significant differences found between groups A vs. D (p = 0.2), B vs. D (p = 0.1) and C vs. D (p = 0.4). In an exploratory analysis, progression-free survival in prednisolone-treated (A + C) arms was 0/29 (100%) in comparison to 25/30 (83%) in those not so treated (B + D) arms, and the log-rank test was p = 0.02, whereas no such difference found (p = 0.60) between doxycycline-treated (B + C) arms 27/29 (93%) vs those not so treated (A + D) arms 27/30 (90%). CONCLUSION Prednisolone and doxycycline were not beneficial for the earliest presentation of CKDu at 6 months. However, there is a potential benefit of prednisolone on the long-term outcome of CKDu. An adequately powered steroid trial using patients reaching < 30 ml/min/1.73m2 eGFR by 3 years, as an outcome is warranted for AIN of unknown aetiology. TRIAL REGISTRATION Sri Lanka Clinical Trial Registry SLCTR/2014/007, Registered on the 31st of March 2014.
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Affiliation(s)
- Zeid Badurdeen
- Centre for Education Research and Training On Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka.
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Tilak Abeysekera
- Renal Transplant and Dialysis Unit, Teaching Hospital, Kandy, Sri Lanka
| | - Abdul W M Wazil
- Renal Transplant and Dialysis Unit, Teaching Hospital, Kandy, Sri Lanka
| | | | | | | | - Nadeeka Ratnayake
- Renal Transplant and Dialysis Unit, Teaching Hospital, Kandy, Sri Lanka
| | | | - Hemalika Abeysundara
- Department of Statistics and Computer Science, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
| | - Ranjith Kumarasiri
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Richard Taylor
- School of Public Health and Community Medicine (SPHCM), Faculty of Medicine, University of New South Wales (UNSW), Kensington, Australia
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Premarathne S, Chandrajith R, Nanayakkara N, Gamage CD, Ratnatunga N, Wijetunge S, Badurdeen Z, Guruge S, Elladeniya N, Madushan KPS, Samarasiri KOCU, Hewavitharane P, Herath D, Senarathne S. Could Consumption of Trace Element-Contaminated Rice Be a Risk Factor for Acute Interstitial Nephritis with Uncertain Etiology in the Dry Zone of Sri Lanka? Biol Trace Elem Res 2022; 200:2597-2605. [PMID: 34431070 DOI: 10.1007/s12011-021-02880-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Ingestion of toxic trace elements in the human body has been considered one of the major reasons for renal dysfunction. Chronic kidney disease with uncertain etiological factors (CKDu) is a recently described clinical entity in which the disease is found in geographically isolated pockets in the dry zone of Sri Lanka. In CKDu regions, an increasing number of cases are reported with acute interstitial nephritis without any known reason (AINu). However, recent exposure to certain risk behaviors or nephrotoxins, or both, is suspected for the AINu. Consumption of foods that are contaminated with trace elements is one of the main pathways of human exposure to environmental toxins. The current study was carried out to assess the possibility of trace element-contaminated rice consumption on the etiopathogenesis of AINu. Samples of rice consumed by 32 clinically diagnosed AINu cases were collected and analyzed for possible nephrotoxic trace elements. Out of 32 patients, 26 were histologically confirmed with tubulointerstitial disease. The results revealed that the mean values of Cd, As, and Pb were 0.18, 0.055, and 0.135 mg/kg, with ranges of 0.020-1.06, 0.012-0.222, and 0.003-0.744 mg/kg (on dry weight basis), respectively. This study indicated that the investigated toxic trace element levels of rice consumed by AINu were reasonably below the recommended levels of the Codex Alimentarius Commission of FAO and WHO. Hence, it is less likely that rice consumption is to be a risk factor for the etiology of AINu.
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Affiliation(s)
| | - Rohana Chandrajith
- Department of Geology, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka.
| | | | - C D Gamage
- Department of Microbiology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Sulochana Wijetunge
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Zeid Badurdeen
- Centre for Education Research and Training On Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Shashika Guruge
- State Key Laboratory of Environmental Aquatic Chemistry, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing, 100085, China
| | - N Elladeniya
- Centre for Education Research and Training On Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - K P S Madushan
- Centre for Education Research and Training On Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - K O C U Samarasiri
- Centre for Education Research and Training On Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | | | | | - Sachintha Senarathne
- Department of Geology, Faculty of Science, University of Peradeniya, Kandy, Sri Lanka
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BADURDEEN Z, Ratnatunga N, Abeysekera T, Nanayakkara N. POS-004 A CASE REPORT ON EPISODIC ACUTE INTERSTITIAL NEPHRITIS OF UNKNOWN ETIOLOGY. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Fonseka S, Wijeyaratne CN, Gawarammana IB, Kalupahana NS, Rosairo S, Ratnatunga N, Kumarasiri R. Effectiveness of Low-dose Ethinylestradiol/Cyproterone Acetate and Ethinylestradiol/Desogestrel with and without Metformin on Hirsutism in Polycystic Ovary Syndrome: A Randomized, Double-blind, Triple-dummy Study. J Clin Aesthet Dermatol 2020; 13:18-23. [PMID: 32983332 PMCID: PMC7492016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND: The effectiveness of different combined oral contraceptive pills and metformin in reducing hirsutism in patients with polycystic ovary syndrome (PCOS) remains unclear. OBJECTIVE: We sought to determine the effects of ethinylestradiol (35μg)/cyproterone acetate (2mg) (EE/CPA) and ethinylestradiol (20μg)/desogestrel (0.15mg) (EE/DES), alone or with metformin, on hirsutism in PCOS. METHODS: A randomized, double-blind, triple-dummy study was conducted on women with PCOS and hirsutism (N=107) who received one of four drug combinations (Arm A: EE/CPA; Arm B: EE/DES; Arm C: EE/CPA plus metformin; or Arm D: EE/DES plus metformin). Hirsutism was assessed at baseline, six months, and 12 months by using five outcomes variables. RESULTS: No outcomes variable showed a significant difference between the four arms at 12 months. There was a significant reduction in both hair density and modified Ferriman-Gallwey score (mFGS) in Arm A, mFGS in Arm B, hair density in Arm C, and diameter of sideburn hair in Arm D, respectively. Separately, there was a significant increase noted in the hair growth rate of chin and an improvement in patients' perceptions of hirsutism in all four study arms. CONCLUSION: EE/CPA and EE/DES were equally effective in improving hirsutism in PCOS, with no added benefit from low-dose metformin. Sri Lanka Clinical Trials Registry (http://www.slctr.lk) registration no. SLCTR/2015/007.
