Browsing by Author "Fonseka, V.N.R.M."

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Central nervous system infections in a tertiary care hospital: disease patterns and difficulties in diagnosis
(Sri Lanka Medical Association, 2011) Ranawaka, U.K.; Harshani, M.L.; Fonseka, V.N.R.M.; Hathagoda, K.L.W.; Nawaratne, A.N.H.M.U.K.G.D.B.; Weerasooriya, W.A.L.K.; Samarakoon, S.M.S.B.; Thirumawalawan, K.; Premawansa, G.; Fernando, M.A.M.; de Silva, L.; Perera, K.V.H.K.K.; Dassanayake, K.M.M.P.; Wijesooriya, T.; Rajindrajith, E.G.D.S.
INTRODUCTION AND OBJECTIVES: Central nervous system (CNS) infections produce high morbidity and mortality, and effective treatment and outcome depend on precise microbiological diagnosis. We aimed to describe the pattern of CNS infections and accuracy of diagnosis in patients presenting to a tertiary care hospital. METHODS: We prospectively studied patients with suspected CNS infection admitted to medical and paediatric units of Colombo North Teaching Hospital over three years. Data related to demographic and clinical features, laboratory findings, treatment and immediate outcome. Diagnosis of CNS infection was categorised as definite, probable, possible, and uncertain. RESULTS: 426 patients (293 adults, 133 children) were studied [57.2% males, mean age (SD) years-adults 44(20), children 4(3.15)]. Of them, 27.5% had received antibiotics before admission. Blood cultures were done in 149 (35%) and only 14 were positive. Lumbar puncture was done in 347 (81.4%). CSF culture was positive only in two patients. CSF Gram stains and TB-PCR were all negative. The likely diagnosis was meningitis in 35.4%, encephalitis in 10.6% and a non-specific 'meningo-encephalitis' in 16.7%. A 'definite' microbiological diagnosis was made only in five patients. Diagnosis was considered 'probable' in, 53.7%, 'possible' in 8.7%, and 'uncertain' in 14.8%. An alternative diagnosis was found in 22% (13.6% adults, 40.6% children). Intravenous antibiotics (86.8%) and acyclovir (42.5%) were widely used on empiric grounds. CONCLUSIONS: Diagnosis of CNS infections is highly unsatisfactory with available facilities, even in a tertiary care setting. Better facilities are needed to improve aetiological diagnosis, and are likely to improve care and minimise treatment costs.
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.
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.