Udaya Ralapanawa

University of Peradeniya | UOP · Department of Medicine

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...

Hypertension is the one of major risk factor contributes to the burden of heart disease, stroke, kidney failure, disability and premature death. According to 2019 WHO fact sheet, an estimated 1.13 billion people worldwide have hypertension while only 21% of people have it under control. Further, more than one million deaths are related to hypertens...

The association between hypertension with anthropometric measurements and dietary patterns has been studied globally, giving variable results. This study analyses the anthropometry and dietary patterns of hypertensive patients in Sri Lanka. A cross-sectional descriptive study was designed to include hypertensive patients admitted to Teaching Hospit...

Introduction: Cardiovascular Disease (CVD) is the leading cause of death and disability worldwide. The objective of this study was to assess the prevalence of selected risk factors of CVDs and their associations with socio-demographics and anthropometrics factors among adults in the Sabaragamuwa Province of Sri Lanka. Methods: A descriptive cross-s...

Cardiovascular diseases are the leading cause of death globally, taking an estimated 18 million lives each year. They include conditions affecting the heart or blood vessels, such as coronary heart disease, cerebrovascular disease, peripheral arterial disease, rheumatic heart disease, deep vein thrombosis, and pulmonary embolism. Hypertension, acut...

Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high-and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, presen...

Introduction Various factors affect the long-term mortality of Acute Coronary Syndrome (ACS). Methodology A retrospective follow-up study was performed using 377 patients diagnosed with ACS presented to Teaching Hospital, Peradeniya, Sri Lanka, from March 2016 to September 2019. Trained interviewers collected the on-admission data, and the follo...

Background: Fibromuscular dysplasia (FMD) is a rare, medium-sized arteriopathy affecting less than 7% of the population. It affects predominantly young women of childbearing age. Stroke caused by fibromuscular dysplasia of the carotid artery is uncommon and reported to range between 0.6% by angiography and 1.1% by autopsy. Case presentation: A 35-y...

Acute coronary syndrome is the main cause of mortality and morbidity worldwide and early diagnosis is a challenge for clinicians. Though cardiac Troponin, the most commonly used biomarker is the gold standard for myocardial necrosis, it is blind for ischemia without necrosis. Therefore, ideal biomarkers are essential in the care of patients present...

Cardiovascular disease is the leading cause of mortality and morbidity worldwide. The 2011 annual report from the World Health Organization mentioned that, coronary heart disease and cerebro-vascular disease which were reported as the top two causes of mortality in 2004, are predicted to remain the major cause of death in the next 20 years. Coronar...

Introduction: Autoimmune encephalitis (AE) manifests with various neurologic and psychiatric symptoms. Case presentation: We present a case of a 39-year-old female, postpartum seven months, who presented with altered behaviour, visual hallucinations, and headache without any focal neurological signs. The electroencephalogram showed a focal seizure....

The assessment of patients presenting with chest pain or symptoms indicative of cardiac ischemia remains a diagnostic challenge. Many types of research have focused on the search for ideal biological markers for the rapid detection of cardiac cell injuries. Markers of inflammation and oxidative stress are the way forward. At present, the biomarker...

Background Rheumatoid arthritis is a common autoimmune disease with many extra-articular manifestations. Pure red cell aplasia is a rare manifestation of rheumatoid arthritis and is sparsely documented in the literature, with a variable clinical outcome following immunosuppressive therapy. Case presentation A 63-year-old Sinhalese female presented...

Introduction Acetaminophen-induced liver injury is the most common cause of acute liver failure, where multiple ingestions or a delay in the presentation may lead to a poor prognosis. N-acetylcysteine (NAC) is the conventional antidote used to treat acute acetaminophen toxicity, and plasmapheresis can be used as an adjunct, though there are no sys...

Introduction: Acute coronary syndrome (ACS) is the leading cause of death worldwide, even higher in South Asian countries. South Asia shows a higher incidence of ACS and an increasing trend of overweight and obesity. Methods: This cross-sectional descriptive study was conducted at the Teaching Hospital Peradeniya, Sri Lanka, among the patients pres...

