Browsing by Author "Fernando, N."

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Addressing climate change in Sri Lanka in light of the Human Rights Law: legal analysis
(Department of Zoology and Environmental Management, University of Kelaniya, 2015) Fernando, N.; Bogahawatte, I.
Adoption and impact of E-commerce on Sri Lankan tourist sector
(University of Kelaniya, 2008) Widyasekara, S.; Fernando, N.; Hettige, R.
Azygous anterior cerebral artery infarction
(Oxford, 2024) Fernando, N.; Ranawaka, U.
No abstract available
Can we improve physiology tutorials? An assessment of targeted vs. non-targeted tutorials
(University of Kelaniya, Sri Lanka, 2003) Fernando, N.; Devanarayana, N.; Ferdinandis, H.; Jinadasa, S.; Karunasena, C.; Fernando, S.; de Silva, D.C.
Abstract available
Changes in full blood count parameters in leptospirosis: a prospective study
(BioMed Central, 2014) de Silva, N.L.; Niloofa, M.; Fernando, N.; Karunanayake, L.; Rodrigo, C.; de Silva, H.J.; Premawansa, S.; Handunnetti, S.M.; Rajapakse, S.
BACKGROUND: Leptospirosis presents diagnostic challenges to clinicians, in settings where other acute febrile illness are prevalent. The patterns of serial changes in haematological parameters in leptospirosis has not been evaluated previously. METHODS: Clinical and laboratory data were collected prospectively from patients with leptospirosis in two hospitals in Sri Lanka. Leptospirosis was diagnosed based on WHO clinical criteria with confirmation using Microscopic Agglutination Test titre > 400 or 4 fold rise between acute and convalescent samples. Full blood count parameters were analysed up to the 14th day of illness. RESULTS: Data from 201 patients with leptospirosis were available. Leukocyte counts and absolute neutrophil counts showed a decline over the first 5 days of illness, then rose until the end of the second week. On day 3 of fever, the majority (75%) had normal leukocyte counts, and by day 5, leukocytosis was seen only in 38.1%; leucopenia was an uncommon finding. Lymphopenia was seen in over half on day 5, declining to just under a quarter of patients by day 10. Platelets declined over the first 6 days and then gradually rose. Thrombocytopenia was seen in nearly three-fourths of patients by day 5. Haemoglobin and haematocrit levels declined over the course of illness. Total white cell and neutrophil counts were higher, and haemoglobin and haematorcrit were significantly lower, in patients with severe disease. CONCLUSIONS: Neither leukocytosis nor lymphopenia were prominent features, while thrombocytopenia was seen during the 3rd to 5th day of illness, with dropping haemoglobin levels. Neutrophilia and low haemoglobin levels appear to predict severe disease. These findings may be of use to clinicians in differentiating leptospirosis from other acute infections like dengue, and could help in predicting severe leptospirosis.
Clinical and laboratory associations of severity in a Sri Lankan cohort of patients with serologically confirmed Leptospirosis - a prospective study
(Sri Lanka Medical Association, 2015) Rajapakse, S.; Weeratunga, P.N.; Rodrigo, C.; Sriharan, S.; Niloofa, M.J.R.; Fernando, N.; de Silva, H.J.; Karunanayake, L.; Premawansa, S.; Handunnetti, S.
