Browsing by Author "Arunath, V."

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6379 Pre-admission management of children presenting with febrile illness in a tertiary hospital of Sri Lanka
(BMJ, 2024) Arunath, V.; Mettananda, S.
OBJECTIVES To describe the symptoms and pre-admission management of children presenting with febrile illness to the Colombo North Teaching Hospital, Ragama, Sri Lanka.METHODS A retrospective descriptive study was conducted at University Paediatric Unit of Colombo North Teaching Hospital, Ragama, Sri Lanka. Data on pre-admission management of all children admitted with febrile illness from July to December 2019 were extracted from patient records. Children who were transferred from other units, children with chronic illnesses and children developed fever following vaccinations were excluded. Ethical approval was obtained from Ethics Review Committee of Sri Lanka College of Paediatricians and data was analysed using SPSS version 22.RESULTS A total of 366 children were admitted; 56% were males. Mean age was 53.5 ± 41.7 months and the majority were from Gampaha district. Mean duration of illness on admission was 3.6 ± 2.5 days. 236 (65.6%) patients had recorded fever spikes at home while 150 (60.7%) reported a contact history of fever. Common associated symptoms were cough (62.3%), cold (56%) and vomiting (39.6%). 199 (54.5%) underwent investigations prior to admission and full blood count was the commonest (47.5%) investigation. Although 357 (97.8%) had taken medication prior to admission, only 87.3% had consulted a doctor. 356 (97.3%) received paracetamol at home of which 24 (7.9%) and 123 (40.6%) received sub-therapeutic and supra-therapeutic doses respectively. Significantly higher proportion (44.9%) of children who consulted a doctor received appropriate dose of paracetamol compared to others (3.7%), (c2=11.9, p=0.003, p<001). Higher proportion children who had recorded fever spikes consulted a doctor (c2=3.99, p=0.046, p<0.05) and received therapeutic doses of paracetamol prior to admission (c2=4.94, p=0.026, p<0.05).CONCLUSION Use of sub- and supra-therapeutic doses of paracetamol was common before admission to the hospital. Recording temperature at home and medical consultation prior to admission were associated with appropriate dose paracetamol usage (p<005).
Acute on chronic osteomyelitis due to coliforms in a Sri Lankan child with homozygous sickle cell disease
(Sri Lanka College of Paediatricians, 2021) Hoole, T.J.; Arunath, V.; de Silva, M.H.A.D.; Muthukumarana, O.G.W.; Kumarasiri, I.M.; Rathnasiri, G.B.A.M.R.; Mahendra, G.; Premawardhena, A.; Mettananda, S.
No Abstract Available
A child with Imerslund-Gräsbeck syndrome concealed by co-existing α-thalassaemia presenting with subacute combined degeneration of the spinal cord: a case report
(BioMed Central, 2021) Arunath, V.; Hoole, T. J.; Rathnasri, A.; Muthukumarana, O.; Kumarasiri, I.M.; Liyanage, N.D.; Costa, Y.; Mettananda, S.
BACKGROUND: Imerslund-Gräsbeck syndrome is a rare genetic disease characterised by vitamin B12 deficiency and proteinuria. CASE PRESENTATION: A 4-year old Sri Lankan boy presented with gradually worsening difficulty in walking for two weeks duration. He was previously diagnosed and managed as having non-transfusion-dependent α-thalassaemia based on the presence of hypochromic microcytic anaemia, haemoglobin H inclusion bodies in the blood film and compound heterozygous α-thalassaemia genotype with a gene deletion. However, his transfusion requirement increased over the past three months and he gradually lost his motor developmental milestones during two weeks before admission. The neurological examination revealed generalised hypotonia, exaggerated knee jerks and extensor plantar response. His complete blood count showed pancytopenia, and bone marrow biopsy revealed megaloblastic changes. Serum vitamin B12 and red blood cell folate levels were low. MRI revealed sub-acute combined degeneration of the spinal cord with characteristic 'inverted V sign'. Urine analysis showed non-nephrotic range proteinuria. The diagnosis of Imerslund-Gräsbeck syndrome was made due to the presence of non-nutritional vitamin B12 deficiency and asymptomatic proteinuria. He showed a rapid haematological and neurological improvement to intramuscular hydroxocobalamin. CONCLUSIONS: This case report presents a rare occurrence of severe vitamin B12 deficiency due to Imerslund-Gräsbeck syndrome masked by co-existent α-thalassaemia, resulting in serious consequences. It highlights the need for a high index of suspicion in evaluating children with severe anaemia, especially in the presence of mixed pathologies. KEYWORDS: Anaemia; Hypopigmented hair; Imerslund-Gräsbeck syndrome; Inverted V sign; Megaloblastic changes; Subacute combined degeneration of the spinal cord; Thalassaemia; Vitamin B12.
