Browsing by Author "Danansuriya, D.S.T."

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Gender based differences in acute coronary syndrome
(Sri Lanka Medical Association, 2011) Danansuriya, D.S.T.; Alexander, M.A.F.; Harshanie, R.L.P.; Gammulla, S.P.K.H.M.A.T.; Pemarwansa, G.; Thirumavalan, K.; Samarakoon, S.M.S.B.; de Silva, A.P.; de Silva, S.T.; Ranawaka, U.K.
INTRODUCTION AND OBJECTIVES: To describe gender based differences in demographics, risk factors, management and early outcome in Sri Lankan patients with acute coronary syndromes (ACS). Methods: All adults admitted with ACS to medical units of Colombo North Teaching Hospital are enrolled in a prospective Registry. We studied data obtained from patients admitted over a period of 11/2 years. RESULTS: 765 patients were studied (56.9% males). Females were likely to be older [mean age years (SD) - male 59.5(11.4), female 62.9(11.4), pO.OOl]. Women were more likely to have unstable angina (female -56.4%, male- 40,0%)7 while men were more likely to have ST elevated myocardial infarction (M-36.6%? 19.4%) (pO.OOl). Several risk factors were commoner in women (p<0.001): hypertension-female- 70%, male- 49.6%; diabetes - female- 49.7%, male- 35.6%; hyperlipidaemia - female-73.6%, male-56.6%; high waist circumference- female 65.8%, male-29.8%. Smoking and alcohol use were almost exclusively seen in men (75.9% and 84.6% respectively vs. 1.2% and 1.5%; /K0.001). 32.4% of women and 37.6% of men had previous IHD (p=0.079). Women were more likely to be on pre-admission antiplatelet, statin, beta blocker and ACE inhibitor therapy (/7<0.005). Five patients died. There were no differences in care given and early outcome. CONCLUSIONS: There are important gender-related differences in the pattern of ACS in Sri Lankan patients. Several modifiable cardiovascular risk factors were commoner in women, highlighting the need for targeted preventive strategies. Acknowledgements: Japan International Cooperation Agency
Pre-admission antiplatelet therapy in patients presenting with acute coronary syndrome
(Sri Lanka Medical Association, 2011) Fonseka, V.N.R.M.; Danansuriya, D.S.T.; Harshanie, R.L.P.; Harshini, M.L.; Thirumavalan, K.
INTRODUCTION AND OBJECTIVES: Some patients who present with acute coronary syndrome (ACS) are on prophylactic antiplatelet therapy prior to hospital admission. This study aims to describe factors associated with pre-admission antiplatelet use in patients with ACS admitted to a tertiary care setting. METHODS: With informed consent, data was gathered from patients diagnosed with ACS at the Colombo North Teaching Hospital over 18 months, using a validated questionnaire. Demographic data, risk factors, management and early outcome were analysed using SPSS 17. RESULTS: 254 (33.2%) of a total of 765 patients were on antiplatelet therapy prior to hospital admission. 62/254 (24.5%) were on primary prophylaxis, while 192/254 (75.5%) were on secondary prophylaxis for coronary artery disease (CAD). Although 265 patients had a history of CAD, only 192 (72.4%) were on secondary prophylaxis. Most (115/192 - 59.9%) were on two antiplatelet agents at the time they developed ACS this time. The commonest risk factor for commencing primary prophylaxis was diabetes mellitus (47/62 - 75.8%), and most (52/62 - 83.9%) were on a single anti-platelet agent. Early outcome (death, recurrent ACS) was not significantly associated with pre-admission use of antiplatelet agents as primary or secondary prophylaxis. CONCLUSIONS: A quarter of the patients with pre-existent CAD were not on any antiplatelet agent. One-third of patients developed ACS while on antiplatelet therapy. This highlights the need for better strategies for prevention of ACS. Acknowledgements: Japan International Cooperation Agency.
Prevalence of rickettsial infections in acute coronary syndromes in Sri Lanka: a case control study
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Mettananda, K.C.D.; Danansuriya, D.S.T.; Bandara, N.K.B.K.R.G.W.; Premaratna, B.A.H.R.
Background: Place of infection in atherosclerosis and or coronary heart disease has recently drawn interest. Rickettsiae are a group of obligate intracellular pathogens who invade vascular endothelial cells leading to vasculopathy. A study conducted in Thaiwan, scrub typhus was found to increase the risk of acute coronary syndromes (ACS) by 37% compared to general population after adjusting for age, sex and other known independent risk factors. Objective: To assess the prevalence of Rickettsial infections in patients with ACS residing in Western province, Sri Lanka. Methods: Patients admitted with ACS to Professorial-Medical-unit, were studied for serological prevalence of Rickettsial infections and were compared with a matched control group; who had no fever or ACS. 2ml serum samples were obtained at enrolment and 2weeks after and were assessed for IFA-IgG antibody titres against Orientiatsutsugamushi (OT) and Spotted-fever-group-rickettsioses (SFG). An IgG titre>1:128 or a rising/declining titre were considered positive for acute rickettsioses. A static titre was considered to be due to previous exposure to rickettsioses. Results: 46 ACS patients (males-23.9%, mean age 61.1 [SD=13.1] years) and 52 controls (male-50%, mean age 56.0[SD=13.6] years) were studied. None had evidence of acute Rickettsiel infection. Sero-prevalence of IgG-OT was 6.4% and IgG-SFG was 15.2% among ACS patients. Same for control group were 3.8% and 11.5% respectively. There was no significant difference in sero-prevalence of OT [OR =0.74; CI: 0.28-10.93; p=0.66] or SFG [OR=1.376; CI:0.43-4.44; p=0.59] in patients with ACS compared to controls. Conclusions: No significant difference was observed in sero-prevalence of rickettsioses in patients with acute coronary syndromes compared to controls in this study.