INTRODUCTION AND OBJECTIVES: Leptospirosis is a zoonotic infection of significant morbidity and mortality. This study elucidates the markers of severity in a cohort of Sri Lankan patients with serologically confirmed leptospirosis. METHOD: Prospectively recruited patients presenting to three healthcare institutions in the Western province of Sri Lanka with serological confirmation of leptospirosis with the microscopic agglutination test were included. Data regarding the socio-deruographic profile, clinical presentation, complications and biochemical parameters were recorded. Univariate associations and subsequent multivariate logistic regression models were constructed with severity as the dependent variable. RESULTS: A total of 232 patients were included. Majority were male (86.6%). Severe disease was noted in 68.5%. Significant clinical associations of severe disease included fever > 38.8°C on presentation (p=0.008), age>40 yrs; (p = 0.033), muscle tenderness (p=0.04) and tachycardia on admission (p=0.05). Laboratory associations of severe disease were highest white cell count > 12,350/mm3 (p<0.001) and < 7900/mm3 (p = 0.009), highest neutrophil percentage > 84% {p < 0.001). Hemoglobin > 11.2g/dL (p<0.001) and < 10.2 (p<0.001), packed cell volume > 33.8% (p <0.001) and <29.8% (p <0.001), lowest platelet count <63,500/mm3 (p = 0.01), highest ALT > 70 IU/L {p = 0.02) and hyponatremia with sodium <131mEq/L (p=0.004) On multivariate analysis, PCV < 29.8 (P = 0.011; adjusted OR =3.750; Cl = 1.394 - 10.423), ALT >70 P =0.044 adjusted OR =2.639; Cl =1.028-6.774 and hyponatremia< 131 (p=0.019 adjusted OR=6.413; Cl=1.353 -30.388) were found to be independent associations of severe disease. CONCLUSION: Severity associations were demonstrated with both clinical and laboratory parameters.
Clinical and laboratory associations of severity in a Sri Lankan cohort of patients with serologically confirmed leptospirosis: a prospective study
(Oxford : Oxford University Press, 2015) Rajapakse, S.; Weeratunga, P.; Niloofa, M.J.; Fernando, N.; Rodrigo, C.; Maduranga, S.; de Silva, N.L.; de Silva, H.J.; Karunanayake, L.; Handunnetti, S.
BACKGROUND: Leptospirosis results in significant morbidity and mortality. This study elucidates markers of severity in a cohort of Sri Lankan patients. METHODS: Patients presenting to three healthcare institutions in the Western province of SriLanka with leptospirosis serological confirmed by the microscopic agglutination test (MAT) were included. Prospective data regarding demographic, clinical and laboratory parameters was extracted. Univariate associations and subsequent multivariate logistic regression models were constructed. RESULTS: The study included 232 patients, with 68.5% (159) demonstrating severe disease. Significant associations of severe disease at a significance level of p<0.05 were fever >38.8°C on presentation, age >40 years, muscle tenderness, tachycardia on admission, highest white cell count >12 350/mm(3) and <7900/mm(3), highest neutrophil percentage >84%, haemoglobin >11.2 g/dL and <10.2 g/dL, packed cell volume (PCV) >33.8% and <29.8%, lowest platelet count <63 500/mm(3), highest alanine transaminase (ALT) >70 IU/L and hyponatremia with sodium <131mEq/L. On multivariate analysis, PCV <29.8% (p=0.011; OR 3.750; CI: 1.394-10.423), ALT >70 IU/L (p=0.044; OR 2.639; CI: 1.028-6.774) and hyponatremia <131mEq/L (p=0.019; OR 6.413; CI: 1.353-30.388) were independent associations of severe disease. CONCLUSIONS: Severity associations were demonstrated with both clinical and laboratoryparameters. There is a need for novel biomarkers for prediction of severity in leptospirosis. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Clinico-epidemiological characteristics, treatment and outcomes of patients with confirmed Leptospirosis in a Sri Lankan healthcare setting
(Sri Lanka Medical Association, 2015) Rajapakse, S.; Weeratunga, P.N.; Rodrigo, C.; Sriharan, S.; Niloofa, M.J.R.; Fernando, N.; de Silva, H.J.; Karunanayake, L.; Premawansa, S.
INTRODUCTION AND OBJECTIVES: Leptospirosis is a zoonotic infection caused by spirochaetes of the genus Leptospira, with humans being affected as incidental hosts. Leptospirosis is endemic in Sri Lanka. There is paucity of prospective data on the clinico-epidemiological characteristics, treatment profiles and outcomes of patients with ieptospirosis in Sri Lanka. METHOD: This was a prospective cross sectional study of patients, over 12 years of age, with a diagnosis of ieptospirosis based on the WHO surveillance criteria with subsequent laboratory confirmation, presenting to three hospitals in the Western province of Sri Lanka. RESULTS: Of a total of 178 patients, males (84.3%) between the ages of 40-49 years were more likely to be affected. 51.7% were direct admissions and 47.8% were transfers. Exposure to water potentially contaminated with rat urine was seen in the majority (71.9%). A significant proportion of patients developed acute kidney injury (66.9%). Penicillin was the most commonly used antibiotic for treatment (47.2%), however more than one antibiotic was used in 43.3%. The use of chemoprophylaxis by the patients was low (1.1%). Hemodialysis was needed for 36.5%. Recovery was seen in 71.3%, 2.8% died, 10.1% were transferred out and 15.8% were lost to follow-up. On discharge, 70.6% had been treated for severe leptospirosis. Mean length of hospital stay was 7.5 days (±5.1). CONCLUSION: The incidence of severe leptospirosis with organ dysfunction is higher in patients presenting to hospitals in the .Western province. Males aged 40-49 are most commonly affected. More than two thirds of the patients developed acute kidney Injury. Chemoprophylaxis rates were low.
