Browsing by Author "Silva, S."

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Antibiotic sensitivity patterns among ESBL UTIs in Sri Lanka
(Elsevier, 2016) Luke, N.; Wickramasinghe, B.; Sebastiampillai, M.; Miththinda, N.; Fernando, S.; Silva, S.; Premaratna, R.
BACKGROUND: Extended-spectrum β-lactamase (ESBL) producing organisms causing urinary tract infections (UTI) are increasing in incidence and poses a major burden to health care requiring treatment with expensive antimicrobials and prolonged hospital stay. The prevalence of ESBL producing organisms particularly in the Asian region remains unknown. In a study carried out in a tertiary care center in India,70/218(32.1%) clinical isolates of Enterobacteriaceae were confirmed as ESBL. Of them K. pneumonia were the most common ESBL producers(46.4%), followed by E coli (31.7%). Previous studies to evaluate antibiotic susceptibility shows high sensitivity to meropenem (95-100%) with aminoglycoside susceptibility ranging from 45-60%. Objective of this study was to evaluate the antibiotic sensitivity patterns of ESBL UTIs in Sri Lanka. METHODS & MATERIALS: Patients with ESBL-UTI admitted to Professorial Medical Unit, Colombo North Teaching Hospital, Ragama over a period of 6 months from January-July 2015 were recruited to the study. Their Urine culture and ABST reports were analysed after obtaining informed written consent. RESULTS: There were 52 patientswho consented for the study;males30 (57.7%),mean (SD) age 64.11 (12.59)years. The most common organisms causing the ESBL-UTI were E. coli in 44(84.6%),followed by Klebsiella in 8 (15.4%) . The ESBL organisms were mostly sensitive to carbapenems;Meropenem 50 (96.2%) and Imipenem in 38(73.1%). The other sensitivity patterns were Amikacin in 30 (57.7%), Nitrofurantoin in 24 (46.2%) andCeftriaxone in 2 (3.8%). None were sensitive to Ceftazidime. Meropenem resistance was found in 2 (3.8%) and wereE.coli. These two patients had received multiple antibiotics including meropenem in the recent past for recurrant UTI.CONCLUSION: It is evident from the above data that Carbapenems remain as the first line therapy for the majority of UTIs caused by ESBL producing organisms in the local setting. However 3.8% prevalence of meropenem resistance among the study population should draw attention of clinicians and needs implementation of measures to prevent emergence and spread of carbapenum resistant ESBL organisms.
Audit of stroke care in a Sri Lankan stroke unit
(Asia Pacific Stroke Organization, Hong Kong Stroke Society and Jiangsu Stroke Association & Karger publishing, 2017) Ranawaka, U.; Tissera, G.; Silva, S.; Nanayakkara, Y.; Goonetilleke, C.; Muwanwella, P.; Sooryabandara, V.; Hill, K.; Markus, R.
BACKGROUND AND RATIONALE: Data on quality of stroke care is limited from Sri Lanka, and available data suggests poor quality of care. We sought to evaluate quality of care in a Sri Lankan tertiary care centre using internationally accepted criteria. METHODS: All patients admitted with acute stroke to the Stroke Unit of the Colombo North Teaching Hospital, Ragama over a 2-year period (January 2015-December 2016) were prospectively enrolled. Stroke care was evaluated with the Stroke Foundation, Australia Acute Stroke Audit Tool. RESULTS: 156 patients were studied {54.5% males; mean age (SD) 59 years (9.3); 83.3% ischaemic stroke}. 92.3% were living with spouse/ family. Private transport was the mode of arrival in 87.8%. CT scanning was done in 92.2%. None of the patients received thrombolysis. 39.7% were functionally independent (mRS 0–2) at 7–10 days. 71.6% were discharged on anti-hypertensive. Of those with ischemic stroke, 88.2% received anti-platelets and 95.5% statins. Swallowing screening was done in 92.5%, and for mal swallowing assessment by a speech therapist in 52.6%. Assessment by a physiotherapist was done in 96.7%, occupational therapist in 85.8%, mental health specialist in 96.8%, and communication assessment by a speech therapist in 76.6%. Multi-disciplinary team met with care-givers in 83.1%. Care-giver needs assessment was done in 96.1%, and 90.3% of care-givers received training in home care.52.6% were discharged home with rehabilitation support, and 32.1% were transferred for in-patient rehabilitation. All patients/care-givers received education before dis charge, 96.1% received a community care plan, and 93.5% were given a discharge summary. CONCLUSION: Quality of acute stroke care was satisfactory in almost all the domains studied. Care related to neuro-imaging, secondary preventive treatments, multi-disciplinary team assessment, provision of early rehabilitation services, patient education, care giver support and discharge planning was especially good. Stroke care of good quality is feasible even in resource-limited settings.