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Affiliation(s)
- Sanjeewani Fonseka
- Dr. Fonseka is with the Department of Pharmacology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Wijeyaratne is with the Department of Obstetrics and Gynocology, Faculty of Medicine at the University of Colombo in Sri Lanka
- Dr. Gawarammana is with the Department of Medicine, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Kalupahana is with the Department of Physiology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Rosairo is with the Department of Radiology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Ratnatunga is with the Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Kumarasiri is with the Faculty of Medicine at the University of Peradeniya in Sri Lanka
| | - Chandrika N Wijeyaratne
- Dr. Fonseka is with the Department of Pharmacology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Wijeyaratne is with the Department of Obstetrics and Gynocology, Faculty of Medicine at the University of Colombo in Sri Lanka
- Dr. Gawarammana is with the Department of Medicine, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Kalupahana is with the Department of Physiology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Rosairo is with the Department of Radiology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Ratnatunga is with the Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Kumarasiri is with the Faculty of Medicine at the University of Peradeniya in Sri Lanka
| | - Indika B Gawarammana
- Dr. Fonseka is with the Department of Pharmacology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Wijeyaratne is with the Department of Obstetrics and Gynocology, Faculty of Medicine at the University of Colombo in Sri Lanka
- Dr. Gawarammana is with the Department of Medicine, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Kalupahana is with the Department of Physiology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Rosairo is with the Department of Radiology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Ratnatunga is with the Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Kumarasiri is with the Faculty of Medicine at the University of Peradeniya in Sri Lanka
| | - Nishan S Kalupahana
- Dr. Fonseka is with the Department of Pharmacology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Wijeyaratne is with the Department of Obstetrics and Gynocology, Faculty of Medicine at the University of Colombo in Sri Lanka
- Dr. Gawarammana is with the Department of Medicine, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Kalupahana is with the Department of Physiology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Rosairo is with the Department of Radiology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Ratnatunga is with the Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Kumarasiri is with the Faculty of Medicine at the University of Peradeniya in Sri Lanka
| | - Shanthini Rosairo
- Dr. Fonseka is with the Department of Pharmacology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Wijeyaratne is with the Department of Obstetrics and Gynocology, Faculty of Medicine at the University of Colombo in Sri Lanka
- Dr. Gawarammana is with the Department of Medicine, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Kalupahana is with the Department of Physiology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Rosairo is with the Department of Radiology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Ratnatunga is with the Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Kumarasiri is with the Faculty of Medicine at the University of Peradeniya in Sri Lanka
| | - Neelakanthi Ratnatunga
- Dr. Fonseka is with the Department of Pharmacology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Wijeyaratne is with the Department of Obstetrics and Gynocology, Faculty of Medicine at the University of Colombo in Sri Lanka
- Dr. Gawarammana is with the Department of Medicine, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Kalupahana is with the Department of Physiology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Rosairo is with the Department of Radiology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Ratnatunga is with the Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Kumarasiri is with the Faculty of Medicine at the University of Peradeniya in Sri Lanka
| | - Ranjith Kumarasiri
- Dr. Fonseka is with the Department of Pharmacology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Wijeyaratne is with the Department of Obstetrics and Gynocology, Faculty of Medicine at the University of Colombo in Sri Lanka
- Dr. Gawarammana is with the Department of Medicine, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Kalupahana is with the Department of Physiology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Rosairo is with the Department of Radiology, Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Ratnatunga is with the Faculty of Medicine at the University of Peradeniya in Sri Lanka
- Dr. Kumarasiri is with the Faculty of Medicine at the University of Peradeniya in Sri Lanka
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Jayawardena N, Ralapanawa U, Kumarihamy P, Jayalath T, Abeygunawardana SP, Dissanayake N, Dissanayake P, Udupihille J, Ratnatunga N, Dalugama C. Infective myositis, an uncommon presentation of melioidosis: a case report and review of the literature. J Med Case Rep 2019; 13:388. [PMID: 31888746 PMCID: PMC6937802 DOI: 10.1186/s13256-019-2321-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/20/2019] [Indexed: 11/22/2022] Open
Abstract
Background Melioidosis is considered endemic in certain areas of the world. Musculoskeletal and soft tissue involvement are relatively uncommon presentations in melioidosis. We present a case of infective myositis in a patient with melioidosis in Sri Lanka, which is not considered an endemic country. Even though multiple cases of melioidosis have been reported with an increasing number in Sri Lanka, infective myositis secondary to melioidosis was not reported previously. Case presentation A 60-year-old Sinhalese man with diabetes presented with fever of 4 months’ duration and a limp with a painful lump on the right side of the upper thigh of 2 months’ duration. He had been treated in a local hospital for community-acquired pneumonia 3 weeks prior to this admission, for which he had received intravenous meropenem and teicoplanin with intensive care unit admission. He had a 0.5-cm × 0.5-cm tender lump over the right vastus lateralis muscle, and contrast-enhanced computed tomography of the area showed an ill-defined, heterogeneously enhancing, hypodense area involving the vastus lateralis, vastus intermedius, and quadratus femoris, suggestive of infective myositis but without abscess formation. Histopathology of the muscle biopsied from the vastus lateralis showed suppurative inflammation of subcutaneous fat with connective tissue necrosis and muscle infiltrated by lymphocytes. These features are suggestive of infective myositis possibly due to melioidosis. Although the result of a culture taken from the muscle biopsy was negative, the patient’s antibody titer was strongly positive for melioidosis. He did not show any other areas with infected foci. He was treated with intravenous meropenem for 2 weeks and responded well. He was discharged with trimethoprim-sulfamethoxazole for 6 months as a maintenance therapy. Conclusion Melioidosis is commonly an undiagnosed disease that has a wide variety of clinical presentations. Myositis in melioidosis is uncommon, and careful evaluation is mandatory to avoid misdiagnosis of this treatable but fatal disease. The clinician should have a high index of clinical suspicion, and further clinical and epidemiological studies are needed to determine the true burden of the disease.
