Papers by Thilak Jayalath
Introduction: Autoimmune thyroid diseases (AITD) are the most common causes of thyroid gland dysf... more Introduction: Autoimmune thyroid diseases (AITD) are the most common causes of thyroid gland dysfunctions and nonendemic goiter, which result from dysregulation of the immune system leading to an immune attack on the thyroid. We present a case of an unusual presentation of AITD of a patient presented with pyrexia of unknown origin. Case Presentation: A 40-year previously well female presented to the Professorial Medical Unit Peradeniya with six weeks of bilateral lower limb pain with eight weeks of fever which subsided two weeks before the presentation, associated with lethargy, tiredness, and intermittent episodes of sweating. On examination, her blood pressure was 120/80 mmHg, pulse rate was 80 bpm, and she had tenderness over bilateral thighs and calves. The diagnostic workup revealed low TSH 0.004 µIU/L, T4 20.93 µIU/L, ESR 90 mm/h, CRP 45.1 mmol/L, and anti-thyroid peroxidase antibody (Anti-TPO) level was positive with 32 IU/ml. Therefore, the patient was treated as hyperthyroidism with autoimmune thyroid disease, and she improved with one week of treatment with carbimazole and prednisolone. After two weeks, a free T3 level was done on the review, which revealed a low value indicating Hashitoxicosis as the possible diagnosis. Conclusion: Anti-TPO antibodies can be positive in Hashimoto's thyroiditis, and Graves' disease and differentiation can be done using other clinical parameters and preferably by radionuclide studies. Autoimmune thyroid diseases could be presented with unusual manifestations where fever and myalgia would be the only presentation. Therefore, it is essential to have a prompt clinical suspicion and perform serum investigations to exclude any thyroid disease.
BMC Research Notes, Mar 9, 2018
Background: Acute pancreatitis is an inflammatory condition with varying severity and a range of ... more Background: Acute pancreatitis is an inflammatory condition with varying severity and a range of local and systemic complications. Here we report a patient with acute necrotizing pancreatitis complicated with a true non ST elevation myocardial infarction. Case presentation: A 58 year old lady was admitted to our unit with acute onset epigastric pain and vomiting for 4 h duration. Following admission she complained of retrosternal tightening type of a chest pain. She had elevated serum amylase and cardiac troponin. Electrocardiogram (ECG) revealed lateral ischaemia. Contrast computerized tomography abdomen revealed acute severe necrotizing pancreatitis. Conclusions: Nonspecific ECG changes can occur in patients with acute pancreatitis. But the diagnosis of true myocardial infarction in a context of acute pancreatitis using ECGs, 2D echocardiography, cardiac biomarkers and coronary angiograms can be challenging with the choice of revascularization therapy and safety of antiplatelet agents and anticoagulant therapy. Decision making regarding the management of such a patient is also critical.
Asian Pacific journal of health sciences, Jun 1, 2020
Introduction: Ischemic heart diseases (IHDs)are a leading cause of mortalities in Sri Lanka. Amon... more Introduction: Ischemic heart diseases (IHDs)are a leading cause of mortalities in Sri Lanka. Among a variety of risk factors, hypertension is a leading cause for IHDs; however, unequal distribution of proper diagnostic facilities complicates the early diagnosis of ischemic changes among adults in Sri Lanka. Therefore this study aimed at studying the possibility of using two basic diagnostic tools, including Rose angina questionnaire (RAQ) and 12 lead electrocardiogram (EGC), to estimate the potential ischemic heart changes among the hypertensive patients in a selected Sri Lankan adult population. Methods: A consecutive sample of 150 hypertensive individuals was recruited, and data were gathered through an interviewer-administered questionnaire, RAQ, blood pressure measurement, and ST-segment analysis of standard 12-lead ECG recordings. Results and Discussion: The majority of the participants (n = 93, 62%) were females. The mean age was 61.5 ± 10.33 years, and their average systolic and diastolic blood pressures were 146 ± 23.27Hgmm and 85 ± 12.08 Hgmm. The association of ST-segment deviations that denote IHDs and the presence of stage I or II hypertension (n = 52, 42%) was statistically significant (p <0.05, df = 1). Based on positive responses to both RAQ and ST-segment deviations, the proportion of individuals with potential Ischemic Heart changes among the hypertensive individuals was 23% (34/150). Except these, 37/150 (25%) of hypertensive individuals, exhibited potential ischemic heart changes only in 12 lead ECG, but the responses to RAQ were negative. On the other hand, responses RAQ was positive among 32/150 (21%) individuals, though none of them exhibited any significant ST-segment changes in their 12 lead ECGs. Conclusion: Based on the utility of RAQ and 12 lead ECG, about a quarter of hypertensive individuals could be detected as having potential ischemic heart changes. Therefore it is suggested that RAQ can be incorporated along with 12 lead ECG into the routine clinical assessment to identify the risk of IHDs among Sri Lankan hypertensive individuals.
