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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Prevalence, associations and treatment outcome of anaemia in a cohort of patients with Chronic Kidney Disease(Sri Lanka Medical Association, 2019) Luke, W.A.N.V.; Lakmini, K.M.S.; Nadeeka, D.; de Silva, S.T.INTRODUCTION & OBJECTIVES: Anaemia is a common complication of chronic kidney disease (CKD) that can adversely affect cardiovascular health and quality of life. We conducted a study to assess prevalence, associations and treatment response of anaemia in a cohort of patients with CKD. METHODS: A descriptive cross sectional study was conducted among consecutive, consenting adult patients with stable CKD attending clinics and wards of University Medical Unit, Colombo North Teaching Hospital, Ragama. RESULTS: Of 149 patients with CKD [86/149 males (57.7%)], 105 (70.5%) had diabetes, 125 (83.9%) had hypertension and 57 (37.6%) had ischemic heart disease. 58/63 (90.6%) females and 80/86 (93%) males had anaemia. Severity of anaemia was associated with female sex (p=0.02), advancing CKD stage (p<0.01), diabetes (p=0.03), chronic liver cell disease (p=0.03), being on dialysis (p<0.005) and increasing degree of proteinuria (p<0.001). Of 91 patients investigated for the cause of anaemia, 55/91 (60.4%) had iron deficiency with anaemia of chronic disease while 25/91 (27.5%) had anaemia of chronic disease only. Of 88 patients with haemoglobin <10g/dL, only 40 (45.4%) were on erythropoietin and 50 (56.8%) had received blood transfusions. 76.1% (67/88) of the anaemic patients continued to have hemoglobin below 10g/dL at follow up despite treatment. CONCLUSION: Anaemia was highly prevalent in the CKD cohort we studied, compared to similar populations in other countries. Timely evaluation of anaemia, treatment of coexistent nutritional deficiencies and initiation of erythropoietin therapy are important to prevent anaemia-related complications and minimize the need for transfusions.Item Prevalence and patterns of dyslipidaemia among hypertensive patients in North Western Sri Lanka: A cross sectional study(Sri Lanka Medical Association, 2018) Luke, W.A.N.V.; Ediriweera, N.S.; de Silva, C.K.; Perera, K.M.N.; Ranasinha, C.D.; Kasturiratne, A.; de Silva, H.A.INTRODUCTION AND OBJECTIVES: Dyslipidaemia and hypertension are major risk factors for cardiovascular disease. Data on prevalence and patterns of dyslipidaemia in rural settings of Sri Lanka are limited. We conducted a study to determine the prevalence of dyslipidaemia among hypertensive adults over 40 years of age in the Puttalam district. METHODS: A community-based study was conducted in selected Grama Niladhari divisions in ten Medical Officer of Health areas in the Puttalam district. Socio-demographic data were obtained from adult hypertensive and basic investigations were carried out. RESULTS: Total of 798 hypertensive patients (546 females and 252 males) were included in the study. Median (Interquartile range) levels of total cholesterol, HDL, LDL and TG of the patients were 205 (173 - 238), 55 (48 - 63), 125 (96 - 155), 109 (85 - 143) respectively. Elevated levels of total cholesterol, LDL, TG and non HDL were reported in 192 (24. %), 371(46.4%), 173 (21.6%) and 527 (66%) respectively and low HDL was observed among 40 (5%) patients. High non HDL cholesterol was associated with female gender (P=0.03) and advancing age showed a negative association (P<0.01). CONCLUSION: Prevalence of dyslipidaemia is high in this hypertensive adult cohort. Suboptimal level of modifiable risk factor control is observed in this population which should be addressed to further reduce cardiovascular morbidity and mortalityItem Prevalence of hypertension in a rural district of Sri Lanka(Sri Lanka Medical Association, 2017) Luke, W.A.N.V.; Ediriweera, D.S.; de Silva, K.C.; Balasooriya, E.R.; Perera, K.M.N.; Ranasinha, C.D.; Kasturiratne, A.; de Silva, H.A.INTRODUCTION & OBJECTIVES: Hypertension is a leading cause of cardiovascular morbidity and mortality. Data on prevalence of hypertension in rural settings of Sri Lanka is limited. We conducted a study to determine the prevalence of hypertension among adults over 40 years of age in the Puttalam district.METHODS: A community-based prevalence study was conducted in selected Grama Niladhari divisions in ten Medical Officer of Health areas in the Puttalam district. Adults over 40 years of age living in consecutive households were screened by trained research assistants using digital blood pressure (BP) meters. Basic demographic data were obtained using an intervieweradministered questionnaire. Previously undiagnosed adults with persistent elevation of BP (SBP > 140 and /or DBP > 90 mmHg on two readings) and those already on treatment for hypertension were identified. RESULTS: A total of 2289 were screened. The mean (SD) of SBP and DBP were 134.5(21.3) and 82.1 (13.5) mmHg respectively. The overall hypertension prevalence was 458.5 (95% CI 438.1– 478.8) per 1000 population. 16.3% were newly diagnosed. Prevalence of uncontrolled hypertension among those on treatment was 516.2 (95% CI 479.4–552.9) per 1000. 98.7 (95% CI 86.6–110.9) per 1000 had blood pressure >160/110 mmHg. There was an increasing trend in blood pressure with increasing age (OR=1.07, 95% CI 1.06–1.08, p<0.01) but not with the male sex. CONCLUSION: Prevalence of hypertension is high in this rural adult cohort. Previously undetected hypertension and uncontrolled hypertension among those already on treatment are common. Community-based approaches targeting screening and BP control are essential to reduce adverse outcomes of hypertension.