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Affiliation(s)
| | - Udaya Ralapanawa
- Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Thilak Jayalath
- Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | | | | - Jeevani Udupihille
- Department of Radiology, University of Peradeniya, Peradeniya, Sri Lanka
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BADURDEEN Z, Hemage R, Fernando B, Hettiarachchi- T, Dharmasiri T, Ratnatunga N, Abeysekera T, Abeysundara H, Hettipolage S, Nishantha N. SAT-176 A PILOT STUDY: MANIFESTATION OF CANDIDATE RENAL BIOMARKERS IN PATIENTS WITH CHRONIC KIDNEY DISEASE OF UNCERTAIN ETIOLOGY. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Basnayake D, Wazil A, Nanayakkara N, Mahanama B, Ratnatunga N, Dissanayake K, Priyadarshana P. SP166A RETROSPECTIVE STUDY ON CLINICAL AND HISTOLOGICAL PATTERN OF PRESENTATION IN LUPUS NEPHRITIS PATIENTS - A SINGLE CENTRE EXPERIENCE IN SRI LANKA. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Duminda Basnayake
- No 315, Williumgopallawa Road, Suduhumpola, Kandy, Sri Lanka, Sri Lanka
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Herath N, Uluwattage W, Weliwitiya T, Karunanayake L, Lekamwasam S, Ratnatunga N, Karunanayake P, Wickramasinghe S, Patabendi S, Senaviratne S, Agampodi S. Sequel and therapeutic modalities of leptospirosis associated severe pulmonary haemorrhagic syndrome (SPHS); a Sri Lankan experience. BMC Infect Dis 2019; 19:451. [PMID: 31113404 PMCID: PMC6530063 DOI: 10.1186/s12879-019-4094-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/15/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The emergence of leptospirosis-associated severe pulmonary hemorrhagic syndrome (SPHS) with high case fatality has been reported from many countries. Understanding of clinical disease and sequel of SPHS needs larger studies with adequate numbers. The purpose of this study was to describe the characteristics and sequel by different therapeutic approaches for SPHS in Leptospirosis in Sri Lanka. METHODS This study was conducted at Teaching Hospital-Karapitiya (THK), Galle, Sri Lanka from June 2015 to December 2017. THK is the main tertiary care center for the Southern Province. All confirmed-cases of leptospirosis who presented during this period and were admitted to five medical units of THK were included in this study. SPHS was defined as a patient presenting; haemoptysis, arterial hypoxemia (Acute Lung Injury Score < 2.5), haemoglobin drop (10% from the previous value), or diffused alveolar shadows in the chest radiograph, without alternative explanation other than leptospirosis. RESULTS Of the 128 MAT confirmed cases of leptospirosis, 111 (86.7%) had acute kidney injury (AKI) whilst SPHS was seen in 80 (62.5%). Patients typically developed SPHS within the first week of illness, mostly on days 4 and 5. The case fatality rate of this study sample was 28.1% (n = 36), while for patients with SPHS, it was 41.5%. Most of the deaths (n = 19) were within the first 3 days of admission (on the same day 8, and within next 48 h 11). Among SPHS patients, 59 received therapeutic plasma exchange (TPE). The survival rate was higher (n = 35, 74.5%) when the TPE was performed within the first 48 h of detecting SPHS compared to patients in whom the procedure was done after 48 h (n = 5, 54.5%). Of the 19 leptosprosis patients with SPHS who did not receive TPE, 17 died (89.5%). However, the group of patients who received TPE was primarily the patients survived beyond day 3. CONCLUSIONS We observed that during the study period, SPHS was common and the mortality rate was higher in the study area. The treatment modalities tested need further evaluation and confirmation.
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Affiliation(s)
| | | | | | | | - Sarath Lekamwasam
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Panduka Karunanayake
- Department of Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | | | | | | | - Suneth Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka.
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Wettasinghe MC, Rosairo S, Ratnatunga N, Wickramasinghe ND. Diagnostic accuracy of ultrasound characteristics in the identification of malignant thyroid nodules. BMC Res Notes 2019; 12:193. [PMID: 30940214 PMCID: PMC6444851 DOI: 10.1186/s13104-019-4235-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/28/2019] [Indexed: 01/15/2023] Open
Abstract
Objective This study was aimed at determining the diagnostic accuracy of the ultrasound characteristics in the identification of malignant thyroid nodules in patients attending the surgical clinic at a tertiary care hospital in Sri Lanka. Results This prospective validation study was conducted among 263 patients attending the surgical clinic at a tertiary care hospital, Sri Lanka. The ultrasound characteristics having statistically significant associations with thyroid malignancies were identified by employing a multivariable analysis. These ultrasound characteristics were compared with Fine Needle Aspiration Cytology results and indicators of diagnostic accuracy were computed. The study sample consisted of 33 malignant and 230 benign nodules. Internal vascularity, hypoechogenicity and microcalcification showed statistically significant positive associations with thyroid malignancy (p < 0.05). The highest positive likelihood ratio was observed for the presence of microcalcifications (10.4, 95% CI 4.6–23.7) with a specificity of 96.5% (95% CI 93.3–98.5%). Hypoechogenicity had a sensitivity of 66.7% (95% CI 48.2–82.0%) and a specificity of 74.8% (95% CI 68.6–80.3%). The presence of at least one positive ultrasound characteristic yielded the highest sensitivity (87.9%, 95% CI 71.8–96.6%), whereas, the presence of all three characteristics yielded a near perfect specificity (99.6%, 95% CI 97.6–99.9%). Hence, the presence of microcalcifications was found to be the single most useful criterion in predicting thyroid malignancy.
