Browsing by Author "Samarakoon, S.M.S.B."

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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.
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
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.