A Comparative Evaluation Between the Economic Crisis (2008) and the Covid-19 Impacts in the Stock Market
(Faculty of Commerce and Management Studies, University of Kelaniya, Sri Lanka, 2021) Fernando, N.; Piyananda, S.D.P.
Introduction: This study determines the most influenced crisis between the economic crisis (2008) and the COVID-19 pandemic in the share market performance. Design/Methodology/Approach: The study sample consists of six Asian countries, and the data were collected from 2006 to 2008 for the economic crisis and from June 2018 to June 2021 for the COVID-19. This study has been used the positivist research paradigm, deductive approaches, and quantitative research methods to track down the most influenced crisis. Regression analysis (based on the ARIMA model), descriptive analysis, and ARIMA model (for forecasting) were employed to analyze the data. Log returns of each country have been used as the dependent variable, while Lags of the log-returns and dummy variable (Pres-crisis and during the crisis) have been used as the independent variables. Findings: Both crises had shown a negative impact on the share market. However, based on the study results among the two crises, the economic crisis had created a significant negative impact compared to the COVID-19 pandemic. Furthermore, During the economic crisis period (2008), DSEX had shown the highest negative impact where NEPSE in the COVID-19 recession. ASPI is the least affected index during both phases among the six indices. However, according to the ARIMA model, future ASPI returns will be negative. Conclusion: The final result emphasizes that both crises have negatively affected the share market performance while the economic crisis had created the highest impact. Therefore, there is a negative relationship between the crisis and the share market performance.
A Comparison of Pathogenic Bacterial Spectrum and Antibiotic Susceptibility Pattern in Adult Cancer and Non-Cancer Patients Who Have Received Prior Antibiotic Therapy at Two Tertiary Care Institutions – Preliminary Findings
(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Chathuranga, G.; Dissanayake, T.; Fernando, N.; Wanigatunge, C.
Infectious diseases are an important cause of increased morbidity and mortality among patients of all age groups particularly in the immunosuppressed including those with malignancies. Objective of this study was to compare the spectrum of pathogenic bacteria causing respiratory infections, skin and soft tissue infections (SST) and complicated urinary tract infections (UTI) in adults with malignancies and without, and their antimicrobial sensitivity pattern. Patients with diagnosed malignancies and those without, who presented with lower respiratory tract infections, SST and complicated UTI were included. Those with malignancies were selected from Apeksha Hospital, Maharagama while those without malignancies were selected from Colombo South Teaching Hospital. Samples were collected from May 2018 to September 2018. Both patient groups were on antibiotic therapy at the time of specimen collection. All those with malignancies were also on immunosuppressive therapies. Pathogenic bacteria were isolated from sputum, pus, urine, wound swabs and broncho-alveolar lavage specimens. Samples obtained from 59 patients with malignancies and 68 patients without malignancies were analyzed. Lower respiratory tract infections were predominant (42% / n=25) among cancer patients whereas in non-cancer patients it was complicated UTIs (41% / n=28). In cancer patients, majority of the infections were caused by coliform bacteria (63%, 37) followed by S. aureus (17%, 10) and Pseudomonas spp. (10%, 6). Coliform bacteria were the predominant pathogen in non-cancer patients (72%, 49) followed by Pseudomonas spp. (13%, 9) and S. aureus (9%, 6). Of the S. aureus isolates obtained, 7/10 in cancer patients and 4/6 from non-cancer patients were methicillin resistant (MRSA). Inducible clindamycin resistance was observed in 2 S. aureus isolates from cancer patients while it was not detected among non-cancer patients. Multi drug resistant Acinetobacter species was isolated from 4 cancer patients and 1 non-cancer patient with respiratory infection. Imipenem/ meropenem resistance rate in coliform was 43.2% (16/37) among cancer patients and 16.3% (8/49) among non-cancer patients. Amikacin showed the highest sensitivity rate for coliform bacteria in both patient groups; 78.3% (29/37) in cancer patients and 85.7% (42/49) in non-cancer patients. All the Pseudomonas spp. isolates obtained from non-cancer patients were sensitive to imipenem and meropenem while in cancer patients the sensitivity was observed as 50% (3/6) to imipenem and 33.3% (2/6) to meropenem. Higher antibiotic resistant rates were observed in the patients with malignancies in comparison to those without malignancies which could be a major problem when selecting antibiotics for the treatment of infections in that patient population
Conflict Resolution, Reporting and its Implication on the Recipient?s mentality
(Conflict Resolution, Reporting and its Implication on the Recipient?s mentality, Media and Transformation: Exploring role of ICT, Innovative Communication and New Media, Global Communication Research Association and Sri Lanka Development Journalist Forum, 2014) Mallawaarachchi, A.; Herath, O.; Fernando, N.
