Browsing by Author "Amarasena, P."

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Differential expression of microRNA, miR-150 and Enhancer of Zeste Homolog 2 (EZH2) in peripheral blood cells as early prognostic markers of severe forms of dengue
(Karger Medical and Scientific Publishers., 2020) Hapugaswatta, H.; Amarasena, P.; Premaratna, R.; Seneviratne, K.N.; Jayathilaka, N.
BACKGROUND: Dengue presents a wide clinical spectrum. Most patients recover following a self-limiting non-severe clinical course. A small proportion of patient’s progress to severe disease, mostly characterized by plasma leakage with or without hemorrhage. Early symptoms of severe dengue (SD) are similar to those of non-severe dengue fever (DF). Severe symptoms manifest after 3-5 days of fever, which can be life threatening due to lack of proper medications and inability to distinguish severe cases during the early stages. Early prediction of SD in patients with no warning signs who may later develop severe infection is very important for proper disease management to alleviate related complications and mortality. microRNA are small non-coding RNA molecules that regulate post-transcriptional gene expression. Due to the remarkable stability and the role of microRNA in gene expression, altered expression of microRNA was evaluated to explore clinically relevant prognostic markers of severe dengue. METHODS: The relative expression of microRNA hsa-let-7e (let-7e), hsa-miR-30b-5p (miR-30b), hsa-miR-30e-3p (miR-30e), hsa-miR-33a (miR-33a), and hsa-miR-150-5p (miR-150) and several putative target genes in peripheral blood cells (PBC) collected from 20 DF and 20 SD positive patients within 4 days from fever onset was evaluated by quantitative reverse transcription PCR (qRT-PCR). RESULTS: miR-150 showed significant (P < 0.01) up regulation in PBC of SD patients compared to DF patients during the acute phase of infection. Expression of enhancer of zeste homolog 2 (EZH2) was significantly (P < 0.01) down regulated indicating that genes involved in epigenetic regulation are also deferentially expressed in SD patients during the early stage of infection. CONCLUSIONS: Differential expression of microRNA miR-150 and the putative target gene EZH2 may serve as reliable biomarkers of disease severity during early stages of dengue infection. KEYWORDS: Acute dengue biomarkers; Dengue; Severe dengue; microRNA.
Familial thrombocytopaenia in three male siblings
(Sri Lanka Medical Association, 2017) Amarasena, P.; Premawardhena, A.P.; Herath, H.R.B.M.; Seneviratne, S.L.
INTRODUCTION & OBJECTIVES: Familial thrombocytopaenia is uncommon. Specific molecular defects have been identified in some families. We describe three male siblings with thrombocytopaenia and other immune related findings. The parents are healthy and non-related. METHODS: Clinical and investigative findings were obtained from the brothers and their parents. RESULTS: Case 1: A 15 year old male presented with spontaneous ecchymotic patches and oral mucosal bleeding. Platelet count was 1000/mm3, mild hepatomegaly was present on ultrasonography and IgA was raised. As the response to IV methyl-prednisolone was poor, IVIG, prednisolone and azathioprine were used. He has had recurrent RT infections and as his latest platelet counts are suboptimal, Rituximab is being considered. Case 2: A 19 year old male was found to have thrombocytopaenia whilst being investigated for a large scalp haematoma aged 2 years. He had been treated with oral prednisolone and needed pulse IV dexamethasone. Presently he is off steroids and the platelet count is 54000/mm3. Serum IgM is reduced and IgA is raised. He has chronic bilateral lower limb eczema, an atrio-fascicular accessory pathway and gets recurrent RT infections. Case 3: A 12 year old male had fever, cervical lymphadenopathy and hepatosplenomegaly aged 3 years. He then developed AIHA and thrombocytopaenia. The thrombocytopaenia persisted and was treated with prednisolone and cyclosporine. Aged 9 years, he developed SLE and a year later, class IV lupus nephritis was found on renal biopsy. CONCLUSION: An AR or XR genetic cause is likely in this family. The identification of the exact molecular defect may help with selecting appropriate medications to target abnormal immune pathways.
Pseudo polycythaemia and its association with cardio-metabolic risk factors: A preliminary descriptive analysis from a tertiary care hospital
(Sri Lanka Medical Association, 2018) de Silva, S.T.; Amarasena, P.; Dias, M.A.D.H.; Lakmini, K.M.S.; Premathilaka, L.H.R.A.; Ranatunga, R.J.K.L.D.; Moratuwegama, H.M.D.; Siriwardana, S.R.; Niriella, M.A.; Premawardhena, A.P.
