Browsing by Author "Wickramasinghe, P."

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Asia-Pacific consensus statement on integrated 24-hour activity guidelines for the early years
(Elsevier, 2022) Loo, B.K.G.; Okely, A.; Taylor, R.; Novotny, R.; Wickramasinghe, P.; Müller-Riemenschneider, F.; Waqa, G.; Pulungan, A.; Kusuda, S.; Tan, K.H.; Mettananda, Sachith (Asia–Pacific 24-Hour Activity Guidelines for the Early Years Committee)
BACKGROUND: Early childhood is a vital period for development and growth. Promoting beneficial lifestyle behaviours in early childhood can help optimise children's health, development and learning, shape their behaviours in adulthood and offer the best protection against future non-communicable diseases (NCDs). In the Asia-Pacific region, NCDs are significant causes of healthcare burden and mortality. Furthermore, there is also a high prevalence of adverse metabolic risk factors and unhealthy lifestyle behaviours among these children. METHOD: Representatives from 19 Asia-Pacific nations and/or jurisdictions developed a consensus statement on integrated 24-hour activity guidelines for the early years using the GRADE-ADOLOPMENT framework. FINDINGS: These guidelines apply to all infants, toddlers and pre-schoolers below 5 years of age. The guidelines aim to provide a holistic and practical approach to lifestyle activities by framing physical activity, sedentary behaviour and sleep within a 24-hour period. Dietary patterns were included as they play an integral role in metabolic health and energy balance. INTERPRETATION: Aligned with the World Health Organization's Global Action Plan for the Prevention and Control of NCDs through health promotion interventions in early life, through cultivating healthy lifestyle behaviours in the children's early years, we aim to provide children with the best start in life and reduce the burden of future NCDs in the Asia-Pacific region. FUNDING: Funded by Integrated platform for research in advancing metabolic health outcomes of women and children.
Case report of an infant with congenital mesoblastic nephroma leading to pulmonary metastasis
(Sage Publishing, 2023) Athapathu, A.S.; Wijayawardhana, S.M.; Meegoda, J.; Gunaratne, S.A.; Somathilaka, M.; Chang, K.T.E.; Wickramasinghe, P.
Congenital mesoblastic nephroma is considered a tumour with favourable clinical behaviour with only few reported cases of metastases. We report an infant who underwent complete resection and later developed pulmonary metastasis. Ten-month-old baby girl initially presented at 3 weeks of age with macroscopic haematuria, hypertension and a lumbar mass. Contrast-enhanced computed tomography revealed a tumour arising from the left kidney without local invasion or metastasis. She underwent left nephrectomy. Immunohistochemistry confirmed a cellular type of congenital mesoblastic nephroma. At 10 months, she presented with difficulty in breathing. Contrast-enhanced computed tomography revealed an opacity in the right hemi-thorax. Histology of lung mass was suggestive of deposits from the previously excised mesoblastic nephroma. She developed a right-sided haemothorax and succumbed. This case report highlights the fact that even though congenital mesoblastic nephromas are considered tumours with favourable clinical behaviour, they can present later with distant metastasis. Therefore, clinicians need to be aware of this rare malignant potential and adhere to meticulous follow-up protocols.
A child with intravenous immunoglobulin-resistant Kawasaki disease who responded to intravenous methyl prednisolone
(Sri Lanka College of Paediatricians, 2019) Kankananarachchi, I.; Wickramasinghe, P.; Fernando, M.; Pussagoda, K.; Dissanayake, R.; Morawakkorala, R.; de Silva, H.
No abstract available
Efficacy of a dengue vaccine candidate (TAK-003) in healthy children and adolescents two years after vaccination
(University of Chicago Press, 2022) López-Medina, E.; Biswal, S.; Saez-Llorens, X.; Borja-Tabora, C.; Bravo, L.; Sirivichayakul, C.; Vargas, L.M.; Alera, M.T.; Velásquez, H.; Reynales, H.; Rivera, L.; Watanaveeradej, V.; Rodriguez-Arenales, E.J.; Yu, D.; Espinoza, F.; Dietze, R.; Fernando, L.; Wickramasinghe, P.; Moreira Jr, E.D.; Fernando, A.D.; Gunasekera, D.; Luz, K.; da Cunha, R.V.; Tricou, V.; Rauscher, M.; Liu, M.; LeFevre, I.; Wallace, D.; Kosalaraksa, P.; Borkowski, A.; TIDES study group.