A conflict can be identified as unavoidable circumstances of our day to day life. Its results can be both positive and negative. In reporting conflicts, different media methods are used to attract the recipients. Above concerned methods maintain close and direct relationship with the end results of the conflicts and in return it can make an impact on recipient?s mentality as a whole. As it causes some behavioral changes, therefore it can have a direct impact in settlement of disputes. The objectives of this research are to study the measures taken to settle conflicts and the relationship of reporting and to study how reporting makes and impact on recipient?s mentality, both primary and secondary data have been used in this study. In collecting primary data both questionnaires and interviews were used and in addition primary books, Newspaper, on line article, other document , reports etc were used secondaory data. This research is based on a study of five main conflict occurred June to November 2013, and a focus has been given on have Sri Lankan newspapers such as ?The Island, Dinamina & Lankadeepa? have contributed to charge the recipient?s mentality. An analysis has been done both as quantitatively and qualitatively to come with above research findings. In reporting conflicts violation of media ethics has had a negative impact on recipient?s mentality is the main findings of this study. The end result of it is the fact that it has made some significance changes of the direction of conflict.
Cross-cultural adaptation and validation of the Sinhala version of the hospital anxiety and depression scale (HADS) for patients diagnosed with ischemic heart disease (IHD) in Sri Lanka
(College of Community Physicians of Sri Lanka, 2023) Gamage, C.K.W.; de Zoysa, P.; Balasuriya, A.; Fernando, N.; Jayamanne, D.
INTRODUCTION: The Hospital Anxiety and Depression Scale (HADS) is a frequently used instrument to measure depression and anxiety symptoms among patients diagnosed with ischaemic heart disease (IHD). However, a Sinhala version of HADS for Sri Lankan IHD patients has not been validated in Sri Lanka. OBJECTIVES: To translate, cross-culturally adapt and validate the HADS in a Sinhala-speaking Sri Lankan population with IHD METHODS: The Sinhala translation of HADS was conducted in four phases: forward translation, backward translation, patient testing and proofreading with the Mapi Research Trust guidelines. Content and consensual validation of the translated scale was conducted with the Delphi method, and the ratings were evaluated for consensus. The validated scale was administered to a sample selected using systematic sampling of 140 IHD patients attending medical clinics at a base hospital in Sri Lanka. Factor structure was verified with Confirmatory Factor Analysis (CFA) and reliability with internal consistency by Cronbach's alpha. RESULTS: The HADS Sinhala version showed good content and consensual validity. CFA proved that the uncorrelated two-factor structure was compatible with the original instrument (x2=156.98; df=76; p<0.001). The Confirmatory Fit Index (CFI) was 0.89, and the Root Mean Square Error of Approximation (RMSEA) was 0.09. The reliability analysis indicated Cronbach's alpha for depression and anxiety as 0.86 and 0.83, respectively. CONCLUSIONS & RECOMMENDATIONS: The cross-culturally adapted HADS Sinhala version shows similar psychometric properties as the original instrument and can be used in future studies with confidence.
