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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Annotated checklist of chigger mites (Trombidiformes: Leeuwenhoekiidae, Trombiculidae and Walchiidae) in Sri Lanka(Elsevier, 2022) Ashani, M.L.S.; Gunathilaka, P.A.D.H.N.; Premaratna, B.A.H.R.; Chandrasena, T.G.A.N.; Jacinavicius, F.C.; Silva, R.B.Chigger mites (Leeuwenhoekiidae, Trombiculidae, and Walchiidae) are parasites of any terrestrial vertebrate. The present study updates the list of chigger mite (Trombiculidae, Leeuwenhoekiidae, and Walchiidae) species recorded from Sri Lanka along with taxonomic classification based on previous investigations since 1946 to date and our observations in western and southern parts of the country. This checklist listed 15 species in 9 genera within the three chigger families. For now, murid species were the host most sampledparasitized by chiggers in Sri Lanka. However, further studies are required to increase the diversity of chigger mites in Sri Lanka and probably the description of new species, which will be possible with morphological and molecular characterization.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 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 Prevalence of rickettsial infections in acute coronary syndromes in Sri Lanka: a case control study(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Mettananda, K.C.D.; Danansuriya, D.S.T.; Bandara, N.K.B.K.R.G.W.; Premaratna, B.A.H.R.Background: Place of infection in atherosclerosis and or coronary heart disease has recently drawn interest. Rickettsiae are a group of obligate intracellular pathogens who invade vascular endothelial cells leading to vasculopathy. A study conducted in Thaiwan, scrub typhus was found to increase the risk of acute coronary syndromes (ACS) by 37% compared to general population after adjusting for age, sex and other known independent risk factors. Objective: To assess the prevalence of Rickettsial infections in patients with ACS residing in Western province, Sri Lanka. Methods: Patients admitted with ACS to Professorial-Medical-unit, were studied for serological prevalence of Rickettsial infections and were compared with a matched control group; who had no fever or ACS. 2ml serum samples were obtained at enrolment and 2weeks after and were assessed for IFA-IgG antibody titres against Orientiatsutsugamushi (OT) and Spotted-fever-group-rickettsioses (SFG). An IgG titre>1:128 or a rising/declining titre were considered positive for acute rickettsioses. A static titre was considered to be due to previous exposure to rickettsioses. Results: 46 ACS patients (males-23.9%, mean age 61.1 [SD=13.1] years) and 52 controls (male-50%, mean age 56.0[SD=13.6] years) were studied. None had evidence of acute Rickettsiel infection. Sero-prevalence of IgG-OT was 6.4% and IgG-SFG was 15.2% among ACS patients. Same for control group were 3.8% and 11.5% respectively. There was no significant difference in sero-prevalence of OT [OR =0.74; CI: 0.28-10.93; p=0.66] or SFG [OR=1.376; CI:0.43-4.44; p=0.59] in patients with ACS compared to controls. Conclusions: No significant difference was observed in sero-prevalence of rickettsioses in patients with acute coronary syndromes compared to controls in this study.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.Item Rickettsial diseases: revisiting an old enemy(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Premaratna, B.A.H.R.The history of rickettsioses in Sri Lanka dates back to 1930-1940s. Since of late, rickettsial infections have re-emerged in many parts of the world, including Sri Lanka. We observed patients presenting with serious complications such as encephalitis, myocarditis, pneumonitis and multi-organ involvement carrying high morbidity and mortality due to rickettsioses. Such presentations made us realize the importance of establishing diagnostic facilities in the country in order to face the challenge posed by rickettsioses. After initial collaborative work with the Centers for Disease Control and Prevention, Atlanta, USA, we established IFA based diagnostics in the Faculty in 2008. Subsequently we were able to describe the epidemiological pattern, different clinical presentations, and new serological cut-off points for IFA-IgG based serological diagnostics based on sero-prevalence. Thereafter, in collaboration with the University of Texas Medical Branch at Galveston, USA, we were able to describe the diverse distribution of scrub typhus serotypes in two different localities in Sri Lanka. Subsequently, in collaboration with ImmuneMed diagnostic laboratory at Incheon, South Korea, we were able to identify antibody-based rapid diagnostic tests which could be employed for rapid diagnosis and identification of scrub typhus strains in Sri Lanka.Item Liver dysfunction and its outcome in patients with dengue infection(Sri Lanka Medical Association, 2010) Kumarasena, R.S.; de Silva, A.P.; Keragala, B.S.D.P.; Premaratna, B.A.H.R.; Premawardhena, A.P.; Jayamanna, S.F.; de Silva, H.J.; de Silva, S.T.OBJECTIVES: To determine the frequency and severity of liver dysfunction due to dengue infection among hospitalised patients. METHOD: A retrospective, descriptive study was done at University Medical Unit, Colombo North Teaching Hospital. Records of all serologically confirmed dengue (IgM antibody positive) patients admitted from 1/1/09-31/1/10 were analysed. Results of blood tests, imaging and serology were noted. A diagnosis of acute liver failure was made in patients with an INR >1.5 together with hepatic encephalopathy. Patients on hepatotoxic drugs, alcohol abusers and patients with known chronic liver diseases (total 14 patients) were excluded from the analysis. RESULTS: Of 328 patients (58.5% female), aged 14-68 years (mean 38) with confirmed dengue, 169 (51.5%) had dengue fever, 147 (34.2%) dengue haemorrhagic fever (grade 1 and 2) and 47 (14.3%) dengue shock syndrome. 