Introduction: Acute coronary syndrome (ACS) is the leading cause of death worldwide, even higher in South Asian countries. South Asia shows a higher incidence of ACS and an increasing trend of overweight and obesity. Methods: This cross-sectional descriptive study was conducted at the Teaching Hospital Peradeniya, Sri Lanka, among the patients pre...

Introduction: SLE is a multisystem autoimmune disease with variable clinical presentation. DAH is a rare but catastrophic manifestation of SLE with high mortality, requiring early, intensive therapy. Case Presentation: A 31-year-old female presented with low-grade fever and joint pains for six weeks associated with alopecia, anorexia, and weight lo...

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 w...

Introduction and Objectives Acute Coronary Syndrome (ACS) is the leading cause of death and disability worldwide. Epidemiological studies on females with ACS are limited in Sri Lanka. Methods This cross-sectional descriptive study was conducted at the Teaching Hospital Peradeniya, Sri Lanka, among females with ACS. An interviewer-administered s...

Background: Fibromuscular dysplasia (FMD) is a rare, medium-sized arteriopathy affecting less than 7% of the population. It affects predominantly young women of childbearing age. Stroke caused by fibromuscular dysplasia of the carotid artery is uncommon and reported to range between 0.6% by angiography and 1.1% by autopsy. Case Presentation: A 35-y...

Cases of Coronavirus disease are rapidly increasing across the world. Hypertension is the commonest co-morbidity among COVID-19 infected patients and hypertension is one of the determinants of severity of COVID-19.COVID-19 virus uses ACE-2 as an entry receptor and ACE-2 plays a vital role in blood pressure control in an individual. Certain antihype...

Background Rheumatoid 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 presentation A 63-year-old female presented with transfusion-...

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...

Background The cardiovascular risk profile and adverse events following acute coronary syndrome (ACS) differ between the Sex, indicating the importance of studying the sex differences in factors associated with ACS. Methods A cross-sectional descriptive study was performed among ACS patients presented to Teaching Hospital Peradeniya. An interviewer...

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 infe...

Chronic hypertension accounts for about 50% of deaths due to heart diseases and strokes. Approximately 40% of the adults above 25 years had been diagnosed with hypertension. People from lower-income countries are more prone to get hypertension which leads to increased risk of heart and renal diseases. This study aimed to identify the characteristic...

Pharmacotherapy is vital in the management of chronic hypertension. Different antihypertensives are prescribed for the patients with hypertension. Mainly antihypertensives are prescribed in patterns of mono-drug therapy or multi-drug therapy. This study was conducted to identify the commonly prescribed antihypertensives and their pattern in Sri Lan...

Background: Coronary Artery Disease (CAD) is the foremost single cause of mortality and loss of Disability Adjusted Life Years (DALYs) globally. A large percentage of this burden is found in low and middle income countries. This accounts for nearly 7 million deaths and 129 million DALYs annually and is a huge global economic burden. Objective: T...

Background: Dengue is a severe and notifiable infection in Sri Lanka and other tropical countries.There are other febrile illnesses,which have the same symptoms as dengue. Identifying early changingmarkers in blood and their changing patterns in dengue and other febrile illnesses will help to differentiatedengue patients from other febrile illnesse...

Objective: Hypertension (HTN) remains a major risk factor for cardiovascular diseases globally. Despite considerable improvement in increasing awareness, treatment, and control of HTN, undiagnosed and uncontrolled HTN remains a major public health challenge. Our focus was on studying the knowledge, attitude, and practice regarding HTN in adult hyp...

Introduction: "Man-in-the-barrel syndrome" is a neurological phenotype with brachial diplegia, normal sensation, and preserved motor function of the lower limb. It has been described in various neuropathological conditions affecting the cerebral hemispheres, pons, upper spinal cord, and peripheral neurons. Severe hypotension leading to watershed i...

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 wit...

Background: Aedes mosquitoes have a high vectorial capacity for the dengue virus, chikungunya virus, Zika virus and yellow fever virus akin to their wide spread, behavior, habitats and adoptability.