Journal of Medical Case Reports, Jan 18, 2023
Background Dengue is still a recurrent challenge to the global population, without specific antiv... more Background Dengue is still a recurrent challenge to the global population, without specific antiviral therapy. Clinical management strategies are aimed to mitigate the deaths. The use of blood products in dengue is recommended mainly in cases of bleeding. Case presentation We prospectively collected data on Sri Lankan dengue cases in the Teaching Hospital, Peradeniya, Sri Lanka from 2017, and selected ten severe cases where blood transfusions were involved in the management. The series comprises seven females and three males, with a median age of 36 years (range 12-53 years). All patients were critically ill at the time of blood transfusion, with dramatic stabilization of vital parameters after the transfusions. Only one patient had detectable bleeding, while five patients had occult blood loss as indicated by dropping hematocrit. Even though four patients had stable hematocrit, they had metabolic acidosis. Two patients had a very high increase of hepatic transaminases along with acidosis. Two patients had myocarditis with dropping hematocrit, suggestive of occult bleeding. Conclusions Clinical deterioration despite fluid management commonly occurs due to occult bleeding in dengue infection. Blood transfusion is lifesaving in such cases of blood loss, acidosis, and severe hepatic damage. The mechanism of this effect needs an explanation, such as enhanced oxygen delivery to the tissues and hemostasis to hypothesize a few possibilities.
Asian Journal of Internal Medicine, 2022
Background: Main objective of this study is to evaluate the clinical and epidemiological characte... more Background: Main objective of this study is to evaluate the clinical and epidemiological characteristics and outcome of patients with COVID-19 admitted to six treatment centres in Sri Lanka.Methods: A descriptive retrospective study was conducted in six treatment centres in the country between March 10, 2020, and May 30, 2020.Results: The study included 431 laboratory confirmed patients with COVID- 19. Their mean age was 37± 13.2 years. Of them, 335 (78.2%) were males. The majority were asymptomatic (243, 56.3%) and of the symptomatic patients, the most common symptom was sore throat (81, 19%), followed by cough (72, 17%), headache (72, 17%), fever (50, 12%), and nasal discharge (36, 8%). Hydroxychloroquine (HCQ) was used as a treatment modality in 248 patients, and they had significantly longer (17.6 days) durations of hospital stay compared to those who were not treated (13.6 days) with HCQ.Conclusions: The majority of patients remained asymptomatic during the course of illness. T...
