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Search Results: 1 - 10 of 10315 matches for " Chaturaka Rodrigo "
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Delay in diagnosis of generalized miliary tuberculosis with osseo-articular involvement: a case report
Chaturaka Rodrigo, Inoshi Atukorala
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-512
Abstract: We present the case of a 17-year-old Sri Lankan man who presented to our facility with an ill-defined large induration over the skin of his left buttock and thigh. A cause could not be found despite extensive investigations. He also complained of chronic knee pain, but this was not investigated further at the time due to spontaneous resolution. Three years later his knee disease flared up again, with pain, swelling and restriction of movement. A synovial biopsy was suggestive of tuberculosis. He was started on antituberculosis therapy, to which he responded well. Our patient was asymptomatic two months after completion of therapy without any subsequent flare-ups. A chest roentgenogram taken on his second presentation showed evidence of tuberculosis sequelae in his lungs. The most likely diagnosis for the buttock and thigh swelling, when considering the entire clinical picture, is a tuberculous abscess. The constellation of skin and skeletal symptoms and pulmonary tuberculosis is a rare occurrence in an immunocompetent individual, but cases have been reported.This case demonstrates the different presentations and the diagnostic difficulties posed by atypical manifestations of tuberculosis. It also demonstrates the value of maintaining a high degree of suspicion in endemic areas, even in the absence of microbiological evidence.The incidence of tuberculosis (TB) was assumed to be increasing in parallel with the HIV epidemic. However, latest data show that it is in fact falling slowly [1]. Once thought to be a disease of the poor and the malnourished, TB in the modern-day setting can occur anywhere regardless of socioeconomic status. Physicians need to be aware of the widely different manifestations of TB, which is a multi-system disorder. A diagnosis of atypical disease can be difficult to make and years may pass before a firm diagnosis is settled on. We present a case of tuberculosis in a young man where the atypical nature of the illness delayed the correct diagnosis
Cannabis and schizophrenia spectrum disorders: A review of clinical studies
Rodrigo Chaturaka,Rajapakse Senaka
Indian Journal of Psychological Medicine , 2009,
Abstract: Cannabis is the most widely used illegitimate substance in the world, and the number of users has increased by 10% over the last decade worldwide. Therefore, it is important to review the evidence on psychoactive properties of cannabis and its possible association with schizophrenia spectrum disorders (SSD). We searched MEDLINE with the key words cannabis and schizophrenia. The search was limited to articles published in English over the last 10 years (1999-2009). Bibliographies of cited literature were also searched. Data sources included reviews published in core clinical journals, cohort studies, interventional studies, case-control studies, cross-sectional analyses and epidemiological data. Results are discussed under 2 topics. Firstly, evidence related to biochemical functioning of cannabinoids and their relationship to endocannabinoid system is discussed briefly. Secondly, the evidence from clinical studies on cannabis, psychosis proneness and SSD are discussed in detail. The discussion is structured to fit in the evidence from results section to 3 plausible hypotheses on cannabis use and SSD. The evidence for and against each hypothesis is discussed. Despite new evidence, the exact relationship between cannabis and SSD is unclear. There is no firm evidence that cannabis causes SSD. The evidence for the argument that schizophrenic patients are attracted to cannabis is also not strong. The most plausible explanation is that cannabis use and psychosis proneness may have synergistic effects in a vulnerable minority.
Looking at complicating non-biological issues in women with HIV
Rodrigo Chaturaka,Rajapakse Senaka
Journal of Global Infectious Diseases , 2010,
Abstract: Introduction: The increasing number of women acquiring Human Immunodeficiency Virus (HIV) has resulted in a ′feminization′ of the epidemic. In this article we are reviewing whether females are disadvantaged in the epidemic, due to factors independent of the biological differences in sexes. Materials and Methods: We searched MEDLINE and EMBASE for articles with key words ′Women′, ′Gender,′ and ′HIV′ in any field. The search was restricted to articles published in English within the last 10 years (1999-2009). Data were coded independently by two reviewers from 94 selected sources. The coded data were categorized under five commonly encountered concepts; violence, poverty, gender norms, prevention-/treatment-related issues, and Highly Active Anti-Retroviral Treatment (HAART). Results: The link between inter-partner violence (IPV) and HIV risk for women is observed by many authors. In assessing the link between poverty and HIV, indicators such as food insufficiency and income inequality may be better indicators compared to wealth itself. Although women are disadvantaged with male-dominated gender norms, evidence suggests that the traditional norms are changing in many societies. A positive association between living in urban communities, education, and better HIV knowledge has been observed in females, although it is not always synonymous with reduced risk behavior. Conclusions: Women are still disadvantaged in many HIV-related issues such as poverty, violence, and gender norms. At least in Africa, there is evidence of a positive change in spheres of education and gender norms. However, the situation in Asia is largely unexplored.
