Browsing by Author "Siriwardana, S.R."

Now showing 1 - 7 of 7

A Case of Urinary Tract Infection Caused by Providencia stuartii in a Sterile Mid-Stream Urine Sample
(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Wijesooriya, L.I.; Siriwardana, S.R.
Introduction: Urinary tract infections (UTI) are frequently caused by enterobacteria and most commonly caused by Escherichia coli both in the community and hospital settings. UTIs are diagnosed microbiologically by culturing mid-stream urine sample in non-catheterized patients. Significant bacteriuria is defined as having pure growth of >105 colony forming units/ml of urine. Treatment of UTIs is guided by antibiotic sensitivity testing of the isolated pathogen. Herewith, we report a case of upper UTI with no growth in midstream urine sample. Case report: A 65-year-old male was admitted to a Private Hospital, Ragama with high spiking fever and left, low backache for four days. His past medical history was unremarkable and renal calculi were not known previously. On examination, he was febrile but systemic examination was uneventful except left loin tenderness. Urine full report was normal except having red cells of 10-5/high power filed. Blood and urine cultures were sterile. Serum creatinine was rising (2.9, 3.01, 4.16 mg/dL). Full blood count showed leukocytosis (11,400–15,900/ mm3) - with neutrophilia (75%-87%). His C-reactive protein levels were rising at 81,93,133 mg/L. Abdominal ultrasound scanning revealed dilated pelvicalyceal system filled with echogenic debris, suggestive of pyonephrosis. Further, left upper ureter was dilated due to obstruction by a 10mm sized calculus. Ultrasound-guided percutaneous nephrostomy (PCN) was performed and a 7F pigtailed catheter was inserted. Drain fluid was cultured on blood and MacConkey agar and incubated overnight at 370C yielding a heavy growth of Gram-negative bacilli, which were oxidase negative. The pathogen was identified into species level using the RapID™ ONE system as Providencia stuartii. As per antibiotic sensitivity test, the organism was resistant to amoxicillin, gentamicin, cefuroxime, cefotaxime, co-amoxiclav, ciprofloxacin, ceftazidime, co-trimoxazole, piperacillin-tazobactam, and ticarcillin-clavulanic acid. It was sensitive only to amikacin, imipenem & meropenem. The patient was treated with intravenous ceftriaxone 1g (only one dose) and intravenous ciprofloxacin 400mg twice a day for 2 days. However, the patient did not improve clinically. Since the pathogen was resistant to empiric therapy, the patient was treated with meropenem 1g 8 hourly for one week and the patient had an uneventful recovery. Conclusion: It is important to note that UTI is a possibility even though urine culture is sterile since bacterial cultures may be negative due to many reasons. Hence, it is important to probe with other means of investigations such as interventional procedures to evacuate possible foci of infection and obtain relevant samples for microbiological identification to confirm the clinical diagnosis and thereby streamline antibiotic therapy
Incidental Extra Spinal Findings in Magnetic Resonance Imaging of Spine: Beyond the Focus.
(In: Proceedings of the International Postgraduate Research Conference 2017 (IPRC – 2017), Faculty of Graduate Studies, University of Kelaniya, Sri Lanka., 2017) Siriwardana, S.R.; Herath, S.; Wijesooriya, L.I.