International Journal of Medical Research and Health Sciences, 2018
Background: Dengue is a mosquito born flavivirus infection which has been endemic in Sri Lanka si... more Background: Dengue is a mosquito born flavivirus infection which has been endemic in Sri Lanka since late 19th century. Since there is no effective vaccination to prevent this deadly disease, knowledge of early recognition and appropriate management of the disease and practice of effective vector control are mandatory to control the disease. Method: Hospital based descriptive cross-sectional study was conducted on patients attending the outpatient department (OPD) of the Teaching hospital Peradeniya (THP) from 26th to 31st of January 2015. Data were collected using a standard questionnaire and entered in to a password protected excel worksheet. Statistical analysis was done using SPSS 20. Results: Data from 500 participants (146 males, 354 females) was used for primary analysis. Only 46.4% of the sample had above average knowledge on dengue fever and its vector. Knowledge had a significant association with education level (p<0.01). Overall attitude towards dengue and its preventi...
BMC Research Notes, 2015
Background: Star fruit (Averrhoa carambola) is commonly consumed as a herbal remedy for various a... more Background: Star fruit (Averrhoa carambola) is commonly consumed as a herbal remedy for various ailments in tropical countries. However, the dangers associated with consumption of star fruit are not commonly known. Although star fruit induced oxalate nephrotoxicity in those with existing renal impairment is well documented, reports on its effect on those with normal renal function are infrequent. We report two unique clinical presentation patterns of star fruit nephrotoxicity following consumption of the fruit as a remedy for diabetes mellitus-the first, in a patient with normal renal function and the second case which we believe is the first reported case of chronic kidney disease (CKD) due to prolonged and excessive consumption of star fruits. Case presentation: The first patient is a 56-year-old female diabetic patient who had normal renal function prior to developing acute kidney injury (AKI) after consuming large amount of star fruit juice at once. The second patient, a 60-year-old male, also diabetic presented with acute on chronic renal failure following ingestion of a significant number of star fruits in a short duration with a background history of regular star fruit consumption over the past 2-3 years. Both had histologically confirmed oxalate induced renal injury. The former had histological features of acute tubulo-interstitial disease whilst the latter had acute-on-chronic interstitial disease; neither had histological evidence of diabetic nephropathy. Both recovered over 2 weeks without the need for haemodialysis. Conclusion: These cases illustrate the importance of obtaining the patient's detailed history with respect to ingestion of herbs, traditional medication and health foods such as star fruits especially in AKI or CKD of unknown cause.
Journal of Medical Case Reports
Background Haemophagocytic lymphohistiocytosis (HLH) is an uncommon systemic inflammatory syndrom... more Background Haemophagocytic lymphohistiocytosis (HLH) is an uncommon systemic inflammatory syndrome that can happen secondary to numerous conditions. It rarely occurs due to dengue infection causing significant mortality and morbidity even with appropriate treatment. The outcome is further poor if the diagnosis of HLH is delayed or left untreated. Therefore, a high degree of clinical suspicion is paramount in diagnosing HLH. Case presentation A 17-year-old Sinhalese boy was admitted to a tertiary care hospital in Sri Lanka with a 4-day history of fever, headache, nausea, vomiting, and diarrhea. He was hemodynamically stable, and the serological investigation confirmed a dengue infection. On the fifth day of fever, he entered the critical phase of dengue infection, confirmed by ultrasound evidence of plasma leaking. However, he had ongoing high fever spikes during the critical phase, and even after the critical phase was over, the fever spikes continued. Simultaneously, hepatosplenome...
