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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Association of depression, anxiety and stress among outpatients with rheumatoid arthritis at a tertiary care hospital in Sri Lanka; a cross-sectional study(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Wijewantha, K.S.L.; Wijewardena, D.L.T.M.; Wijethunga, W.T.N.K.; de Silva, N.L.; Fernando, S.D.Introduction: Depression, anxiety and stress and their associated factors, in patients with rheumatoid arthritis, vary across regions. Sri Lankan studies assessing the prevalence and associations of these factors are lacking. Objectives: To describe the prevalence and factors associated with depression, anxiety and stress among patients with Rheumatoid arthritis at specialised Rheumatology clinics of the National Hospital Sri Lanka. Methods: A cross-sectional study was carried out at three rheumatology clinics at the National Hospital of Sri Lanka. Sociodemographic and clinical data including the Clinical Disease Activity Index (CDAI) was recorded using an interviewer-administered questionnaire. The validated Depression, Anxiety, Stress Scale-21 was used. Analysis was done using descriptive analysis and chi-square. Results: The prevalence of depression, anxiety and stress in the study cohort (n= 118) was 50.93%, 57.41% and 47.17% respectively. Majority of the patients were in the moderate (39%) and high disease activity groups (36%). Increased prevalence of all three was observed with reduced functional status. Depression was observed among those > 60 years (p=0.035) and with CDAI >22.1 (p=0.004). Anxiety was observed with increased CDAI >22.1 (p=0.023). Stress was associated with unemployment (p=0.009) and morning stiffness > 60 minutes (p=0.001). Diabetes (p=0.016), ischemic heart disease (p= 0.042) and dyslipidaemia (p=0.005) were adversely associated with depression. Anxiety was associated with dyslipidaemia (p=0.005). Conclusions: Prevalence of depression, anxiety and stress is high and interferes with the quality of life and disease prognosis. Disease activity, functional deterioration as well as the presence of co-morbidities are associated with these mental health issues.Item First report of V1016G and S989P knockdown resistant (kdr) mutations in pyrethroid-resistant Sri Lankan Aedes aegypti mosquitoes(BioMed Central, 2018) Fernando, S.D.; Hapugoda, M.; Perera, R.; Saavedra-Rodriguez, K.; Black WC 4th; de Silva, N.K.; ; ;BACKGROUND: Dengue is a serious arboviral disease in Sri Lanka with a large number of dengue fever (DF) cases every year. Control of the primary vector Aedes aegypti depends upon larval habitat source reduction and insecticide application. However, increases in the number of reported cases suggest the inefficiency of current control strategies and the possibility of resistance to currently used insecticides. Early detection of mutations in the voltage-gated sodium channel (vgsc) gene that confer knockdown resistance (kdr) to pyrethroid insecticides is important in resistance management in vector populations. RESULTS: Resistance to pyrethroid insecticides was detected in the three populations studied. Polymerase chain reaction was used to detect the presence of two kdr mutations F1534C and V1016G. During this process a S989P mutation was also detected in pyrethroid-resistant Ae. aegypti populations. These mutations were found to be widespread and frequent in the collections studied. CONCLUSIONS: To our knowledge, this study reveals for the first time the presence of V1016G and S989P mutant alleles in the vgsc of Sri Lankan Ae. aegypti populations. The spread of the mutant alleles throughout the country poses a threat of increased resistance to pyrethroids. Long-term insecticide applications and indiscriminate use of pyrethroids has led to the evolution of resistance. More strategic and diverse strategies, including novel insecticides with new modes of action and community participation, should be engaged for Ae. aegypti control.Item Should chemoprophylaxis be a main strategy for preventing re-introduction of malaria in highly receptive areas? Sri Lanka a case in point(BioMed Central, 2017) Wickremasinghe, A.R.; Wickremasinghe, R.; Herath, H.D.B.; Fernando, S.D.BACKGROUND: Imported malaria cases continue to be reported in Sri Lanka, which was declared 'malaria-free' by the World Health Organization in September 2016. Chemoprophylaxis, a recommended strategy for malaria prevention for visitors travelling to malaria-endemic countries from Sri Lanka is available free of charge. The strategy of providing chemoprophylaxis to visitors to a neighbouring malaria-endemic country within the perspective of a country that has successfully eliminated malaria but is highly receptive was assessed, taking Sri Lanka as a case in point. METHODS: The risk of a Sri Lankan national acquiring malaria during a visit to India, a malaria-endemic country, was calculated for the period 2008-2013. The cost of providing prophylaxis for Sri Lankan nationals travelling to India for 1, 2 and 4 weeks was estimated for that same period. RESULTS: The risk of a Sri Lankan traveller