Cross-cultural adaptation of the type D personality scale for use with patients diagnosed with Ischemic heart disease in Sri Lanka
(The Sri Lanka Medical Association, 2021) Walpita Gamage, C.K.; de Zoysa, P.; Balasuriya, A.; Fernando, N.; Jayamanne, B.D.W.
INTRODUCTION: Ischemic Heart Disease (IHD), a major cardiovascular disease globally, has become the primary cause of death in Sri Lanka. Negative affectivity (NA) and social inhibition (SI) are two personality traits which increase the risk of IHD. The Type D Scale (DS-14) evaluates a person’s general level of distress on NA and SI. However, DS-14 has not been translated and validated into Sinhala in Sri Lanka. OBJECTIVES: The study aimed to cross-culturally adapt and validate the DS-14 for use with Sinhala speaking patients diagnosed with IHD. METHODS: Translation, back translation and pre-test were conducted before a two-rounds of a Delphi process which assessed content and consensual validity of the instrument. The validated questionnaires were administered to 140 patients diagnosed with IHD at a Base Hospital. Factor structure was confirmed through Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) and reliability, by internal consistency with Cronbach’s alpha. RESULTS: The questionnaire was administered among 140 participants (85 females), aged 18-60 years. The DS-14 Sinhala version showed good content and consensual validity. Factor analysis proved two factors compatible with the original instrument, which explained the variance of 62.9%. CFA confirmed the two-factor model. The reliability analysis indicated Cronbach’s alpha for NA and SI as 0.93 and 0.88, respectively. CONCLUSION: The cross-culturally adapted DS-14 Sinhala version indicated the same psychometric properties as the original instrument, in the local context with IHD patients. It can be confidently applied in the investigation of Type D personality in IHD prevention and treatment, as well as in research. KEYWORDS: Ischemic Heart Disease, Type D Personality, DS-14
Diagnosis of leptospirosis: comparison between microscopic agglutination test, IgM-ELISA and IgM rapid immunochromatography test
(Public Library of Science, 2015) Niloofa, R.; Fernando, N.; de Silva, N.L.; Karunanayake, L.; Wickramasinghe, H.; Dikmadugoda, N.; Premawansa, G.; Wickremasinghe, A.R.; de Silva, H.J.; Premawansa, S.; Rajapakse, S.; Handunnetti, S.
BACKGROUND: Leptospirosis is diagnosed on clinical grounds, and confirmed by microscopic agglutination test (MAT). IgM-ELISA (Serion-Virion) and immunochromatography test (Leptocheck-WB) are two immunodiagnostic assays for leptospirosis. Their sensitivity, specificity and applicability in Sri Lanka have not been systematically evaluated. METHODS: Clinically diagnosed leptospirosis patients (n = 919) were recruited from three hospitals in the Western Province of Sri Lanka, during June 2012 to December 2013. MAT, IgM-ELISA and Leptocheck-WB were performed on all patient sera. MAT titer of ≥400 in single sample, four-fold rise or seroconversion ≥100 in paired samples were considered as positive for MAT. For diagnostic confirmation, MAT was performed during both acute and convalescent phases. Anti-leptospiral IgM ≥20 IU/ml and appearance of a band in the test window were considered as positive for IgM-ELISA and Leptocheck-WB test respectively. Patients with an alternative diagnosis (n = 31) were excluded. Data analysis was performed using two methods, i) considering MAT as reference standard and ii) using Bayesian latent class model analysis (BLCM) which considers each test as imperfect. RESULTS: MAT, IgM-ELISA and Leptocheck-WB positivity were 39.8%, 45.8% and 38.7% respectively during the acute phase. Acute-phase MAT had specificity and sensitivity of 95.7% and 55.3% respectively, when compared to overall MAT positivity. IgM-ELISA and Leptocheck-WB had similar diagnostic sensitivity when compared with acute-phase MAT as the gold standard, although IgM-ELISA showed higher specificity (84.5%) than Leptocheck-WB (73.3%). BLCM analysis showed that IgM-ELISA and Leptocheck-WB had similar sensitivities (86.0% and 87.4%), while acute-phase MAT had the lowest sensitivity (77.4%). However, acute-phase MAT had high specificity (97.6%), while IgM-ELISA and Leptocheck-WB showed similar but lower specificity (84.5% and 82.9%). CONCLUSIONS: Both IgM-ELISA and Leptocheck-WB shows similar sensitivities and specificities. IgM-ELISA may be superior to MAT during the acute phase and suitable for early diagnosis of leptospirosis. Leptocheck-WB is suitable as a rapid immunodiagnostic screening test for resource limited settings.