Sri Lanka Journal of Medicine, 2021
International Journal of Infectious Diseases, 2022
Purpose A Community vaccination programme is the best approach to combat COVID-19 pandemic. The f... more Purpose A Community vaccination programme is the best approach to combat COVID-19 pandemic. The first priority was given to the health care workers (HCWs) with the introduction of Indian Covishield (ChAdOx1 nCoV-19) vaccine to Sri Lanka since February 2021. An independent post-vaccine surveillance is important to identify the occurrence of adverse effects(A/E) in the population. Methods & Materials A multicentered cross-sectional survey was conducted in four provinces of Sri Lanka to estimate the prevalence of A/E after covishield vaccination A/E among HCWs after the first dose. A self-administered questionnaire was used to gather demographic data and A/E. Data was analysed using descriptive statistics. Results Of 4834 participants, 3500(72.4%) were females. The median age was 42.23(SD±9.64) years. Only 0.8%(n=31) persons has had Covid infection in the past. 2.2% were breastfeeding mothers and 0.2% were pregnant ladies. 87.4% of persons had at least one A/E and 53.1% had local A/E. Body aches(68.2%), headaches(63.8%), fever(58%), chills 51.4%), fatigue(41.2%), arthralgia(38.1%) and rigors (32%) were the most commonly reported systemic A/E. Most of the systemic A/E were more prevalent among the ≤42-year-old group, and females. Their duration was mainly 24 hours. Mean duration of onset of fever is 9.76 hours. Pain and redness at the site were the most commonly reported local A/E. All of the local A/E were more prevalent among the ≤42-year-old group and females. Mean duration of pain at the site is 4.47 hours. 1.7%(n=61) had reactions within first 20 minutes. 0.08%(n=4) developed anaphylaxis, 0.8%(n=31) had urticaria. 15.4% had at least one comorbidities but there were no significant association between having a comorbidity and developing systemic or local. 1.3% had history of drug or food allergies, they did not show significant relation to current vaccine induced allergies or anaphylaxis. 69.2% attended the routine work despite having minor A/E. 0.13%(n=7) were hospitalised and treated. 22.4% were stayed at home and rested for 24-48 hours due to A/E. Conclusion Eventhough more than 60% reported minor A/E, there were only a few serious A/E. A/E were more prevalent in younger age and females. Overall, the first dose of the Covishield vaccine was well-tolerated by HCWs.
IntroductionA community vaccination programme is the best approach to combat the COVID-19 pandemi... more IntroductionA community vaccination programme is the best approach to combat the COVID-19 pandemic. Post-vaccine surveillance is important to identify adverse events (AE) following COVID -19 vaccination in the population.MethodsA multicentre cross-sectional survey was conducted in six provinces to estimate the prevalence of AE following the first dose of COVISHIELD (ChAdOx1nCoV-19) among all categories of health care workers (HCWs). A self-administered questionnaire was used to gather demographic data and AE.ResultsOf 5140 participants 67.8% were females. The mean (SD) age was 40.69 (±9.85) years. At least one comorbidity was reported in 15.4%. At least one AE was reported in 86.6% and 49.3% had local AE. Fever (67.2%), headaches (57.3%), body aches (54.4%), chills (51.2%), fatigue (37.5%) and arthralgia (36%) were the most reported systemic AE. The majority of AE lasted less than 24 hours. Pain and redness at the site were the most reported local AE. Mean duration of onset of fever...
Background Clinical manifestations of coronavirus disease 2019 (COVID19) can vary from asymptomat... more Background Clinical manifestations of coronavirus disease 2019 (COVID19) can vary from asymptomatic to profusely symptomatic due to many factors. Having data on the clinical characteristics of the affected patients is important for the screening and diagnosis of COVID-19. Main objective of this study is to evaluate the clinical and epidemiological characteristics and outcomes of patients with COVID-19 admitted to six treatment centres in Sri Lanka. Methods For the specific epidemic situation of COVID-19, we chose to conduct a descriptive retrospective study from six treatment centres in the country between March 10, 2020 and May 30, 2020. Results The study included 431 laboratory confirmed patients with COVID-19. Of them, 335 (78.2%) were males and their mean age was 37 years. Most patients (373: 86.5%) had had close contact with COVID-19 positive patients. The majority were asymptomatic (243: 56.3%) and of the symptomatic patients, the most common symptom was sore throat (81, 19%),...
