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 Clinical and virological features of dengue in 2010(Sri Lanka College of Microbiologists, 2011) Hapugoda, M.D.; Manamperi, H.; Gunasena, S.; Athapaththu, A.M.M.H.; Premawansa, G.; Wellawaththage, C.; Jayarathna, T.D.S.S.; Abeyewickreme, W.INTRODUCTION: Dengue is an important viral infection in Sri Lanka. All 4 serotypes co-circulate in Sri Lanka. OBJECTIVE: To study the clinical and virological features of dengue in 2010. DESIGN, SETTING AND METHODS: A hospital-based study was carried out at North Colombo Teaching Hospital, Ragama in 2010. Patients clinically suspected of having dengue, with fever less than 5 days were recruited. Acute and convalescent blood samples were collected within 7 days after obtaining informed written consent. Demographic, clinical information and laboratory results were obtained. Acute serum samples were tested using molecular (RT-PCR and Semi-Nested PCR) and serological (ELlSAs and HAI) assays. Convalescent samples were tested by serological assays. RESULTS: Of 209 patients enrolled, 93 % (195/209) were laboratory confirmed as recent positive cases of dengue viral infection; of these, 5% (9/195) were classified as dengue fever; 85%(1G5/195) dengue haemorrhagic fever (DHF) and 0.5% (1/195) dengue shock syndrome. Mean platelet value and packed cell volume (PCV) in laboratory confirmed dengue patients were 56,107/mm3 (range 10,000-306,000) and 42%(range 34-61 %) respectively. Patients infected with DHF showed both primary (n=45) and secondary (n=102) infections. Interestingly, secondary infection was not significantly correlated with DHF (x2-0.3:p=0.6). DEN-1 was responsible for the majority of cases, with a minority due to other three serotypes; all serotypes contributed to severe disease. CONCLUSION: DEN-1 was responsible for the majority of cases in 2010 but it circulated at a low level during previous epidemics. Majority of patients had severe clinical symptoms. In this epidemic, the clinical presentation of dengue differed according to the geographic region and viral serotype. ACKNOWLEDGMENTS: Financial assistance and technical co-operation by International Center for Genetic Engineering and Biotechnology (ICGEB CRP SRL 08/02), National Science Foundation (NSF/RG/2009/BT/01) and International Atomic Energy Authority (lAEA/SRL/5/042) is acknowledged.Item 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.Item 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.Item Shifting of circulating serotypes in dengue outbreaks during 2009/2010 in Sri lanka(Faculty of Tropical Medicine, Mahidol University, 2010) Manamperi, N.H.; Athapaththu, A.M.M.H.; Premawansa, G.; Wellawaththage, C.; Jayarathna, T. D. S. S.; Abeyewickreme, W.; Hapugoda, M.D.OBJECTIVES: Sri Lanka has experienced explosive outbreaks of dengue infection in 2009 and 2010. It has been identified that DEN- 3 and DEN- 2 were the predominant serotypes with DEN-1 and DEN- 4 circulating at a lower level in previous dengue outbreaks during 2003-2006, Objective of this study was to identify the circulating serotype/s during 2009 - 2010 outbreaks. METHODOLOGY: A prospective study was carried out at North Colombo Teaching Hospital, Sri Lanka during December 2009-August 2010. Clinically suspected dengue patients, with fever less than 5 days were recruited. An interviewer administered questionnaire was filled for each patient, by a Medical Officer. Venous blood samples confirmed for the presence of dengue virus by RT-PCR were typed by Semi-Nested PCR. RESULTS: Out of the 209 patients recruited in the study 80 (38%) were positive for dengue virus by RT-PCR. Of the positives, 43 (54%) were typed and circulation of all 4 serotypes was observed- Of the 43 positives, presence of DEN-1, DEN-2, DEN-3 and DEN-4 serotypes was 34 (79%), 3 (7%), 2 (5%) and 3 (7%) respectively DEN-1 was the predominant serotype in the recent epidemics which was circulating at a low level in previous epidemics. In DEN-1 infected patients, the mean platelet value was 58,588/ rnm3 and the mean PCV value was 41.4%. Associated symptoms such as headache, retro-orbital pain, neck pain and limb pain were present in 94% (32/34), 59% (20/34), 24% (8/34J and 91% (31/34) patients respectively. Bleeding manifestation developed in 47 % (16/34) patients. The mortality rate ranged from 0.7%- 1.0% during the recent outbreaks. Acknowledgement: Financial and technical assistance from the International Centre for Genetic Engineering and Biotechnology (ICGEB CRP/ SRI08-02) and the International Atomic Energy Agency (IAEA SRI 5/042) is gratefully acknowledged.Item Differences in ischaemic and haemorrhagic strokes in Sri Lanka: 7-year data from the Ragama Stroke Registry(American Academy of Neurology & Lippincott Williams & Wilkins, 2015) Ranawaka, U.; Peiris, A.; Thirumavalavan, K.; Premawansa, G.; Kasturiratne, A.OBJECTIVE:We sought to describe the differences in stroke characteristics of patients with ischaemic and haemorrhagic stroke attending a Sri Lankan tertiary care hospital. BACKGROUND:The burden of stroke in South Asia is high, but epidemiological data are limited from the region. DESIGN/METHODS:The Ragama Stroke Registry is the first comprehensive stroke registry in Sri Lanka capturing data of all stroke patients admitted to an entire hospital. We collected data from all consenting patients with stroke admitted to the Colombo North Teaching Hospital over a seven-year period. We compared data from ischaemic stroke patients (IS group) with intracerebral haemorrhage patients (ICH group) regarding demographic characteristics, clinical features, risk factors, stroke severity and early disability. RESULTS:A total of 2690 patients were studied [mean age (SD) 64.4 (12.3) years; 58.6[percnt] males]; IS group- 2185 patients (81.3[percnt]); ICH group- 411 patients (15.3[percnt]). No differences were noted in age & sex distribution between ICH and IS groups. ICH patients presented to hospital earlier (<6 hours- ICH 74.5[percnt], IS 54.0[percnt], p<0.05). Altered consciousness, dysphasia, dysphagia, gaze palsy and bladder involvement were commoner among ICH patients (p<0.05). Previous history of stroke/ TIA, diabetes, heart disease, obesity/overweight and smoking were commoner in IS group. ICH patients presented with more severe strokes (NIHSS score >7 in ICH 67.6[percnt] vs. IS 43.8[percnt], p<0.05), and had more severe initial disability according to Barthel index and modified Rankin scale (p<0.05). CONCLUSIONS:Clinical and risk factor profiles were different between ICH and IS patients. Stroke severity and functional disability were higher among ICH patients. Study Supported by:Ragama Stroke Registry has been partly supported by research grants from the University of Kelaniya and Research Institute, International Medical Centre of Japan. Disclosure: Dr. Ranawaka has nothing to disclose. Dr. Peiris has nothing to disclose. Dr. Thirumavalavan has nothing to disclose. Dr. Premawansa has nothing to disclose. Dr. Kasthuriratne has nothing to disclose.