Current Evidence on the Use of Antifilarial Agents in the Management of bancroftian Filariasis
Sumadhya Deepika Fernando,Chaturaka Rodrigo,Senaka Rajapakse
Journal of Tropical Medicine , 2011, DOI: 10.1155/2011/175941
Abstract: Many trials have explored the efficacy of individual drugs and drug combinations to treat bancroftian filariasis. This narrative review summarizes the current evidence for drug management of bancroftian filariasis. Diethylcarbamazine (DEC) remains the prime antifilarial agent with a well-established microfilaricidal and some macrofilaricidal effects. Ivermectin (IVM) is highly microfilaricidal but minimally macrofilaricidal. The role of albendazole (ALB) in treatment regimens is not well established though the drug has a microfilaricidal effect. The combination of DEC+ALB has a better long-term impact than IVM+ALB. Recent trials have shown that doxycycline therapy against Wolbachia, an endosymbiotic bacterium of the parasite, is capable of reducing microfilaria rates and adult worm activity. Followup studies on mass drug administration (MDA) are yet to show a complete interruption of transmission, though the infection rates are reduced to a very low level. 1. Introduction There are nine filarial nematodes causing disease in humans. According to the location of the parasite and the pathogenesis, the disease can be classified as lymphatic, subcutaneous, and serous cavity filariasis. Two filarial worms, namely, Wuchereria bancrofti and Brugia malayi cause lymphatic filariasis. The World Health Organization (WHO) considers lymphatic filariasis to be a global health problem affecting approximately 120 million people in over 80 countries [1]. One-third of affected individuals are from South Asia and another one third is from Africa [1]. One sixth of the world population is at risk of infection [1]. The adult W. bancrofti worms live within the human lymphatic system. They have a long life span of 4–6 years. Females are viviparous and release thousands of microfilaria into the blood stream of the host after mating. These are taken up by vector mosquitoes during feeding, and the parasite undergoes several moults within the intermediate host to become the L3 larva which is the infective stage. During a feed, this larva enters the human blood stream and migrates to the lymphatics where it moults to become an adult worm [2]. There is a range of clinical manifestations in bancroftian filariasis with asymptomatic microfilaremics being at one end of the spectrum. Symptomatic patients may have acute (lymphangitis, lymphadenitis), chronic (elephantiasis, lymphoedema, hydrocoele, chyluria), or atypical (funiculitis, mastitis) manifestations [3]. Some may suffer from tropical pulmonary eosinophilia (TPE) due to the immunological hyperresponsiveness to the parasite [4].