Behaviour of Cytokines IL10, IL6 and IFy during late febrile and immediate defervercent phases of Dengue
(Sri Lanka Medical Association, 2014) Weerasinghe, O.M.S.; Premaratna, R.; Gomes, L.; Perera, J.; Silva, S.; Abeyratna, C.; Kasturiratne, A.; Malavige, N.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Cytokines have been implicated in dengue (DF) pathogenesis. Behaviour of cytokines during the late febrile phase (LFP) and immediate defeversence have not been studied, but may be useful to understand the pathophysiology of disease progression and effect of interventions. METHODS: A preliminary prospective study was performed to investigate 1L-10, IL6 and IFy (pg/ml) responses during the late febrile phase (around fifth day) and immediate defervestence in confirmed (NSlAg positive} dengue patients. Demographic, clinical and laboratory data were collected. Two samples of 1 m! serum were obtained during the above stages of the illness and stored at -80°C to assess cytokine levels. Cytokine levels were compared between phases (LFP and afebrile) and stages (DF, precritical and critical dengue shock syndrome (DSS)). LFP cytokine levels were compared for disease stages using one-way Anova test. RESULTS: 18 patients (11 males, mean age 26 years (SD 10.6)) were studied. There were 3 DF, 9 precritical and 6 criticaj DSS based on national guidelines. Mean temperature during LFP and defervescent phases were 102.07°F (SD 0.98) and 98.53°F (SD 0.26). Median (interquartile range) of IL10, IL6 and IFy in LFP were 164.3 (90.8 - 259.5), 26 (12.7-54.6), 246.5 (117.5-511.8) and during defervescent phase were 17.4 (6A-112.2), 11.9 (4.9-28.2), 2.58 (0.0-58.4) respectively. LFP IL10 significantly correlated with disease stages (F-3.99, P-0.041), IL6 and IFy had no correlation. CONCLUSIONS: All three cytokines rapidly declined with defervecence. IL10 in febrile phase showed significant correlation with disease severity.
Comparison of liver MRI R2(FerriScan®) VS liver MRI T2* as a measure of body iron load in a cohort of Beta Thalassaemia major patients
(BioMed Central, 2020) Padeniya, P.; Siriwardana, S.; Ediriweera, D.; Samarasinghe, N.; Silva, S.; Silva, I.; Ahamed, N.; Niriella, M.A.; Premawardhena, A.
ABSTRACT: To compare the similarity of the non-patented T2* and the high cost patented R2 (Ferriscan®) MRI techniques in the measurement of liver iron concentration (LIC) in heavily transfused patients with thalassaemia major in a real- life Sri Lankan hospital setup. We compared LIC measured by MRI, obtained 2 weeks apart, using both T2* and R2 techniques in 15 patients with beta thalassaemia major. They all had a history of > 100 units of blood transfusions life long and also a history of sub optimal chelation. MRI R2 and MRI T2* scan values showed a negative correlation (co-rrelation coefficient = - 0.63, p = 0.01) This correlation was strong in lower LICs and progressively decreased with upper LIC values. Thus a significant discrepancy was observed between median values of two MRI technologies (p = 0.0005) with T2* tending to underestimate iron overload especially in those with very high LIC identified by R2. The lack of concordance of T2* and R2 especially in those with very high reading on R2 suggest the potential errors in interpretations that can occur in "non-expert centres"; which are likely to lead to errors in clinical judgement on the intensity of chelation therapy needed. KEYWORDS: FerriScan®; Iron overload; Liver iron concentration; MRI; T2* scan.
