Impulse control disorders and other non-motor symptoms in Sri Lankan patients with Parkinson's disease.

The impact of non-motor symptoms is often overlooked in favour of the motor symptoms when managing Parkinson's disease resulting in suboptimal patient outcomes. This study aimed to characterise the non-motor symptoms of Parkinson's disease in a cohort of Sri Lankan patients with a special focus on the impulsive control disorders and other compulsive behaviours (ICDs-CB) that had not been previously studied in this population. All patients with idiopathic Parkinson's disease followed up at the National Hospital of Colombo, Sri Lanka were included.

Estimation of body weight using anthropometric parameters in Sri Lankan hospitalized adult patients.

Body weight is an important clinical parameter for accurate dosing of drugs with a narrow therapeutic window, However, it is difficult to measure the body weight of a patient if they cannot stand on a scale. There are several anthropometrics-based equations to estimate the body weight, but most of these are derived from white Caucasian populations and are not validated for South Asians. This study aimed to validate existing anthropometrics-based weight estimation equations and develop a new equation for the same purpose for Sri Lankan adults.

Outcomes of stroke patients undergoing thrombolysis in Sri Lanka; an observational prospective study from a low-middle income country.

Background: Stroke related deaths are relatively higher in low- and middle-income countries where only a fraction of eligible patients undergo thrombolysis. There is also limited evidence on post-thrombolysis outcomes of patients from Asian countries in these income bands.

Methods: This is a single center prospective observational study of a patient cohort with acute ischaemic stroke, undergoing thrombolysis with alteplase (low and standard dose), over a 24-month period in 2019/2020.

Anterior clinoid mucocoele presenting as progressive fluctuating visual loss mimicking inflammatory optic neuropathy.

Optic nerve lesions usually produce monocular visual loss, and in compressive optic neuropathies, gradual vision loss is the more usual presentation. Mucocele in the anterior clinoid process is a rare cause of compressive optic neuropathy that can lead to monocular visual loss. A 19-year-old Sri Lankan girl presented with progressive, painless fluctuating right-sided monocular visual loss over 1-year duration.

Effectiveness of paranasal air suction on acute migraine using portable air sucker - a randomized, double blind study.

Background: Migraine is a primary headache disorder and is the most common disabling primary headache disorder that occurs in children and adolescents. A recent study showed that paranasal air suction can provide relief to migraine headache. However, in order to get the maximum benefit out of it, an easy to use effective air sucker should be available.

Artery of Percheron infarction presenting as nuclear third nerve palsy and transient loss of consciousness: a case report.

Background: Thalamic blood supply consists of four major vascular territories. Out of them paramedian arteries supply ipsilateral paramedian thalami and occasionally rostral mid brain. Rarely both paramedian arteries arise from a common trunk that arise from P1 segment of one sided posterior cerebral artery (PCA).

Coexistence of mycobacterial infections - Mycobacterium tuberculosis and Mycobacterium leprae - in Sri Lanka: a case series.

Background: Leprosy is one of the oldest mycobacterial infections and tuberculosis is the most common mycobacterial infection with a higher degree of infectivity than leprosy. Although both diseases are prevalent in clusters in developing countries, simultaneous occurrence of them in an individual is a rare entity, even in an endemic setting.

Case Presentation: We describe six cases of tuberculosis and leprosy coinfection: a 57-year-old Sinhalese woman, a 47-year-old Tamil woman, a 72-year-old Tamil man, a 59-year-old Sinhalese man, a 54-year-old Sinhalese man, and a 50-year-old Sinhalese man.

Subacute sclerosing panencephalitis: a rare cause of acute cortical visual impairment in an adult.

Adult onset subacute sclerosing panencephalitis (SSPE) after the third decade of life is rare and the manifestations can mimic disorders such as dysmyelinating and metabolic disorders. This case report presents a patient with acute binocular visual impairment in his fifth decade as the first manifestation of SSPE. This is preventable with immunisation against measles.

Systemic lupus erythematosus presenting with status epilepticus and acute cardiomyopathy with acute heart failure: case report.

Introduction: Systemic lupus erythematosus is a connective tissue disorder, which causes complex multi organ involvement. Neurological and cardiac manifestations have been well noted but complications such as status epilepticus and acute myocarditis with heart failure at presentation remains uncommon.

Case Description: A 15-year-old, previously healthy, South Asian, Sri Lankan female presented with status epilepticus and the seizures only responded to intravenous midazolam and thiopentone sodium.

Disseminated Mycobacterium simiae infection in a patient with adult-onset immunodeficiency due to anti-interferon-gamma antibodies - a case report.

Background: Mycobacterial species other than Mycobacterium tuberculosis and Mycobacterium leprae are generally free-living organisms and Mycobacterium simiae is one of the slowest growing Non-tuberculous mycobacteria. This is the first case report of Mycobacterium simiae infection in Sri Lanka and only very few cases with extrapulmonary manifestation reported in the literature.

Case Presentation: A 24-year-old, previously healthy Sri Lankan male presented with generalized lymphadenopathy with discharging sinuses, evening pyrexia, weight loss, poor appetite and splenomegaly.

Paranasal sinus air suction for immediate pain relief of acute migraine - a randomized, double blind pilot study.