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Affiliation(s)
| | - Shanthini Rosairo
- Department of Radiology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, 20400, Sri Lanka
| | - Nuwan Darshana Wickramasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka.
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Anand S, Montez-Rath ME, Adasooriya D, Ratnatunga N, Kambham N, Wazil A, Wijetunge S, Badurdeen Z, Ratnayake C, Karunasena N, Schensul SL, Valhos P, Haider L, Bhalla V, Levin A, Wise PH, Chertow GM, Barry M, Fire AZ, Nanayakkara N. Prospective Biopsy-Based Study of CKD of Unknown Etiology in Sri Lanka. Clin J Am Soc Nephrol 2019; 14:224-232. [PMID: 30659059 PMCID: PMC6390926 DOI: 10.2215/cjn.07430618] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/30/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVES A kidney disease of unknown cause is common in Sri Lanka's lowland (dry) region. Detailed clinical characterizations of patients with biopsy-proven disease are limited, and there is no current consensus on criteria for a noninvasive diagnosis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We designed a prospective study in a major Sri Lankan hospital servicing endemic areas to ascertain pathologic and clinical characteristics of and assess risk factors for primary tubulointerstitial kidney disease. We used logistic regression to determine whether common clinical characteristics could be used to predict the presence of primary tubulointerstitial kidney disease on kidney biopsy. RESULTS From 600 new patients presenting to a tertiary nephrology clinic over the course of 1 year, 87 underwent kidney biopsy, and 43 (49%) had a biopsy diagnosis of primary tubulointerstitial kidney disease. On detailed biopsy review, 13 (30%) had evidence of moderate to severe active kidney disease, and six (15%) had evidence of moderate to severe chronic tubulointerstitial kidney disease. Patients with tubulointerstitial kidney disease were exclusively born in endemic provinces; 91% spent a majority of their lifespan there. They were more likely men and farmers (risk ratio, 2.0; 95% confidence interval, 1.2 to 2.9), and they were more likely to have used tobacco (risk ratio, 1.7; 95% confidence interval, 1.0 to 2.3) and well water (risk ratio, 1.5; 95% confidence interval, 1.1 to 2.0). Three clinical characteristics-age, urine dipstick for protein, and serum albumin-could predict likelihood of tubulointerstitial kidney disease on biopsy (model sensitivity of 79% and specificity of 84%). Patients referred for kidney biopsy despite comorbid diabetes or hypertension did not experience lower odds of tubulointerstitial kidney disease. CONCLUSIONS A primary tubulointerstitial kidney disease occurs commonly in specific regions of Sri Lanka with characteristic environmental and lifestyle exposures.
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Affiliation(s)
| | | | - Dinuka Adasooriya
- Kandy Teaching Hospital, Kandy, Sri Lanka
- Center for Education Research and Training on Kidney Diseases, Faculty of Medicine and
| | | | | | | | | | - Zeid Badurdeen
- Center for Education Research and Training on Kidney Diseases, Faculty of Medicine and
| | | | | | | | - Penny Valhos
- Department of Marine Sciences, University of Connecticut, Groton, Connecticut; and
| | - Lalarukh Haider
- Division of Nephrology, University of Connecticut Health Center, Farmington, Connecticut
| | | | - Adeera Levin
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Michele Barry
- Medicine, Stanford University School of Medicine, Palo Alto, California
| | | | - Nishantha Nanayakkara
- Kandy Teaching Hospital, Kandy, Sri Lanka
- Center for Education Research and Training on Kidney Diseases, Faculty of Medicine and
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12
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Ratnayake S, Badurdeen Z, Nanayakkara N, Abeysekara T, Ratnatunga N, Kumarasiri R. Screening for chronic kidney disease of uncertain aetiology in Sri Lanka: usability of surrogate biomarkers over dipstick proteinuria. BMC Nephrol 2017. [PMID: 28629425 PMCID: PMC5477244 DOI: 10.1186/s12882-017-0610-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background The use of dipstick proteinuria to screen Chronic Kidney Disease of uncertain aetiology (CKDu) in Sri Lanka is a recently debated matter of dispute. The aim of this study was to assess the suitability of biomarkers: serum creatinine, cystatin C and urine albumin to creatinine ratio (ACR) for screening CKDu in Sri Lanka. Methods Forty-four male CKDu patients and 49 healthy males from a CKDu-endemic region were selected. Meanwhile, 25 healthy males from a non-endemic region were selected as an absolute control. The diagnostic accuracy of each marker was compared using the above three study groups. Results In receiver operating characteristics (ROC) plots for creatinine, cystatin C and ACR, values of area under the curve (AUC) were 0.926, 0.920 and 0.737 respectively when CKDu was compared to non-endemic control. When CKDu was compared to endemic control, AUCs of above three analytes were distinctly lower as 0.718, 0.808 and 0.678 respectively. Cystatin C exhibited the highest sensitivity for CKDu when analyzed against both control groups where respective sensitivities were 0.75 against endemic control and 0.89 against non-endemic control. ROC-optimal cutoff limits of creatinine, cystatin C and ACR in CKDu vs non-endemic control were 89.0 μmol/L, 1.01 mg/L and 6.06 mg/g-Cr respectively, whereas in CKDu vs endemic control the respective values were 111.5 μmol/L, 1.22 mg/L and 12.66 mg/g-Cr. Conclusions Amongst the three biomarkers evaluated in this study, our data suggest that Cystatin C is the most accurate functional marker in detecting CKDu in endemic regions, yet the high cost hinders its usability on general population. Creatinine is favorable over dipstick proteinuria owing to its apparent accuracy and cost efficiency, while having the ability to complement the kidney damage marker (ACR) in screening. ACR may not be favorable as a standalone screening marker in place of dipstick proteinuria due to its significant decline in sensitivity against the CKDu-endemic population. However, creatinine and ACR in a complementary manner could overcome current shortcomings of dipstick proteinuria and such a dual marker tool could be commodious in screening CKDu-type tubulointerstital diseases. Furthermore, use of ACR may also increase the ability to clinically discriminate CKDu from other glomerular nephropathies.
