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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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.Item Prevalence and correlates of postpartum depression in the puttalam district(Sri Lanka College of Obstetricians and Gynaecologists, 2004) Rowel, D.D.S.; Jayawardena, P.L.; Fernando, N.OBJECTIVES: To study the prevalence and the correlates of postpartum depression. METHODOLOGY: This was a community based prospective study, carried out in the District of Puttalam during the period of October 2003 to April 2004. The sample size computed was 1100. The validated Sinhala translation of the Edinburgh Postnatal Depression Scale (EPDS) was used to determine the prevalence of postpartum depression, at 6 weeks postpartum at home, where the cut off for depression was determined to be 9/10. In addition, the questionnaires on socio demographic data and reproductive health, the Maternity Social Support Scale, the Abuse Assessment Questionnaire, the Modified Life Events Inventory and the questionnaire on delivery and the index child were administered to identify the independent variables associated with postpartum depression. Multivariate logistic regression analysis was carried out and the results are expressed as Odds Ratios (OR) and 95% Confidence Intervals (95% CI). RESULTS: The prevalence of postpartum depression in the district of Puttalam was 32.1%. From multivariate analysis, unplanned pregnancy (OR=1.6; 95% CI= 1.1-2.3) , conflicts with the husband (OR=1.5; 95% CI= 1.1-2.0), physical abuse during pregnancy (OR=5-2; 95% CI= 1.6-16.1), death of a close friend (OR=2.2; 95% CI= 1.3-3.7), use of harsh words by the husband (OR=2.1; 95% CI= 1.2-3.1), normal vaginal delivery (OR=1.7; 95% CI= 1.1-2.6), low birth weight of the baby (OR=1.6; 95% CI= 1.01-2.4), illness in the baby (OR=2.1;95%CI= 1.2-3.4) and poor sleeping pattern of the baby at night (OR=1.6; 95% CI= 1.1-2.2), were the factors found to be significantly associated with postpartum depression. CONCLUSIONS: Postpartum depression which had a prevalence of 32.1% is considered a major public health problem in Sri Lanka. Therefore it is important to address the factors found to be associated with it, because of its negative impact on the mother, the child and the family.Item 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.Item 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.Item 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.Item 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.Item Validation of the Sinhala translation of the Edinburgh Postnatal Depression Scale(Sri Lanka Medical Association, 2005) Rowel, D.D.S.; Jayawardena, P.L.; Fernando, N.OBJECTIVE: To validate the Sinhala translation of Edinburgh Postnatal Depression Scale (EPDS) to detect depression in antenatal and postnatal mothers. METHODOLOGY: Content validity of EPDS was checked by a panel of experts. Translation of the English questionnaire by bilingual experts to Sinhala by 'translation back translation1 method followed. Thereafter alternate form reliability of the instrument was checked. Criterion validity of the instrument was assessed against a 'gold standard', which was the clinical diagnosis by a consultant psychiatrist based on ICD 10 Research Diagnostic Criteria. This was done in field combine clinics of Medical Officer of Health area Kolonnawa. The antenatal mothers completing 34 weeks of period of amenorrhea and postnatal mothers 6 weeks after partus were administered the EPDS followed by the clinical psychiatric interview. The cut off scores for EPDS to identify depression in antenatal and postnatal mothers were determined using the Receiver Operator Characteristic (ROC) curves. RESULTS: The cut off score of 9/10 (sensitivity of 90.7% and a specificity of 86.8%) was the best cut off to screen for depression in antenatal mothers. In postnatal mothers a cut off score of 9/10 (sensitivity of 89.9% and a specificity of 78,9%) was the best cut off score to screen for postpartum depression.CONCLUSION: Sinhala translation of EPDS is a reliable and a valid instrument to detect depression in antenatal and postnatal mothers in Sri Lanka.Item Validation of the Sinhala translation of Edinburgh Postnatal Depression Scale(Sri Lanka Medical Association, 2008) Rowel, D.; Jayawardana, P.; Fernando, N.INTRODUCTION:To determine the validity and reliability of the Sinhalese translation of the Edinburgh Postnatal Depression Scale (EPDS) as a screening instrument to detect antenatal and postnatal depression. METHOD: Two hundred and sixty five antenatal women and 204 postnatal women attending the field polyclinics of the Medical Officer of Health (MOH) area Kolonnawa participated in the study. Psychiatric diagnosis based on ICD 10 Classification of Mental and Behavioural Disorders was the 'gold standard' and the receiver operating characteristic (ROC) analysis was used to evaluate the test performance of the translated EPDS for antenatal and postnatal depression separately. Reliability was tested using test-retest method and computing intra-class correlation coefficients. RESULTS: A cut-off score of 9 was selected as the best to screen for depression, in antenatal (sensitivity 90.7% and specificity 86.8%) andpostnatal women (sensitivity 89.9% and specificity 78.9%). The intra-class correlation coefficients of the instrument for antenatal and postnatal women were 0.95 (95% CI = 0.82 - 0.99) and 0.96 (95% CI = 0.86 - 0.99). CONCLUSION: The Sinhalese translation of the EPDS is a valid and a reliable instrument to screen for depression in antenatal and postnatal women in Sri Lanka.