Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Evaluation of an In-House genetic testing method for confirming Prader-Willi and Angelman Syndromes in Sri Lanka(Clinical Laboratory Publications, 2024) Kugalingam, N.; De Silva, D.; Rathnayake, P.; Atapattu, N.; Ranaweera, D.M.; Chandrasekharan, N.V.BACKGROUND Prader-Willi syndrome (PWS, MIM 176,270) and Angelman syndrome (AS, MIM 105,830) are caused by imprinting defects of chromosome 15q11-13, with loss of maternal gene expression causing AS and paternal gene expression causing PWS. The diagnosis, once established in most cases by using a methylation-specific PCR test, enables appropriate therapeutic interventions and avoids the need for further investigations. Genetic testing for PWS/AS is limited in Sri Lanka (and in other low- and middle-income countries), mainly because parents are unable to pay for testing as these are not funded by the health service.METHODS Ninety cases (46 female) with clinical features suggesting PWS (n = 37) and AS (n = 53), referred by a pediatric endocrinologist and a pediatric neurologist, were recruited. Clinical information and blood samples were obtained following informed consent. DNA was extracted and methylation-specific PCR (MS-PCR) was performed following bisulfite modification of DNA by using an in-house method and a kit. Results were validated using known positive controls. Parent-child trio DNA samples were used in cases with confirmed PWS and AS to determine if the disease was due to a deletion or uniparental disomy. The cost of the MS-PCR testing of the two modification methods and the microsatellite analysis was determined.RESULTS Among the suspected PWS cases, 19/37 were positive, while 5/53 of the suspected AS cases were positive. The lower identification rate of AS is probably related to the overlap of clinical features of this condition with other disorders. The kit-based modification method was more reliable, less time-consuming, and cost-effective in our laboratory.CONCLUSIONS The kit-based modification followed by MS-PCR described in this study enables more affordable genetic testing of suspected PWS/AS cases, and this is likely to improve patient care by targeting appropriate therapy for the affected cases. Parental genetic counselling is made possible regarding the low recurrence risk, especially where a deletion or uniparental disomy is confirmed. In MS-PCR, negative cases with a strong clinical suspicion of AS, UBE3A mutation testing is required. In addition, imprinting center mutation/deletion testing may also be needed in strongly clinically suspected, MS-PCR negative PWS and AS cases.Item Functional analysis of a novel parasitic nematode-specific protein of Setaria digitata larvae in Culex quinquefasciatus by siRNA mediated RNA interference(BioMed Central, 2018) Somarathne, M.B.C.L.; Gunawardene, Y.I.N.S.; Chandrasekharan, N.V.; Ellepola, A.N.B.; Dassanayake, R.S.BACKGROUND: Functional analysis of animal parasitic nematode genes is often quite challenging due to the unavailability of standardised in vitro culture conditions and lack of adequate tools to manipulate these genes. Therefore, this study was undertaken to investigate the suitability of Culex quinquefasciatus, as an in vivo culture platform for Setaria digitata larvae and RNA interference (RNAi), as a post-transcriptional gene silencing tool to study the roles of a vital gene that encodes a novel parasitic nematode-specific protein (SDNP). RESULTS: The red colour fluorescence detected following RNAi injection to the thorax of C. quinquefasciatus indicated the uptake of dsRNA by S. digitata larvae. The reduction of SDNP transcripts in siRNA treated larvae compared to non-treated larvae, as determined by qPCR, indicated that the siRNA pathway is operational in S. digitata larvae. The observation of motility reductions and deformities during the development indicated the association of SDNP in larvae locomotion and development processes, respectively. The irregularities in the migration of larvae in mosquitoes and elevated survival rates of mosquitoes compared to their untreated counterparts indicated reduced parasitism of S. digitata larvae in mosquitoes upon targeted downregulation of SDNP by siRNA treatment. CONCLUSION: SDNP plays vital roles in muscle contraction, locomotion, development processes, larval development and parasitism of S. digitata. Its ubiquitous presence in parasitic nematodes and its absence in their hosts provide a tantalising prospect of the possibility of targeting SDNP for future development of anthelmintic drugs. The susceptibility of the larval stages of S. digitata for RNAi in Culex quinquefasciatus was also demonstrated for the first time in this study.Item Identification of cattle, buffaloes and rodents as reservoir animals of Leptospira in the District of Gampaha, Sri Lanka(Biomed Central, 2017) Denipitiya, D.T.H.; Chandrasekharan, N.V.; Abeyewickreme, W.; Hartskeerl, R.A.; Hapugoda, M.D.BACKGROUND: Leptospirosis is an important emerging infectious disease in Sri Lanka. Rats are the most important reservoir of Leptospira but domestic and wild mammals may also act as important maintenance or accidental hosts. In Sri Lanka, knowledge of reservoir animals of leptospires is poor. The objective of this study was to identify potential reservoir animals of Leptospira in the District of Gampaha, Sri Lanka. FINDINGS: Blood and kidney samples were collected from 38 rodents and mid-stream urine samples were randomly collected from 45 cattle and five buffaloes in the District of Gampaha. Kidney and urine samples were tested by real-time polymerase chain reaction (PCR) and serum samples were tested by the microscopic agglutination test (MAT). Of the 38 rodent kidney samples, 11% (4/38) were positive by real-time PCR. The prevalence of leptospiral carriage