Browsing by Author "Darshana, L.G.T."

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A descriptive study of anaemia in the elderly at a tertiary care institute in Sri Lanka
(The Sri Lanka Medical Association, 2022) Chathurangani, K.C.; Darshana, L.G.T.; Premathil, R.A.; Costa, Y.J.; Amarasekara, A.A.D.S.; Premawardhena, A.P.
INTRODUCTION: Anaemia is a commonly encountered condition among the elderly population which calls for further evaluation to identify the cause and to prevent complications.OBJECTIVES: To determine the prevalence, causes and complications related to anaemia among elderly patients admitted to two medical wards (15/16) of Colombo North (Teaching) Hospital, Ragama, Sri Lanka.METHODS: Patients aged over>65 years admitted to the above wards between April –Sep 2020 and who had anaemia were included in the study. Clinical and nutritional data were collected using an interviewer-administered questionnaire. Laboratory findings were extracted from hospital records.RESULTS: The majority of the patients were females (63.2%; n = 129). The mean age was 72.5 years (65 – 92 years). Most of the patients (62.3%; n = 127) were symptomatic for anaemia at the time of hospital admission. The majority of the participants (75.5%; n = 154) did not demonstrate any complications related to anaemia. The severity of the anaemia was moderate among more than half of the patients (52.5%; n=107). Anaemia of chronic disease (54.4%; n=111) was the commonest etiological category detected. The majority of the cases with anaemia of chronic disease were due to chronic renal insufficiency (73.9%; n=82). The severity of the anaemia increased significantly with the presence of chronic disease (p 0.030).CONCLUSION: Most patients in the present study had moderate anaemia whilst anaemia of chronic disease was the leading aetiological class contributor. Community-based studies are needed to understand the true burden of anaemia in the ageing population in Sri Lanka.
THE GENETIC ORIGIN (S) AND THE DISTRIBUTION OF THE SICKLE CELL GENE AND THE CLINICAL DESCRIPTION OF THE SICKLE CELL DISEASE IN SRI LANKA
(2020) Darshana, L.G.T.
Case reports and limited case series of Sickle cell disease (SCD) in Sri Lanka have been reported since 1962. Yet, no attempt has been made up till now to undertake a comprehensive genotypic-phenotypic analysis of this “rare” group of patients in Sri Lanka. The national thalassaemia prevention programme in Sri Lanka is currently using Full Blood Count with (FBC) red cell indices as the technique for haemoglobionopathy screening. This approach is likely to miss sickle haemoglobin (Hb S) carriers. Present study intends to describe the clinical picture of SCD in Sri Lanka, analyze its molecular basis, including the effects of genetic modifiers on the phenotype and describe the screening utility of sickling test in identifying sickle carriers among a relatively high-risk population in Hambantota district of Sri Lanka. All accessible sickle patients, totaling 60, including, 51 Sickle β-thalassaemia (SBT) and 9 homozygous sickle patients (Hb SS) were enrolled from seven thalassaemia treatment centres. All the patients were clinically evaluated and details were recorded. -globin haplotypes,  - thalassaemia mutations, common α+ thalassaemia gene deletions and 5 known Fetal haemoglobin (Hb F) modifiers (rs6545816, rs1427407, rs66650371, rs9402686, rs7482144) were assessed. Geographically, two prominent patient clusters were identified and the distribution of Hb S in the island contrasted with that of the other haemoglobinopathies. 3/ 9 Hb SS and 3/ 51 SBT patients were receiving regular transfusion. Joint pain was the commonest clinical presentation among all SCD patients (n=39, 65.0%). Dactylitis was significantly more common in Hb SS patients compared with the SBT group (p 0.034). Two genetic backgrounds Hb S mutation were identified and confirmed namely, Arab Indian and Benin. Among the Hb F regulators rs1427407 G>T seemed to be the most prominent modifier, with a significant association with Hb F levels (p 0.04). Sickling test demonstrated 100 % sensitivity and 100 % specificity. FBC by itself was unreliable to detect Hb S but if combined with sickling test was able to pick up Hb S in addition to most other haemoglobinopathies.
Genetic origin and clinical variability of sickle cell disease in Sri Lanka
(Sri Lanka Medical Association, 2018) Darshana, L.G.T.; Bandara, W.D.M.S.; Nawaratna, U.S.B.; Costa, Y. J.; Nizri, A.H.M.; Silva, D.P.S. l.; de Silva, T.U.N.; Pushpakumara, K.P.C.; Pathirage, S.P.; Manamperi, A.; Premawardhena, A.P.
INTRODUCTION AND OBJECTIVES: Sickle cell disease (SCD) is found at a low prevalence In Sri Lanka. A recent hospital based survey identified 60 patients in the country The clinical spectrum of SCD in Sri Lanka has not been studied and its genetic origin remains unknown.We envisaged to study the genetic origin and to carry out a clinical description ofSCD in Sri Lankan patients. METHODS: Patients were recruited from Ragama, Anuradhapura Hambantota and Kurunegala thalassaemia centres. All patients were examined and clinical details recorded. Genetic analyses were performed to identify the haplotype of HbS, Xmn I polymorphism gene deletions and mutations. RESULTS: A total of 49 SCD patients were studied Ages ranged from 5 - 47 years (mean 20.4) 91.8% of the patients were Sinhalese and the rest were Muslims. 87.7% of the patients had sickle-thalassaemia (SBT) and 6 were homozygous (HbSS) Joint pains were the commonest symptom in patients with SBT Clinical presentations in SBT varied from those with none to frequent crises Clinical management varied with only 42.86% of patients being on hydroxyurea. Most patients had not inherited disease ameliorating genetic factors with 95 9% not having gene deletions and 89 8% not having Hb F up-regulators Three Sickle haplotypes were identified including; Arab• Indian, Benin and Bantu.CONCLUSION: There appears to be at-least three genetic origins of HbS in Sri Lanka SCD is extremely clinically variable in Sri Lanka. The reason for this variation needs further study as most patients seem not to have common inherited modifiers
The genetic origin(s) and the distribution of the sickle cell gene and the clinical description of sickle cell disease in Sri Lanka
(University of Kelaniya, 2020) Darshana, L.G.T.