Magnetic resonance imaging (MRI) of the spine is a special imaging modality to evaluate various symptoms in spine including low back pain. However, extra spinal incidental findings (IF) which detect additionally during the MRI might influence the management of the patient. Objective: To describe IF detected during MRI spine and to emphasize the importance of identification of those. Methodology: Five patients who underwent MRI spine for back pain were selected and imaging appearances of various IFs were discussed.GE MR 360 advance 1.5-tesla MRI machine was used for the imaging. Results: Case 1: Thirty-seven year old female patient was evaluated for chronic neck pain. Sagittal T1W and T2W images show moderate size cystic lesion on posterior fossa of the brain. Follow-up MRI brain showed a moderate size arachnoid cyst causing indentation to the cerebellum. Case 2:Sixty-seven year old female patient was assessed for low back pain (LBP).T2W sagittal and coronal images showed 3.7 cm size oval shape mass medial to the right kidney. The mass was identified as an accessory kidney in follow-up contrast computed tomography (CT). Case 3:Thirty-eight year old female patient was assessed for LBP. Sagittal T1W, T2W and STIR images showed moderate size cystic mass with internal fat, fluid and low intensity nodules suggestive of calcium. MRI lumbar spine was uneventful. Subsequent surgery and histology revealed the mass as a dermoid cyst. Case 4:Forty- five year old male patient was evaluated for LBP. Sagittal T2W and Coronal STIR images showed uncomplicated left side pelvic kidney. Follow-up ultrasound scan too confirmed the diagnosis. Case 5:Eighty-three year old male patient presented with back pain and lower limb weakness. Sagittal and axial T2W images showed multiple spinal metastasis and coronal STIR images showed incidentally detected pleural based lung mass as a primary lesion.
Incidentally Detected Radiopacities in X-Rays of the Abdomen and Lumbar-Sacral Spine: A Pictorial Essay
(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Siriwardana, S.R.; Gunawardane, N.H.; Bandara, A.S.; Fernando, D.P.S.
Introduction: Incidental radiopacities (IR) are commonly seen in routine X-rays. Those may be incidental findings or directly related to the underlying pathology. Deposition of calcium can occur in normal anatomical structures as an age-related phenomenon. Similarly, the presence of calcification in certain organs /structures indicate a pathological abnormality in those areas. Eg: pancreatic calcification. Presence of calcific density in an organ/structure itself may be the pathology in a certain situation Eg; Ureteric calculi. Objective: To describe the important X-ray imaging appearances of additional radiopaque densities in a pictorial essay. Methodology: Total of 556 routine X-rays of the abdomen and lumbar-sacral spine were reviewed and IR were identified in 56 X-rays. IR were confirmed by computed tomography (CT) in 12 and by ultrasonically in 34 cases and radiological features were described. Results: Renal, ureteric and bladder calcifications: Calcifications were seen within the calyceal system, renal pelvis, ureteric pathways and bladder. Those single or multiple and appearances are well defined or branching type calculi. Lower ureteric calculi should be differentiated from phleboliths. Gallbladder and pancreatic calcifications: Gall bladder calcification appeared in right hypochondrium as single or multiple calcific densities with various shapes. Porcelain gallbladder appeared as eggshell calcification around gallbladder wall. Calcification in the epigastric region was associated with calcification in chronic pancreatitis Vascular calcifications: Very common in old age. Aortic and iliac calcifications were common and few were associated with the peripheral vascular disease. Pelvic calcification: Calcified fibroids and dermoid cysts were common and identified as ill-defined calcific masses in the pelvis Iatrogenic structures: Foreign bodies, intrauterine contraceptive devices, ureteric/biliary stents, vascular filters, and calcification within bowel loops had characteristic shapes to identify them. Conclusion: Incidental radiopacities are often visible on plain film radiographs. Knowing the characteristic nature and the site of these calcifications would support the physician to determine the treatment for the condition or to request further investigations.
Non-alcoholic fatty liver disease and pregnancy complications among Sri Lankan women: A cross sectional analytical study.
(Public Library of Science, 2019) Herath, R.P.; Siriwardana, S.R.; Ekanayake, C.D.; Abeysekara, V.; Kodithuwakku, S.U.A.; Herath, H.P.