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Affiliation(s)
- Samantha Ratnayake
- Center for Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. .,Sri Lanka Institute of Nanotechnology (SLINTEC), Homagama, Sri Lanka.
| | - Zeid Badurdeen
- Center for Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | | | - Tilak Abeysekara
- Center for Research and Training on Kidney Diseases (CERTKiD), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ranjith Kumarasiri
- Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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13
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Herath N, Ratnatunga N, Weerakoon K, Wazil A, Nanayakkara N. Clinicopathological findings, treatment response and predictors of long-term outcome in a cohort of lupus nephritis patients managed according to the Euro-lupus regime: a retrospective analysis in Sri Lanka. BMC Res Notes 2017; 10:80. [PMID: 28148285 PMCID: PMC5288939 DOI: 10.1186/s13104-017-2402-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 01/24/2017] [Indexed: 11/18/2022] Open
Abstract
Background Despite the improvement in survival of patients with lupus nephritis (LN) globally, there is sparse data from Sri Lanka (SL). The current study aims to describe the clinicopathological findings, treatment response and predictors of long-term outcome of patients with WHO class III–IV LN in SL, managed according to the Euro-lupus regime. Results Of 72 patients, 64 were females. In half of them, LN was diagnosed within the 1st year of the illness. The most common presenting feature was sub-nephrotic proteinuria. Sixteen and twenty patients had nephrotic syndrome and abnormal renal function respectively at the time of diagnosis. Fifty-four patients (75%) responded to the Euro-lupus regimen [CR, 20 (28%); PR, 34(47%)]. Later at 6 months, 65 patients (90%) achieved remission [CR, 31(43%); PR, 34 (47%)]. Seven patients experienced treatment failure. During the total duration of follow up, 54 patients remained in complete or partial remission, 26 developed renal relapses, and 19 suffered severe infective episodes. Renal relapses were more common in people who achieved partial remission than complete remission. The long term renal outcome was not associated with age, sex, severity of proteinuria, class of LN or initial renal function. Patients who achieved remission at 6 months had a good long-term outcome. Conclusions The demographic and clinical features of WHO class III and IV LN in Sri Lankan patients were similar to that reported in the global literature. 75% of patients responded to the Euro-lupus regimen. Therefore, this regime is a suitable initial regimen for LN patients in SL. Good long-term renal outcome can be predicted by early response to therapy. Further studies are necessary to explore better treatment options for patients who fail to achieve remission during initial therapy.
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Affiliation(s)
- Nalaka Herath
- Nephrology Unit, Teaching Hospital, Karapitiya, Galle, Sri Lanka.
| | - Neelakanthi Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Kosala Weerakoon
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, Sri Lanka
| | - Abdul Wazil
- Nephrology Unit, Teaching Hospital, Kandy, Sri Lanka
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Nanayakkara S, Senevirathna STMLD, Abeysekera T, Chandrajith R, Ratnatunga N, Gunarathne EDL, Yan J, Hitomi T, Muso E, Komiya T, Harada KH, Liu W, Kobayashi H, Okuda H, Sawatari H, Matsuda F, Yamada R, Watanabe T, Miyataka H, Himeno S, Koizumi A. An Integrative Study of the Genetic, Social and Environmental Determinants of Chronic Kidney Disease Characterized by Tubulointerstitial Damages in the North Central Region of Sri Lanka. J Occup Health 2014; 56:28-38. [DOI: 10.1539/joh.13-0172-oa] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shanika Nanayakkara
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
- Institute of Dental Research, Westmead Centre for Oral Health, Faculty of DentistryThe University of SydneyAustralia
| | - STMLD Senevirathna
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
- School of Computing, Engineering and Mathematics, University of Western SydneyAustralia
| | - Tilak Abeysekera
- Department of Pharmacology, Faculty of MedicineUniversity of PeradeniyaSri Lanka
| | - Rohana Chandrajith
- Department of Geology, Faculty of ScienceUniversity of PeradeniyaSri Lanka
| | | | | | - Junxia Yan
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | - Toshiaki Hitomi
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | - Eri Muso
- Department of Nephrology and DialysisTazuke Kofukai Medical Research Institute, Kitano HospitalJapan
| | - Toshiyuki Komiya
- Department of Nephrology and DialysisTazuke Kofukai Medical Research Institute, Kitano HospitalJapan
| | - Kouji H. Harada
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | - Wanyang Liu
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | - Hatasu Kobayashi
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | - Hiroko Okuda
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
| | | | - Fumihiko Matsuda
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto UniversityJapan
| | - Ryo Yamada
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto UniversityJapan
| | | | - Hideki Miyataka
- Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical SciencesTokushima Bunri UniversityJapan
| | - Seiichiro Himeno
- Laboratory of Molecular Nutrition and Toxicology, Faculty of Pharmaceutical SciencesTokushima Bunri UniversityJapan
| | - Akio Koizumi
- Department of Health and Environmental SciencesGraduate School of Medicine, Kyoto UniversityJapan
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15
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Nanayakkara S, Senevirathna STMLD, Abeysekera T, Chandrajith R, Ratnatunga N, Gunarathne EDL, Yan J, Hitomi T, Muso E, Komiya T, Harada KH, Liu W, Kobayashi H, Okuda H, Sawatari H, Matsuda F, Yamada R, Watanabe T, Miyataka H, Himeno S, Koizumi A. An integrative study of the genetic, social and environmental determinants of chronic kidney disease characterized by tubulointerstitial damages in the North Central Region of Sri Lanka. J Occup Health 2013. [PMID: 24351856 DOI: 10.1539/joh.13‐0172‐oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Previous investigations on chronic kidney disease of unknown etiology characterized by tubulointerstitial damages (CKDu) in the North Central Region (NCR) of Sri Lanka have supported the involvement of social, environmental and genetic factors in its pathogenesis. METHODS We conducted a social-environmental-and-genetic epidemiology study on a male population in NCR to investigate the genetic and environmental contributors. We recruited 311 case-series patients and 504 control candidates. Of the 504 control candidates, 218 (43%) were eliminated because of the presence of hypertension, proteinuria, high HbA1c, high serum creatinine or high alpha-1 microglobulin in urine. RESULTS AND DISCUSSION None of 18 metals measured (μg//) in urine, including Cd, As and Pb, showed significantly higher concentrations in cases compared with controls. As speciation results showed that 75-80% of total urinary As was in the form of arsenobetaine, which is non-toxic to humans. None of the metal concentrations in drinking water samples exceeded guideline values. A genome-wide association study (GWAS) was conducted to determine the genetic contributors. The GWAS yielded a genome-wide significant association with CKDu for a single nucleotide polymorphism (SNP; rs6066043; p=5.23 × 10(-9) in quantitative trait locus analysis; p=3.73 × 10(-9) in dichotomous analysis) in SLC13A3 (sodium-dependent dicarboxylate transporter member 3). The population attributable fraction and odds ratio for this SNP were 50% and 2.13. Genetic susceptibility was identified as the major risk factor for CKDu. However, 43% of the apparently healthy male population suffers from non-communicable diseases, suggesting their possible influence on CKDu progression.