Lupus, 2003
We describe the case of a 23-year-oldwoman with a mild form of systemic lupus erythematosus who p... more We describe the case of a 23-year-oldwoman with a mild form of systemic lupus erythematosus who presented a febrile illness rapidly followed by general worsening, neurologic involvement, renal failure and coma. While hospitalized in the intensive care unit she also suffered from acute pancreatitis, microangiopathic hemolitic anemia, thrombocytopenia and prolongation of clotting times. Despite aggressive treatment the patient died at day 17 of hospitalization in the intensive care unit. At autopsy necrotico-hemorragicpancreatitis, diffuse pneumonia, peritonitis and cerebral edema were present. Most striking was the presence of invasive aspergillosis, which was detected in all organs examined. In this case thrombotic thrombocytopenic purpura, invasive aspergillosis and multiorgan failure including acute pancreatitis were present. The relationship between the three entities is complex, and it is difficult to establish which of the different events took place first and triggered the oth...
Case Reports in Infectious Diseases, 2020
Introduction. Appendicular tuberculosis is a rare form of extrapulmonary tuberculosis involving t... more Introduction. Appendicular tuberculosis is a rare form of extrapulmonary tuberculosis involving the gastrointestinal tract. Diagnosis of appendicular tuberculosis is difficult due to its atypical presentation. Histological confirmation remains the gold standard in diagnosis. Case Presentation. We report a 37-year-old Sri Lankan male presenting with a diarrheal illness with high fever for 8 days in the background of constitutional symptoms for 1-month duration. He was pale and had moderate amount of free fluid in the abdomen. Inflammatory markers were elevated, and CT abdomen revealed a thickened elongated appendix. Diagnostic paracentesis revealed a lymphocytic transudative ascites. A macroscopically minimally inflammed appendix removed at laparotomy and histology confirmed presence of tuberculous granulomata with caseation. He made an uneventful recovery by the anti-tuberculous therapy. Conclusion. High degree of suspicion is needed in diagnosis of appendicular tuberculosis due to ...
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium... more Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Chikungunya outbreaks occurred in the central province, Sri Lanka in 2006. This community-based study reports the epidemiology and the natural history of the infection from an affected village. Of the 199 families and 1001 individuals in the village, 159 (80%) and 513 (51%) were affected, respectively, comprising 237 (46%) males with peak incidence at 40–50 years. The acute illness caused polyarthritis in 233 (46%), and of them 230 (98%) progressed to chronic arthritic disability (CAD). Of the CAD patients, 102 (44%) had recovered in 141 days (range 30–210 days) from the disability state whilst 128 (56%) had persisting disability which lasted 12, 24, and 36 months in 41 (17.8%), 22 (9.5%), and 14 (6.1%) individuals, respectively. Carpal tunnel syndrome (CTS) manifested in 110 (21%). Females showed preponderance for complications over males:...
Epidemiology: Open Access, 2016
Background: Pulmonary hemorrhage is a very rare complication of dengue infection. This condition ... more Background: Pulmonary hemorrhage is a very rare complication of dengue infection. This condition presenting with hemoptysis has been reported in 1.4% of dengue infections. However, major hemorrhage is unusual except when associated with profound or prolonged shock. In contrast although this case showed no features of plasma leakage, it resulted in massive pulmonary hemorrhage leading to death. Case Presentation A 17 year old previously healthy Sri Lankan, Sinhalese male presented with a 5 day history of fever. On admission he was ill looking and the hematocrit was 44.8%. He was treated in the High Dependency Unit with close monitoring and was started on normal saline 100 ml per hour and showed improved blood pressure and hematocrit value of 41.5% with the initial chest X-ray and ultrasound on abdomen showing no fluid leakage. But within a few hours he developed sudden onset of hemoptysis and respiratory distress, and an urgent chest X-ray taken showed a patchy right sided middle lobe opacity with no pleural effusion. Death occurred following failed resuscitation and the post mortem revealed massive pulmonary hemorrhage. Conclusion Pulmonary hemorrhage in dengue infection has rapid progression associated with high mortality. Thus, a high index of suspicion is needed for diagnosis.