257 (78.4%) had elevated hepatic transaminases of whom 153 (46.6%) had minimal elevation (<3 times upper limit) and 38 (11.6%) had >1000 IU/1. Of those with elevated transaminases, 94% had AST: ALT >1. Thirteen (3.9%) with transaminases >1000 IU /I developed acute liver failure of whom 2 died. In 3 patients of whom 1 died, ischaemic liver injury (prolonged shock followed by rapid rise in ALT>AST) probably accounted for abnormal transaminases. Presence of nausea or vomiting at the time of AST/ALT>1000 was the only independent risk factor for development of acute liver failure (pO.OOl) on multivariate analysis. CONCLUSION: Abnormal liver function was common among hospitalised dengue patients. Liver failure was uncommon, and nausea or vomiting at the time of AST/ALT>1000 predicted its development.Item Comparison of methods for diagnosis of bancroftian filariasis(Sri Lanka Medical Association, 2000) Chandrasena, T.G.A.N.; Premaratna, B.A.H.R.; Abeyewickreme, W.; de Silva, N.R.OBJECTIVE: Evaluate a rapid format immuno-chromatographic card test (ICT Diagnostics, Australia) in the diagnosis of bancroftian filariasis. METHOD: Thick night blood films (TBF), Nuclepore membrane filtration (NMF) and ICT were performed on venous blood collected from 226 individuals selected from highly endemic localities in Colombo [n~153 (63%)] and Gampaha [n=73 (32.3%)] districts. Blood was collected between 20.00 and 23.00 hours. 60ul of non-heparinised blood, 1ml and lOOpl of heparinised blood were used in TBF, NMF and ICT tests respectively. A self-administered questionnaire (expert validated) was used to screen for clinical manifestations. RESULTS: The mean age of the study population was 34-8yrs (range 14-76, SD 16.78); the male: female ratio was 98: 128. NMF was positive in 66/226 (29%), with a mean microfilariae count of 343/ml (range 9-1782, SD 422). All 66 were positive by ICT (sensitivity = 100%) but only 63 by TBF (sen.sitivity=95%). 59/226 (26.1%) had one or more filariasis specific symptoms (lymphoedema, hydrocoele, lymphadenitis, lymphangitis, fever, night cough and red spots). Of the 59, 25 (42.3%) were positive by the ICT, 24 (40.6%) were positive by NMF. The other 34 were negative in both tests. Out of the 166 asymptomatics, 42 were positive in both NMF and ICT, but there were 13 more positives with ICT. CONCLUSIONS: ICT card test was more sensitive in detecting microfilaria compared to venous thick night blood film. Both ICT and NMF were positive in only in about 40% of individuals with symptoms suggestive of filariasis.Item Effects of pollution on health of residents in an industrial area in Sri lanka(Sri Lanka Medical Association, 2000) Premaratna, B.A.H.R.; Chandrasekera, K.A.B.; Dissanayake, A.S.D.; de Silva, H.J.INTRODUCTION: The effect of industrialisation on the health of people living in industrial areas of Sri Lanka is not known. METHOD: A cross sectional comparative prevalence study was done in two randomly selected populations [population 1: from Ekala industrial zone (I), and 2; from nonindustrialised suburban area (Controls)] using Illnesses related interview (using a pre-tested questionnaire), clinical examination and peak expiratory flow rate measurement. RESULTS: Population: Age 1-12y; I: n=81 (male: female=36:45), C: n=73 (male:female = 32:41); Age >12y; I: n=158 (male:female = 51:107), C: n=146 (male:female=58:88). There was no difference in demographic characteristics between the two populations. In the l-12y age group; prevalence of cough I: 15/81 (191%) and C: 5/73 (7%) [OR: 3.09 (Cl; 0.98 -10.3), p= 0.05] and rhinitis I: 18/81 (22%) and C: 5/73 (7%) [OR: 3.09 (CI; 0.9840.3) p=0.01). In the >12y group; unexplained cough L 22/158 (14%) and C: 8/146 (5.4%) [OR: 2.79 (CI; 1.13-7.09), p=0.02], unexplained headache I: 60/158 (38%) and C: 33/146 (23%) [OR 2.1(CI; 1.23-3.58), P-0.003], rhinitis L 20/158 (13%) and C: 9/14 (6.2%) [OR: 2.21 (CI; 0,91-5.44) p=0.08], PEF; females (<4201/min) I: 43/91 (47%) and C: 22/8] (27%) [OR: 2.4 (CI; 1,21-4-8) p= 0.006] and males (<4701/min) I: 16/32 (50%) and C: 8/40 (20%) [OR: 4 (CI; 1,26-12.9) p=0.01). There were no significant differences in frequency of medical consultations, miscarriages, birth defects, wheezing, and skin conditions. CONCLUSIONS: Both children and adults living in the industrial zone seem to be more at risk of respiratory disorders other than bronchial asthma. The occurrence of unexplained headache is a new finding, which needs further evaluation.