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.Item Cluster randomized trial on integrated primary care strategies to reduce high blood pressure in rural communities in Sri Lanka: Report from the feasibility study(Sri Lanka Medical Association, 2016) de Silva, H.A.; Kasturiratne, A.; Luke, W.A.N.V.; Ediriweera, D.S.INTRODUCTION: Hypertension is the leading cause of mortality worldwide. Control of Blood Pressure and Risk Attenuation (COBRA) trial conducted in Pakistan, demonstrated that the combined intervention of home health education (HHE) plus training general practitioners (GPs)was more effective for lowering blood pressure (BP) compared to usual care. OBJECTIVES: A feasibility study was conducted to adapt and integrate evidence-based strategies to control hypertension in the primary healthcare system in rural Sri Lanka. METHOD: Public Health Midwives (PHMs) in three Medical Officer of Health areas in Kurunegala district were trained on digital BP measurement and health education of hypertensive patients and their families PHMs screened household members above 40 years of age to identify individuals with hypertension. Socio-demographic data was collected and HHE was delivered as per training manual.PHMs referred probable patients to trained medical officers in the closest divisional hospital for further care and regular follow up. A referral loop was maintained by tracking the referred patients at the rural hospital by supervising PHM and medical officers. RESULTS: 142 hypertensive individuals were recruited and 129(90.8%) of them presented to the health care facility for follow up. At the end of follow up mean systolic blood pressure reduction of 13.8 mmHg (p-0.001) in those with poorly controlled BP (SBP≥160or DBP≥100 ) was demonstrated. CONCLUSIONS: It is feasible to implement this community-based strategy integrated to routine care for improving the management of hypertension in rural communities. Findings of this feasibility study will be fully evaluated in a large randomized controlled trial.Item Antibiotic sensitivity patterns of Extended-Spectrum β-Lactamase urinary tract infections in Sri Lanka(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Sebastiampillai, B.S.; Premaratna, B.A.H.R.; Luke, W.A.N.V.; Wickramasinghe, R.D.S.S.; Gunathilake, M.P.M.L.; Miththinda, J.K.N.D.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. OBJECTIVES: To identify common ESBL producing organisms and to evaluate the antibiotic sensitivity patterns of ESBL UTIs in Sri Lanka. METHODS: Patients admitted with ESBL-UTI to Professorial Medical Unit, Colombo North Teaching Hospital, Ragama over a period of 6 months from January 2015 were recruited. Their Urine culture and ABST reports were analysed after obtaining informed written consent. RESULTS: Of the 52 patients who consented to be on the study, 30 (57.7%) were males. Mean age was 64.11 (SD=12.59) years. E. coli was the commonest organisms (84.6%; n=44), causing the ESBL-UTI followed by Klebsiella (15.4%; n=8). Fifty (96.2%) patients were sensitive to meropenem, 38 (73.1%) to imipenem, 30 (57.7%) to amikacin and 24 (46.2%) to nitrofurantoin. Meropenem resistance was found in 2 (3.8%) cases which were due to infection with E. coli.These two patients had received multiple antibiotics including meropenem in the recent past for recurrent UTI. CONCLUSIONS: While E. coli and Klebsiella are the commonest ESBL producing organisms causing UTI, carbapenems remain as the first line therapy. However 3.8% prevalence of meropenem resistance among the study population should draw attention of clinicians and needs implementation of measures to prevent emergence of carbapenum resistant ESBL organisms.Item Factors influencing urinary tract infections caused by extended spectrum β-lactamase producing organisms among a cohort of hospitalized patients in Sri Lanka(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Luke, W.A.N.V.; Premaratna, B.A.H.R.; Fernando, S.C.; Silva, F.H.D.S.; Sebastiampillai, B.S.; Wickramasinghe, R.D.S.S.; Gunathilake, M.P.M.L.BACKGROUND: Urinary tract infections (UTI) caused by extended-spectrum β-lactamase (ESBL)-producing organisms are a management challenge and a health care burden. OBJECTIVES: To describe factors that influence ESBL UTI among hospitalized patients. METHODS: Fifty two consecutive patients who were admitted with culture positive ESBL UTI to the Professorial Medical Units, Colombo North Teaching Hospital, Ragama over a period of 6 month since January 2015 were recruited. Data was collected by an interviewer administered questionnaire and patients medical records after obtaining informed written consent. RESULTS: Among all 52 ESBL UTI patients, 46 (88.5%) had diabetes mellitus, 32 (61.5%) hypertension, 10 (19.2%) chronic liver disease, 18 (34.6%) a history of constipation. Four (7.7%) patients each were detected to have either hydronephrosis, hydroureter or prostatomegaly in USS assessment. Thirty two (61.5%) had received antibiotic treatment within the last 3 months: 18 (34.6%) has had penicillins and 16 (30.8%), 3rd generation cephalosporins, Twenty four (46.2%) had hospitalization in the last 3 months and 16 (30.8%) had a history of urinary catheterization. CONCLUSIONS: Diabetes, recent antibiotic treatment, hospitalization and catheterization were observed to influence ESBL UTIs. However the fact that 53.8% patients who developed ESBL UTI did not have a history of recent hospitalization, suggests high existence of community acquired ESBL.