Factors associated with urinary tract infections caused by extended spectrum beta-lactamase (ESBL) producing organisms in Sri Lanka
(Elsevier, 2016) Fernando, S.; Luke, N.; Wickramasinghe, S.; Sebastiampillai, B.; Gunathilake, M.; Miththinda, N.; Silva, S.; Premaratna, R.
BACKGROUND: Urinary tract infections (UTI) caused by extendedspectrum beta-lactamase (ESBL)-producing organisms are a major burden in clinical practice. Hospitalization in the past 3 months, antibiotic treatment in the past 3 months, age over 60 years, diabetes mellitus, Klebsiella pneumoniae infection, previous use of second or third-generation cephalosporins, quinolones or penicillins are known associations and risk factors for ESBL-UTI. METHODS & MATERIALS: A descriptive study was conducted over a period of 6 months from January - July 2015 recruiting patients with UTI caused by ESBL producing organisms, who were admitted to the Professorial Medical unit, Colombo North Teaching Hospital, Ragama Sri Lanka in order to identify risk factors and associations. Data were obtained using a pre-tested interviewer administered questionnaire and from relevant medical records after obtaining informed written consent. RESULTS: 52 patients were recruited; males 30 (57.7%), mean (SD) age 64.1(.12.6)years. Of them, 46 (88.5%) had diabetes mellitus, 32 (61.5%) had hypertension and 10 (19.2%) had chronic liver disease as comorbidities.20 (38.5%) had ultrasonographic evidence of acute pyelonephritis. At presentation16 (30.8%)had biochemical and/or ultrasonographic evidence of chronic or acute on chronic kidney disease. History of constipation was observed in 18 (34.6%), hospitalization during the past 3 months was seen in 24(46.2%)and history of urinary catheterization in 16(30.8%). Features of obstructive uropathy such as hydronephrosis, hydroureter and prostatomegaly were seen in 4 (7.7%) patients each. Antibiotic treatment within the past 3 months was observed in 32(61.5%);penicillins in 18(34.6%), 3rd generation cephalosporins in 16(30.8%),quinolones in 14(26.9%) and 2nd generation cehalosporins in 12 (23.1%). 18 (34.6%) had received more than one antibiotic within the past 3 months. 8(15.4%)patients studied were on prophylactic antibiotics for recurrant UTIs. None of them had recent Klebsiella pneumonia. CONCLUSION: Similar to other studies,diabetes mellitus, recent antibiotic treatment, hospitalization and catheterization were observed in our patients with ESBL-UTI. The fact that only 53.8% patients had received antibiotics at community level and 38.5% patients had never received antibiotics prior to developing ESBLUTI suggest high prevalence of ESBL producing organisms at community level.
Factors associated with Urinary tract infections caused by extended spectrum β-lactamase (ESBL) producing organisms in Sri Lanka
(Elsevier, 2016) Fernando, S.; Luke, N.; Wickramasinghe, S.; Sebastiampillai, B.; Gunathilake, M.; Miththinda, N.; Silva, S.; Premaratna, R.