BACKGROUND: Takeda's dengue vaccine is under evaluation in an ongoing Phase 3 efficacy study; we present an update after 2 years. METHODS: 20,099 children (4-16 years old) were randomized to receive two doses of TAK-003 or placebo three months apart and are under long-term febrile surveillance to detect dengue by serotype-specific RT-PCR. (NCT02747927). RESULTS: Cumulative efficacy against dengue over ~27 months since first dose was 72.7% (95% CI: 67.1 - 77.3), which included efficacy of 67.0% (95% CI: 53.6 - 76.5) in dengue-naïve and 89.2% (82.4 - 93.3) against hospitalized dengue. In the second year after vaccination, a decline in efficacy was observed [56.2% (42.3 - 66.8)] with the largest decline in 4 - 5 year-old children [24.5% (-34.2 - 57.5)]; efficacy was 60.6% (43.8 - 72.4) in 6 - 11 year and 71.2% (41.0 - 85.9) in 12 - 16 year age groups. As TAK-003 efficacy varies by serotype, changes in serotype dominance partially contributed to the efficacy differences in year by year analysis. No related serious adverse events occurred during the second year. CONCLUSION: TAK-003 demonstrated continued benefit independent of baseline serostatus in reducing dengue with some decline in efficacy during the second year. Three-year data will be important to see if efficacy stabilizes or declines further. KEYWORDS: Dengue; TAK-003; efficacy; immunogenicity; persistence; safety; vaccine.
Pre natal diagnosis of congenital syphilis in a pregnancy complicated with secondary syphilis in third trimester: A Case Report
(Sri Lanka College of Obstetricians and Gynaecologists, 2015) Jayawardena, G.R.M.U.G P.; Ranatunga, R.G.J.D.; Gunarathna, S.M.S.G.; Wickramasinghe, P.; Dias, T.
Background: Early accurate estimation of gestational age is the most important intervention in pregnancy. Ultrasound between 11 and 13 weeks is most reliable in dating. There is no uniform policy in timing of dating scan in Sri Lanka. Objective: Aim of this study was to find out factors that determine the timely dating scan before 14 weeks in a district general hospital in Sri Lanka. Methods: This was a prospective observational study carried out at District General Hospital in Sri Lanka. A detail history was taken in order to ascertain age, parity, menstrual history, time taken to reach the hospital, distance to the hospital, level of education and gestation at the first booking visit with public health midwife (PMH). We offered dating scans for every pregnant mother before 14 weeks. Logistic regression analyses were performed to evaluate the association of socio-demographic factors and receiving timely dating scan before 14 Weeks. Results:A total 199 women were included for the analysis with a mean age of 26.98 years (SD 5.58). A 190 out of total recruitments (95.5%) were booked with PHM before 14 weeks. A total of 171 (86%) pregnant women received their first scan before 14 weeks. Logistic regression analysis demonstrated that only booking before 14 weeks with PMH (Odds ratio 12.272 (95% CI, 4.563-33.000) p<0.000) contributed significantly to receive dating scan before 14 weeks, while maternal age, parity, time taken to reach the hospital, distance to the hospital and mother’s level of education did not. Conclusion: Our study showed it is entirely possible to offer dating scan before 14 weeks even in a peripheral District General Hospital. Moreover, we demonstrated that none other than booking before 14 weeks was determined the dating scan prior to 14 weeks.
Prediction equation for physical activity energy expenditure in 11-13-year-old Sri Lankan children
(MDPI Publishing, 2023) Dabare, P.; Wickramasinghe, P.; Waidyatilaka, I.; Devi, S.; Kurpad, A.V.; Samaranayake, D.; de Lanerolle-Dias, M.; Wickremasinghe, R.; Hills, A.P.; Lanerolle, P.
This study aimed to develop a regression equation to predict physical activity energy expenditure (PAEE) using accelerometry. Children aged 11-13 years were recruited and randomly assigned to validation (n = 54) and cross-validation (n = 25) groups. The doubly labelled water (DLW) technique was used to assess energy expenditure and accelerometers were worn by participants across the same period. A preliminary equation was developed using stepwise multiple regression analysis with sex, height, weight, body mass index, fat-free mass, fat mass and counts per minute (CPM) as independent variables. Goodness-of-fit statistics were used to select the best prediction variables. The PRESS (predicted residual error sum of squares) statistical method was used to validate the final prediction equation. The preliminary equation was cross-validated on an independent group and no significant (p > 0.05) difference was observed in the PAEE estimated from the two methods. Independent variables of the final prediction equation (PAEE = [0.001CPM] - 0.112) accounted for 70.6% of the variance. The new equation developed to predict PAEE from accelerometry was found to be valid for use in Sri Lankan children.
School-based physical activity intervention in 11-13-year-olds: study protocol for cluster randomized controlled trial
(Medip Academy, 2019) Prasangi, M.; Dabare; Waidyatilaka, I.; Jayawardena, R.; Wickremasinghe, R.; Andrew, P.; Hills; Wickramasinghe, P.; Lanerolle, P.