The 'antisocial' person: an insight in to biology, classification and current evidence on treatment
Chaturaka Rodrigo, Senaka Rajapakse, Gamini Jayananda
Annals of General Psychiatry , 2010, DOI: 10.1186/1744-859x-9-31
Abstract: PubMed was searched with the keywords 'antisocial personality disorder', 'dissocial personality disorder' and 'psychopathy'. The search was limited to articles published in English over the last 10 years (1999 to 2009)Both diagnostic manuals used in modern psychiatry, the Diagnostic and Statistical Manual published by the American Psychiatric Association and the International Classification of Diseases published by the World Health Organization, identify a personality disorder sharing similar traits. It is termed antisocial personality disorder in the diagnostic and statistical manual and dissocial personality disorder in the International Classification of Diseases. However, some authors query the ability of the existing manuals to identify a special category termed 'psychopathy', which in their opinion deserves special attention. On treatment-related issues, many psychological and behavioural therapies have shown success rates ranging from 25% to 62% in different cohorts. Multisystemic therapy and cognitive behaviour therapy have been proven efficacious in many trials. There is no substantial evidence for the efficacy of pharmacological therapy. Currently, the emphasis is on early identification and prevention of antisocial behaviour despite the ethical implications of defining at-risk children.Further research is needed in the areas of neuroendocrinological associations of violent behaviour, taxonomic existence of psychopathy and efficacy of treatment modalities.The concept of a personality disorder with callousness and unemotionality plus disregard for social norms is well established in psychiatry [1]. Such people share a combination of traits that may include violence, aggression, callousness, lack of empathy and repeated acts of criminality against social norms. However, the classifications and definitions from this point onward are not clear.Though such traits would have existed in human societies from time immemorial, identifying and classifying such behavi
Life threatening self starvation; a case report
Chaturaka Rodrigo, Thushani Henegama, Raveen Hanwella
BMC Research Notes , 2013, DOI: 10.1186/1756-0500-6-36
Abstract: We report a case of a twenty two year old Sri Lankan male who presented with life threatening self starvation due to severe obsessive compulsive disorder. The diagnosis was not considered till late due to the atypical presentation of the patient. While his symptoms bordered on a delusional psychosis, a decision was made to treat him as for obsessive compulsive disorder with behavioural therapy which was successful in the end.In analysis of a patient with severe anorexia, the psychological causes should not be forgotten. In fact, if the feeding pattern of the patient was observed at the beginning, unnecessary investigating and life threatening worsening of the condition could have been avoided.
The 'hidden' burden of malaria: cognitive impairment following infection
Sumadhya D Fernando, Chaturaka Rodrigo, Senaka Rajapakse
Malaria Journal , 2010, DOI: 10.1186/1475-2875-9-366
Abstract: PUBMED and SCOPUS were searched for all articles with the key word 'Malaria' in the title field and 'cognitive impairment' in any field. Google Scholar was searched for the same keywords anywhere in the article. The search was restricted to articles published in English within the last 15 years (1995-2010). After filtering of abstracts from the initial search, 44 papers had research evidence on this topic.Cognitive abilities and school performance were shown to be impaired in sub-groups of patients (with either cerebral malaria or uncomplicated malaria) when compared with healthy controls. Studies comparing cognitive functions before and after treatment for acute malarial illness continued to show significantly impaired school performance and cognitive abilities even after recovery. Malaria prophylaxis was shown to improve cognitive function and school performance in clinical trials when compared to placebo groups. The implications of these findings are discussed.Mortality and morbidity due to malaria is still substantial in many tropical countries. In 2006, 247 million cases of malaria were estimated, resulting in 881,000 deaths [1]. Of the 109 endemic countries, 30 countries in sub-Saharan Africa and five in Asia accounted for 98% of malaria deaths globally [2]. The financial cost to tackle malaria is staggering. The global estimate of direct losses due to malaria (i.e., the personal and public expenditures to prevent and treat the disease) is USD 12 billion annually. Approximately 35.4 million disability adjusted life years (DALYs) are lost in sub-Saharan Africa alone due to the mortality and morbidity of malaria [2]. The estimates of expenditure to tackle malaria globally in 2009 and 2010 are USD 5.335 billion and 6.180 billion, respectively, and include direct costs for diagnosis, treatment and prevention [2].There exists an important hidden burden of malaria, namely, that of cognitive impairment and effects on school performance resulting from malaria infectio
Primaquine in vivax malaria: an update and review on management issues
Deepika Fernando, Chaturaka Rodrigo, Senaka Rajapakse
Malaria Journal , 2011, DOI: 10.1186/1475-2875-10-351
