A Descriptive Study on Sepsis: Causes, Outcomes, and Adherence to Guidelines on Patients with Sepsis at a Tertiary Care Hospital in Sri Lanka

The global incidence of sepsis is increasing, and mortality remains high. The mortality is even higher in resource-poor countries where facilities and equipment are limited. The Surviving Sepsis Campaign (SSC) recommends an updated hour-1 bundle based on the evidence from the International Guidelines for Management of Sepsis and Septic Shock 2018. To reduce mortality from sepsis, compliance with the “bundle” is essential. Data from developing countries like Sri Lanka on the management of sepsis according to the SSC guidelines are not available. Hence, this study looks at the patient characteristics and management of septic patients at a tertiary care hospital in Sri Lanka. Patients admitted to the University Medical Unit of Colombo South Teaching Hospital from January to August 2019 fulfilling the inclusion criteria were included. The hour-1 sepsis bundle adherence, demographic data, and management were recorded. There were 387 patients: 163 males and 224 females. The age range was 15-95 with a mean age of 63. 83.7% were direct admissions while 16.3% were transfers from a peripheral hospital. The most common source of infection was urine (82 (21.2%)) followed by blood stream (105 (27.1%)) and skin and soft tissue (114 (29.5%)). One-hour SSC bundle compliance is as follows: administration of intravenous fluids: 42 (10.9%), blood cultures before antibiotics: 225 (58.1%), first dose antibiotic: 15 (3.9%), and arterial blood gas: 60 (15.5%). Staffing capacity did not make a difference to adherence to the bundle. The study mortality rate was 37 (9.6%). Binary logistic regression indicates that quick sequential organ failure assessment (qSOFA) score is a significant predictor of mortality (chi‐square=35.08, df=3, and p=0.001 (<0.05)) with an odds ratio (OR) of 7.529 (95% CI 3.597-14.323). The other predictors, age, sex, adherence to sepsis care bundle, and comorbidities, were not significant. In conclusion, mortality of sepsis is high and adherence to sepsis care bundle is poor in Sri Lanka even at a tertiary care hospital. Education and training of staff are needed to boost adherence. This will in turn improve quality of care and outcomes of septic patients in resource-poor countries.

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The High Burden of In-Hospital Diabetes Mellitus at A Tertiary Care Hospital in Sri Lanka; A Case Control Study

Journal of Diabetes & Metabolism ◽

10.4172/2155-6156.1000502 ◽

2015 ◽

Vol 06 (03) ◽

Author(s):

Arjuna B Medagama

Keyword(s):

Diabetes Mellitus ◽

Sri Lanka ◽

Case Control Study ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Case Control ◽

Care Hospital ◽

High Burden ◽

Control Study

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Teleradiological implementation as a decision support system at an accident service unit in a tertiary care hospital in Sri Lanka

Sri Lanka Journal of Bio-Medical Informatics ◽

10.4038/sljbmi.v10i3.8082 ◽

2019 ◽

Vol 10 (3) ◽

pp. 18

Author(s):

D. H. Jayakody ◽

R. B. Marasinghe

Keyword(s):

Decision Support ◽

Sri Lanka ◽

Decision Support System ◽

Support System ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Service Unit

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Endoscopic evaluation of patients with dyspepsia in a tertiary care hospital in Sri Lanka

Sri Lanka Journal of Surgery ◽

10.4038/sljs.v33i4.8201 ◽

2016 ◽

Vol 33 (4) ◽

pp. 23

Author(s):

R. T. Gamage ◽

J. R. Wijesekera ◽

A. L. A. M. C. Ambegoda ◽

D. T. Wijesinghe ◽

K. I. Panditharathne

Keyword(s):

Sri Lanka ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Endoscopic Evaluation

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Prevalence and associations of psychoactive substance use among male supportive staff members in a tertiary care hospital of Sri Lanka

BJPsych Open ◽

10.1192/bjo.2021.778 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S293-S293

Author(s):

Chathurie Suraweera ◽

Iresha Perera ◽

Priyanka Rupasinghe ◽

Janith Galhenage

Keyword(s):

Substance Use ◽

Sri Lanka ◽

Alcohol Use ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Psychoactive Substance ◽