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Affiliation(s)
- Shanika Nanayakkara
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University
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16
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Herath N, Wazil A, Kularatne S, Ratnatunga N, Weerakoon K, Badurdeen S, Rajakrishna P, Nanayakkara N, Dharmagunawardane D. Thrombotic microangiopathy and acute kidney injury in hump-nosed viper (Hypnale species) envenoming: a descriptive study in Sri Lanka. Toxicon 2012; 60:61-5. [PMID: 22483846 DOI: 10.1016/j.toxicon.2012.03.015] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 02/01/2012] [Accepted: 03/20/2012] [Indexed: 12/18/2022]
Abstract
Hump-nosed viper (Hypnale species) bites are common in Sri Lanka and a proportion of these bites lead to coagulation abnormalities and acute kidney injury (AKI). We observed thrombotic microangiopathy (TMA) among some of these patients, but its contribution to severity of AKI and other morbidities remains unknown. Thus, we report a case series of TMA following hump-nosed viper bite addressing the complications and renal out comes in Sri Lanka. This was a prospective observational study carried out at the nephrology unit, Kandy in Sri Lanka from October 2010 to October 2011 and included 11 patients with AKI following hump-nosed viper bites. All eleven cases needed renal replacement therapy (RRT) with intermittent haemodialysis for a period of 1-5 weeks. Of them, 7 patients developed TMA with evidence of microangiopathic haemolytic anaemia (MAHA), thrombocytopenia and severe anaemia needing multiple blood transfusions. They needed longer duration of RRT (range 2-5 weeks); 2 patients developed chronic kidney disease and two died during acute stage. Autopsy study found thrombosis of micro-vessels. Thrombotic microangiopathy could be a causative pathology of AKI in hump-nosed viper bite carrying poor outcome.
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Affiliation(s)
- Nalaka Herath
- Nephrology and Transplant Unit, Teaching Hospital, Kandy, Sri Lanka.
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17
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Senevirathna L, Abeysekera T, Nanayakkara S, Chandrajith R, Ratnatunga N, Harada KH, Hitomi T, Komiya T, Muso E, Koizumi A. Risk factors associated with disease progression and mortality in chronic kidney disease of uncertain etiology: a cohort study in Medawachchiya, Sri Lanka. Environ Health Prev Med 2011; 17:191-8. [PMID: 21881957 DOI: 10.1007/s12199-011-0237-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 08/08/2011] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The alarming rise in the prevalence of chronic kidney disease of uncertain etiology (CKDu) among the low socioeconomic farming community in the North Central Province of Sri Lanka has been recognized as an emerging public health issue in the country. METHODS This study sought to determine the possible factors associated with the progression and mortality of CKDu. The study utilized a single-center cohort registered in 2003 and followed up until 2009 in a regional clinic in the endemic region, and used a Cox proportional hazards model. RESULTS We repeatedly found an association between disease progression and hypertension. Men were at higher risk of CKDu than women. A significant proportion of the patients in this cohort were underweight, which emphasized the need for future studies on the nutritional status of these patients. CONCLUSIONS Compared with findings in western countries and other regions of Asia, we identified hypertension as a major risk factor for progression of CKDu in this cohort.
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Affiliation(s)
- Lalantha Senevirathna
- Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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18
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Ratnatunga N, Wazil AWM, Ariyaratne C. Acute diffuse proliferative glomerulonephritis with atypical presentation in Sri Lankan adults--clinical features and outcome. Ceylon Med J 2009; 54:101. [PMID: 19999795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Ratnatunga N, Tissera HW. Kimura's disease in a Sri Lankan man. Ceylon Med J 1999; 44:175-6. [PMID: 10895270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- N Ratnatunga
- Department of Pathology, University of Peradeniya
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21
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Kularatne SA, Ratnatunga N. Severe systemic effects of Merrem's hump-nosed viper bite. Ceylon Med J 1999; 44:169-70. [PMID: 10895268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To report unpredictable severe systemic effects of hump-nosed viper envenomation. SETTING Medical unit, General hospital, Anuradhapura. METHODS The clinical outcome of seven patients bitten by Merrem's hump-nosed viper were monitored until recovery or death. Limited autopsies were performed on the latter. Offending snakes were positively identified by medical officers and in one instance by a herpetologist. CONCLUSION Merrem's hump-nosed viper bites, caused an array of potentially fatal systemic manifestations. One patient developed neurological effects, severe Raynaud's syndrome leading to ascending gangrene of distal limbs and adult repiratory distress syndrome (ARDS), in addition to the known complications of severe renal cortical necrosis and haemostatic dysfunction. Two patients who developed acute renal failure and prolonged coagulopathy recovered completely. The combination of extensive renal cortical necrosis, disseminated intravascular coagulation, and ARDS proved fatal in three.