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is the commonest cause of liver disease worldwide and is the hepatic manifestation of metabolic syndrome. Effects of NAFLD on pregnancy is still unclear with few studies showing an association to gestational diabetes and pre-eclampsia. We aimed to describe the association between the NAFLD and pregnancy complications. This is the first study, to our knowledge, in a South Asian population. METHOD: A cross sectional analytical study was done in Teaching Hospital, Ragama, Sri Lanka. Women carrying a singleton pregnancy, admitted for delivery were assessed for NAFLD with liver ultrasound scan. Data were extracted from interviewer administered questionnaire and antenatal and inpatient records. Pregnancy complications and labour outcomes were compared between the women with NAFLD and women without NAFLD (non-NAFLD). RESULTS: Out of the 573 women who participated, 18.2% (n = 104) were found to have NAFLD. Out of them, 58 (55.8%), 32(30.8%), and 14(13.5%) had fatty liver grade 1,2 and 3 respectively. Women with NAFLD were 2 times more likely to develop gestational hypertension and pre-eclampsia compared to the women in the non-NAFLD group, after adjusting for BMI, age and Hyperglycaemia in pregnancy [Adjusted OR 2.09, (95% CI 1.07-4.10)]. There was no association between the grade of steatosis and a composite outcome of gestational hypertension and pre-eclampsia, within the NAFLD group. Composite outcome of gestational diabetes mellitus and diabetes in pregnancy diagnosed during pregnancy was a significant complication in the NAFLD group compared to non-NAFLD group in the bivariate analysis (27.2% vs 17.7%; p<0.05), but the significance disappeared after adjusting for confounders. The current study did not demonstrate a significant association between NAFLD with preterm labour, caesarean section rate, low birth weight, and Apgar score of the baby. CONCLUSION: Women with NAFLD had a 2-fold higher risk of developing gestational hypertension and pre-eclampsia during pregnancy compared to women without NAFLD, after controlling for other confounding variables.
A Pilot Study on Antibiotic Prescription by General Practitioners in Ragama Medical Officer of Health (MOH) area, Western Province, Sri Lanka
(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Wijesooriya, L.I.; Perera, D.P.; Dissanayake, D.M.D.P.; Wijenayake, D.L.C.D.; Siriwardana, S.R.
Introduction: Antibiotic usage in healthcare has increased dramatically over past few decades. In parallel, bacteria have developed antibiotics resistance (AR) making a great challenge in healthcare. However, antibiotic misuse is a key behind AR. Therefore, strict regulation of antibiotic use is mandatory to minimize the development of AR. Hence, antibiotics are color-coded as red (Circular No. 01-56/2016, Ministry of Health, Sri Lanka), orange and green light antibiotics according to the level of authorization. However, these circulars and national antibiotic guidelines are mainly focusedinhospital practice. Hence, it is important to understand the current antibiotic prescription at general practitioner (GP) level. Objective: To study antibiotic prescription patterns of GPs in Ragama MOH area, Western Province, Sri Lanka. Methods: A cross-sectional, descriptive study was piloted involving 100 antibiotic prescribing encounters. (Total sample number was six hundred according to the WHO manual on “how to investigate drug use in health facilities”). Six randomly selected general practitioners, registered in general practitioners’ registry, published by College of General Practitioners of Sri Lanka, and practicing in Ragama MOH area were involved for the study which was conducted from May – August 2017. Data were collected from patients, using a pre-tested, interviewer-administered questionnaire. Demographic and clinical data of patients &details of antibiotic prescription as type, dose, frequency and duration were analyzed. Results: Of 100 antibiotic prescriptions, 23% for children (<12-65 years), 64% for adults (12-65 years) and 13% for elderly (>65 years) patients. Antibiotic prescription; 69% for respiratory tract infections (RTI), 12% skin infections 7% digestive tract infections, 2% urinary tract infections (UTI) and 10% for other infections. Common antibiotics prescribed for RTIs were amoxicillin (27.5%), Cephalexin (24.6%), followed by amoxiclav (17.4%), azithromycin (14.5%), clarithromycin (11.6%) cefixime (2.9%) & levofloxacin (1.4%). Ciprofloxacin was prescribed for digestive tract infections, UTI& sinusitis. All antibiotics were prescribed as per recommended doses and frequencies. Duration of antibiotics prescribed for RTI ranged from 3-15 days; in 29.4%, it was for 5 days, in 25% and 17.5% it was for 3 & 4 days respectively. In 33.8% prescriptions, duration of antibiotic therapy was more than 5 days. Conclusion: RTIs were the commonest condition for which antibiotics were prescribed. The most common antibiotics prescribed for RTIs were amoxicillin & cephalexin. A considerable number of prescriptions for RTIs was less than the minimum treatment duration recommended in the national guideline for empirical and prophylactic use of antimicrobials. Use of ciprofloxacin, (orange light antibiotic) and levofloxacin (red light antibiotic) has been noted in general practice.