Background: Targeted strategies to enhance regular physical activity appear to be promising to promote health and well-being of adolescents. This article reports the design of a cluster randomised controlled trial to evaluate the effectiveness of a school-based physical activity programme on the rate and duration of moderate-to-vigorous physical activity, sitting time including screen time, and health-related physical fitness parameters among 11-13 year-old adolescents. Methods: This is a cluster randomized controlled trial conducted in 360 adolescents from government schools in the Colombo Municipal Council area, Sri Lanka. An individual school was considered as a unit of randomization and the 12 selected schools were randomly assigned to one of two groups: control (six schools) and intervention groups (six schools). The intervention group follows a physical activity programme for 30 minutes on three school days per week, for three consecutive months in addition to the standard practice. The primary outcomes are moderate-to-vigorous physical activity rate and duration and sitting time including screen time. Secondary outcomes are the health-related physical fitness parameters: cardiovascular fitness, muscle fitness and flexibility, and body composition. All the outcomes are measured at baseline and three-months following the intervention. Discussion: The outcomes of this study will be an evidence-based intervention programme with the potential to be incorporated into the national education system thus promoting health and well-being of adolescents in Sri Lanka. Trial Registration: Registered at the Sri Lanka Clinical Trials Registry (SLCTR/2018/028). Keywords: Physical activity, Adolescents, Physical fitness, Moderate-to-vigorous physical activity
Three years efficacy and safety of Takeda's dengue vaccine candidate (TAK-003)
(Oxford University Press, 2022) Rivera, L.; Biswal, S.; Sáez-Llorens, X.; Reynales, H.; López-Medina, E.; Borja-Tabora, C.; Bravo, L.; Sirivichayakul, C.; Kosalaraksa, P.; Vargas, L.M.; Yu, D.; Watanaveeradej, V.; Espinoza, F.; Dietze, R.; Fernando, L.; Wickramasinghe, P.; Duarte Moreira, E. J.; Fernando, A. D.; Gunasekera, D.; Luz, K.; Venâncio da Cunha, R.; Rauscher, M.; Zent, O.; Liu, M.; Hoffman, E.; LeFevre, I.; Tricou, V.; Wallace, D.; Alera, M.T.; Borkowski, A.
Background: Takeda's live attenuated tetravalent dengue vaccine candidate (TAK-003) is under evaluation in a long-term clinical trial across eight dengue-endemic countries. Previously, we have reported its efficacy and safety in both seronegative and seropositive participants and that its performance varies by serotype, with some decline in efficacy from first to second year post-vaccination. This exploratory analysis provides an update with cumulative and third year data. Methods: Healthy 4-16 year-olds (n=20,099) were randomized 2:1 to receive TAK-003 or placebo (0, 3 month schedule). The protocol included baseline serostatus testing of all participants and detection of all symptomatic dengue throughout the trial with a serotype specific RT-PCR. Results: Cumulative efficacy after three years was 62.0% (95% confidence interval: 56.6%, 66.7%) against virologically-confirmed dengue (VCD) and 83.6% (76.8%, 88.4%) against hospitalized VCD. Efficacy was 54.3% (41.9%, 64.1%) against VCD and 77.1% (58.6%, 87.3%) against hospitalized VCD in baseline seronegatives, and 65.0% (58.9%, 70.1%) against VCD and 86.0% (78.4%, 91.0%) against hospitalized VCD in seropositives. Efficacy against VCD during the third year declined to 44.7% (32.5%, 54.7%), while efficacy against hospitalized VCD was sustained at 70.8% (49.6%, 83.0%). Rates of serious adverse events were 2.9% in TAK-003 group and 3.5% in placebo group during the ongoing long-term follow-up (i.e. second half of the three years following vaccination), but none were related. No important safety risks were identified. Conclusions: TAK-003 was efficacious against symptomatic dengue over three years. Efficacy declined over time but remained robust against hospitalized dengue. A booster dose evaluation is planned.
Validation of accelerometer-based energy expenditure equations using doubly-labelled water technique in 11-13 year-old Sri Lankan children
(Sri Lanka College of Paediatricians, 2021) Dabare, P.M.; Wickramasinghe, P.; Waidyatilaka, I.; Devi, S.; Kurpad, A.V.; Samaranayake, D.; de Lanerolle-Dias, M.; Wickremasinghe, R.; Hills, A.P.; Lanerolle, P.
INTRODUCTION: Accelerometer based prediction equations are used to calculate physical activity energy expenditure (PAEE) among children. Currently, accelerometer-derived PAEE prediction equations validated against a criterion method do not exist for Sri Lankan children. Objective: To assess the validity of published prediction equations to estimate PAEE in Sri Lankan children against the doubly labelled water (DLW) technique. Method: Ninety-six children aged 11-13 years from an urban area of Sri Lanka were included in the study. Energy expenditure was assessed using the DLW technique over 10 days and participants wore ActiGraph accelerometers during the same period. Correlation between the measured and predicted PAEE was assessed by the Pearson correlation coefficient. Validity of equations was assessed by the paired t-test and the level of agreement using the Bland Altman analysis. Results: Predicted PAEE values were significantly (p<0.05) correlated with the measured PAEE except for the equations of Treuth and Schmitz. Prediction equations of Ekelund, Freedson, Mattock and Zhu significantly overestimated measured PAEE (p<0.05) whereas, Trost and Puyau equations significantly underestimated PAEE. A wide limit of agreement with a large mean bias was observed in all estimated PAEE, except for the equation of Zhu. Conclusions: Existing accelerometer-based PAEE equations have low accuracy in predicting PAEE in Sri Lankan children.