Umesh Jayarajah

Renal manifestations of dengue virus infections

Dengue is a significant health problem in many countries. In recent years, complications involving specific organ systems have been increasingly observed and appear to have important effects on overall dengue related morbidity and mortality. Renal involvement in dengue could potentially cause increased mortality and long term effects. We review the different renal manifestations associated with dengue virus infections and explore their potential underlying pathophysiological mechanisms. The serum electrolyte and urinary abnormalities seen in dengue are discussed and Acute Kidney Injury (AKI) due to acute glomerulonephritis, rhabdomyolysis and haemolytic uraemic syndrome following dengue are explored. Renal manifestations of dengue in patients with chronic kidney disease or a transplanted kidney provides new insights into the pathophysiology of the disease.

Incidence and histological patterns of thyroid cancer in Sri Lanka 2001-2010: an analysis of national cancer registry data

BackgroundAn increasing incidence of thyroid cancer is observed in many developed countries. Increasing incidence may also reflect better reporting or increased diagnostic scrutiny. We conducted this study to examine trends in thyroid cancer incidence and histological patterns in Sri Lanka.MethodsA retrospective cohort evaluation of patients with thyroid cancer during 2001–2010 was performed using population based data published from the Sri Lanka National Cancer Registry. Trends in incidence and histological patterns were analysed by age and gender.ResultsThe age-standardized incidence of thyroid cancer increased from 2.44 per 100,000 in 2001 (95% confidence interval [95% CI]: 2.21–2.67) to 5.16 per 100,000 in 2010 (95% CI: 4.85–5.47); a 2.1-fold increase (p < 0.05 for trend). A greater part of this increase is attributable to increase in incidence of papillary thyroid cancer, which increased from 1.64 to 3.61 per 100,000; a 2.2-fold increase (p < 0.05 for trend). Follicular cancer showed lesser, yet a significant increase from 0.56 to 0.95 per 100,000 (p < 0.05). Other varieties of thyroid cancer showed no significant increases in incidence. Trends in the increases in incidence of papillary cancer in females showed a much greater increase compared with males (from 2.45 to 5.60 per 100,000, a 2.28-fold increase in females compared with from 0.82 to 1.55; a 1.89-fold increase in males, p < 0.001). Highest incidence of papillary cancer was observed in 30–39-year age group, which has increased from 5.56 to 12.9 per 100,000; a 2.32-fold increase (p < 0.001).ConclusionsThe increasing incidence of thyroid cancer in Sri Lanka is predominantly due to the increasing incidence of papillary cancers. These trends may reflect increased detection and better reporting, although an inherent increase in the incidence is the likely main contributor. Further studies including tumour stage and mortality may help answer these questions.

Psychological adaptation to alteration of body image among stoma patients: A descriptive study

Background: Creation of an ostomy leads to significant change in the body image of the patient. However, adaptation to this alteration of body image is necessary for rehabilitation following surgery. The objective of this study was to identify the factors that influence adaptation to altered body image. Materials and Methods: An analytical cross-sectional study was conducted among 41 ostomy patients who were treated at a single tertiary care unit. Body image disturbance questionnaire (BIDQ) was used to assess the perception of body image. Data were analyzed using independent samples t-test (unpaired), Chi-square test, and Spearmans correlation. Results: In our study, the mean BIDQ score was 2.22 (standard deviation ± 0.88). The body image disturbance was significantly associated with younger age (P < 0.05). The prevalence of body image disturbance was significantly higher among overweight patients (P < 0.05). Males had a higher BIDQ score than females. Those who had temporary stoma had significantly higher BIDQ score (P < 0.05). Those who felt depressed or had thoughts of self-harm soon after surgery had significantly high body image disturbance score (P < 0.05). There was a significant negative correlation with the perception of self-efficacy and body image disturbance (P < 0.01). There was no significant association between body image disturbance and the diagnosis, type of surgery, or time duration after surgery. Conclusions: Poor adaptation to alteration of body image was associated with younger age, overweight, and temporary stoma. Individuals at risk of poor adaptation should be identified before surgery and counseled before surgery, after surgery, and during follow-up visits.