Pseudo polycythaemia and its association with cardio-metabolic risk factors: A preliminary descriptive analysis from a tertiary care hospital
(Sri Lanka Medical Association, 2018) de Silva, S.T.; Amarasena, P.; Dias, M.A.D.H.; Lakmini, K.M.S.; Premathilaka, L.H.R.A.; Ranatunga, R.J.K.L.D.; Moratuwegama, H.M.D.; Siriwardana, S.R.; Niriella, M.A.; Premawardhena, A.P.
INTRODUCTION AND OBJECTIVES: Polycythaemia is the result of either an actual increase in red cell mass (true) or relative reduction in plasma volume (spurious). Spurious or pseudo-polycythaemia (PP) is a poorly-researched entity with unexplained increase in mortality noted in previous studies. We aimed to characterize PP and determine an association between PP and metabolic syndrome (MS) in a Sri Lankan clinic-based population. METHODS: Consecutive, consenting adults > 18 years, with two consecutive haemoglobin levels> l 6.5mg/dL and > 16mg/dL and/or PCV >49% and >48% in men and women respectively, with non-tourniquet samples taken few days apart in a well-hydrated state, were recruited from clinics of University Medical Unit, Colombo North Teaching Hospital and from the private sector. Interviewer-administered questionnaire was used to gather data.RESULTS: 46 participants were recruited: 3 (6.5%) had primary polycythemia, 5 (10.9%) had secondary polycythemia due to identifiable causes. 38 (82.6%) patients had PP [mean age 42.2 (SD=l5.2) years and 36 (94.7%) were males]. Of these 14 (36.8%) had diabetes, 22 (57.9%) had hypertension, 25 (65.8%) had hyperlipidemia and 25 (65.8%) were obese. 19 (50%) had fatty liver, 23 (60.5%) were light smokers, 8 (21.1%) consumed alcohol beyond safe limits, 6 (15.8%) had increased neck circumference, 1 (2.6%) had ischemic heart disease, 2 (5.3%) had chronic kidney disease and 2 (5.3%) had hyperuricaemia. Comparison of PP and secondary polycythemia with regard to prevalent components of MS was not possible due to small numbers.CONCLUSION: Components of MS were prevalent among those with PP. The significance of this finding remains unexplained. This needs to be replicated in a larger sample to establish whether these are independent risk factors for the development of PP.
Study on Knowledge, Attitudes and Practices Regarding Dengue Fever in a Cohort of Advanced Level Students in Sri Lanka.
(In: Proceedings of the International Postgraduate Research Conference 2017 (IPRC – 2017), Faculty of Graduate Studies, University of Kelaniya, Sri Lanka., 2017) Wijesooriya, L.I.; Hitige, D.G.; Herath, Y.B.; Sugandhi, R.A.I.; Siriwardana, S.R.
Dengue is a leading healthcare challenge in Sri Lanka. In 2015, 29,777 dengue cases were reported and this increased by 85.2% (55150 cases) in 2016. Last 10 months of year 2017 reported 158854 suspected dengue cases. Of them, about 30% were children of 519 years. Schoolchildren of advanced level (A/L) (Grade-12&13) are influential and useful on dengue control activities in schools.