A diagnostic model for Leptospirosis for use in resource limited settings
(Sri Lanka Medical Association, 2015) Rajapakse, S.; Weeratunga, P.N.; Rodrigo, C.; Sriharan, S.; Niloofa, M.J.R.; Fernando, N.; de Silva, H.J.; Karunanayake, L.; Premawansa, S.
INTRODUCTION AND OBJECTIVES: Leptospirosis is a zoonotic infection with significant morbidity and mortality. In this prospective study, we attempted to develop a model for diagnosis of leptospirosis. METHOD: Data was extracted from a prospective multicentre study. All patients with a suspected diagnosis of leptospirosis based on the WHO surveillance criteria were recruited. A derivation cohort and a validation cohort were selected. Positive MAT was used as the gold standard and significant associations in the derivation cohort were selected for construction of a multivariate regression model. Adjusted odds ratios were extracted for significant variables. ROC curves were generated. RESULTS: A total of 592 patients were included with 450 (180 confirmed leptospirosis) in the derivation cohort and 142 (52 confirmed leptospirosis) in the validation cohort. The variables in the final model were: history of exposure to possible source of leptospirosis (OR=2.878;95% Cl=1.527-5.425;p=0.001), serum creatinine>150u.mol/L (OR =2.742; 95% CN1.474-5.101; p=0.001), neutrophil differential percentage (on day 3 of illness) > 82.8% of total WBC count (OR 2.063; 95% Cl = 1.109 - 3.837; p =0.022), serum bilirubin > 27 U/L (OR = 1.767;95%CI 0.968 - 3.226; p=0.050) and platelet count (on day 3 of illness)< 85,000/mm3 (OR=2.350; 95%CI=1.281 -4.313;p=0.006). The Nagelkerke R2 was 0.654. ROC analysis demonstrated a diagnostic model score >14 to have a sensitivity of 80% and a specificity of 60% in the diagnosis of leptospirosis against MAT as the gold standard. CONCLUSION: This proposed diagnostic model for diagnosis of leptospirosis is of potential value to clinicians treating acute febrile illness in areas with limited diagnostic facilities.
A Diagnostic scoring model for Leptospirosis in resource limited settings
(Public Library of Science, 2016) Rajapakse, S.; Weeratunga, P.; Niloofa, R.; Fernando, N.; de Silva, N.L.; Rodrigo, C.; Maduranga, S.; Nandasiri, N.; Premawansa, S.; Karunanayake, L.; de Silva, H.J.; Handunnetti, S.
