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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Breeding habitat distribution of medically important mosquitoes in Kurunegala, Gampaha, Kegalle, and Kandy districts of Sri Lanka and potential risk for disease transmission: A Cross-sectional study(Hindawi Pub. Corp., 2020) Ranasinghe, K.; Gunathilaka, N.; Amarasinghe, D.; Udayanga, L.ABSTRACT: Some arbovirus infections, especially dengue, have increased rapidly over the last few decades in Sri Lanka. Prevalence and distribution of different mosquito species have been limitedly documented, which remains grossly inadequate in providing evidence for potential health risks. In this study, the diversity and species composition of mosquitoes in four selected districts in Sri Lanka (Kurunegala, Gampaha, Kegalle, and Kandy) were investigated. Entomological surveys were conducted from a total of 160 temporary and permanent mosquito breeding habitats identified in the study area from June 2017 to October 2018. Mosquito immature stages were sampled using standard dipping, siphoning, or pipetting methods and identified up to the species level. Percentage relative abundance and habitat characteristics such as species richness, dominance, and Shannon-Weiner diversity were calculated for each surveyed habitat type. Associations between co-occurring species were estimated by Hulbert's coefficient of interspecific association (C8). A total of 4663 mosquito larvae belonging to seven genera and fifteen species of mosquitoes were collected. The relative distribution of mosquito species differed significantly among the four studied districts (X 2 = 143.248; df = 33; P < 0.001). According to Kruskal-Wallis statistics (P < 0.05 at 95% of significance), all diversity indices for immature stages of medically important mosquitoes varied significantly across different breeding sites. Paddy fields had the significantly highest species richness of 4.0 ± 2.82. The coefficients of interspecific association among all the recorded medically important vector mosquitoes were found negative during the present study. The findings of the current study would be useful to identify the entomological potential for disease transmission and facilitate the implementation of appropriate vector control interventions. This would ultimately provide an avenue to improve the personal skills of health staff rather than limiting their knowledge to specified disease vectors, under which the control program is concerned.Item Histopathology of cutaneous leishmaniasis caused by Leishmania donovani in Sri Lanka.(Hindawi Pub. Co., 2020) Wijesinghe, H.; Gunathilaka, N.; Semege, S.; Pathirana, N.; Manamperi, N.; de Silva, C.; Fernando, D.ABSTRACT: Cutaneous leishmaniasis (CL) is a neglected tropical disease that is gaining importance in Sri Lanka and internationally. The clinical presentation, pathology, and method of parasite elimination in CL vary according to the species. Leishmania donovani is the causative organism for leishmaniasis in Sri Lanka. This collaborative cross-sectional study describes the clinicopathological features of cutaneous leishmaniasis among personnel of the tri-forces serving in the North and East of the country. The histology of fifty cases of CL confirmed by at least two methods (slit skin smear, lesion aspirate, tissue impression, and histology) was reviewed. The parasitic load was assessed semiquantitatively. The histological features were correlated with the clinical presentation and organism load. The majority (89.8%; n = 44) presented with a single lesion mostly located in the upper limb (69.4%). The lesion types included papule (34.7%), nodule (32.7%), and an ulcer (30.6%). The evolution time of lesions averaged 31.55 weeks. Epidermal changes were observed in 49 of the biopsies and included hyperkeratosis (90.0%; n = 45), acanthosis (44.0%; n = 22), atrophy (34.0%; n = 17), and interface change (66%; n = 33). Dermal changes were seen in all cases and were characterized by a lymphohistioplasmacytic inflammatory infiltrate of variable intensity with ill-formed granuloma in 19 cases (38%) and well-formed epithelioid granulomas in 22 cases (44%). Focal necrosis was present in 20% (n = 10). Leishmania amastigote forms were observed in 88% (n = 44). Transepidermal elimination (P = 0.025), granuloma (P = 0.027) formation, and type of lesion (P = 0.034) were significantly associated with the organism load. Granuloma formation was associated with a reduction in organism load, indicating that the macrophage activation played an important role in the control of the organism.Item Prevalence of cutaneous leishmaniasis infection and clinico-epidemiological patterns among military personnel in Mullaitivu and Kilinochchi districts of the Northern Province, early war-torn areas in Sri Lanka.