Case reports and limited case series of Sickle cell disease (SCD) in Sri Lanka have been reported since 1962. Yet, no attempt has been made up till now to undertake a comprehensive genotypic-phenotypic analysis of this "rare" group of patients in Sri Lanka. The national thalassaemia prevention programme in Sri Lanka is currently using Full Blood Count with (FBC) red cell indices as the technique for haemoglobionopathy screening. This approach is likely to miss sickle haemoglobin (Hb S) carriers. Present study intends to describe the clinical picture of SCD in Sri Lanka, analyze its molecular basis, including the effects of genetic modifiers on the phenotype and describe the screening utility of sickling test in identifying sickle carriers among a relatively high-risk population in Hambantota district of Sri Lanka. All accessible sickle patients, totaling 60, including, 51 Sickle p-thalassaemia (SBT) and 9 homozygous sickle patients (Hb SS) were enrolled from seven thalassaemia treatment centres. All the patients were clinically evaluated and details were recorded. P-globin haplotypes, p - thalassaemia mutations, common a+ thalassaemia gene deletions and 5 known Fetal haemoglobin (Hb F) modifiers (rs6545816, rs 1427407, rs66650371, rs9402686, rs7482144) were assessed. Geographically, two prominent patient clusters were identified and the distribution of Hb S in the island contrasted with that of the other haemoglobinopathies. 3/ 9 Hb SS and 3/ 51 SBT patients were receiving regular transfusion. Joint pain was the commonest clinical presentation among all SCD patients (n=39, 65.0%). Dactylitis was significantly more common in Hb SS patients compared with the SBT group (p 0.034). Two genetic backgrounds Hb S mutation were identified and confirmed namely, Arab Indian and Benin. Among the Hb F regulators rs 1427407 G>T seemed to be the most prominent modifier, with a significant association with Hb F levels (p 0.04). Sickling test demonstrated 100 % sensitivity and 100 % specificity. FBC by itself was unreliable to detect Hb S but if combined with sickling test was able to pick up Hb S in addition to most other haemoglobinopathies.
The Genetic Origins and Molecular Characterization of Sickle Cell Disease in Sri Lanka.
(In: Proceedings of the International Postgraduate Research Conference 2017 (IPRC – 2017), Faculty of Graduate Studies, University of Kelaniya, Sri Lanka., 2017) Darshana, L.G.T.; Manamperi, A.; Premawardhena, A.P.
Sickle cell disease (SCD) is globally the commonest monogenic disease. Although the incidence is not as common as in India, it is found in Sri Lanka too. A recent hospital based survey identified around 60 patients in the country but no detailed study of SCD have been done to-date. The genetic origin of Haemoglobin (Hb) S found in Sri Lanka is not yet known.
Retrospective analysis of Pyrexia of Unknown Origin (PUO) among adult patients in a Tertiary Care Hospital in Sri Lanka
(Sri Lanka Medical Association, 2021) Premathilaka, L.H.R.A.; Darshana, L.G.T.; Liyanage, I.K.; Nishshanka, N.A.S.; Gamage, M.P.; Gunasena, J.B.; Sajeethan, P.; Mendis, B.M.I.U.; Shashiprabha, W.M.M.; Tilakaratna, P.M.Y.I.; Premawardhena, A.P.
Introduction and Objectives Pyrexia of “unknown origin” remains a clinical entity universally despite advances in diagnostic technologies. There are few if any systematic studies on PUO conducted in Sri Lanka. We retrospectively analysed data of patients with PUO from a tertiary care hospital. Methods Records of PUO patients admitted to Colombo North (Teaching) Hospital during the period of January 2015 – January 2020 were extracted from the archives. Details of etiology, diagnosis and usage of medication of each patient was recorded. Results A total of 100 PUO patients were recruited. Majority were males (n=55;54.5%). Median ages of male and female patients were 53.0 and 50.0 years respectively. A final diagnosis had been reached in the majority (n=65;65%). Mean number of days of hospital stay was 15.16 (SD; 7.81). Median of the total number of fever days among PUO patients was 30.5. Out of 65 patients whose etiology were identified, the majority were diagnosed with an infection (n = 47; 72.31%) followed by noninfectious inflammatory conditions (n=13; 20.0%) and malignancies (n=5; 7.7%). Tuberculosis was the commonest infection detected (n=15; 31.9%). Mean number of days taken to reach the final diagnosis was 11.57 (SD: 11.42). Contrast enhanced CT scan (CECT) pelvis/abdomen (n = 15; 23.1%) was the commonest investigation leading to the final diagnosis. Antibiotics had been prescribed for the majority of the PUO patients (n=90; 90%). Conclusion Infections, mainly tuberculous, was the commonest cause for PUO while a third of patients remained undiagnosed despite a prolonged hospital stay.