Delayed-onset Sinus Node Dysfunction in a child victim of Russell's Viper Bite.
(Asia Pub., 2020) Athapathu, A.S.; Arunath, V.; Aruppala, A.A.; Hoole, T. J.; Suntharesan, K.; Mettananda, S.
ABSTRACT:Cardiac complications following envenomation by Russell's viper venom are uncommon. We describe a 14-year-old girl who developed delayed-onset sinus node dysfunction. She presented with mucosal bleeding, ptosis, and muscle weakness. Her 20-min whole blood clotting time and international normalized ratio were prolonged. The initial electrocardiogram showed sinus tachycardia. Her systemic manifestations responded to antivenom serum. After 24 h, she developed bradycardia and electrocardiography showed sinus node dysfunction with sinus arrest and an atrial escape rhythm. This case shows that arrhythmias can have a delayed onset even after resolution of other systemic manifestations, and even after treatment with antivenom serum. KEYWORDS: Arrhythmias; adolescent; cardiac; electrocardiography; sinus; snake bites; tachycardia; viperidae.
Knowledge, attitudes and practices related to chronic childhood urinary tract infections among care givers of patients with urinary tract infections - a single centre experience
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Arunath, V.; Gnanasekar, B.; Coonghe, P.A.D.; Sathiadas, M.G.
BACKGROUND: Adequate knowledge, positive attitude and good practices of care givers of children with chronic urinary tract infections (UTI) are important for optimal management of the disease. OBJECTIVES: To describe the knowledge attitudes and practices related to management of chronic childhood urinary tract infections (UTI) and influence of socio economic and demographic factors on it among care givers of children with UTI attending a paediatric clinic in the Teaching Hospital of Jaffna. METHODS: A descriptive cross sectional study which included 172 care giver/patient pairs was conducted. A structurally prepared interviewer administered questionnaire was used to collect data from April to July 2014. Chi square test and independent sample t test were used for analysis. RESULTS: Among caregivers, 163 (94.8%) were females and among them 151 (87.8%) were mothers. The proportion with good knowledge about childhood UTI was 55.8%. More than two third of the participants had good knowledge on symptoms (73.8%), urine collection techniques (73.3%) and investigations (68.6%). Around two fifth of them had good knowledge regarding causes (44.8%) and treatment (46.5%). Of the participants, 84.9% were worried about their child’s illness. About 44% of care givers used napkins for their children and 81.4% of participants washed their child’s anal region front to back after defecation. One tenth of them used home remedies to manage UTI. Almost all brought their child to clinic regularly and received explanations about UTI. The factors significantly associated with mean of total knowledge score included care givers’ age, educational level, occupation, and monthly income. Knowledge of care givers was significantly associated with usage of home remedies and health education given by health professionals. CONCLUSIONS: Knowledge, attitude and practices of care givers were satisfactory but need to improve in certain aspects. Health education should be more effective and it should augment the awareness and eliminate misconceptions prevailing in the community.
A rare co-occurrence of duchenne muscular dystrophy, congenital adrenal hypoplasia and glycerol kinase deficiency due to Xp21 contiguous gene deletion syndrome: case report.