was 11% (3/26) and 8% (1/12) in female and male rodents, respectively. Three rodent serum samples were positive by MAT. Of the 50 cattle/buffalo urine samples tested, 10% (5/50) were positive by real-time PCR. The prevalence of leptospiral carriage was 9% (4/45) and 20% (1/5) in cattle and buffaloes, respectively. CONCLUSION: Results of PCR and MAT showed that Leptospira were present in a significant proportion of the rodents and farm animals tested in this study and suggest that these (semi-) domestic animals form an infection reservoir for Leptospira. Therefore, there is a potential zoonotic risk to public health, most notably to farmers in this area.Item Evaluation of a case definition for leptospirosis diagnosis using serological assays(Sri Lanka Association for the Advancement of Science, 2013) Denipitiya, D.T.H.; Jiffriy, A.M.; Chandrasekharan, N.V.; Abeyewickreme, W.; Hapugoda, M.D.Item Detection of pathogenic Leptospira species in rat blood samples by molecular-based assays(University of Kelaniya, 2013) Denipitiya, D.T.H.; Chandrasekharan, N.V.; Abeyewickreme, W.; Hapugoda, M.D.Background: Leptospirosis is a worldwide zoonotic infection, caused by pathogenic species of the genus Leptospira. It was traditionally known as ‘rat fever’ in Sri Lanka, because rodents, especially rats, are considered to be the most important reservoirs or maintenance hosts of Leptospira. In 2012, the highest numbers of cases were reported in the District of Gampaha. The objective of this study is to detect pathogenic Leptospira species in rat blood samples by molecular based assays. Method: Rats (n=38) were trapped in a high risk area (Mirigama) in the District of Gampaha, from May 2012 to February 2013 by using live traps. Each rat was anesthetized by using diethyl ether and 2-3 ml sample of blood was collected from each rat. Blood samples collected from all rats were tested by molecular- based assays and a serological assay. Qualitative Polymerase Chain Reaction (PCR), real time PCR and Loop Mediated Isothermal Amplification (LAMP) were used as molecular-based assays which targetted conserved gene regions among pathogenic serovars of Leptospira species. Microscopic Agglutination Test (MAT), the Gold Standard assay for detection of anti Leptospira antibody was used as a serological assay. Results and Discussion: Of the 38 rat blood samples, molecular-based assays confirmed Leptospira infection in 5% (2/38), 16% (6/38) and 11% (4/38) by qualitative PCR, real time PCR and LAMP assay respectively. None of the samples was positive by MAT. After first infection, some Leptospira species live in the host animal as commensal bacteria. Therefore, host does not stimulate antibody production further and that may be below the detection level of the antibody by MAT. Conclusions: Results of molecular based assays showed that Leptospira are circulating among the rats tested in this study, although at the time of collection, their antibody levels were too low to detect by MAT, which had the lowest detection limit of 1:800.Item Risk factors associated with human leptospirosis in the District of Gampaha, Sri Lanka(University of Kelaniya, 2013) Denipitiya, D.T.H.; Athapaththu, M.; Chandrasekharan, N.V.; Abeyewickreme, W.; Hapugoda, M.D.Background & Objective: A large number of leptospirosis cases are recorded in Sri Lanka every year. Increased numbers of cases have been reported in the District of Gampaha in the recent past. The incidence of leptospirosis is often influenced by various socio-economic, occupational, environmental and other factors. To date, a study on potential risk factors has not been conducted in the District of Gampaha. The objective of this study is to identify risk factors involved in transmission of leptospirosis to humans in the District of Gampaha. Methods: Data were collected at the household level, using an interviewer-administered questionnaire and by inspecting the surrounding of laboratory confirmed leptospirosis patients (n=81) and non leptospirosis persons (n=117) during the period of June 2011 to June 2013. The risk factors in the questionnaire were divided into three broad categories: environmental, contact with animals and behavioral/occupational factors. Chi-square test (The SAS System for Windows 9.0) was used for comparison of data from different categories. Results and discussion: 95% of the leptospirosis patients were adult males (77/81) and they had a monthly income of Rs. 10,001-20,000 and 50% of them were agricultural and rental work labourers (40/81). In contrast, 56% of persons not infected with leptospirosis were adult females (66/117) and most of them (48%) were housewives or homemakers (56/117). Data on the type of premises were collected under three categories as poor, moderate and well constructed along with the land use type of the surrounding areas. There were significant statistical associations between the leptospirosis patient with the type of premises (, χ2=23.38, p=0.00), surrounding cleanliness of premises (χ2=45.05, p=0.00), sanitary facilities (χ2=11.66, p=0.00), waste disposal method (χ2=32.23, p=0.00) and age level of patients (χ2=21.07, p=0.00). No significant statistical associations were observed between recorded leptospirosis cases and vegetation coverage in surrounding area of premises (χ2=1.25, p>0.05), source of drinking water (χ2= 0.55, p>0.05) and numbers of persons in family (χ2=0.17, p>0.05). Conclusion: Identification of the potential risk factors would help understand the transmission dynamics of the disease and formulate public health interventions.Item Identification of cattle/buffalo and rats as reservoir animals of pathogenic Leptospires in the Gampaha district(Sri Lanka Association for the Advancement of Science, 2014) Denipitiya, D.T.H.; Chandrasekharan, N.V.; Abeyewickreme, W.; Hapugoda, M.D.