Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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Item Sero-prevalence of rickettsial infections in patients with Parkinson’s disease(Sri Lanka Medical Association, 2017) Gunathilake, M.P.M.L.; Luke, N.; Benedict, S.; Wickremasinghe, S.; Ranawaka, U.K.; Premaratna, R.INTRODUCTION & OBJECTIVES: Role of infections in Parkinson’s disease (PD) pathogenesis has been proposed. A patient who had features of PD during scrub typhus infection fully recovered following treatment. Two years later, he developed features suggestive of early PD and raised the question, whether rickettsial infections could trigger development of PD. METHODS: In order to study the sero-prevalence of rickettsioses, a descriptive cross-sectional study was carried out in patients with diagnosed PD. Their IFA-IgG titres against O. tsutsugamushi (IFA-IgG-OT) antigens at 1:32 and 1:128 dilutions were compared with the population seroprevalence. Statistical analysis was performed using SPSS. RESULTS: A total of 35 patients; 20 (57.1%) males [mean age 62 years (SD 8.8)], 15 (42.9%) females [mean age 68.5 years (SD 7.4)]. Mean age at diagnosis of PD; males: 57.2 years (SD 9.7), females: 64.7 years (7.5). 10/35 (29.8%) had IFA-IgG-OT titre 1:32 (p=0.19 compared to population sero-prevalence of 19.8%) and one had a titre 1:128 (2.8% compared to population prevalence of 3.17%). At the time of assessment for sero-prevalence of rickettsioses, the mean (SD) duration of diagnosis of PD between IFA-IgG +ve vs IFA-IgG –ve were 4.3(3.9) vs 4.2(4.4) years. CONCLUSION: Although patients with PD had a higher percentage sero-prevalence compared to the population, it was not significantly different. The drawback of this study was the long duration of PD at the time IFA-IgG levels were done. Following up of patients who present with extrapyramidal features due to acute rickettsioses and assessing whether they later develop PD would help to arrive at conclusions.Item Factors associated with urinary tract infections caused by extended spectrum β-lactamase producing organisms (ESBL-UTI) among hospitalized patients in a tertiary care hospital(Sri Lanka Medical Association, 2016) Fernando, S.C.; Wickramasinghe, R.D.S.S.; Luke, W.A.N.V.; Gunathilake, M.P.M.L.; Sebastiampillai, B.S.; Miththinda, J.K.N.D.; Silva, F.H.D.S.; Premaratna, B.A.H.R.INTRODUCTION AND OBJECTIVES: Management of infections caused by ESBL producers is a challenge and expensive. Known associations for ESBL-UTI include recent hospitalizations, recent treatment with cephalosporins, quinolones or penicillin, age over 60 years, male gender, diabetes mellitus, recent Klebsiella pneumoniae infection and obstructive uropathy. Associations for ESBL-UTI in Sri Lanka are not known. METHOD: In order to identify associations of urinary tract infections (UTIs) caused by ESBL producers (ESBL-UTI),a descriptive cross-sectional study was carried out in patients with culture positive ESBL-UTIs admitted to the Professorial Medical unit, Colombo North Teaching Hospital. Patients’ medical records and an interviewer administered questionnaire were used to obtain data. RESULTS: There were 61 patients, 30 (49.1%) males with a mean age of 64.1 years. Of them, 54 (88.5%) had diabetes mellitus,38 (62.2%) had hypertension and 10 (16.3%) had chronic liver disease (CLD). 21 (34.4%) had acute pyelonephritis, 19 (31.1%) had evidence of chronic kidney disease,8 (13%) had obstructive uropathy by ultrasonography. A history of constipation was given in 27 (44.2%), hospitalization during the past 3 months in 30 (49.2%), urinary catheterization in 20 (32.7%) and antibiotic treatment within the past 3 months in 39 (63.9%). CONCLUSION: Most associations for ESBL-UTI in Sri Lanka were similar to that had been previously described. However the observed higher incidence of CLD, hypertension and CKD needs further evaluation. The fact that 50.8% did not have a history of recent hospitalization and 36.1% did not have recent antibiotic therapy suggest high community prevalence of ESBL producing organisms.Item Antibiotic sensitivity patterns among extended spectrum β-lactamase (ESBL) producing organisms causing urinary tract infections in Sri Lanka(Sri Lanka Medical Association, 2016) Luke, W.A.N.V.; Fernando, S.C.; Wickremasinghe, R.D.S.S.; Sebastiampillai, B.S.; Gunathilake, M.P.M.L.; Miththinda, J.K.N.D.; Silva, F.H.D.S.; Premaratna, B.A.H.R.INTRODUCTION AND OBJECTIVES: ESBLs are enzymes that confer resistance to all penicillins, cephalosporins, and aztreonam. ESBL producing organisms causing urinary tract infections (ESBL-UTI) are increasing in incidence and pose a major burden to health care requiring treatment with expensive antimicrobials and prolonged hospital stay. Documented antibiotic susceptibility of ESBL organisms include meropenem (95-100%) and aminoglycosides (45-60%). This study evaluated the antibiotic sensitivity patterns of ESBL-UTI in Sri Lanka. METHOD: Patients with ESBL-UTI admitted to Professorial Medical Unit, Colombo North Teaching Hospital (CNTH) from January – June 2015 were recruited to the study. Their Urine culture and ABST reports were evaluated after obtaining informed written consent. RESULTS: Of 61 culture positive ESBL-UTIs, E. coli accounted for 53 (86.8%), followed by Klebsiella in the 8 (13.1%). The ESBL organisms were mostly sensitive to carbapenems; 58 (95%) to Meropenem and 45 (73.7%) to Imipenem. The other sensitivity patterns were 37 (60.6%) to Amikacin, and 28 (45.9%) to Nitrofurantoin. Meropenem resistance was observed in 3 (4.9%) and were E.coli. These three patients had received multiple antibiotics including meropenem in the recent past for recurrent UTI. CONCLUSIONS: It is evident from the above data that Carbapenems remain as the first line therapy for the majority of ESBL-UTI in the local setting. However 4.9 % prevalence of meropenem resistance is alarming compared to 0.4% prevalence in Pakistan and 0.02% prevalence in Germany. Such high prevalence of meropenem resistance should draw attention of clinicians and needs to implement measures to prevent emergence and spread of carbapenum resistant ESBL organisms in the country.