Browsing by Author "Perera, U.D.C.A."

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Hypoglycaemia among patients with type II diabetes mellitus: A retrospective study
(Sri Lanka Medical Association, 2013) Perera, U.D.C.A.; Silva, F.H.D.S.; de Silva, S.T.
INTRODUCTION AND OBJECTIVES; Although there is emphasis on strict glucose control in type II diabetes mellitus (T2DM), information about problems that occur due to hypoglycaemia, especially in resource-poor settings, is lacking. We aimed to determine the prevalence of symptomatic hypoglycaemia, awareness of hypoglycaemia and knowledge about avoiding, detecting and treating hypoglycaemia, in a cohort of patients with T2DM. Methods: A descriptive, retrospective study of patients with T2DM attending general medical clinics of the University Medical Unit, Teaching Hospital, Ragama was carried out for 7 months from May 2012 using an interviewer administered questionnaire. RESULTS: Three hundred patients were recruited. One hundred and two (34%) had experienced at least one hypoglycaemic episode, and more than 2 episodes were experienced by 88 (86.3%). Commonest symptoms were sweating (65.7%) and palpitations (54%). Neuroglycopaenic symptoms were experienced by 54 (52.9%) and 18 (17.6%) had "become unconscious. Thirty (29.4%) had required hospital admission. Sixty nine (67.6%) were on sulphonylurea alone or in combination with metfonnin. Sixty nine (67.6%) were unaware of hypoglycaemia. Main reasons for hypoglycaemia were missed meals 49 (48%) and associated illness 49 (23.5%). Two hundred and thirty eight (79.3%) knew how to treat hypoglycaemia and 151 (50.3%) had received information on hypoglycaemia from medical officers. Two hundred and sixty one (87%) were not using a glucometer and 223 (74%) were unaware of such a device, although 249 (83%) said they could afford one. CONCLUSIONS: Hypoglycaemia is a common but under-recognised symptom among T2DM patients. Severe or recurrent hypoglycaemia is associated with a high cost to the individual and to the health service. Raising awareness by health education, with emphasis on self-monitoring where possible, should receive priority.
Repeated dengue shock syndrome and "Dengue myocarditis" responding dramatically to a single dose methyl prednisolone
(Sri Lanka Medical Association, 2012) Premaratna, R.; Rodrigo, K.M.D.; Anuratha, A.; de Alwis, V.K.D.; Perera, U.D.C.A.; de Silva, H.J.
INTRODUCTION: Place of steroids in the management of severe dengue is unclear. A retrospective observational study appeared to show benefit of methylprednisolone (MP) in a highly selected group of patients. CASE REPORT: A 14-year-old schoolboy developed "myocarditis" (4th day) and on the fifth day, he collapsed with Dengue shock syndrome DSS needing rapid resuscitation with intravenous fluid boluses and dextran. He continued to have high fever (39-410C), and pulse rate (PR)>110/min and developed two further episodes of DSS and was resuscitated with further boluses of dextran. As there was no response with temperature 40.20C, PR 160/min, mid-arm systolic BP 70 mmHg, confused, restless, respiratory rate 36/min, dropping capillary 02 saturation, moderate pleural effusions and ascites, urine output <0.2ml/kg/Hr, made it extremely difficult to select the amount and type of fluid for resuscitation. Due to rapid deterioration a single dose of methylprednisolone (MP) (SOOmg in 200ml saline iv over 20 minutes) was administered as a rescue medication. He had deferversence within 30 minutes, became conscious and alert in 1 hour, PR reduced to 96/minute, BP remained stable above 100/80mmHg and urine output increased to 0.8-1.4ml/Kg/Hr. His ECG became normal after 3 hours, and the echo cardiogram in 12 hours (EF-55%). CONCLUSIONS: This patient with dengue developed three episodes of severe haemodynamic compromise within 12 hours while having third space fluid accumulation, "myocardits" and altered level of consciousness making it difficult to institute fluid therapy. A single dose of MP given as rescue measure resulted in a dramatic recovery suggesting a beneficial effect of MP in sever dengue.by
Repeated dengue shock syndrome and 'dengue myocarditis' responding dramatically to a single dose of methyl prednisolone
(Elsevier(Open Access), 2012) Premaratna, R.; Rodrigo, K.M.D.J.; Anuratha, A.; de Alwis, V.K.D.; Perera, U.D.C.A.; de Silva, H.J.
The place of steroids in the management of severe forms of dengue is unclear. A retrospective observational study showed the benefits of a single dose of intravenous methyl prednisolone in a highly selected group of patients who developed severe dengue during the febrile phase of infection. We report the case of a 14-year-old boy with dengue who developed three episodes of severe hemodynamic compromise while having high fever, 'myocarditis', third space fluid accumulation, progressive reduction in urine output, and altered mentation, who made a dramatic recovery following a single dose of intravenous methyl prednisolone. Results justify a well powered randomized controlled trial to evaluate the efficacy of this treatment in severe dengue.