Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Stroke subtypes in Sri Lanka(Sri Lanka Medical Association, 1997) Gunatilake, S.B.; Premawardhena, A.AIM: Data on stroke subtypes in Sri Lanka are limited. This is due to the unavailability of brain imaging facilities in most government hospitals in the country. In two leading private hospitals in Colombo, a high proportion of stroke patients are subjected to computerised tomography (CT) scanning. Therefore it was decide to study the stroke patients admitted to these two hospitals to determine the stroke subtypes METHODS: A prospective study of 103 consecutive first -ever stroke patients who were under the eare of the first author during the period 15lhMay 1995 lo30th August 1996 were studied. Diagnosis of stroke was made according to the WI10 definition. Transient ischaemic attacks (TIA) were not included in the study. The pathological subtype was confirmed by CT scan in 99 patients RESULTS: The age of the patients ranged from 37 to 94 years (mean 65y). 87 patients were over the age of 50 years. The proportion of pathological subtypes confirmed by CT scanning was cerebral infarction (CI) 74%, intracerebral haemorrhage (ICH) 19% and subarachnoid haemorrhage (SAII) 6%. Of the 74 infarcts 31 (23%) were cortical, 30 (22%) were lacunar, 12(9%) were cerebellar and brains tern and 1 (0.7%) was a border zone infarct, In-hospilal mortality was 19% for all strokes: 14% for infarcts and 35% for haemorrhages. Mortality was lowest in (he lacunar stroke group (3%). In the cortical infarct group the mortality was 16%, in the ICH group 22% and in the SAM group 50%. CONCLUSION: Direct comparisons with stroke subtypes seen in other countries are not possible due to differences in methodology. In developed countries in the West cerebral infarcs account for about 80% of alI first-ever strokes and of these 13 to 21% are lacunar strokes. Countries in the East like Japan and Hongkong have reported higher proportion of haemorrhages; 27% of first-ever strokes in Hong Kong. In Sri Lanka The proportion of stroke subtypes seem to be intermediate between these countries from die west and east. Lacunar .stroke .seem to be commoner in Sri Lanka than in other countries. These differences may be because of differences in risk factors prevalent in our country.Item Follow-up of patients with stroke(Sri Lanka Medical Association, 2003) Gunatilake, S.B.; Karunaratne, A.; Gnanathilake, G.K.; Silva, H.K.M.S.BACKGROUND: Stroke is the commonest cause of adult disability. Information about the long-term outcome following a stroke is important for planning rehabilitation services. No long-term follow up studies looking at prognosis are available from Sri Lanka. Aims: To study the follow up pattern of a cohort of stroke patients admitted to hospital. METHODS: We planned a follow up assessment of all first-ever stroke patients admitted to the University Medical Unit in the North Colombo Teaching Hospital. This is an on-going study and was started on August 15, 2001. Validated Rankin Disability scale was used to grade the disability of patients at the time of discharge, and at follow-up. Follow-up defaulters were contacted by telephone or letter. This paper presents the data on the follow-up of the first 100 patients. RESULTS: During the period between August 15, 2001 and November 15, 2002, 152 patients with stroke were admitted. Of the first 100 patients all have completed six months after the stroke and of them 14 have died, and 58 have attended the six-month follow up with 28 defaulting. At discharge from hospital 34 were having minor or no disability (group 1) and 61 were having moderate or severe disability (group 2). Of the. 58 who attended the six-month follow up 44 were in group 1 and 14 were in group 2. Of the defaulters 7 were in group 1 and 21 were in group 2. Six-month follow-up rate was 72%. CONCLUSIONS: Follow up rate was inadequate despite incentives given to attend. 14 of the patients came for follow up despite a severe disability. Of the 28 defaulters 21 had a severe disability at discharge and only six were from remote areas. Reason for default is not clear from our study.Item Safety of low dose subcutaneous adrenaline used as prophylaxis against acute reactions to anti-venom serum (AVS) in patients bitten by snakes(Sri Lanka Medical Association, 2002) Dassanayake, A.S.; Karunanayake, P.; Kasturiratne, K.T.A.A.; Fonseka, M.M.D.; Wijesiriwardena, B.; Gunatilake, S.B.; de Silva, H.J.INTRODUCTION: Low dose subcutaneous adrenaline significantly reduces acute adverse reactions to AVS in patients envenomed following snake bite. OBJECTIVES: To further study the safety of low dose subcutaneous adrenaline. METHODS: We prospectively