Background: Migraine is a primary headache disorder, which cause significant disability in adolescence. This double blind, randomized clinical trial assessed the immediate effects of suction of paranasal sinus air during an acute migraine episode.

Methods: A randomized, double blind study was conducted with 56 selected Sri Lankan school children of 16-19 years of age.

A seven-year retrospective analysis of patch test data in a cohort of patients with contact dermatitis in Sri Lanka.

Background: Patch testing with a baseline series is a common tool employed when the sensitizing agent in contact dermatitis is unclear. However, for Asian countries, there are no locally validated baseline series to utilize in screening.

Methods: We completed a retrospective analysis of all patients that had undergone patch testing with the European Baseline series, Shoe Series or Comprehensive International Baseline series, over 7 years from 2012 to 2018 in a tertiary care reference dermatology clinic in Sri Lanka to evaluate the suitability of these investigations to identify causes for contact dermatitis in the local study population.

Scleredema associated with immunoglobulin A-κ smoldering myeloma: a case report and review of the literature.

Background: Scleredema is a rare sclerodermoid skin condition characterized by diffuse symmetrical thickening of the upper part of the body. Its association with monoclonal gammopathy and myeloma was recently described; very few cases have been reported to date.

Case Presentation: A 66-year-old Sri Lankan woman who had been followed in a dermatology unit for 34 years with diffuse systemic sclerosis presented with an acute exacerbation of the skin disease.

A patient with neurofibromatosis type 1 presenting with bilateral frontal lobe infarctions following anterior communicating artery aneurysm rupture.

Neurofibromatosis is a neurocutaneous genetic condition with dysplasia of the mesodermal and ectodermal tissues. Vascular abnormalities are well recognized in neurofibromatosis and cerebral aneurysms are rarely reported in literature. Here, we present a 20-year-old Sri Lankan female presented with headache, altered personality, disinhibited behaviour, and urinary incontinence.

Co-existence of mycobacterial infections: is it an emerging issue with retroviral infections?

We report a 46-year-old woman presenting with leprosy, HIV and active pulmonary tuberculosis (TB). It is advisable to screen for each one of TB, HIV and leprosy patients, especially when an extra feature emerges. Particularly in a leprosy case, if TB remains undiagnosed, the development of rifampicin resistance secondary to monotherapy in leprosy is a major concern.

Is there a delay in seeking medical care after the first seizure in "resource limited settings": a pilot study from Sri Lanka.

Objectives: Current guidelines suggest that patients presenting with the first seizure should be assessed by a specialist, preferably with investigations such as electroencephalography and imaging to reach a definitive diagnosis. We conducted a cross sectional study among patients with confirmed epilepsy, at a tertiary level neurology clinic in Sri Lanka with the aim of assessing delays in first contact with a medical doctor and in performing key investigations after the first seizure.

Results: Majority had sought medical attention within 24 h of the first seizure (71.

Effectiveness of corticosteroid in the treatment of dengue - A systemic review.

Corticosteroids are used therapeutically for a broad spectrum of diseases including autoimmune, allergic and inflammatory diseases. However in trials, the evidence for using corticosteroids in dengue is inconclusive and the quality of evidence is low. This systemic review is conducted to review clinical trials on dengue and steroid therapy to identify the current strength and weakness of evidence for the use of corticosteroids.

Knowledge, attitudes and skills in melanoma diagnosis among doctors: a cross sectional study from Sri Lanka.

Objectives: This study aimed to assess the knowledge, attitudes and skills of non-specialist doctors on timely referral of suspicious lesions for melanoma diagnosis.

Results: One hundred and twenty-three doctors (mean age; 30.4 years, SD ± 8.

A case report of giant pancreatic pseudocyst following acute pancreatitis: experience with endoscopic internal drainage.

Background: Pancreatic cysts are being diagnosed more frequently because of the increasing usage of imaging techniques. A pseudocyst with the major diameter of 10 cm is termed as a giant cyst. Asymptomatic pseudo-cysts up to 6 cm in diameter can be safely observed and monitored without intervention, but larger and symptomatic pseudocysts require intervention.

Erythroderma and extensive poikiloderma - a rare initial presentation of dermatomyositis: a case report.

Background: Dermatomyositis is a humoral-mediated inflammatory myopathy with symmetrical proximal muscle weakness and dermatological manifestations such as Gottron's papules, heliotrope rash, periungual abnormalities, and flagellate erythema. Erythroderma is a severe and potentially life-threatening dermatological condition with diffuse erythema and scaling involving more than 90% of the skin surface area. Poikiloderma vasculare atrophicans refers to mottled hyperpigmentation and hypopigmentation of the skin with in-between telangiectases and areas of atrophy and is considered a variant of mycosis fungoides.

Tongue fasciculations with denervation pattern in osmotic demyelination syndrome: a case report of diagnostic dilemma.

Background: The pathogenesis of osmotic demyelination syndrome is not completely understood and usually occurs with severe and prolonged hyponatremia, particularly with rapid correction. It can occur even in normonatremic patients, especially who have risk factors like alcoholism, malnutrition and liver disease. Bilateral tongue fasciculations with denervation pattern in electromyogram is a manifestation of damage to the hypoglossal nucleus or hypoglossal nerves.