(BioMed Central, 2020) Gunathilaka, N.; Semege, S.; Pathirana, N.; Manamperi, N.; Udayanga, L.; Wijesinghe, H.; Premaratne, P.; Fernando, D.BACKGROUND: The 30-year-old armed conflict in Sri Lanka resulted in a general breakdown of civil administration in the Northern and Eastern provinces, leading to mobilisation of many armed forces personnel to assist with reconstruction and resettlement. This occupational group has been identified as a priority risk group for leishmaniasis. METHODS: Individuals enlisted at all military establishments in Mullaitivu and Kilinochchi districts, Northern Province of Sri Lanka were included. Five thousand individuals were screened for skin lesions between September 2018 and August 2019. Persons with lesions suspected as cutaneous leishmaniasis (CL) were further investigated. Information on sociodemographic/other potential risk factors was obtained through an interviewer-administered structured questionnaire. The diagnosis was confirmed by microscopic visualization of parasitic stages from different samples obtained (skin scraping, lesion aspirate and tissue impression smears), histopathology and polymerase chain reaction DNA amplification. RESULTS: Among 5000 individuals screened, 74 individuals were suspected of having CL. Of these, 67.6% (n = 50) patients were confirmed for CL by microscopy. Around two third of both males (67.6%; n = 48) and females (66.6%; n = 2) were positive for Leishmania. The soldiers belonging to 26-35-year age group reported the highest susceptibility (83.3%; OR: 4.83, 95% CI: 3.49-6.20%). Of the sociodemographic factors, age, wearing short-sleeved upper body clothing as the uniform and non-use of insect repellents were identified as significant risk factors. Most of the CL patients had a single lesion (86.0%; n = 43) of an ulcerative type (34.0%; n = 17), mostly on their upper limb (67.9%; n = 34). Lesions were mostly 5-10 mm diameter (59.9%; n = 30) in size with poorly defined margins (72.0%; n = 36). Amongst the diagnostic techniques, microscopic examination of slit skin smear and tissue impression smear were able to discriminate the majority of patients (92.1%; n = 46) for CL. CONCLUSIONS: In order to highlight the true burden of leishmaniasis in the military personnel, cases of leishmaniasis from military institutes should be recognized as a different entity per say and be included in the national figures so as to depict the real magnitude of the disease burden amongst this high-risk group. KEYWORDS: Clinical; Cutaneous leishmaniasis; Epidemiological; War-torn areas.Item Assessment of anxiety, depression, stress, and associated psychological morbidities among patients receiving ayurvedic treatment for different health Issues: first study from Sri Lanka.(Hindawi Pub. Co., 2019) Gunathilaka, H.J.; Vitharana, P.; Udayanga, L.; Gunathilaka, N.BACKGROUND:Good mental condition is a vital part of health. Physical impairments would potentially have psychiatric manifestations during the course of a disease that could cause patients to experience a wide range of psychological conditions. This study was conducted to determine prevalence of anxiety, depression, stress, and psychological morbidities among the patients who received warded treatments at Gampaha Wickramarachchi Ayurveda Teaching Hospital, Sri Lanka. METHODS: A total of 148 patients admitted to the hospital were selected for the study on a random systematic basis under four systemic groups (gastrointestinal, integumentary, musculoskeletal, and nervous system) depending on the chief complaint. The presence of depressive, anxiety, and stress symptoms was assessed by the Depression Anxiety Stress Scale 21 item version (DASS 21). The General Linear Model (GLM) was used for statistical analysis. RESULTS:Over 50% of the participants in all four patient groups belonged to age group of 35 to 65 years, encompassing the fraction of population that actively contribute to the workforce in the society. Stress, anxiety, and depression values of patients belonging to different complications varied significantly, as indicated by GLM (p < 0.05). Patients diagnosed with integumentary system-related issues denoted the highest stress levels (27.7 ± 2.54), while the mean stress values among the other systemic groups were not significantly different among each other. The highest anxiety levels were indicated by patients with nervous system-related issues (18.6 ± 1.51), while the lowest anxiety levels were indicated by patients with integumentary disorders (6.0 ± 2.73). The highest depression level was identified from patients suffering from integumentary system-related disorders (31.7 ± 3.42), followed by nervous system (23.2 ± 1.78), gastrointestinal (19.5 ± 3.77), and musculoskeletal (16.8 ± 1.57) disorders. CONCLUSION:Overall, high distress levels were observed among the majority of the patients. Furthermore, integumentary issues