to India acquiring malaria ranged from 5.25 per 100,000 travellers in 2012 to 13.45 per 100,000 travellers in 2010. If 50% of cases were missed by the Sri Lankan healthcare system, then the risk of acquiring malaria in India among returning Sri Lankans would double. The 95% confidence intervals for both risks are small. As chloroquine is the chemoprophylactic drug recommended for travellers to India by the Anti Malaria Campaign of Sri Lanka, the costs of chemoprophylaxis for travellers for a 1-, 2- and 4-weeks stay in India on average are US$ 41,604, 48,538 and 62,407, respectively. If all Sri Lankan travellers to India are provided with chemoprophylaxis for four weeks, it will comprise 0.65% of the national malaria control programme budget. CONCLUSIONS: Based on the low risk of acquiring malaria among Sri Lankan travellers returning from India and the high receptivity in previously malarious areas of the country, chemoprophylaxis should not be considered a major strategy in the prevention of re-introduction. In areas with high receptivity, universal access to quality-assured diagnosis and treatment cannot be compromised at whatever cost.Item The need for preventive and curative services for malaria when the military is deployed in endemic overseas territories: a case study and lessons learned(BioMed Central, 2017) Fernando, S.D.; Booso, R.; Dharmawardena, P.; Harintheran, A.; Raviraj, K.; Rodrigo., C.; Danansuriya, M.; Wickremasinghe, A.R.BACKGROUND: Sri Lanka has been free from indigenous malaria since November 2012 and received the WHO certificate for malaria-free status in September 2016. Due to increased global travel, imported malaria cases continue to be reported in the country. Military personnel returning home from international peace-keeping missions in malaria endemic countries represent a key risk group in terms of imported malaria. The present study intended to characterize the potential causes of a malaria outbreak among the Sri Lankan security forces personnel deployed in the Central African Republic (CAR). METHODS: Data were collected from a cross-sectional survey distributed among Sri Lankan Air Force personnel who had returned from United Nations peace-keeping missions in the CAR region. A pre-tested questionnaire was used for the data collection, and focus group discussions were also conducted. RESULTS: One hundred twenty male Air Force personnel were interviewed (out of a group of 122 officers and airmen). All participants were deployed in the CAR for 14 months and were aware of the existence of chemoprophylaxis against malaria. The majority of the subjects (92.5%, 111/120) also knew that prophylaxis should be started prior to departure. However, the regular use of chemoprophylaxis was reported by only 61.7% (74/120) of the sample. Overall, 30.8% of the participants (37/120) had 44 symptomatic episodes of malaria during deployment, and one person succumbed to severe malaria. All cases were associated with noncompliance with chemoprophylaxis. CONCLUSION: Better coordination with overseas healthcare services and the establishment of directly observed chemoprophylaxis may help to avoid similar outbreaks in the future.Item Contribution of the private sector healthcare service providers to malaria diagnosis in a prevention of re-introduction setting(BioMed Central, 2016) Fernando, S.D.; Dharmawardena, P.; Epasinghe, G.; Senanayake, N.; Rodrigo, C.; Premaratna, R.; Wickremasinghe, R.BACKGROUND: Sri Lanka is currently in the prevention of re-introduction phase of malaria. The engagement of the private sector health care institutions in malaria surveillance is important. The purpose of the study was to determine the number of diagnostic tests carried out, the number of positive cases identified and the referral system for diagnosis in the private sector and to estimate the costs involved. METHODS: This prospective study of private sector laboratories within the Colombo District of Sri Lanka was carried out over a 6-month period in 2015. The management of registered private sector laboratories was contacted individually and the purpose of the study was explained. A reporting format was developed and introduced for monthly reporting. RESULTS: Forty-one laboratories were eligible to be included in the study and 28 participated by reporting data on a monthly basis. Excluding blood bank samples and routine testing for foreign employment, malaria diagnostic tests were carried out on 973 individuals during the 6-month period and nine malaria cases were identified. In 2015, a total of 36 malaria cases were reported from Sri Lanka. Of these, 24 (67 %) were diagnosed in the Colombo District and 50 % of them were diagnosed in private hospitals. CONCLUSIONS: An equal number of cases were diagnosed from the private sector and government sector in the Colombo District in 2015. The private sector being a major contributor in the detection of imported malaria cases in the country should be actively engaged in the national malaria surveillance system.Item Climate change and malaria(United Nations Publications, 2010) Wickremasinghe, R.; Wickremasinghe, A.R.; Fernando, S.D.