Senanayake N.P.,General Sir John Kotelawala Defence University |
Chandrasiri N.S.,Colombo South Teaching Hospital
Sri Lanka Journalof Child Health | Year: 2015
Introduction: Urinary tract infections (UTIs) are an important cause of morbidity and mortality in children. Objective: To determine the common bacterial pathogens causing UTI in children less than 12 years old and their antimicrobial susceptibility patterns at the Colombo South Teaching Hospital, Sri Lanka. Method: A prospective study was done by analyzing records of urine samples received at the Department of Microbiology, Colombo South Teaching Hospital, from 1st May 2011 to 30th April 2012. Urine samples were inoculated on Cystine Lactose Electrolyte Deficient agar, according to standard operating procedures. The isolates were initially identified by Gram staining and colony characteristics. Gram positive organisms were further identified by catalase, coagulase and bile-aesculin tests. Lactose fermentation or non-lactose fermentation (NLF) of Gram negative organisms was recorded. The NLF isolates were further identified by oxidase, urease and Kleigler Iron Agar tests. Antibiotic susceptibility tests were carried out using the Stokes method. Results: A total of 2620 urine samples was analyzed. Of the 426 (16.3%) pure growths, Gram negative isolates of bacteriuria (>105 colony forming units/ml of urine) and Gram positive isolates of bacteriuria (>104 colony forming units/ml of urine) were found in 264 (62%) and 56 (13.1%) patients respectively. The female: male ratio of the total positive samples was 2.1:1. LF and NLF Coliforms (excluding Proteus, Providencia, and Morganella spp.) were isolated in 142 (33.3%) and 68 (16%) samples respectively. Proteus spp. were isolated in 43 (10.1%) samples 38 (88.4%) of which were identified in males. The sensitivity of LF Coliforms to nitrofurantoin, cephalexin and ampicillin was 83.9%, 57.4% and 11.3% respectively. The sensitivity of NLF Coliforms to nitrofurantoin, cephalexin and ampicillin was 85.3%, 36.8% and 7.4% respectively. Conclusions: Enterobacteriaceae were the predominant pathogens causing UTI in our population and showed high resistance against ampicillin and cephalexin. Proteus infections were predominant in males.
Gurugama P.,Colombo South Teaching Hospital |
Garg P.,Childrens Hospital at Westmead |
Perera J.,University of Colombo |
Wijewickrama A.,Infectious Diseases Hospital |
Seneviratne S.,St. Mary's College
Indian Journal of Dermatology | Year: 2010
Dengue viral infections are one of the most important mosquito-borne diseases in the world. Presently dengue is endemic in 112 countries in the world. It has been estimated that almost 100 million cases of dengue fever and half a million cases of dengue hemorrhagic fever (DHF) occur worldwide. An increasing proportion of DHF is in children less than 15 years of age, especially in South East and South Asia. The unique structure of the dengue virus and the pathophysiologic responses of the host, different serotypes, and favorable conditions for vector breeding have led to the virulence and spread of the infections. The manifestations of dengue infections are protean from being asymptomatic to undifferentiated fever, severe dengue infections, and unusual complications. Early recognition and prompt initiation of appropriate supportive treatment are often delayed resulting in unnecessarily high morbidity and mortality. Attempts are underway for the development of a vaccine for preventing the burden of this neglected disease. This review outlines the epidemiology, clinical features, pathophysiologic mechanisms, management, and control of dengue infections.
Yudhishdran J.,National Hospital of Sri Lanka |
Navinan R.,National Hospital of Sri Lanka |
Ratnatilaka A.,National Hospital of Sri Lanka |
Jeyalakshmy S.,Colombo South Teaching Hospital
BMC Research Notes | Year: 2014
Background: Dengue fever is a common mosquito borne viral fever in South Asia, which causes significant morbidity and mortality. Dengue fever is well known to involve the liver, especially in dengue hemorrhagic fever. The hepatic involvement is usually that of a mild hepatitis with transaminase derangement without jaundice. In cases of dengue hemorrhagic fever where shock has ensued, a severe hepatitis with gross derangements of transaminases and bilirubin may occur. These are two rare cases of adult patients with dengue hemorrhagic fever presenting with a cholestatic type of jaundice. Case presentation. This case report describes two female patients aged 30 and 46 years who presented with fever, icterus and biochemical analysis revealed cholestatic jaundice. Evolution of the clinical picture and dropping platelets prompted serological investigations in the form of dengue non-structural protein 1 antigen and dengue immunoglobulin M which confirmed acute dengue infection. Conclusion: These cases highlight the importance of considering dengue fever as a differential diagnosis even in the presence of a cholestatic jaundice, especially in countries where dengue fever is endemic, and in travelers returning from dengue endemic countries. The early diagnosis of dengue fever and timely institution of supportive fluid management is essential to prevent morbidity and mortality. © 2014 Yudhishdran et al.; licensee BioMed Central Ltd.