Pattern of dengue virus infections in adult patients from Sri Lanka

Background Sri Lanka experienced its largest dengue epidemic in 2017. This study describes the disease pattern of adult dengue patients from two hospitals in Sri Lanka. Methods Demographic, clinical and investigation findings of adult dengue patients admitted to the two hospitals from June to August 2017 were collected and analysed. Results A total of 1167 patients (777 males [66.2%], mean age 32.9 y) were studied. There were 775 (66.4%) patients with dengue fever (DF), 334 (28.6%) with dengue haemorrhagic fever grade I, 54 (4.6%) with DHF grade II and 4 (0.3%) with DHF grade III. DHF was significantly associated with abdominal symptoms/signs and bleeding manifestations (p<0.001). A considerable variation in time of onset of the critical phase was noted (day 3, 11.9%; day 4-5, 63.1%; day 6, 16.2%; day ≥7, 8.7%). Significantly lower platelet and white blood cell counts and elevated transaminase levels were found in DHF than DF (p<0.001). Other complications included myocarditis (two patients) and mild renal impairment (three patients). None had neurological manifestations. Conclusions We found abdominal symptoms/signs, low platelet and white blood cell counts and high transaminase to be associated with DHF. The onset of the critical phase was variable and difficult to predict. Compiling data from various regions would help to understand disease patterns, which in turn would help in formulating evidence-based management guidelines and the allocation of limited health care resources.

Testicular adrenal rest tumour in an adult patient with congenital adrenal hyperplasia: a case report and review of literature

Abstract Late presentations of testicular adrenal rest tumours (TART) are rarely seen in males with congenital adrenal hyperplasia, and are often misdiagnosed as primary testicular germ cell tumours. We report a case of bilateral TART in an adult patient with congenital adrenal hyperplasia who had defaulted treatment. He presented with a gradually increasing swelling of the left testis and genital examination revealed a large hard indurated swelling of both epididymes more prominent on the left side. As imaging was inconclusive, a biopsy was performed which showed features in favour of TART rather than Leydig cell neoplasm and he had good response to steroids. Histopathological evaluation is helpful in cases where there is a strong need for excluding a malignancy. Optimal steroid replacement is the treatment of choice and leads to regression of the lesion in the majority.

Lithium-induced symptomatic hypercalcemia and hyperparathyroidism in a patient with bipolar affective disorder: A case report and review of literature

Lithium induced primary hyperparathyroidism is an uncommon endocrine side effect of long term lithium therapy. We studied the case of a 67-year-old female patient on long term lithium therapy for bipolar affective disorder, who developed resistant hypercalcaemia and parathyroid adenoma which required parathyroidectomy. Furthermore, the effect of chronic lithium therapy on parathyroid glands and serum calcium levels, its pathogenesis, and management were reviewed. Periodic monitoring of serum calcium levels in patients on long term lithium therapy should be practiced. Surgical removal of the affected parathyroid gland is an effective treatment modality in selected patients with resistant hypercalcaemia and parathyroid adenoma and/or hyperplasia. However, regular post-operative follow up is needed for early identification of recurrence in such patients.

Retrocaval ureter associated with cryptorchidism: A case report and review of literature

We report an incidentally diagnosed retrocaval ureter in a 14‐year‐old boy, while evaluating for right‐sided hydronephrosis associated with cryptorchidism. Therefore, we suggest that any significant right‐sided hydronephrosis associated with cryptorchidism may require investigations to exclude this rare anomaly.

Nonhealing scrotal ulceration-an unusual manifestation of TB epididymo-orchitis: case report and review of literature

The clinical presentation of genitourinary tuberculosis (TB) may be variable and a high index of suspicion is required for a timely diagnosis, especially in endemic areas. Recurrent scrotal ulcers associated with epididymo‐orchitis even without other constitutional symptoms should alert the clinician of a possible diagnosis of TB.

Partial cystectomy for a primary locally advanced leiomyosarcoma of the bladder: a case report and review of the literature

Partial cystectomy with wide local excision may be considered a suitable option for selective cases of locally advanced bladder leiomyosarcoma without evidence of distant metastasis; thereby preserving the functional outcome and quality of life. A negative margin, complete tumor resection, and frequent follow‐up in such patients are mandatory.

Inflammatory myofibroblastic tumor of the esophagus presenting with hematemesis and melaena: a case report and review of literature

Esophageal inflammatory myofibroblastic tumors (IMT) are extremely rare, and the understanding on the clinical presentation is limited. IMT of esophagus should be considered as a differential diagnosis in the context of unexplained upper gastrointestinal bleeding and rapidly progressing dysphagia in young patients.