Recurrent vs. first presentation with acute coronary syndrome in a tertiary care hospital
(Sri Lanka Medical Association, 2012) Thirumavalavan, K.; Premawansa, G.; Bandara, G.M.T.R.; Fonseka, V.N.R.M.; Danansuriya, D.S.T.; Premawansa, G.; Samarakoon, S.M.S.B.; de Silva, A.P.; de Silva, S.T.; Ranawaka, U.K.
INTRODUCTION: Profile of recurrent acute coronary events may differ from first-ever events, but no data is available from South Asia where morbidity and mortality are high. AIMS: To describe characteristics of patients with recurrent acute coronary syndrome (ACS) admitted to a tertiary care hospital. METHODS: Data was prospectively collected from all patients admitted with ACS to the Colombo North Teaching Hospital over 18 months. Differences in demographic data, presentation, risk factors, management and early outcome between those with first and recurrent ACS were analysed. Results: Of 765 patients admitted with ACS, 501 (65.5%) presented with the first episode, while 264 (34.5%) presented with a second or subsequent episode. Those with recurrent ACS were more likely to:- present with unstable angina (61.4% vs 39.5%, p<0.001), present directly to hospital instead of a primary care provider (84.1% vs 71.3%, p<0.001), have hypertension (74.1% vs 50.1%, p<0.001) and hyperlipidaemia (51.5% vs 34.3%, p<0.001), and be ex-smokers (28% vs 19.3%, p<0.001). Those with the first episode were more likely to be current smokers (23.8% vs 11%, p<0.001). No differences were noted between the two groups in:- age and sex distribution, presenting symptoms, presence of diabetes, family history of coronary artery disease, alcohol use, in-hospital management, duration of hospital stay and early outcome. CONCLUSIONS: Patients with recurrent ACS were more likely to have unstable angina than myocardial infarction. They were more likely to present directly to hospital, and to have stopped smoking. Hypertension and hyperlipidaemia were commoner among them, highlighting the need for better secondary preventive measures.
Rickettsial infections in acute coronary syndromes
(Sri Lanka Medical Association, 2013) Mettananda, K.C.D.; Danansuriya, D.S.T.; Bandara, N.K.B.K.R.G.W.; de Silva, H.J.; Premaratna, R.
INTRODUCTION AND OBJECTIVES: Rickettsiae are a group of obligate intraceliular pathogens which invade endothelial cells causing vasculopathy. Vasculitis of any cause may result in acute coronary syndromes (ACS). Objectives were to assess the prevalence of Rickettsial infections in patients with ACS from Western province, Sri Lanka. METHODS: Prospective patients from Western province with ACS admitted to Professorial Medical Unit, Colombo North Teaching Hospital, Ragama from April-December 2011 were recruited as the study group. A matched control group was selected from in-ward-patients without fever or ACS. Serum samples (2ml) collected at enrolment and after 2 weeks were analysed. Rickettsial-antibody (IgG) titre >128, or a rising or a declining titre were considered positive for acute rickettsioses. A static titre was considered as previous exposure to rickettsioses (sero-prevalence). RESULTS: Of the 46 patients with ACS 11 (23.9%) were male and of the 52 controls 26 (50%) were male. Mean age was, ACS=60.7 years and controls= 55.98 years. None had evidence of acute rickettsiel infection. In ACS group, 3 and 7 were positive for [gG-OT-Orientia tsutsugamushi (prevalence=0.065) and lg-RC-Rickettsia conori (prevalence=0.152) respectively. In the control group 2 were positive for IgG-OT( prevalence = 0.038) and 6 for IgG-RC (prevalence = 0.115). There was no significant difference in sero-pre valence of rickettsie- antibodies in the study group compared to controls; odds-ratio IgG-OT 1.744 (CI, 0.278-10.928) and IgG-RC 1.376 (CI, 0.427-4.438). CONCLUSION: Sero-prevaSence of Orientia tsutsugamushi was 0.038 while that of Rickettsia conori was 0.115 in the selected population. Rickettsia conori was more prevalent than Orientia tsutsugamushi in the Western province of Sri Lanka. There was no significant association between sero-prevalence of rickettsioses and acute-coronary-syndromes.