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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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 Knowledge about acute coronary syndrome of patients admitted to National Hospital of Sri Lanka(Sri Lanka Medical Association, 2010) Ariyarathne, A.M.N.; Abeysena, C.; Liyanage, D.L.D.C.OBJECTIVES: To describe knowledge about ACS, secondary prevention of ACS and selected risk factors and sources of knowledge of patients with ACS, admitted to NHSL. METHODS: This was a hospital based descriptive cross sectional study carried out in two settings at NFISL, cardiology unit and medical wards during September to October 2009. A sample consisting of 345 patients were recruited in to the study, who were diagnosed as ACS. Data was collected by using a self administered questionnaire and it was used to collect data about knowledge on ACS, secondary preventive measures, smoking, alcohol and life style change. There were 17.6% (n=61) non respondents for the self administered questionnaire. RESULTS: Knowledge about ACS was good among 32.7% (n=93) study subjects. Good knowledge on smoking, alcohol and lifestyle change was 61.3% (n=174), 53.6% (n=155) and 60.9% (n=173), respectively. Patients treated at cardiology unit had statistically significant good knowledge about ACS, compared to medical wards. Total knowledge score in relation to the age, education level of the study subjects was statistically significant (p<0.05). Many of the patients gathered their knowledge from medical officers who were working at NHSL and TV/Radio and printed media were also good sources of knowledge. CONCLUSIONS: Patients' knowledge about acute coronary syndrome, secondary prevention of acute coronary syndrome and selected risk factors were poor. Medical officers working at NHSL were a good source of knowledge.Item Gender based differences in acute coronary syndrome(Sri Lanka Medical Association, 2011) Danansuriya, D.S.T.; Alexander, M.A.F.; Harshanie, R.L.P.; Gammulla, S.P.K.H.M.A.T.; Pemarwansa, G.; Thirumavalan, K.; Samarakoon, S.M.S.B.; de Silva, A.P.; de Silva, S.T.; Ranawaka, U.K.INTRODUCTION AND OBJECTIVES: To describe gender based differences in demographics, risk factors, management and early outcome in Sri Lankan patients with acute coronary syndromes (ACS). Methods: All adults admitted with ACS to medical units of Colombo North Teaching Hospital are enrolled in a prospective Registry. We studied data obtained from patients admitted over a period of 11/2 years. RESULTS: 765 patients were studied (56.9% males). Females were likely to be older [mean age years (SD) - male 59.5(11.4), female 62.9(11.4), pO.OOl]. Women were more likely to have unstable angina (female -56.4%, male- 40,0%)7 while men were more likely to have ST elevated myocardial infarction (M-36.6%? 19.4%) (pO.OOl). Several risk factors were commoner in women (p<0.001): hypertension-female- 70%, male- 49.6%; diabetes - female- 49.7%, male- 35.6%; hyperlipidaemia - female-73.6%, male-56.6%; high waist circumference- female 65.8%, male-29.8%. Smoking and alcohol use were almost exclusively seen in men (75.9% and 84.6% respectively vs. 1.2% and 1.5%; /K0.001). 32.4% of women and 37.6% of men had previous IHD (p=0.079). Women were more likely to be on pre-admission antiplatelet, statin, beta blocker and ACE inhibitor therapy (/7<0.005). Five patients died. There were no differences in care given and early outcome. CONCLUSIONS: There are important gender-related differences in the pattern of ACS in Sri Lankan patients. Several modifiable cardiovascular risk factors were commoner in women, highlighting the need for targeted preventive strategies. Acknowledgements: Japan International Cooperation Agency