Leptospirosis is a zoonotic infection with significant morbidity and mortality. The clinical presentation of leptospirosis is known to mimic the clinical profile of other prevalent tropical fevers. Laboratory confirmation of leptospirosis is based on the reference standard microscopic agglutination test (MAT), direct demonstration of the organism, and isolation by culture and DNA detection by polymerase chain reaction (PCR) amplification. However these methods of confirmation are not widely available in resource limited settings where the infection is prevalent, and reliance is placed on clinical features for provisional diagnosis. In this prospective study, we attempted to develop a model for diagnosis of leptospirosis, based on clinical features and standard laboratory test results. METHODS: The diagnostic score was developed based on data from a prospective multicentre study in two hospitals in the Western Province of Sri Lanka. All patients presenting to these hospitals with a suspected diagnosis of leptospirosis, based on the WHO surveillance criteria, were recruited. Confirmed disease was defined as positive genus specific MAT (Leptospira biflexa). A derivation cohort and a validation cohort were randomly selected from available data. Clinical and laboratory manifestations associated with confirmed leptospirosis in the derivation cohort were selected for construction of a multivariate regression model with correlation matrices, and adjusted odds ratios were extracted for significant variables. The odds ratios thus derived were subsequently utilized in the criteria model, and sensitivity and specificity examined with ROC curves. RESULTS: A total of 592 patients were included in the final analysis with 450 (180 confirmed leptospirosis) in the derivation cohort and 142 (52 confirmed leptospirosis) in the validation cohort. The variables in the final model were: history of exposure to a possible source of leptospirosis(adjusted OR = 2.827; 95% CI = 1.517-5.435; p = 0.001) serum creatinine > 150 micromol/l (adjusted OR = 2.735; 95% CI = 1.374-4.901; p = 0.001), neutrophil differential percentage > 80.0% of total white blood cell count (adjusted OR 2.163; 95% CI = 1.309-3.847; p = 0.032), serum bilirubin > 30 micromol/l (adjusted OR = 1.717; 95% CI 0.938-3.456; p = 0.049) and platelet count < 85,000/mm3 (adjusted OR = 2.350; 95% CI = 1.481-4.513; p = 0.006). Hosmer-Lemeshow test for goodness of fit was 0.931. The Nagelkerke R2 was 0.622. The area under the curve (AUC) was noted as 0.762. A score value of 14 reflected a sensitivity of 0.803, specificity of 0.602, a PPV of 0.54, NPV of 0.84, a positive LR of 2.01 and a negative LR of 0.32. CONCLUSIONS: The above diagnostic model for diagnosis of leptospirosis is suggested for use in clinical settings. It should be further validated in clinical practice.
Do doctors really know about “hs-cTnI”? A comprehensive evaluation of knowledge regarding high-sensitivity cardiac troponin I (hs-cTnI) assay among medical officers in Gampaha district
(College of Chemical Pathologists of Sri Lanka, 2024) Fernando, N.; Fernando, K.; Gallage, T.; Dayanath, B.K.T.P.; De Silva, S.
INTRODUCTION AND OBJECTIVES The high-sensitivity cardiac troponin I (hs-cTnI) assay is a crucial diagnostic marker in the triage of patients presenting with chest pain. Notably, errors in interpreting the testing method have been identified among medical officers, leading to an increased likelihood of inaccuracies in testing and interpretation. This study aims to evaluate the level of understanding among medical officers regarding the hs-cTnI assay in relation to the most recent European Society of Cardiology (ESC) guideline released in 2020. METHODS A cross sectional questionnaire-based study was conducted at two government hospitals in Gampaha District during June 2022. A self-administered e-questionnaire was used to assess knowledge regarding hs-cTnI. Knowledge was measured through cumulative scoring of questionnaire responses, subsequently categorized as either good or poor knowledge. Scores below 60% were designated as poor, and vice versa. Descriptive statistics were employed for data summarization. RESULTS Out of 300 participants, 76% (227) responded. Only 14.5% (33/227) exhibited proficient knowledge of the analytical component, while 41.9% (95/227) demonstrated good knowledge of the clinical component. A score ≥60% on the analytical component knowledge correlated significantly with factors such as designation being a senior registrar or consultant (p<0.001), postgraduate enrolment (p<0.001), participation in continuous professional development programmes (p<0.001), and employment in a teaching hospital (p=0.025). Conversely, no significant associations were observed with age (p=0.066) or private practice (p=0.118). Clinical component knowledge scores ≥60% were significantly associated with age between 25 and 35 years (p=0.006), postgraduate enrolment (p<0.001), participation in continuous professional development programs (p<0.001), and employment in a teaching hospital (p=0.001) but not with doing private practice (p=0.170). CONCLUSIONS In Sri Lanka, medical officers’ analytical knowledge on the hs-cTnI assay seems lacking. Ongoing training programmes are essential to enhance their knowledge and proficiency in hs-cTnI testing.
Effect of antimicrobial agents on inflammatory cytokines in acute Leptospirosis
(American Society for Microbiology, 2018) Fernando, N.; de Silva, R.; Hadunnetti, S.M.; Karunanayake, L.; de Silva, N.L.; de Silva, H.J.; Rajapakse, S.; Premawansa, S.
