The National Hospital of Sri Lanka (sometimes General Hospital) is a government hospital in Colombo, Sri Lanka. Founded in 1864 as the General Hospital, it is the leading hospital in Sri Lanka and is controlled by the central government. The hospital has 18 intensive care units and 21 operating theaters and 3,404 beds. It employs 7,500 staff of which 1,500 are doctors. The hospital carries out 5,000 major and minor surgeries each month and treats over two million out patients a year. Situated on a 36-acre site, it includes the Dental Institute, Maligawatte Kidney Hospital, Nurse's Training School, Post Basic Nurse's Training School, School of Eco Cardiograph, School of Physiotherapy, School of Radiography and the University of Colombo's Faculty of Medicine.
Follicular variant of papillary thyroid carcinoma (FV-PTC) is a distinct subtype of thyroid cancer with intermediate clinical behavior between classical papillary and follicular carcinomas. While generally associated with favorable prognosis, FV-PTC can rarely present with distant metastases, including to the skull and scalp, posing diagnostic and therapeutic challenges. We report a 51-year-old woman initially diagnosed with primary hypothyroidism and a thyroid goitre, later confirmed as FV-PTC after total thyroidectomy. Three years postoperatively, she developed a painless scalp lump. Magentic resonance imaging (MRI) revealed a large heterogeneously enhancing mass involving bilateral frontal skull bones with bone erosion and extension into scalp tissues, compressing adjacent brain structures without parenchymal invasion. Surgical excision of the scalp mass confirmed metastatic follicular thyroid carcinoma. The patient was managed with levothyroxine replacement and calcium supplementation after receiving radioiodine ablation therapy. This case highlights the importance of recognizing late solitary skull and scalp metastases in FV-PTC, which can lead to bone erosion and potential involvement of the brain parenchyma. The complementary use of MRI and computed tomography (CT) is vital for thorough assessment of both soft tissue and bony invasion. Given the risk of intracranial extension, management often requires a neurosurgical approach combined with reconstructive surgery to achieve effective tumor resection and restore structural integrity. Long-term surveillance and multidisciplinary treatment strategies remain essential to optimize outcomes in these complex and atypical metastatic presentations.
Severe leptospirosis often requires intensive care unit (ICU) treatment. The clinical phenotypes and outcomes of severe leptospirosis remain poorly characterised. We aimed to characterise the phenotypes and outcomes of patients with severe leptospirosis treated in the ICU. We conducted a prospective cohort study at the Medical ICU of the National Hospital of Sri Lanka between January 2019 and January 2022 on adult patients with serologically or microbiologically confirmed leptospirosis. Clinical and laboratory data were recorded prospectively. Unsupervised two-step cluster analysis using six variables selected a priori (acute kidney injury, pulmonary haemorrhage, myocarditis, mechanical ventilation, renal replacement therapy, and hospital-acquired infections) was used to identify clinical phenotypes and to generate phenotypically distinct clusters of patients. Laboratory and biochemical parameters were compared across clusters. Kaplan–Meier survival analysis was used to compare mortality. The primary outcome was in-hospital mortality. One hundred and sixteen patients were included (mean age 43.9 years; males n = 103, 88.8
Background Acute intermittent porphyria (AIP) is a rare inherited disorder of heme biosynthesis that typically presents with neurovisceral or gastrointestinal symptoms. Hyponatremia secondary to syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a recognized complication, but persistent electrolyte abnormalities with renal electrolyte wasting during pregnancy are rarely reported. We describe an unusual presentation of AIP in pregnancy mimicking a renal tubular disorder. Case Presentation: A 29-year-old previously healthy primigravid woman at 14 weeks’ gestation was referred for evaluation of persistent hyponatremia following severe hyperemesis gravidarum. Although vomiting resolved by 18 weeks, serum sodium remained low at 122 mmol/L. Investigations demonstrated hypotonic hyponatremia with features suggestive of SIADH and possible renal salt wasting. Additional abnormalities included hypokalemia (2.8 mmol/L; trans tubular potassium gradient 14) and hypomagnesemia (1.2 mg/dL) with elevated urinary magnesium excretion, indicating renal magnesium wasting. Physical examination and endocrine evaluation were unremarkable. A Gitelman-like biochemical phenotype was initially suspected. Whole-exome sequencing identified a pathogenic heterozygous HMBS variant, prompting targeted biochemical testing that confirmed AIP with elevated urinary porphobilinogen and porphyrin levels. The patient remained clinically stable throughout pregnancy and received electrolyte supplementation. Following delivery, serum sodium, potassium, and magnesium normalized spontaneously without ongoing treatment. Conclusion This case highlights an atypical presentation of AIP characterized by persistent hyponatremia and renal electrolyte wasting during pregnancy, mimicking a Gitelman-like tubulopathy. In pregnant women with persistent electrolyte disturbances despite resolution of hyperemesis, AIP should be considered in the differential diagnosis. Early recognition may prevent diagnostic delays and facilitate appropriate monitoring and follow-up.
South Asians experience stroke at a younger age than Western populations. There is limited access to advanced neuroimaging and neuro-interventional services. Prospective data from South Asia on outcomes after intravenous thrombolysis are scarce. We aimed to describe the clinical characteristics, treatment, complications and longitudinal functional outcomes of patients treated with intravenous thrombolysis for acute ischaemic stroke in Sri Lanka. We conducted a prospective, single-centre cohort study of consecutive patients who received intravenous thrombolysis for acute ischaemic stroke at the Institute of Neurology, National Hospital of Sri Lanka, from July 2023 to June 2025. Neurological deficit (National Institutes of Health Stroke Scale [NIHSS]), disability (modified Rankin Scale [mRS]) and activities of daily living (Barthel Index) were assessed at presentation, 12 h, 24 h, discharge, 30 days and 90 days. We analysed clinical characteristics, treatment-related complications and mortality. We used multivariable logistic regression to identify predictors of death. We recruited 193 patients (mean age 59.9 ± 11.6 years). Hypertension (61.5
Diabetes distress (DD) refers to the emotional and psychological strain related to the management of diabetes and its complications. It can result in poor self-management behaviours and suboptimal health outcomes. This study aimed to evaluate the prevalence, determinants and impact of DD on self-management behaviours and glycaemic control among people with type 2 diabetes mellitus (T2DM) attending a tertiary care hospital in Sri Lanka. A descriptive, cross-sectional study was conducted at the Diabetes and Endocrine Clinic of the National Hospital, Sri Lanka. DD was measured using the 17-item Diabetes Distress Scale (DDS-17), comprising four domains: emotional burden, physician-related, regimen-related, and interpersonal distress. Self-management was assessed using the Diabetes Self-Management Questionnaire-Revised (DSMQ-R), covering five domains: glucose monitoring, medication adherence, dietary control, physical activity and healthcare use. Both instruments were interviewer-administered. DD severity was defined as clinically significant if DDS-17 score was ≥ 2 (moderate-high level of DD). Logistic regression was used to identify determinants of DD and Spearman’s rank correlation was used to assess the associations between DD, DSMQ-R scores and glycaemic control. A p value of < 0.05 was considered statistically significant. Among 322 participants (mean age 59.9 ± 10.2 years; mean diabetes duration 11.4 ± 7.7 years), the prevalence of DD was 30.4
