The Darker Facets of Systemic Lupus Erythematosus (SLE).

Cerebrovascular events remain a rare but serious feature of systemic lupus erythematosus (SLE). In this report, we see a 25-year-old lady who presented with sudden-onset right-sided weakness and speech disturbances. She was initiated on anti-platelet therapy and glucocorticoids.

A comparative analysis of the outcome of malaria case surveillance strategies in Sri Lanka in the prevention of re-establishment phase.

Background: Sri Lanka sustained its malaria-free status by implementing, among other interventions, three core case detection strategies namely Passive Case Detection (PCD), Reactive Case Detection (RACD) and Proactive Case Detection (PACD). The outcomes of these strategies were analysed in terms of their effectiveness in detecting malaria infections for the period from 2017 to 2019.

Methods: Comparisons were made between the surveillance methods and between years, based on data obtained from the national malaria database and individual case reports of malaria patients.

Case Report: The First Case of Genotypically Confirmed Plasmodium falciparum Kelch 13 Propeller Mutation in Sri Lanka and Its Implications on the Elimination Status of Malaria.

This case report discusses recrudescence of imported Plasmodium falciparum malaria, in the presence of P. falciparum Kelch13 (PfK13) propeller mutation, in a patient diagnosed and fully treated with artemether-lumefantrine under direct observation in Sri Lanka. This patient presented with a history of 5 days of fever following his arrival from the Democratic Republic of Congo (DRC).

Technical and operational underpinnings of malaria elimination from Sri Lanka.

Malaria was eliminated from Sri Lanka in 2012, and the country received WHO-certification in 2016. The objective of this paper is to describe the epidemiology of malaria elimination in Sri Lanka, and the key technical and operational features of the elimination effort, which may have been central to achieving the goal, even prior to schedule, and despite an ongoing war in parts of the country. Analysis of information and data from the Anti Malaria Campaign (AMC) of Sri Lanka during and before the elimination phase, and the experiences of the author(s) who directed and/or implemented the elimination programme or supported it form the basis of this paper.

Severe Plasmodium vivax malaria, HIV, tuberculosis co-infection in a Sri Lankan traveller: case management and challenges during the prevention of malaria reintroduction phase.

Background: The country received malaria-free certification from WHO in September 2016, becoming only the second country in the WHO South East Asia region to be declared malaria-free. Imported malaria cases continue to be reported, with 278 cases reported between 2013 and 2017. The diagnosis of a severe Plasmodium vivax patient co-infected with HIV and tuberculosis is discussed with an overview of the rapid response mounted by the Anti Malaria Campaign (AMC), Sri Lanka.

Utility of pf/pan RDT for diagnosis in the prevention of re-establishment of malaria in Sri Lanka.

The utility of CareStart Malaria Pf/PAN (HRP2/pLDH) Ag Combo Test, in detecting non-endemic clinical malaria cases was evaluated in Sri Lanka, a country in prevention of re-establishment of malaria following elimination. RDT, microscopy and nested PCR were performed for 350 suspected malaria patients recruited prospectively. There were 173 PCR confirmed malaria patients and 177 PCR negative subjects.

Is There a Renaissance of Glucocorticoids in Rheumatoid Arthritis?

The first therapeutic use of glucocorticoids was in a patient with severe rheumatoid arthritis and the symptomatic benefit was astounding. Adverse effects from increasingly large doses led to them being overshadowed, dismissed as inappropriate treatment, and ignored for 20 years - but in the last 2 decades, the accumulating evidence and clinical practice suggest there is a justified renaissance in their use as a first-line treatment.

Rheumatoid arthritis: previously untreated early disease.

Introduction: Rheumatoid arthritis is a chronic autoimmune disease, which most often presents as a symmetrical polyarthritis of the hands and feet. Pharmacological treatments include non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GCs) and other disease-modifying anti-rheumatoid drugs (DMARDs), which may be synthetic (either conventional [csDMARDs] or targeted [tsDMARDs]) or biological (bDMARDs).

Methods And Outcomes: We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of methotrexate in combination with other csDMARDs versus methotrexate monotherapy in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? What are the effects of bDMARDs as monotherapy versus methotrexate or other csDMARDs in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? What are the effects of bDMARDs in combination with methotrexate versus methotrexate monotherapy or other csDMARDs in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? What are the effects of glucocorticoids in combination with methotrexate or with other csDMARDs versus methotrexate or other csDMARDs in people with rheumatoid arthritis who have not previously received any DMARD treatment (first-line treatment)? We searched: Medline, Embase, The Cochrane Library and other important databases up to December 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).

Characterization of imported malaria, the largest threat to sustained malaria elimination from Sri Lanka.

Sri Lanka has reached zero indigenous malaria cases in November 2012, two years before its targeted deadline for elimination. Currently, the biggest threat to the elimination efforts are the risk of resurgence of malaria due to imported cases. This paper describes two clusters of imported malaria infections reported in 2013 and 2014, one among a group of Pakistani asylum-seekers resident in Sri Lanka, and the other amongst local fishermen who returned from Sierra Leone.

Types of the cerebral arterial circle (circle of Willis) in a Sri Lankan population.

Background: The variations of the circle of Willis (CW) are clinically important as patients with effective collateral circulations have a lower risk of transient ischemic attack and stroke than those with ineffective collaterals. The aim of the present cadaveric study was to investigate the anatomical variations of the CW and to compare the frequency of prevalence of the different variations with previous autopsy studies as variations in the anatomy of the CW as a whole have not been studied in the Indian subcontinent.