Jayasundara J.A.S.B.,National Hospital of Sri Lanka |
Jayasundara J.A.S.B.,Colombo South Teaching Hospital |
de Silva W.M.M.,Colombo South Teaching Hospital
Annals of the Royal College of Surgeons of England | Year: 2013
Traditionally, all cholecystectomy specimens resected for symptomatic cholelithiasis were sent for histological evaluation. The objectives of such evaluation are to confirm the clinicoradiological diagnosis, identification of unsuspected findings including incidental gallbladder malignancy, audit and research purposes, and quality control issues. Currently, there is a developing trend to consider selective histological evaluation of surgical specimens removed for clinically benign disease. This article discusses the need for routine or selective histopathological evaluation of gallbladder specimens following cholecystectomy. Although several retrospective studies have suggested selective histological evaluation of cholecystectomy specimens performed for symptomatic cholelithiasis, the evidence is not adequate at present to recommend selective histological evaluation globally. However, it may be appropriate to consider selective histological evaluation on a regional basis in areas of extremely low incidence of gallbladder cancer only after unanimous agreement between the governing bodies of surgical and histopathological expertise.
Marasinghe J.P.,Colombo South Teaching Hospital
The journal of obstetrics and gynaecology research | Year: 2011
A 29-year-old pregnant woman presented with fever, right hypochondrial pain and fatigability at 29 weeks of gestation. Dengue hemorrhagic fever was diagnosed based on clinical, hematological and serological features. However, ultrasound scanning was suggestive of acute acalculous cholecystitis. The patient was managed symptomatically and made a good recovery 8 days following onset of fever. This is the first case of acute acalculous cholecystitis coinciding with dengue hemorrhagic fever reported during pregnancy from an endemic country in Asia. The possible viral and host factors for the development of such a severe form of disease and preventive measures are discussed. © 2011 The Authors. Journal of Obstetrics and Gynaecology Research © 2011 Japan Society of Obstetrics and Gynecology.
Marasinghe J.P.,Colombo South Teaching Hospital |
Condous G.,University of Sydney |
Seneviratne H.R.,University of Colombo |
Seneviratne H.R.,De Soysa Hospital for Women |
Marasinghe U.,Colombo South Teaching Hospital
Acta Obstetricia et Gynecologica Scandinavica | Year: 2011
A prospective observational study was performed to evaluate the performance of a modified uterine compression suturing technique for the management of refractory post partum hemorrhage (PPH) at two leading tertiary referral centers in Colombo, Sri Lanka. An modified anchored B-Lynch suture was done in 17 women with PPH due to uterine atony. In 13 of the women (76%), bleeding was arrested and the uterus conserved. Four women (24%) did not respond to the anchored compression sutures, necessitating emergency post partum hysterectomy. Mean age was 31.2 years. Nine of the women (53%) were primiparous and eight (47%) parous. Mean estimated blood loss was 1994 ml (range 1200-3300 ml). This newly modified anchor B-Lynch compression suture appeared effective in controlling about 75% of PPH due to uterine atony, which allowed uterine conservation. This simple modification can provide a first line surgical step to control PPH. © 2011 The Authorsa Acta Obstetricia et Gynecologica Scandinavica © 2011 Nordic Federation of Societies of Obstetrics and Gynecology.
Wijewickrama E.S.,University of Colombo |
Ratnayake G.M.,Colombo South Teaching Hospital |
Wikramaratne C.,National Hospital |
Sheriff R.,University of Colombo |
Rajapakse S.,University of Colombo
BMC Research Notes | Year: 2014
Background: Acute kidney injury (AKI) is a common and a serious complication among patients admitted to intensive care units (ICUs), and has been the focus of many studies leading to recent advances in diagnosis and classification. The incidence and outcome of AKI in Sri Lankan ICUs is largely unknown. The aim of this study was to describe the incidence, severity and outcome of AKI among patients admitted to the medical ICU, National Hospital, Colombo, Sri Lanka (NHSL). Methods. Patients admitted to the medical ICU, NHSL, over a period of 6 months were studied prospectively.Standard demographic, physiological and clinical data were collected. Severity of illness was assessed using SOFA (Sequential Organ Failure Assessment) score. Diagnosis of AKI was based on Acute Kidney Injury Network (AKIN) criteria. Results: Of 212 patients screened, 108 satisfied the inclusion criteria; males 67(61.5%); mean age 47.8 years(SD 19.4, range 12-94). Mean duration of ICU stay was 11.6 days (SD 10.6, range 2-55). Eighty one (75.0%) received mechanical ventilation. Forty nine (45.4%) had sepsis. ICU mortality was 38.9% and AKI was present in 60.2%. The majority of AKI patients (38, 58.5%) had AKI stage 3. Patients with AKI were at higher risk of death (p < 0.01). Neither age, gender, nor the presence of co-morbidities were associated with increased risk of AKI. Patients with AKI had significantly longer ICU stay (Log-Rank Chi Square: 23.186, p < 0.0001). Both the incidence of AKI and ICU mortality were higher in patients with SOFA scores over 9 (Pearson Chi-Square 7.581, p = 0.006, and 11.288, p = 0.001 respectively). Conclusions: The incidence of AKI is high at 60% among our ICU patients, and those with AKI had higher mortality and longer duration of ICU stay. Age, gender or the presence of co-morbidities was not associated with a higher risk of AKI. Patients with SOFA scores over 9 within the first 24 hours were more likely to develop AKI and had higher risk of death. © 2014 Wijewickrama et al.; licensee BioMed Central Ltd.