Background Haemophagocytic Lymphohistiocytosis (HLH) is an uncommon systemic inflammatory clinica... more Background Haemophagocytic Lymphohistiocytosis (HLH) is an uncommon systemic inflammatory clinical syndrome associated with numerous conditions and a rare complication of dengue associated with significant mortality and morbidity even with appropriate treatment. The outcome is further poor if the diagnosis is delayed or left untreated. Therefore a high degree of clinical suspicion is paramount in the diagnosis of HLH, especially in an atypical presentation of dengue infection. Case Presentation A 17-year-old boy with a non-significant past medical history admitted with a four-day history of fever, headache, nausea, vomiting, and loose stool. On admission, he was hemodynamically stable and managed as serologically confirmed dengue fever. On the 5th day of fever, he entered the critical phase, which was uncomplicated except for high fever spicks. Even after the critical phase was over, he had ongoing high fever spicks, hepatosplenomegaly with persistent thrombocytopenia, neutropenia a...
BackgroundRheumatoid arthritis (RA) is a common autoimmune disease with many extra-articular mani... more BackgroundRheumatoid arthritis (RA) is a common autoimmune disease with many extra-articular manifestations. Pure red cell aplasia (PRCA) is a rare manifestation of RA and is sparsely documented in the literature with a variable clinical outcome following immunosuppressive therapy. Case presentationA 63-year-old female presented with transfusion-dependent anaemia associated with deforming inflammatory arthritis, who also had leukopenia, right subclavian venous thrombosis, and generalized lymphadenopathy. The diagnosis of RA following initial clinical workup and additional blood and bone marrow investigations revealed PRCA as a secondary manifestation of RA after excluding other secondary causes, such as infections, thymoma, thrombophilic conditions and haematological malignancy. She responded well to oral prednisolone, cyclosporine A and hydroxychloroquine, where she attained complete recovery in two months. ConclusionPRCA is a disabling illness that may lead to transfusion-dependen...
Case Reports in Medicine
Introduction. Kounis syndrome is the concurrence of an acute coronary syndrome (ACS) caused by co... more Introduction. Kounis syndrome is the concurrence of an acute coronary syndrome (ACS) caused by coronary vasospasms, acute myocardial infarctions, or stent thromboses in case of allergic or hypersensitivity reactions. Kounis syndrome is mediated by mast cells that interact with macrophages and T-lymphocytes, causing degranulation and inflammation with cytokine release. It is a life-threatening condition that has many trigger factors and is most commonly caused by medicines. Case Presentation. A 71-year-old male was admitted with a fever of five days’ duration associated with cellulitis, for which he had been treated with clindamycin and flucloxacillin before admission. He was a diagnosed patient with hypertension and dyslipidemia five years ago. After taking the antibiotics, he had developed generalized itching followed by urticaria suggesting an allergic reaction. Therefore, he was admitted to the hospital. After admission, he developed an ischaemic-type chest pain associated with a...
Background Patients with HIV infection often develop multiple complications and comorbidities, in... more Background Patients with HIV infection often develop multiple complications and comorbidities, including malignancies and opportunistic infections. The association of HIV infection with typhoid fever remains unclear, though there is a clear risk of typhoid in HIV infected persons. Therefore, the diagnosis of typhoid should be considered in HIV infected individuals, mainly when they present with severe ulcerative diarrhoea. Case Presentation A 38-year-old gentleman presented with fever with significant weight loss and anorexia for eight months. He had worked abroad in a middle east country and had recently returned to Sri Lanka. On examination, he was thinly built with a BMI of 18 kg/m2. The initial full blood count revealed lymphopenia, anaemia and thrombocytopenia. He also had mild hyponatremia. His HIV Ag/Ab combo assay became positive, and he was found to have a low CD4 count. While on antiretroviral therapy, he developed nausea, vomiting and diarrhoea while continuing the preexi...
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Papers by Thilak Jayalath