(BioMed Central,, 2021) Rathnasiri, A.; Senarathne, U.; Arunath, V.; Hoole, T.; Kumarasiri, I.; Muthukumarana, O.; Jasinge, E.; Mettananda, S.
Background: Contiguous gene deletion syndromes are rare genomic disorders caused by deletion of large segments of DNA resulting in co-occurrence of apparently unrelated multiple clinical phenotypes. We report a boy with contiguous gene deletion involving Xp21 genomic location. Case presentation: A Sri Lankan boy with developmental delay and failure to thrive first presented at three years of age with hypovolaemia, hyperpigmentation and drowsiness. Investigations done at that time revealed hypoglycaemia, hyponatraemia, hyperkalaemia, low cortisol, low aldosterone, high ACTH and low 17-hydroxyprogesterone. He was diagnosed to have primary adrenal insufficiency. During follow-up at five years, he was noted to have progressive difficulty in walking, waddling gait, hypotonia, calf hypertrophy and positive Gower’s sign. His creatine kinase was very high, and the electromyogram showed myopathy. Genetic analysis revealed hemizygous deletion involving the final 35 exons of the dystrophin gene confirming the diagnosis of Duchenne muscular dystrophy. Further investigations revealed pseudohypertriglyceridemia, large glycerol peak on urine organic acid analysis and hemizygous deletion of the glycerol kinase gene confirming glycerol kinase deficiency. Based on the presence of Duchenne muscular dystrophy, glycerol kinase deficiency and probable congenital adrenal hypoplasia along with genetic confirmation of deletions involving dystrophin and glycerol kinase genes, the diagnosis of Xp21 contiguous gene deletion syndrome was made.Conclusions: We report a child with contiguous gene deletion syndrome who was initially diagnosed as having isolated primary adrenal insufficiency probably due to congenital adrenal hypoplasia. Later he was confirmed to have Duchenne muscular dystrophy and glycerol kinase deficiency, as well. This case report highlights the importance of pre-emptive evaluation and identification of genetic defects when patients present with seemingly unrelated diseases that could aid in accurate diagnoses of contiguous gene deletion syndromes.
Severe disfiguring scalp and facial oedema due to Henoch–Schönlein Purpura in a child
(Hindawi, 2020) Arunath, V.; Athapathu, A.S.; Hoole, T.J.; Aruppala, H.; Rathnasri, A.; Ranawaka, R.; Mettananda, S.
ABSTRACT: Henoch–Schönlein purpura is a small vessel vasculitis that usually presents with palpable purpura, arthritis, abdominal pain, and nephritis. Subcutaneous oedema of dependent areas is common; however, oedema in the scalp is extremely rare especially in children older than two years. Here, we report a child with massive disfiguring scalp and facial oedema due to Henoch–Schönlein purpura. An eight-year-old boy presented with characteristic palpable purpuric rash and extensive disfiguring scalp and facial swelling for five days. He complained of blurred vision, vomiting, and severe headache on the day of admission. Examination revealed an ill child with extensive oedema of the face and scalp that was tender on palpation. His blood pressure was above the 99th percentile, and he had exaggerated deep tendon reflexes and extensor plantar responses. All biochemical investigations including renal function tests were normal. Noncontrast CT head showed normal brain, with marked soft tissue swelling of the scalp. Ultrasonography showed soft tissue oedema within and surrounding facial muscles without evidence of neck vessel compression. Urine analysis revealed microscopic haematuria on day 14 of the illness, and immunohistochemical staining of renal biopsy confirmed Henoch–Schönlein purpura nephritis. In conclusion, this case report presents a child with severe, disfiguring scalp and facial oedema due to Henoch–Schönlein purpura. It highlights that severe subcutaneous oedema of Henoch–Schönlein purpura can involve any part of the body not limiting to dependent areas.
A Sri Lankan boy with Thurston syndrome (type V oro-facio-digital syndrome)
(Sri Lanka College of Paediatricians, 2021) Athapathu, A.S.; Aruppala, A.A.H.S.; Hoole, T.J.; Arunath, V.; Rathnasiri, G.B.A.M.; Mettananda, S.
No abstract available