studied patients with snake bite envenoming in two units of the Colombo North Teaching Hospital, Ragama, from April 2000 to October 2001. Patients who satisfied inclusion criteria were given 0.25ml 1:1000 adrenaline subcutaneously immediately before administration of AVS. They were observed for adverse effects, and pulse and blood pressure (BP) were recorded before and at frequent intervals for one hour after giving adrenaline. In patients who developed reactions to AVS, subsequent pulse and BP measurements were not included for analysis. Results: 51 patients [M:F=35:16; mean age 34.8yrs (SD 14)] were included in the study. No significant changes in mean pulse rate or BP were observed following administration of subcutaneous adrenaline. Adverse reactions to AVS occurred in 15 (29.4%) patients. There were 4 (7.8%) other complications: one (2%) death due to suspected intracerebral haemorr-hage in a 65yr old man who also had coagulopathy, and developed an adverse reaction to AVS which required treatment with adrenaline; 3 (5.9%) patients, who also had coagulopathy, developed small haematomas at the subcutaneous injection site. CONCLUSIONS: Low dose subcutaneous adrenaline did not cause significant changes in pulse rate or BP. The 3 small haematomas could be directly attributed to the injection. Although the death is unlikely to be directly related to subcutaneous adrenaline, we suggest further studies on the safety of this prophylactic treatment before recommending its routine use.Item Prevalence of dementia in a semi-urban population in Sri Lanka(Sri Lanka Medical Association, 2002) de Silva, H.A.; Gunatilake, S.B.BACKGROUND: The Sri Lankan population is aging rapidly. However, the prevalence of dementia, a devastating disease of the elderly, is unknown. Methods: A community survey to assess the prevalence of dementia in a semi-urban population was done in the Gampaha district. The study was conducted in two phases. Phase I: after informed consent 703 randomly selected subjects over 65 years from four PHM areas in Ragama (population 15828) were screened for cognitive impairment using the Sinhala Mini Mental State Examination (MMSE). Subjects scoring <17 were regarded as suspected dementia cases. Phase II: all subjects who screened positive in phase I were included in phase II for detailed evaluation of dementia according to DSM IV and NINCDSADRDA criteria which included structured neuropsychiatric assessment, laboratory investigations, axial and temporal lobe-oriented CT scans of the brain and an informant interview. The average time interval between screening and detailed evaluation for 1 dementia was 7.7 months. RESULTS: 42 subjects screened positive in phase I. Of these, four died, one moved home and one suffered a stroke before detailed evaluation, and two did not consent. Two had psychiatric disease I and five had no evidence of dementia. 27 subjects [Mean age =71(6.37); M:F=8:19] were diagnosed as having dementia according to operative criteria. Of these, 19 (70.4%) had probable Alzheimer's disease (AD), three had vascular dementia (11.1 %), three had mixed (vascular and AD) dementia (11.1 %), one had Lewy body dementia, and one had dementia due to syphilis. CONCLUSIONS: In our study population, the prevalence rate of dementia is at least 3.8%, and the majority (66.6%) is of the Alzheimer type.Item Stroke patient's knowledge about stroke(Sri Lanka Medical Association, 2001) Gunatilake, S.B.; Biyanwila, C.; Liyanage, B.BACKGROUND: Little is known about stroke patient's general knowledge about stroke symptoms, risk factors, pathology and available treatments. This information is important for implementation of preventive programs. OBJECTIVE: This study attempts to determine the knowledge of stroke patients about the illness after they were discharged from hospital. METHODS: Consecutive patients attending the outpatient clinics following discharge from hospital after a first-ever stroke were included in the study. A structured, standardised interview using a questionnaire was performed by two doctors. Age and sex matched patients attending the clinic for non-vascular illnesses were used as a control group. RESULTS: During a period of two months 48 patients were recruited. Of them 17 had been educated upto GCE ordinary level. All 48 patients knew of at least one stroke symptom and over 90% knew that paralysis, speech disturbance and walking difficulty are stroke symptoms. Only 20 (42%) knew that the primary organ involved was the brain and of them only five knew that a stroke is due to thrombosis or haemorrhage. Thirteen patients (27%) were not aware of any risk factors and 33 (73%) knew that hypertension is a risk factor. Smoking was identified