Staff Members ◽

History Of ◽

Psychoactive Substance Use

AimsThe study describes the prevalence and associated socio-demographic variables of psychoactive substance use among male supportive staff members at a tertiary care hospital in Sri Lanka.MethodA cross-sectional descriptive study was carried out among male supportive staff members of a tertiary care hospital in Colombo District, Sri Lanka by using a self-administered anonymous questionnaire. Participants were recruited using stratified cluster sampling in thirteen overseer divisions of the hospital. Anonymous questionnaires were collected into a sealed box and analysed using Statistical Package for Social Sciences 20.ResultThe mean age of the 404 male staff members who participated in the study was 38.78(SD = 10.90) years and 71.5% were married. Among them 202 (49.1%) were educated up to grade 6-11 and 30 of them has had encounters with law in the past. Thirty of participants had history of psychoactive substance use in the family. Alcohol was used more than once a month by 127(30.9%) and more than once a week by 19(4.6%) individuals. Among other substances, tobacco, beetle and beedi were used by 104(25.3%), 78(19.0%) and 18(4.4%) respectively at least once a month. Further, 22(5.3%), 20(4.8%), 7(1.7%) and 7(1.7%) participants used Mava, Cannabis, Methamphetamine and Thool respectively at least less than once a month. Heroin, Tramadol and Morphine were used by two individuals at least less than once a month. Among substance using participants, 132 wished to cut down their habit. Most commonly identified (14.1%) adverse consequence was financial issues secondary to psychoactive substance use. Eleven (4.5%) staff members used the substance at hospital. Alcohol use was associated with age more than 35 years (p = 0.039) and history of forensic involvement (p = 0.038). Tobacco(p = 0.000), beetle (p = 0.056), Cannabis (p = 0.000) and mava (p = 0.015) use were significantly associated with positive forensic history. Supportive staff members’ alcohol and cannabis use was associated with tobacco (p = 0.000, p = 0.000) and beetle use (p = 0.001, p = 0.049). Mava use was associated with alcohol (p = 0.060) use in addition to tobacco (p = 0.020) and beetle use (p = 0.008).Binomial logistic regression revealed alcohol use and beetle use were associated with the number of children in family and above associations.ConclusionCommonest psychoactive substance consumed by supportive staff members were alcohol, tobacco, beetle, Cannabis and Mava in descending order of frequency. Forensic history was significantly associated with substance use. True prevalence of substance use can be higher than these values.

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A study of Acute Liver Failure in adults in a tertiary care hospital

The Journal of Medical Research ◽

10.31254/jmr.2019.5601 ◽

2019 ◽

Vol 5 (6) ◽

pp. 204-207

Author(s):

Dr. Mohini Singh ◽

◽

Dr. Srilakshmi Sathiyaseelan ◽

Devarasetty Shashank ◽

Dr. S.R. Ramakrishnan ◽

...

Keyword(s):

Liver Function ◽

Liver Failure ◽

Acute Liver Failure ◽

Viral Hepatitis ◽

Tertiary Care Hospital ◽

Early Recognition ◽

Tertiary Care ◽

Care Hospital ◽

Arterial Blood ◽

Function Test

Acute liver failure (ALF) is a condition with rapid deterioration of liver function resulting in hepatic encephalopathy and/or coagulopathy in patients with previously normal liver. Acute liver failure (ALF) is an uncommon condition associated with high morbidity and mortality. The prognosis is poor for untreated cases of Acute liver failure, so early recognition and management of patients with acute liver failure is crucial. A cause for acute liver failure can be identified in 60 to 80 percent of patients. Identifying the underlying cause of the liver failure is important because it influences the approach to management and provides prognostic information. Aims and Objectives: The aim of our study is to identify the clinical features, etiology and outcome of acute liver failure in a tertiary care hospital. Materials and Methods: This study is an observational study where patients with Acute Liver Failure admitted in ICU in our institution after meeting the diagnostic criteria for Acute liver failure were included in the study. Details of history, relevant symptoms and baseline investigations included, complete blood count, blood glucose, renal function test, serum electrolytes, liver function test (LFT), prothrombin time, international normalized ratio (INR), lactate dehydrogenase (LDH), creatine kinase (CK)], arterial blood gas analysis, arterial lactate, arterial ammonia, amylase and lipase level and pregnancy test (if female) and ultrasonography (USG) abdomen were recorded, MRI brain and other investigations relevant to the admission diagnosis, co morbidities and aetiology if needed were recorded. All the patients received standard supportive treatment for ALF. Results: In this study of 57 patients, majority of the patients were from the age group 41 to 50 years (17 patients) and 31 to 40 years (13 patients). 36 patients were male and 21 patients were females. Jaundice and encephalopathy was observed in all 57 (100%) patients, 24 (42%) patients had INR >2.5, 27 (47%) patients had serum creatinine >1.2 mg/dl and 18 (31.5%) patients had serum ammonia levels >100 micromol/L. The lowest value for serum aminotranferase was observed in infections (other than viral hepatitis) and maximum value was observed in drugs leading to ALF.In 20 (35%) patients viral hepatitis was the cause for ALD, followed by drugs and toxins which was the cause of ALD in 18 (31.5%) patients. Infections other viral hepatitis as the aetiology for ALF was observed in 16 (28%) of patients. Ischemic hepatitis was observed in 1 and Wilson’s disease was noted in 2 patients. Total 6 (10.5%) patients out of 57 patients had died, 4 patients with hepatitis B infection, 1 patient with paracetamol over dosage and 1 patient with dengue fever had died. Conclusion: Viral hepatitis and drugs are the commonest cause for acute liver failure. The aetiology of ALF varies significantly worldwide. Determining the etiology of acute liver failure requires a combination of detailed history taking and investigations. A broad evaluation is required to identify a cause of the acute liver failure, as the prognosis is poor in untreated cases of acute liver failure, so early recognition and management of patients with acute liver failure is crucial.

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