Methods: The external diameter of all the arteries forming the CW in 225 normal Sri Lankan adult cadaver brains was measured using a calibrated grid to determine the prevalence in the variation in CW.

Comparison of the configuration of the posterior bifurcation of the posterior communicating artery between fetal and adult brains: A study of a Sri Lankan population.

Objective: The purpose of this study was to examine the degree of contribution from the vertebrobasilar and carotid systems to the origin of the PCA in fetal autopsy brains of last trimester of pregnancy and to compare with published data on the configuration of adult and fetal brains in a population of Sri Lankan origin.

Materials And Methods: The external diameter of the PcomA, pre-communicating part (P1), and the post-communicating part (P2) of posterior cerebral artery (PCA) of 34 fetal brain in the last trimester of pregnancy (30 to 40 weeks of gestation) was measured using a stereomicroscope equipped with a micrometer calibrator.

Results: The blood supply to the occipital lobe mainly via the PCA was seen in 25 (59%) of fetal brains as compared to that in the literature 220 (93%) in adults brains and the blood supply to the occipital lobe mainly via the internal carotid artery (ICA) was seen in 16 (34%) of fetal brains as compared to 25 (7%) of adults brains (P < 0.

Prevalence of typical circle of Willis and the variation in the anterior communicating artery: A study of a Sri Lankan population.

Objective: To determine the extent of hypoplasia of the component vessels of the circle of Willis (CW) and the anatomical variations in the anterior communicating artery (AcomA) in the subjects who have died of causes unrelated to the brain and compare with previous autopsy studies.

Materials And Methods: The external diameter of all the arteries forming the CW in 225 normal Sri Lankan adult cadaver brains was measured using a calibrated grid to determine the occurrence of "typical" CWs, where all of the component vessels had a diameter of more than 1 mm. Variations in the AcomA were classified into 12 types based on Ozaki et al.

Variation in the origin of the posterior cerebral artery in adult Sri Lankans.

Background: The degree of contribution from the vertebro-basilar and carotid systems to the origin of the posterior cerebral artery (PCA) is of clinico-anatomical importance. Three configurations in the bifurcation of the posterior communicating artery (PcomA) have been described, foetal, transitional and adult.

Objective: To examine the extent of contribution from the vertebro-basilar and carotid systems to the origin of the PCA in adult autopsy brains in subjects who had died of causes unrelated to the brain.

Association of idiopathic inflammatory myopathy and Crohn's disease.

We describe a rare case of concurrent polymyositis and Crohn's disease in a female patient. A 69-year-old female presented in December 2007 with a 5-month history of proximal muscle weakness, pain, fatigue and difficulty in walking and swallowing. Blood tests revealed elevated creatine kinase (3,429 U/l) and lactate dehydrogenase (2,013 U/l) levels.

Rare association of antisynthetase syndrome and Kennedy's disease.

Antisynthetase syndrome is a type of Idiopathic Inflammatory Myopathy (IIM) associated with anti-Jo1 antibody. Kennedy's disease or X-linked spinal and bulbar muscular atrophy (SBMA) is a rare neuromuscular disease. We describe the case report of a 53-year-old man who presented with proximal muscle weakness and a history of bilateral hand tremor.

Brain abscess caused by Nocardia asteroides.

A case of Nocardia brain abscess in a patient receiving immunosuppressives is reported. The diagnosis was made by aspiration and culture of pus from the abscess. This is the first documented case of Nocardia brain abscess in Sri Lanka.

Clinical correlation of urodynamic findings in patients with localized partial lesions of the spinal cord and cauda equina.

Urodynamic studies were undertaken in 70 patients with incomplete, confirmed, localized lesions involving the spinal cord and cauda equina, irrespective of clinically evident bladder disturbances. Both detrusor and urethral function were simultaneously evaluated and correlated with neurological deficits and symptoms of lower urinary tract dysfunction. It was evident that in those patients with localized spinal cord lesions, lower urinary tract disturbances were closely associated with disturbances of pinprick sensation.

Urethral function in neurological disorders of the lower urinary tract.

Simultaneous measurements of intravesical pressure, urethral pressure, and electromyographic activity of perianal muscles were performed during bladder filling and voiding in 56 patients with neurogenic lower urinary tract dysfunction. In 21 patients simultaneous measurements were taken of the EMG activity of the striated-muscle external urethral sphincter. During bladder filling the urethral pressure was found to correspond to the EMG activity of both muscles only in those patients with normal urethral pressure.

Detrusor hyperreflexia in neurogenic bladder disorders caused by localized partial lesions of the spinal cord and cauda equina.

In 70 patients studied by cystometry, detrusor hyperreflexia seen with localized partial lesions of the spinal cord and cauda equina could be differentiated into two types. In one type, in which the hyperreflexia was of a reflex nature and bladder compliance was unchanged, the detrusor contractility was described as compliant hyperreflexic. In the other type, in which the contractions were of a rhythmic nature and accompanied by reduced compliance, the contractility of the detrusor was described as noncompliant hyperreflexic.

Significance of detrusor compliance in patients with localized partial lesions of the spinal cord and cauda equina.

Detrusor compliance was measured by cystometry irrespective of any symptoms of lower urinary trace dysfunction in 70 patients with localized, partial, surgically treatable lesions of the spinal cord and cauda equina. Compliance was found to be normal in all patients with upper motor neuron lesions; reduced compliance was encountered only in those with lower motor neuron lesions. Reduced compliance was closely associated with lesions of the conus medullaris and with detrusor hyperreflexia, and it is therefore likely that the mechanism of compliance involves a significant neural component.