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Ramaesh T, Mendis BR, Ratnatunga N, Thattil RO. The effect of tobacco smoking and of betel chewing with tobacco on the buccal mucosa: a cytomorphometric analysis. J Oral Pathol Med 1999; 28:385-8. [PMID: 10535360 DOI: 10.1111/j.1600-0714.1999.tb02108.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The effect of tobacco use on the buccal mucosa has been assessed by cytomorphometry. Cell and nuclear diameters (CD, ND) of exfoliated oral squames were measured in tobacco smokers (S), betel chewers with tobacco (C) and those with a combined habit (S+C). Non-users (NU) served as controls. The mean CD values in S, C, S+C and NU were: 50.8 (+/-0.47), 49.39 (+/-0.48), 49.12 (+/-0.47) and 51.87 (+/-0.76) microm, and the mean ND values were: 8.83 (+/-0.07), 8.61 (+/-0.08), 8.72 (+/-0.10) and 8.33 (-/+ 0.09) microm, respectively. The least significant difference procedure (LSD at P=0.05) showed a significant reduction for CD in C and S+C and an increase for ND in all three habit groups, compared to the controls. This study shows that the use of tobacco influences the cytomorphology of the normal buccal mucosa. Betel chewing with tobacco influences the ND and CD, while smoking influences only the ND.
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Affiliation(s)
- T Ramaesh
- Department of Basic Sciences, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
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Ratnatunga N, Wijesundera MS. Histopathological diagnosis of subcutaneous Dirofilaria repens infection in humans. Southeast Asian J Trop Med Public Health 1999; 30:375-8. [PMID: 10774712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The host tissue response in humans, based on a study of biopsies of 14 subcutaneous nodules caused by Dirofilaria repens is described. The response was characterized by accumulation of eosinophilic material or eosinophilic pus adjacent to the parasite with surrounding granulomatous inflammation associated with extensive eosinophil infiltration of the surrounding tissue. Unlike with fungal lesions, fat necrosis was conspicuously absent. Nodules were all less than 3 cm in size. Fifteen percent of the smaller nodules (less than 1 cm) and 30% of the larger nodules required extensive examination of tissue to visualize the parasite. It is concluded that when typical tissue reactions are seen, extended histological processing is indicated for accurate diagnosis of dirofilariasis, by demonstrating the parasite.
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Affiliation(s)
- N Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Sri Lanka
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Ramaesh T, Mendis BR, Ratnatunga N, Thattil RO. Diagnosis of oral premalignant and malignant lesions using cytomorphometry. Odontostomatol Trop 1999; 22:23-8. [PMID: 11372099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
In this study cytomorphometry has been applied to smears collected from the buccal mucosa. Normal cells and the cells collected from lesions with no dysplasia, dysplasia and squamous. cell carcinoma were differentiated using discriminant analysis based on nuclear and cell diameter values. Cytomorphometrically the dysplastic and malignant cells were well discriminated from the normal cells. A sensitivity of 89%, specificity of 89.7%, positive predictive value of 80% and negative predictive value of 94.4% were obtained when comparing non-dysplastic lesions with dysplastic lesions.
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Affiliation(s)
- T Ramaesh
- Dept of Basic Sciences, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri-Lanka
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Ramaesh T, Ratnatunga N, Mendis BR, Rajapaksa S. Exfoliative cytology in screening for malignant and premalignant lesions in the buccal mucosa. Ceylon Med J 1998; 43:206-9. [PMID: 10355174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE To test the efficacy of exfoliative cytology in the detection of oral premalignant and malignant lesions. DESIGN Cytological diagnosis of lesions of the buccal mucosa assessed using histopathological diagnosis of the same lesions as the gold standard. SUBJECTS Patients with buccal lesions clinically diagnosed as leukoplakia (n = 91) and squamous cell carcinoma (SCC, n = 59), and healthy subjects (n = 40) in whom buccal mucosa appeared clinically normal. SETTING Oral and Maxillo-facial Unit, General Hospital, Kandy and Department of Pathology, Faculty of Medicine, University of Peradeniya. RESULTS A sensitivity of 77%, specificity of 100% and accuracy of 92% were obtained for leukoplakia. SCC gave a sensitivity of 94%, specificity of 100% and an accuracy of 95%. CONCLUSIONS Oral exfoliative cytology is a useful method for detecting oral premalignant and malignant lesions. Anucleated squames in a smear is non-diagnostic.
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Affiliation(s)
- T Ramaesh
- Department of Basic Sciences, Faculty of Dental Sciences, University of Peradeniya
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Ramaesh T, Mendis BR, Ratnatunga N, Thattil RO. Cytomorphometric analysis of squames obtained from normal oral mucosa and lesions of oral leukoplakia and squamous cell carcinoma. J Oral Pathol Med 1998; 27:83-6. [PMID: 9526735 DOI: 10.1111/j.1600-0714.1998.tb02099.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cell and nuclear diameters (CD and ND) were measured in squames obtained from normal buccal mucosa and lesions of oral leukoplakia and squamous carcinoma (SCC) also from buccal mucosa. The study groups consisted of Group 1: normal buccal mucosa (n = 40); Group 2: lesions with no epithelial dysplasia (n = 58); Group 3: lesions with epithelial dysplasia (n = 27); and Group 4: SCC lesions (n = 51). The mean CD and ND values were: Group 1: 51.78 (+/- 0.11) and 8.36 (+/- 0.49); Group 2: 45.73 (+/- 0.16) and 8.31 (+/- 0.68); Group 3: 41.32 (+/- 0.13) and 9.04 (+/- 0.46); Group 4: 38.58 (+/- 0.11) and 10.10 (+/- 0.56) microns, respectively. Correlation between the ND and CD was positive for Group 1 (r = 0.78, P < 0.05) and Group 2 (r = 0.33, P < 0.05). There were no significant correlations in Groups 3 and 4. ANOVA showed significant differences (P < 0.05) for CD between all four groups. Except between Groups 1 and 2, the ND was significantly different (P < 0.05) between all groups. The results indicate that ND and CD could possibly be sensitive parameters in the diagnosis of oral premalignant and malignant lesions.