Abstract: Primaquine, an 8-aminoquinoline, has been approved for treatment of malaria since 1952 by the Food and Drug Administration (FDA), United States [1]. Six decades after its official licensing, primaquine still holds a unique and unchallenged place in anti-malarial regimens of cure and prophylaxis [2]. It is the only drug proven to be effective, and licensed to eliminate, the hypnozoites of Plasmodium vivax and Plasmodium ovale. Though primaquine is effective, unique and irreplaceable, it is also associated with serious hazards and side effects, such as its ability to precipitate haemolysis in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals [3]. This prohibits its use in key groups, such as pregnant women [4]. The current uses of primaquine in vivax malaria are threefold: for radical cure of patients with confirmed parasitaemia; for causal prophylaxis; and for terminal prophylaxis [1]. In addition, it is used as a gametocytocidal agent in falciparum malaria.This update and review deals with the current role of primaquine in treatment of vivax malaria. It will explore this topic on several fronts namely: a) evidence of efficacy of primaquine for its current indications; b) potential hazards of its widespread use c) critical analysis of reported resistance against primaquine containing regimens d) evidence for combining primaquine with artemisinins in areas of chloroquine resistance and e) the potential for replacement of primaquine with newer drugs.A MEDLINE search was performed for all articles with the key word 'primaquine' and 'Vivax' in any field. The search was restricted to articles published in all languages within the last two decades (1991-2011). There were 480 abstracts in the original search with these restrictions. The software Endnote X3 (Thomson Reuters, Carlsbad, CA 92011, USA) was used to filter articles. Bibliographies of cited literature were also searched. All abstracts were read independently by the three authors, and key articles were
Developing a clinically relevant classification to predict mortality in severe leptospirosis
Rajapakse Senaka,Rodrigo Chaturaka,Haniffa Rashan
Journal of Emergencies, Trauma and Shock , 2010,
Abstract: Background : Severe leptospirosis requires critical care and has a high mortality. We reviewed the literature to identify factors predicting mortality, and such predictors were classified according to the predisposition, infection, response, organ dysfunction (PIRO) concept, which is a risk stratification model used in severe sepsis. Material and Methods : PUBMED was searched for all articles (English), with the key word "leptospirosis" in any field, within the last 20 years. Data were collected from 45 relevant papers and grouped into each component of the PIRO model. Results : The following correlated with increased mortality: predisposition - increasing age and chronic alcoholism; infection - leptospiraemic burden; response - hemodynamic disturbances, leukocytosis; organ dysfunction - multiple organ dysfunction syndrome, pulmonary involvement and acute renal failure. Conclusions : Further research is needed to identify the role of infecting serovars, clinical signs, inflammatory markers, cytokines and evidence of hepatic dysfunction as prognostic indicators. It is hoped that this paper will be an initiative to create a staging system for severity of leptospirosis based on the PIRO model with an added component for treatment-related predictors.
Management of Sepsis-Induced Acute Kidney Injury
Senaka Rajapakse,Chaturaka Rodrigo,Eranga S. Wijewickrema
Sri Lanka Journal of Critical Care , 2009,
Abstract: Acute kidney injury (AKI) occurs in a significant proportion of patients with severe sepsis, and is an important cause of mortality in such patients. Current concepts of pathogenesis of AKI are shifting from vasoconstriction-ischaemia induced injury to toxic and immune mediated injury and hyperaemic injury resulting in apoptosis of renal cells. Renal replacement therapy is the mainstay of management of AKI. Adequacy of dialysis is likely to be linked to better outcome, but there is still no clear consensus on the timing, modality, intensity or frequency of dialysis. Haemodynamically unstable patients usually require modes of continuous renal replacement therapy. Biocompatible dialyser membranes are likely to be safer than older cellulose membranes. Bicarbonate is preferred to acetate and lactate as dialysate buffer. Anticoagulation has to be undertaken with care to prevent excessive haemorrhage in the setting of already deranged haemostasis. Adequate volume resuscitation and maintenance of renal perfusion by the use of vasopressors is beneficial; norepinephrine is the vasopressor of choice. There is no place for the use of low- or renal-dose dopamine, mannitol or frusemide in the setting of sepsis-induced AKI, and in fact they may be detrimental. Prevention of kidney damage by nephrotoxic drugs and radio-contrast media is of vital importance. Careful dose management of nephrotoxic drugs will prevent renal injury. Hydration prior to administration of contrast media prevents nephrotoxicity, but the benefit of N-Acetylcysteine is unclear. Tight glycaemic control may have renoprotective effects, though its place in the management of severe sepsis is now controversial. No clear evidence of benefit is seen with other newer therapies.
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