The aim of this study was to assess the inflammatory cytokine response and possible association with antimicrobial treatment with penicillin, ceftriaxone, and doxycycline in acute leptospirosis. In the early acute stage, interleukin-10 (IL-10) levels were higher in mild cases than in severe cases (P = 0.01). IL-6 and IL-8 levels were low in patients who received >5 antimicrobial doses (P < 0.01). IL-8 levels were negatively correlated with the number of ceftriaxone doses administered (r = -0.315; P = 0.031). Further studies are needed to evaluate the possible downregulation of proinflammatory cytokines by ceftriaxone in leptospirosis.
Impact of acalypha indica (Kuppamenia) phytochemicals on glucose-6-phosphate dehydrogenase deficiency: two clinical case studies
(College of Chemical Pathologists of Sri Lanka, 2024) Fernando, K.; Fernando, N.; Dayanath, B.K.T.P.; Williams, S.; Premawardhena, A.
INTRODUCTION Acalypha indica, known as “kuppamenia” in Sinhala, plays a significant role in ayurvedic medicine in Sri Lanka. Despite its medicinal use, certain phytochemicals within the plant have been linked to oxidative stress-induced haemolysis in individuals deficient in glucose-6-phosphate dehydrogenase (G6PD) enzyme activity. However, we know very little regarding those chemicals due to a dearth of literature. Here, we present two cases highlighting the impact of Acalypha indica ingestion on individuals with G6PD deficiency.CASE PRESENTATION Case 1: A 65-year-old man presented with jaundice, pallor, and haematuria after consuming “Kuppamenia mallum”. His peripheral blood picture showed bite cells and Heinz bodies. Positive Brewer’s test raised the clinical suspicion of G6PD deficiency. He received blood transfusions during the acute phase and was discharged upon improvement of symptoms. Low levels of G6PD enzyme at the follow-up visit confirmed the diagnosis. Case 2: A 61-year-old male presented with respiratory distress, jaundice and haematuria, accompanied by peripheral cyanosis and hypotension. He was admitted following four days of continuous ingestion of Acalypha indica. Peripheral oxygen saturation was low, and Heinz bodies were evident in the peripheral blood film. Blotting paper methaemoglobinaemia assessment revealed a level of 70%. Despite optimal medical management, he succumbed to a cardiac arrest on the fourth day of admission.DISCUSSION AND CONCLUSIONS Despite its antioxidant properties, Acalypha indica can precipitate acute haemolysis in G6PD-deficient individuals. Symptomatology and outcomes vary with the amount ingested, underscoring the necessity for research into identifying potentially toxic phytochemicals and their concentrations.
Impact of COVID-19 outbreak on the number of invasive procedures in Institute of Cardiology, National Hospital of Sri Lanka -A descriptive longitudinal study
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Kuruppu, C.; Gunawardena, R.; Dunuwille, A.; Ranasinghe, G.; Fernando, N.; Mendis, S.; Fernando, M.; Wijewardena, A.; Prabath, I.H.D.S.
Introduction: Covid-19 pandemic has significantly affected healthcare services worldwide with a similar impact on invasive procedures, in Institute of Cardiology, National Hospital of Sri Lanka (NHSL). Objectives: To analyse the impact of Covid-19 outbreak on therapeutic cardiology interventions, both elective and emergency, by comparing frequencies of procedures done during the initial affected year and immediate previous year. Methods: A Retrospective longitudinal descriptive study was carried out on frequencies of invasive therapeutic cardiology procedures during the period of 2019 March to 2021 February, at Cardiology Unit, NHSL. Pre-formed data collection sheets were filled using hospital registries. Final analysis was done by Microsoft-Excel 365. Results: Total number of procedures done in affected year was 4690 compared to 6096 in previous year. In April 2020, which was the most affected month, 52 cumulative procedures have been done in comparison to 427 procedures in April 2019. By August 2020 number of procedures has increased to 668 in compared to 486 in August 2019. Total of elective procedures were 3751 and 5061 in affected and non-affected years respectively. Similarly, the number of emergency procedures was 1035 in immediate previous year and 939 during Covid pandemic. Conclusions: Study has highlighted a significant impact on invasive therapeutic cardiology procedures, especially on electives, by the onset of the Covid-19 pandemic, especially during the period of lockdown. However, there has been a compensatory increase in procedures once lockdown was over, partially compensating for the numbers. There has been less impact on emergency procedures, the numbers of which have remained relatively constant.