as a risk factor by 21 (44%), but 29 (60%) didn't know that stopping smoking reduces the stroke risk. Only 30 patients (62%) knew that stroke can be prevented and 37 (77%) said that stroke is an emergency. All except four patients had sought medical advice the same day. CONCLUSIONS: Our patients have a good knowledge of stroke symptoms and seek medical advice early. Awareness of risk factors are average but the knowledge about the organ involved and the pathology was poor.Item Post mortem findings in yellow oleander poisoning(Sri Lanka Medical Association, 2001) Seneviratne, S.L.; de Silva, C.E.; Fonseka, M.M.D.; Gunatilake, S.B.; de Silva, H.J.INTRODUCTION: Death from yellow oleander poisoning (YOP) is mainly due to cardiac toxicity caused by its effect on the conducting system leading to bradyarrhythmias. Whether other organ systems are involved in YOP is not clear. No post-mortem studies of death due to YOP have been documented. OBJECTIVE: To study post-mortem (PM) abnormalities following YOP. METHODS: Post-mortems were performed on patients with YOP who died after admission to Base Hospital, Polonnaruwa (BHP), over a 20 month period from January 1998 to August 1999. Written consent was obtained from relatives for the PM examination. RESULTS: Thirty seven PMs were performed during the study period. There were 21 males and the age range was from 13 to 70 years. Twenty three patients died within 24 hours of admission while ten and two died on the 2" and 3rd days respectively. Two patients died after 72 hours of hospital stay. Almost all subjects (35) had myocardial and pericardial haemorrhages. Congested kidneys were found in 24 (64.8%) while nine had a congested liver. Cerebral oedema was found in 16(43.2%). No abnormalities were found in the lungs and other intra- abdominal organs. CONCLUSION: Deaths occur early in fatal YOP. Myocardial and pericardial haemorrhages were seen in almost all PMs and could have resulted from cardio-pulmonary resuscitation, at least in some patients. PM abnormalities seen in kidneys and brain were probably secondary to hypoperfusion following cardiac arrhythmias. YOP does not seem to cause direct damage to organ systems other than the heart. Further work needs to be done to determine the effects of YOP on the cardiac conducting tissue.Item Scrub typhus in an urban and semi-urban population(Sri Lanka Medical Association, 2001) Hirimuthugoda, L.; Dassanayake, A.S.; Fonseka, M.M.D.; Tillakeratne, Y.; Gunatilake, S.B.; de Silva, H.J.OBJECTIVE: Though it had been suggested that scrub typhus could be occurring in Sri Lanka, there are no properly documented case series. We document our experience with 17 cases of scrub typhus. METHODS: All patients were admitted to the University Medical Unit in North Colombo Teaching Hospital over a period of 18 months. Diagnosis of scrub typhus was made in febrile patients by the presence of an eschar, raised antibody titres to Proteus OX-K in the Weil-Felix test and the dramatic response to specific treatment with tetracycline. RESULTS: All patients presented with high fever and the duration of the fever before diagnosis varied from three days to 21 days with a mean of 9 days. Headache and myalgia were common to all. Sixteen patients were from urban and semi-urban surroundings. All patients had the eschar and in most it was in the groin and axilla. Generalised or regional lymphadenopathy was present in all patients. In nine patients the Weil-Felix test showed raised titres to Proteus OX-K antigen. Sixteen patients were treated with tetracycline and one pregnant patient with chloramphenicol. All patients responded dramatically with fever settling within 24,hours. CONCLUSIONS: Scrub typhus seems to be commoner than thought and occurs even in urban areas. This condition has to be considered in the differential diagnosis of any patient with fever and especially when the fever is not settling early. Eschar is the most useful diagnostic sign that should be looked for.Item Qualities of tomorrow's doctor(Sri Lanka Medical Association, 2004) Weerasingha, M.; Pathiraja, M.; Vipulanayake, T.; Gunatilake, S.B.The General Medical Council in England has published a document named "Tomorrow's Doctors" which outlines the best qualities every new doctor should aspire to. First page of this document lists 15 qualities that a doctor must have. OBJECTIVE: A quantitative assessment of the 15 qualities a doctor must have to decide on the degree of importance of each quality. METHODS: We interviewed 50 first year medical students, 50 final year medical students, 35 intern house officers, 25 consultants, and 200 outpatient attendees selected randomly using a questionnaire to find out the degree of importance