BACKGROUND: Urinary tract infections (UTI) caused by extended-spectrum β-lactamase (ESBL)-producing organisms are a major burden in clinical practice. Hospitalization in the past 3 months, antibiotic treatment in the past 3 months, age over 60 years, diabetes mellitus, Klebsiella pneumoniae infection, previous use of second or third-generation cephalosporins, quinolones or penicillins are known associations and risk factors for ESBL-UTI. METHODS & MATERIALS: A descriptive study was conducted over a period of 6 months from January - July 2015 recruiting patients with UTI caused by ESBL producing organisms, who were admitted to the Professorial Medical unit, Colombo North Teaching Hospital, Ragama Sri Lanka in order to identify risk factors and associations. Data were obtained using a pre-tested interviewer administered questionnaire and from relevant medical records after obtaining informed written consent. RESULTS: 52 patients were recruited; males 30 (57.7%), mean (SD) age 64.1(.12.6)years. Of them, 46 (88.5%) had diabetes mellitus, 32 (61.5%) had hypertension and 10 (19.2%) had chronic liver disease as comorbidities.20 (38.5%) had ultrasonographic evidence of acute pyelonephritis. At presentation16 (30.8%)had biochemical and/or ultrasonographic evidence of chronic or acute on chronic kidney disease. History of constipation was observed in 18 (34.6%), hospitalization during the past 3 months was seen in 24(46.2%)and history of urinary catheterization in 16(30.8%). Features of obstructive uropathy such as hydronephrosis, hydroureter and prostatomegaly were seen in 4 (7.7%) patients each. Antibiotic treatment within the past 3 months was observed in 32(61.5%);penicillins in 18(34.6%), 3rd generation cephalosporins in 16(30.8%),quinolones in 14(26.9%) and 2nd generation cehalosporins in 12 (23.1%). 18 (34.6%) had received more than one antibiotic within the past 3 months. 8(15.4%)patients studied were on prophylactic antibiotics for recurrant UTIs. None of them had recent Klebsiella pneumonia. CONCLUSION: Similar to other studies,diabetes mellitus, recent antibiotic treatment, hospitalization and catheterization were observed in our patients with ESBL-UTI. The fact thatonly 53.8% patients had received antibiotics at community level and 38.5% patients had never received antibiotics prior to developing ESBL-UTIsuggest high prevalence of ESBL producing organisms at community level.
Undetected falls among older adults attending medical clinics in four tertiary care centres in Sri Lanka; the need of a comprehensive geriatric assessment
(BioMed Central, 2024-10) De Zoysa, W.; Rathnayake, N.; Palangasinghe, D.; Silva, S.; Jayasekera, P.; Mettananda, C.; Abeygunasekara, T.; Lekamwasam. S.
OBJECTIVE Falls take a high priority among the prevalent medical conditions in old age. Despite this, a history of falls or the risk of future falls is not routinely assessed or properly managed in medical clinics in Sri Lanka. This study was done to evaluate the prevalence and factors associated with falls and recurrent falls among older adults attending medical clinics in four selected tertiary care centres in the country.METHODS A cross-sectional study was carried out at four centres (Teaching Hospital Karapitiya, Colombo South Teaching Hospital, Colombo North Teaching Hospital and University Hospital-Kotelawala Defence University) with 704 older adults, aged 65 years and above, attending medical clinics for more than six consecutive months. Information related to falls and possible associated factors (socio-demographic, behavioural, environmental and biological) were collected using an interviewer-administered questionnaire.Results: The Mean (SD) age of the participants was 72.5(5.5) years and 58.7% were females. Of the 704 total sample, 220 (31.3%, 95% CI 28-35%) participants experienced at least one fall after the age of 65, and 12.8% (95% CI 10-15%) (n = 90) experienced recurrent falls (two or more falls within the last 12 months). Falls were associated with gender, level of education, marital status, and physical dependence (p < 0.01). For those who had at least one fall, multiple logistic regression (MLR) revealed being single (p = 0.03, OR = 2.12, 95% CI; 1.052-4.304), being widowed/divorced/separated (p = 0.03, OR = 1.47, 95% CI; 1.039-2.093) compared to living with a spouse, presence of moderate (p = 0.007, OR = 1.72, 95% CI; 1.160-2.577) and severe (p = 0.001, OR = 2.98, 95% CI; 1.563-5.688) physical dependency compared to mild physical dependency as risk factors for falls. Having secondary education (p = 0.01, OR = 0.55, 0.350-0.876) was a protective factor for falls. For those with recurrent falls, MLR showed moderate physical dependency (p = 0.001, OR = 2.34, 95% CI; 1.442-3.821) compared to slight physical dependency as a risk factor.CONCLUSIONS Approximately one-third of the older adults attending medical clinics had experienced at least a single fall, and one-eighth have had recurrent falls, which were mostly unrecorded and not clinically assessed. Physical dependency was the major contributing factor to falls and recurrent falls. Falls assessment should be included in the routine clinical assessment of older adults attending outdoor medical clinics. Health professionals should be educated to detect and assess those at risk of falling and take appropriate measures to prevent or minimize falls.