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 th...

Histoplasmosis is caused by Histoplasma capsulatum, and commonly it causes an asymptomatic illness. Although Histoplasma is the commonest organism to infect adrenal glands, disseminated histoplasmosis in an immune-competent host leading to adrenal insufficiency is rare in current literature. Here, we report a case of possible disseminated histoplas...

Objective: Elevation of serum liver transaminase is common during dengue infection. A group of dengue patients was studied to determine the relationship between the elevation of liver transaminases in dengue fever (DF) and dengue hemorrhagic fever (DHF). Methodology: This study was conducted to assess the predictive value of liver enzymes for DHF....

Objectives: Stinging by Asian giant honey bee and hornets is a common environmental hazard leading to many hospital admissions in Sri Lanka. This study aims to study the social and health impact of flying hymenoptera stings in a region of the central hill country of Sri Lanka. Methodology: The study was carried out at the two base Hospitals in Teld...

Background: Melioidosis is considered endemic in certain areas of the world. Musculoskeletal and soft tissue involvement are relatively uncommon presentations in melioidosis. We present a case of infective myositis in a patient with melioidosis in Sri Lanka, which is not considered an endemic country. Even though multiple cases of melioidosis have...

Background: Migraine is a primary headache disorder, which cause significant disability in adolescence. This double blind, randomized clinical trial assessed the immediate effects of suction of paranasal sinus air during an acute migraine episode. Methods: A randomized, double blind study was conducted with 56 selected Sri Lankan school children...

Background: Acute Coronary Syndrome (ACS) is one of the leading causes of death worldwide and studies have shown higher mortality rates and premature death in South Asian countries. The occurrence and effect of risk factors differ by type ofACS.Epidemiological studies in the Sri Lankan population are limited. Methods: This is a cross sectional d...

ARTICLE INFO ABSTRACT Introduction: Blood Pressure (BP) of an individual has a strong implication for cardiac remodeling in different level of tissues even from the cellular level. Objectives: The study was aimed to explore the association of different ambulatory BP variables on echocardiographic evidences of cardiac remodeling, diastolic dysfuncti...

Background: Guillain-Barré syndrome is an acute inflammatory polyradiculoneuropathy. Nearly half of patients with Guillain-Barré syndrome have cranial nerve involvement. However, isolated bilateral ptosis without ophthalmoplegia is a rare manifestation, and isolated unilateral ptosis without ophthalmoplegia in Guillain-Barré syndrome has not previ...

Background Hypertension is a silent killer. Differences between men and women in the pathophysiology, risks, and treatment of essential hypertension have been noted for many years. The aim of this study was to describe the socio-demography and knowledge, attitude and practice with regards to hypertension among female hypertensives. Methodology This...

Background: The number of contrast media-related procedures is ever increasing due to the widespread availability of theoretically safe, low osmolar iodinated contrast material. Although intravenously administered contrast is known to precipitate myasthenic crisis, oral contrast aspiration as a causative factor is not yet documented as such. A 48-...

Background: Lifestyle factors associated with hypertension (HT) in South Asian populations are relatively unknown. The objective of the current study was to investigate the prevalence rates of undiagnosed HT and factors associated with it in a cohort of males from the Central Province of Sri Lanka.

Background Dengue is a global problem mainly in the tropics. Meticulous clinical management of cases has reduced the death rate significantly, but large numbers of people still succumb to severe complications of the infection. Presence of myocarditis is often overlooked leading to a poor outcome. Clinical management guidelines of dengue do not stre...

Background Dengue has global importance as a dreaded arboviral infection. It has 4 serotypes of epidemiological imporatnce. The classification denotes two clinical spectrums- dengue fever (DF) and dengue haemorragic fever (DHF). Most cases are stereotype and amenable to fluid resuscitation. However, unusual manifestations cause fatalities and often...