INTRODUCTION AND OBJECTIVES: Polycythaemia is the result of either an actual increase in red cell mass (true) or relative reduction in plasma volume (spurious). Spurious or pseudo-polycythaemia (PP) is a poorly-researched entity with unexplained increase in mortality noted in previous studies. We aimed to characterize PP and determine an association between PP and metabolic syndrome (MS) in a Sri Lankan clinic-based population. METHODS: Consecutive, consenting adults > 18 years, with two consecutive haemoglobin levels> l 6.5mg/dL and > 16mg/dL and/or PCV >49% and >48% in men and women respectively, with non-tourniquet samples taken few days apart in a well-hydrated state, were recruited from clinics of University Medical Unit, Colombo North Teaching Hospital and from the private sector. Interviewer-administered questionnaire was used to gather data.RESULTS: 46 participants were recruited: 3 (6.5%) had primary polycythemia, 5 (10.9%) had secondary polycythemia due to identifiable causes. 38 (82.6%) patients had PP [mean age 42.2 (SD=l5.2) years and 36 (94.7%) were males]. Of these 14 (36.8%) had diabetes, 22 (57.9%) had hypertension, 25 (65.8%) had hyperlipidemia and 25 (65.8%) were obese. 19 (50%) had fatty liver, 23 (60.5%) were light smokers, 8 (21.1%) consumed alcohol beyond safe limits, 6 (15.8%) had increased neck circumference, 1 (2.6%) had ischemic heart disease, 2 (5.3%) had chronic kidney disease and 2 (5.3%) had hyperuricaemia. Comparison of PP and secondary polycythemia with regard to prevalent components of MS was not possible due to small numbers.CONCLUSION: Components of MS were prevalent among those with PP. The significance of this finding remains unexplained. This needs to be replicated in a larger sample to establish whether these are independent risk factors for the development of PP.
Sporadic cases of adult measles: a research article
(BioMed Central, 2017) Premaratna, R.; Luke, N.; Perera, H.; Gunathilake, M.; Amarasena, P.; Chandrasena, T.G.A.N.
BACKGROUND: Measles caused by a paramyxovirus, characterized by fever, malaise, cough, coryza conjunctivitis, a maculopapular rash is known to result in pneumonia, encephalitis and death. Fatal cases of measles in Sri Lanka are rare after implementation of the National Immunization Programme in 1984. Thereafter 0.1% case fatality rate was observed during October 1999-June 2000 which is a very low figure compared to other regional countries. Immunization guidelines were further revised in 2001, 2011 and in 2012 when additional immunization was recommended to age group 4-21 years; who are likely to have inadequate immunization, in order to achieve elimination of Measles by 2020. However, in 2013-2014, 4690 cases were reported and the majority were children less than 1 year of age. The occurrence in adults is hard to retrieve in published epidemiological reports, however had been 38% (out of 1008 patients) in the 3rd quarter of 2013. During this outbreak 73/101 (72%) reported from the North Central Province of Sri Lanka had been more than 12 years of age with 50% being more than 29 years. 14 Sri lankan adult patients [median age 32 years (range 25-48)] who presented sporadically from June 2014 to March 2016, with confirmed measles infection were enrolled retrospectively after informed consent. Details with regards to their clinical presentation, immunization and other relevant areas were collected using an interviewer administered questionnaire or using patient management records. RESULTS: The patients presented with high fever, headache, severe body aches, sore throat, dry cough, intense tearing, red eyes and posterior cervical lymphadenopathy over 3-5 days duration. Later they developed discrete maculopapular rash helping the diagnosis. They had a variable degree of leucopenia, lymphocytosis, thrombocytopenia and derangements in the liver functions mimicking any other acute febrile illnesses such as dengue, chikungunya, leptospirosis or Zika virus infection. CONCLUSION: At least a 3-5 day delay in the diagnosis was observed (even after the appearance of the rash in some patients), due to non-awareness of its occurrence, unfamiliarity of measles in adults, non-specific nature of the illness and non-availability of rapid diagnostics, risking transmission to the immune-compromised or non-immune staff or patients. Identification of the source of infection in these sporadic adult cases and their virologic surveillance and molecular epidemiology will be important to interrupt the transmission and to achieve the targeted elimination of measles from Sri Lanka by 2020.