they attach to the above 15 qualities. Participants were asked to give a mark from 1 to 15 to each quality giving 15 to the most important quality. RESULTS: New medical students thought a thorough knowledge of medicine is the most important quality of a doctor (score 14.36/15) and the final years thought that the care of your patient being the first concern as the most important quality (13.66/15). House officers thought that treating patients politely and respecting their dignity and privacy were the most important (14/15). Consultants thought that the care of your patient being your first concern was the most important (14.48/15) and having a thorough knowledge of Medicine as the least important (9.58/15). The general public considered a thorough knowledge of medicine (13.34/15) and the care of your patient being the first concern (13.49/15) as the most important and respecting the rights of patients to be fully involved in decisions about their care as the least important (9.83/15). CONCLUSIONS: Public and the new students consider having a thorough knowledge of medicine as very important and respecting the rights of patients to be fully involved in decisions about their care as the least important. Medical personnel especially the consultants thought that having a thorough knowledge of medicine is not so important for a young doctor.Item Misuse of antibiotics for viral fevers by first contact doctors(Sri Lanka Medical Association, 2005) Premaratna, R.; Halambarachchige, L.; Thilakaratne, Y.; Gunatilake, S.B.BACKGROUND: Inappropriate use of antibiotics has led to a steady increase in microbial antibiotic resistance. METHODS: We conducted a survey during the recent outbreak of dengue fever (three months from June 2004), when doctors should be aware the most likely cause for fever is viral, to study the antibiotic prescription pattern at primary contact. Drugs prescribed were identified by analysing the prescriptions or unused drugs provided by the patients. RESULTS: Of the 412 patients with fever admitted to professorial medical unit, 146 patients [(121 males), mean age 26 yrs (SD;9.4yrs)j were randomly selected for the study. Their first contact medical care was: general practitioner (GP) in 122(84.1%); out patient department of the hospital (OPD) in 20( 13.8 %) and a specialist physician in 4(2.1 %). The mean duration of fever at the time of first contact was 1.6 days (SD:0.9). 105(72%) patients had been prescribed an antibiotic; 99 from the GP (81% where GP was first contact) and 6 from the OPD (30% wh«re OPD was first contact). The mean duration of antibiotic use at the time of admission to hospital was 3.5 days (SD;1.9). The most likely diagnoses at the time of admission were dengue fever or viral fever in 128(88%), and of them 93 patients (73%) had taken an antibiotic. Of the patients who had taken an antibiotic only 9(8%) required continuation of the treatment. The antibiotic prescribed was identified in 89(85%): Amoxycillin 61(58%); ciprofloxacin 17(16%); cephalexin 9(8%); erythromycin 3(3%). CONCLUSIONS: There was a high rate of inappropriate use of antibiotics at the first contact.Item Family study of epilepsy in first degree relatives(Sri Lanka Medical Association, 2005) Gunatilake, S.B.; Senanayake, A.E.S.; Mapa Pathirana, T.S.L.; Balasooriya, B.L.H.; Mettananda, K.C.D.OBJECTIVE: Genetic factors play a role in the aetiology of epilepsies. This study was designed to evaluate the family history of epilepsy in the first degree relatives of probands with epilepsy. METHODS: A sample of 434 patients with epilepsy attending the Neurology Clinics of the North Colombo Teaching Hospital was interviewed by two medical officers using a standard questionnaire during a period of three months starting August 2004. Type, and cause of epilepsy, and whether or not any of their family members had seizures were recorded. RESULTS: Of the 434 patients 237 were females and 198 were males. The mean age was 28 years (SD 14). 404 patients (93.7%) had idiopathic epilepsy. 57 (13%) patients had a family history of epilepsy and their mean age of onset was 15.9 years (SD 11.7). Of them 56 were having idiopathic epilepsy. First degree relatives affected were arents~30, siblings-25 and offspring-1. Seventeen probands gave a history of consanguinity in the parents and of the ones with a family history of epilepsy only one proband had parental consanguinity. Five patients had more than one family member affected. CONCLUSIONS: A family history of 13% is significantly high when compared with normal population figures of around 5 to 8 per 1000. This provides strong evidence that in our population also genetic factors play an important part in the aetiology of epilepsy.