may lead to significant psychological impacts. As most of the patients seek for Ayurveda treatments when their diseased condition becomes chronic, it is vital to focus on a biopsychosocial approach to patient assessment and patient care, in actual practice.Item Comprehensive evaluation of demographic, socio-economic and other associated risk factors affecting the occurrence of dengue incidence among Colombo and Kandy Districts of Sri Lanka: a cross-sectional study(BioMed Central, 2018) Udayanga, L.; Gunathilaka, N.; Iqbal, M.C.M.; Lakmal, K.; Amarasinghe, U.S.; Abeyewickreme, W.BACKGROUND: Comprehensive understanding of risk factors related to socio-economic and demographic status and knowledge, attitudes and practices (KAP) of local communities play a key role in the design and implementation of community-based vector management programmes, along with the identification of gaps in existing control activities. METHODS: A total of 10 Medical Officers of Health (MOH) areas recording high dengue incidence over the last five years were selected from Colombo (n = 5) and Kandy (n = 5) Districts, Sri Lanka. From each MOH area, 200 houses reporting past dengue incidence were selected randomly as test group (n = 1000 for each district) based on the dengue case records available at relevant MOH offices. Information on socio-economic and demographic status and knowledge, attitudes and practices were gathered using an interviewer administered questionnaire. The control group contained 200 households from each MOH area that had not reported any dengue case and the same questionnaire was used for the assessment (n = 1000 for each district). Statistical comparisons between the test and control groups were carried out using the Chi-square test of independence, cluster analysis, analysis of similarities (ANOSIM) and multi-dimensional scaling (MDS) analysis. RESULTS: Significant differences among the test and control groups in terms of basic demographic and socio-economic factors, living standards, knowledge, attitude and practices, were recognized (P < 0.05 at 95% level of confidence). The test group indicated similar risk factors, while the control group also shared more or less similar characteristics as depicted by the findings of cluster analysis and ANOSIM. Findings of the present study highlight the importance of further improvement in community education, motivation and communication gaps, proper coordination and integration of control programmes with relevant entities. Key infrastructural risk factors such as urbanization and waste collection, should be further improved, while vector controlling entities should focus more on the actual conditions represented by the public on knowledge, attitudes and personal protective practices. CONCLUSIONS: The design of flexible and community friendly intervention programmes to ensure the efficacy and sustainability of controlling dengue vectors through community based integrated vector management strategies, is recommended.Item Socio-economic, Knowledge Attitude Practices (KAP), household related and demographic based appearance of non-dengue infected individuals in high dengue risk areas of Kandy District, Sri Lanka(BioMed Central, 2018) Udayanga, L.; Gunathilaka, N.; Iqubal, M.C.M.; Pahalagedara, K.; Amarasinghe, U.S.; Abeyewickreme, W.BACKGROUND: Socio-economic, demographic factors and Knowledge Attitude Practices (KAPs) have been recognized as critical factors that influence the incidence and transmission of dengue epidemics. However, studies that characterize above features of a risk free or low risk population are rare. Therefore, the present study was conducted to characterize the household related, demographic, socio-economic factors and KAPs status of five selected dengue free communities. METHOD: An analytical cross-sectional survey was conducted on selected demographic, socio-economic, household related and KAPs in five selected dengue free communities living in dengue risk areas within Kandy District, Central Province, Sri Lanka. Household heads of 1000 randomly selected houses were interviewed in this study. Chi-square test for independence, cluster analysis and Principal Coordinates (PCO) analysis were used for data analysis. RESULTS: Knowledge and awareness regarding dengue, (prevention of the vector breeding, bites of mosquitoes, disease symptoms and waste management) and attitudes of the community (towards home gardening, composting, waste management and maintenance of a clean and dengue free environment) are associated with the dengue free status of the study populations. CONCLUSIONS: The vector controlling authorities should focus on socio-economic, demographic and KAPs in stimulating the community to cooperate in the integrated vector management strategies to improve vector control and reduce transmission of dengue within Kandy District.