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Affiliation(s)
- T Ramaesh
- Department of Basic Sciences, Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
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Ratnatunga N, Muthumala M, Kularatne SA. Castleman's disease with endocrinopathy and parotid gland enlargement. Ceylon Med J 1997; 42:190-2. [PMID: 9476405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- N Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya
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Goonasekera CD, Ratnatunga N, Seneviratne CA, Nahrstedt A, Lechtenberg M. Nai habarala (Alocasia cucullata) fruits; analysed for potential hydrogen cyanide. Ceylon Med J 1997; 42:110-1. [PMID: 9257478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Wijesundera MS, Ratnatunga N, Kumarasinghe MP, Dissanaike AS. First reports of subcutaneous sparganosis in Sri Lanka. Ceylon Med J 1997; 42:30-2. [PMID: 9164028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To report and create awareness of sparganosis, a parasitic zoonosis caused by a larval stage of Spirometra sp. SETTING Two patients with non-tender subcutaneous lumps. DIAGNOSIS CRITERIA: Morphology of solid cestode larva in excision biopsies. CONCLUSIONS Although these two instances were innocuous, infection is potentially dangerous as larvae are long lived and could invade vital organs. The most likely source of infection in Sri Lanka is ingestion of the infected first intermediate host, Cyclops, in water.
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Affiliation(s)
- M S Wijesundera
- Department of Parasitology, Faculty of Medicine, University of Peradeniya, Sri Lanka
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Ratnatunga N, Weerasinghe L. Carcinosarcoma arising in a solitary cylindroma of the hand. Ceylon Med J 1995; 40:151-3. [PMID: 8689704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- N Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Kegalle, Sri Lanka
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Ratnatunga N, Abeygunasekere A, Ratnatung PC. Tumour of the pancreas with unusual clinicopathological features. Ceylon Med J 1995; 40:47-8. [PMID: 7781101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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De Silva HJ, Vitarana T, Ratnatunga N, Breschkin A, Withane N, Kularatne WN. Prevalence of hepatitis C virus markers in Sri Lankan patients with alcoholic cirrhosis. J Gastroenterol Hepatol 1994; 9:381-4. [PMID: 7524722 DOI: 10.1111/j.1440-1746.1994.tb01259.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A high prevalence of antibodies against hepatitis C virus (HCV) has been reported in patients with alcoholic cirrhosis. There are, however, doubts regarding the specificity of the first generation anti-HCV antibody assays used. We prospectively investigated HCV status in 47 Sri Lankan patients with alcoholic cirrhosis. A first generation assay (Ortho HCV enzyme-linked immunosorbent assay [ELISA]) and two second generation tests (Abbott HCV enzyme immunoassay and United Biomedical Incorporated HCV enzyme immunoassay) were used. Positive results were confirmed by the second generation recombinant immunoblot assay (RIBA 2). Of the 47 patients (46 males, mean age 41.7 years), 17 (36.2%) had previously had one or more blood or plasma transfusions. Seven (14.9%) of the samples were positive for anti-HCV antibodies using the Ortho-HCV ELISA, but only one (2.1%) sample was positive when tested with the second generation assays. The positive result was confirmed by RIBA 2. The prevalence of HCV in the patients was low despite many of them being exposed to blood or blood products. Hepatitis C virus, therefore, may not be an important pathogenic factor in alcoholic cirrhosis in Sri Lanka.
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Affiliation(s)
- H J De Silva
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Sri Lanka
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Ratnatunga N, Edussuriya B. Necrotising adenometaplasia (sialometaplasia) of the nasopharynx. Ceylon Med J 1994; 39:107-8. [PMID: 7923445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Necrotising sialometaplasia of the nasopharynx with nasal extension in a 43 year old man, with no preceding history of trauma, is reported. Some unusual histological features are described.
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Affiliation(s)
- N Ratnatunga
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Sri Lanka
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Abstract
Nai Habarala is not documented as a poisonous plant. However, we report two cases of fatal poisoning following ingestion of its fruit. The clinical manifestations have a similarity to cyanogenic glycoside poisoning.
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Affiliation(s)
- C D Goonasekera
- Department of Anaesthesia, Faculty of Medicine, Teaching Hospital, Peradeniya, Sri Lanka
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de Silva HJ, Ratnatunga N, de Silva U, Kularatne WN, Wijewickrema R. Severe fatty change with hepatocellular necrosis following bite by a Russell's viper. Trans R Soc Trop Med Hyg 1992; 86:565. [PMID: 1475836 DOI: 10.1016/0035-9203(92)90115-s] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- H J de Silva
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
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Abstract
Synovial sarcoma is one of the most common soft tissue malignancies of adolescents and young adults. Despite its name, it is no longer thought to be histogenetically derived from the synovium. What seems to be the first case of synovial sarcoma to arise in the orbit presented in a 21 year old woman as a slowly enlarging subconjunctival mass. Although this tumour was typically biphasic, the monophasic spindle cell variant arising at this site could easily be confused with less aggressive orbital connective tissue neoplasms.
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Affiliation(s)
- N Ratnatunga
- Department of Histopathology, St Thomas's Hospital (UMDS), London
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Ratnatunga N, Herath K. Industrial methylated spirits as an alternative cheap dehydrating agent in paraffin histopathological sections. Ceylon Med J 1985; 30:93-6. [PMID: 2423257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Ratnatunga N. An extra adrenal malignant phaeochromocytoma. Ceylon Med J 1983; 28:96-9. [PMID: 6677407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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