Abeysekera W.Y.M.,Colombo South Teaching Hospital |
De Silva W.D.D.,Colombo South Teaching Hospital |
Pinnaduwa S.S.,Colombo South Teaching Hospital |
Banagala A.S.K.,Colombo South Teaching Hospital
High Altitude Medicine and Biology | Year: 2012
Abeysekera, W.Y.M., W.D.D. de Silva, S.S. Pinnaduwa, and A.S.K. Banagala. Acute Massive Splenic Infarction with Splenic Vein Thrombosis Following Altitude Exposure of a Sri Lankan Male with Undetected Sickle Cell Trait. High Alt Med Biol 13:288-290, 2012. - Even though sickle cell disease is not common in Sri Lanka, we report an acute splenic infarction at high altitude of a Sri Lankan male with previously undetected sickle cell trait (SCT). This is the first time such a case is reported from the South Asian region. Early recognition of this hematological condition would simplify the management of acute splenic infarction in these patients, avoiding irreversible surgery. © Copyright 2012, Mary Ann Liebert, Inc. 2012.
Habaragamuwa B.W.P.,Colombo South Teaching Hospital |
Piyasiri G.,Colombo South Teaching Hospital
Sri Lankan Journal of Anaesthesiology | Year: 2011
Background The purpose of this retrospective case review was to identify different patterns of clinical presentation of severe leptospirosis, and to find out any correlation between organ specific complication/s and outcome of the patients. Method Leptospirosis patients who were admitted to the intensive care unit (ICU) at the Colombo South Teaching Hospital during August to September 2008 were included. Organ specific involvement in six organs (heart, lung, kidney, liver, vascular, brain and spinal cord) was recorded. One score was given to each organ involvement. Score was recorded on admission and during ICU stay. Outcome of the patient was recorded as either discharged or died in the ICU. Results Renal, hepatic and haematological involvement was found in all patients. 13(65%) patients died and 7(35%) patients were discharged to the ward. All patients with four organ involvement were survived. All patients with six organ involvement died in the intensive care unit. 8(80%) patients died and 3(20%) patients survived among patients with five organ involvement. Four or more organs were affected on admission to ICU in patients who died and only three organs were affected in discharged patients. Conclusion Outcome of severe leptospirosis was not determined by the involvement of renal, hepatic and haematological systems. Five or more organ involvement was associated with increased mortality. Combination of cardiac and respiratory system involvement or involvement of central nervous system was associated with bad outcome. Seeking critical care management at three organ involvement stage would improve the outcome of the patients.
Sinhabahu V.P.,Colombo South Teaching Hospital |
Sathananthan R.,Colombo South Teaching Hospital |
Malavige G.N.,University of Sri Jayawardanapura
BMC Research Notes | Year: 2014
Background: Dengue in pregnancy is associated with many maternal and foetal outcomes including perinatal transmission of dengue infection. Case Presentation: A baby was born by emergency caesarean section due to foetal distress and meconium stained liquor, to a 27-year old primi-gravidae, Sinhalese female, who was febrile during and 2 days prior to labour. The baby had evidence of respiratory distress due to meconium aspiration and was cared for in the special care baby unit for 3 days. On the 4th day he developed fever and serial blood counts showed a gradual rise in the haematocrit (>20% of baseline value) and lowering of platelet counts. The baby was treated for sepsis and as Sri Lanka was experiencing a massive dengue epidemic was also tested for dengue. His dengue NS1 antigen test was strongly positive and the dengue IgM antibodies weakly positive on day 3 of illness. The mother was positive for both dengue IgM and IgG antibodies. Conclusion: Although rare, vertical transmission of the dengue virus has been reported and the baby most likely developed dengue due to perinatal transmission of dengue.