Objective: This retrospective study was conducted in 2017 with the objective of evaluating the value of acute phase peripheral blood parameters in predicting dengue haemorrhagic fever (DHF). Patients, who were admitted to Teaching Hospital Peradeniya between January and August 2017 due to dengue illness, were recruited into this study. Results:...

Background: Hypertension (HT) is identified as a highly prevalent cardiovascular risk factor and also as a separate disease entity, leading to significant mortality and morbidity. The rate of HT is increasing worldwide with a faster rate identified in developing countries. Thus, it is important to evaluate epidemiological patterns of chronic HT in...

Background: Unilateral pulmonary edema is an uncommon condition and is a rare clinical entity that is often misdiagnosed at the initial stages. In a majority of patients it occurs in the upper lobe of the right lung. There are many causes of unilateral pulmonary edema, but the commonest is the presence of a grade 3 mitral regurgitation. Due to its...

BackgroundA significant number of patients presenting with ureteric colic and other urinary symptoms have been observed at Rikillagaskada District Base Hospital, situated in the Nuwara-Eliya District, Sri Lanka. Materials and Methods Clinical and demographical features of a total of 116 patients presenting with features of urinary stone disease wer...

Abstract Background A significant number of patients presenting with ureteric colic and other urinary symptoms have been observed at Rikillagaskada District Base Hospital, situated in the Nuwara-Eliya District, Sri Lanka. Materials and Methods Clinical and demographical features of a total of 116 patients presenting with features of urinary stone d...

Abstract Objective: This retrospective study was conducted in 2017 with the objective of evaluating the value of acute phase peripheral blood parameters in predicting dengue haemorrhagic fever (DHF). Patients, who were admitted to Teaching Hospital Peradeniya between January and August 2017 due to dengue illness, were recruited into this study. Res...

Abstract Background: Eosinophilic myocarditis is one of the fatal complications of idiopathic hypereosinophilic syndromes. Given the rarity of this form of myocarditis, it is often under-recognized. We describe a young girl who presented with features of heart failure. To our knowledge, this is the first reported case of eosinophilic myocarditis in...

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...

ABSTRACT Background : Hypertension is one of the most prevalent risk factors for myocardial infarction, strokes, congestive cardiac failure and chronic kidney disease (CKD)and its prevalence is significantly higher inthe elderly population. Objectives : To assess the demography, various presentations and the prevalence of risk factors among elderly...

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...

Abstract Background and Objectives Ambulatory blood pressure monitoring (ABPM) is more reflective of an individual’s blood pressure (BP) profile and its control, eliminating several confounding and contributory factors. This study looked at the circadian pattern of BP variation with respect to nocturnal BP fluctuations and compared clinic BP measur...

Background Incidence of dengue fever as well as dengue hemorrhagic fever is increasing in Sri Lanka especially among elderly population. As the number of cases is rising, rare complications of dengue illness also can be seen in clinical practice when compared to the past few years. Prompt identification and treatment of such complications is challe...

Abstract Background Lifestyle factors associated with hypertension (HT) in South Asian populations are relatively unknown. The objective of the current study was to investigate the prevalence rates of undiagnosed HT and factors associated with it in a cohort of males from the Central Province of Sri Lanka. Methods The study group consisted of 2462...

Background: Cardiovascular diseases are the main cause of death in most countries and the past two decades have shown a global increase. Hypertension (HTN) was found to be the leading risk factor in 2010 as qualified by Disability Adjusted Life Years. Epidemiological studies in this regard in Sri Lanka are scarce. Thus, describing epidemiological...

We report a 13 year old girl with thyrotoxicosis due to thyroiditis with positive anti thyroid antibodies presenting with complete heart block followed by dynamic ECG changes and normalization of the cardiac rhythm following control of thyrotoxicosis. Although tachyarrthymias are common in thyrotoxicosis, rarely they can present with bradyarrthymia...

Abstract Background Obesity has become a global epidemic. The prevalence of obesity has also increased in the South Asian region in the last decade. However, dietary and lifestyle factors associated with obesity in Sri Lankan adults are unclear. The objective of the current study was to investigate the association of dietary and lifestyle patterns...