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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Occurrence of major and potential malaria vector immature stages in different breeding habitats and associated biotic and abiotic characters in the district of Trincomalee Sri Lanka(New Delhi : National Institute of Malaria Research, 2020) Ranathunge, R.M.T.B.; Kannangara, D.N.; Gunathilaka, P.A.D.H.N.; Abeyewickreme, W.; Hapugoda, M.D.BACKGROUND & OBJECTIVES: Understanding the effect of biotic and abiotic factors on the biology and ecology of immature stages of anopheline larvae is very important in controlling malaria vector mosquitoes. Therefore, this study was focused on the monitoring of ecological factors affecting the distribution, dynamics, and density of malaria vector mosquitoes in the District of Trincomalee, Sri Lanka. METHODS: Permanent and temporary breeding habitats were identified and selected from five possible malaria sensitive sites in the district of Trincomalee. Anopheles larvae and macro-invertebrates were collected using standard methods for 16 months (from October 2013 to January 2015) and they were identified microscopically. Eight physico-chemical parameters of the breeding habitats were measured. RESULTS: Overall, a total of 4815 anopheline larvae belonging to 13 species were collected from 3,12,764 dips from 18 permanent and temporary breeding habitats. The abundance of anopheline larvae showed a significant positive correlation (p <0.05) with physico-chemical parameters in breeding habitats, such as temperature, dissolved oxygen, and turbidity. A total of 35 macro-invertebrate taxa were collected from the anopheline mosquito breeding habitats. INTERPRETATION & CONCLUSION: This study represents the first systematic update of water quality parameters, macro-invertebrate communities associated with Anopheles mosquito oviposition sites in the District of Trincomalee, Sri Lanka. Rainfall intensity and wind speed are critical meteorological factors for the distribution and abundance of malaria vectors. Knowledge generated on the ecology of Anopheles mosquitoes will help to eliminate malaria vectors in the country. KEYWORDS: Macro-invertebrates; Sri Lanka; malaria vectors; physico-chemical parameters.Item Multivariate spatio-temporal approach to identify vulnerable localities in dengue risk areas using Geographic Information System (GIS)(Nature Publishing Group, 2021) Withanage, G.P.; Gunawardana, M.; Viswakula, S.D.; Samaraweera, K.; Gunawardene, N.S.; Hapugoda, M.D.ABSTRACT: Dengue is one of the most important vector-borne infection in Sri Lanka currently leading to vast economic and social burden. Neither a vaccine nor drug is still not being practiced, vector controlling is the best approach to control disease transmission in the country. Therefore, early warning systems are imminent requirement. The aim of the study was to develop Geographic Information System (GIS)-based multivariate analysis model to detect risk hotspots of dengue in the Gampaha District, Sri Lanka to control diseases transmission. A risk model and spatial Poisson point process model were developed using separate layers for patient incidence locations, positive breeding containers, roads, total buildings, public places, land use maps and elevation in four high risk areas in the district. Spatial correlations of each study layer with patient incidences was identified using Kernel density and Euclidean distance functions with minimum allowed distance parameter. Output files of risk model indicate that high risk localities are in close proximity to roads and coincide with vegetation coverage while the Poisson model highlighted the proximity of high intensity localities to public places and possibility of artificial reservoirs of dengue. The latter model further indicate that clustering of dengue cases in a radius of approximately 150 m in high risk areas indicating areas need intensive attention in future vector surveillances.Item Use of novaluron-based autocidal gravid ovitraps to control Aedes dengue vector mosquitoes in the district of Gampaha, Sri Lanka(Hindawi Pub. Co., 2020) Withanage, G.P.; Viswakula, S.D.; Gunawardene, Y.I.N.S.; Hapugoda, M.D.ABSTRACT:Dengue is the most important mosquito-borne viral infection in Sri Lanka causing an enormous social and economic burden in the country. In the absence of therapeutic drugs and the developed vaccines are under investigation, vector control is the best strategy to reduce the disease transmission. Therefore, the development of novel tools to control dengue vector mosquitoes has become the need of the hour. Novaluron is a recently developed Insect Growth Regulator (IGR) which inhibits chitin synthesis in immature stages of insects. The aim of the study was to identify the efficacy of a simple and cost-effective Autocidal Gravid Ovitrap (AGO) developed using Novaluron to control dengue outbreaks in the District of Gampaha, Sri Lanka. Laboratory and semifield experiments were performed to identify the activity range, optimum field dosage, and residual effects of Novaluron following the World Health Organization guidelines, and field experiments were performed in the Ragama Medical Officer of Health (MOH) area. Two study areas 800 m apart were selected and assigned as treated and control areas randomly. In each study area, 30 households were selected randomly. Each household was given two ovitraps, one placed indoors and the other placed outdoors. Mortality and survival counts were recorded separately for one-year time period and data were analyzed using a two-way repeated measures analysis of variance model. During the laboratory experiments, the adult emerging inhibition was 100% in all tested concentrations. The optimum field dosage was 2 ppm and the residual effect was 28 days. In the field experiments, significantly higher mortality counts were recorded in treated areas both indoor- and outdoor-placed AGOs. Two-factor repeated measures ANOVA followed by Tukey's test confirmed that the mean mortality count is high for the developed AGOs both indoor and outdoor settings. The developed AGO can be deployed to control both indoor and outdoor dengue vector mosquito populations, and in dengue-risk areas, the ovitrap will be supportive to local health authorities to enhance the efficiency of future vector control programs.Item Detection of Dengue Viral Migration to Sri Lanka(19th Conference on Postgraduate Research, International Postgraduate Research Conference 2018, Faculty of Graduate Studies,University of Kelaniya, Sri Lanka, 2018) Withanage, G.P.; Hapuarachchi, H.C.; Gunawardene, Y.I.N.S.; Hapugoda, M.D.Dengue is one of the most important mosquito-borne viral infectionsin Sri Lanka.The causative agent is Dengue Viruses (DENV) and the primary vector of the virus is Aedesaegypti(Linnaeus) while Ae. albopictus (Skuse) is the subsidiary vector. The current research was focused on the detection of DENV serotypes and genotypes circulating in mosquitoes during the dengue epidemic in June and July, 2017 in the EriyawetiyaGramaNiladhari division, where one of the dengue high-risk area in Kelaniya Medical Officer of Health (MOH) area in the District of Gampaha, Sri Lanka. Aedesmosquitoes were collected following WHO guidelinesandthe field-caught mosquitoes were transported to the laboratory for species identification and subsequent analysis. Head and thorax of each mosquito was removed and mosquito samples were pooled separately. Total RNA was extracted from mosquito samples and semi-nested Polymerase Chain Reaction (PCR) was performed to identify DENV serotypes present in the mosquito samples. The results of the PCR indicated the presence of DENV2 in both Ae. aegypti (1/5) and Ae. albopictus (1/27) mosquitoes. Then complete Envelope (E) gene was amplified with DENV2 specific primers for genotyping of the virus which is required to identify the molecular evolution of the DENV2. Prior to sequencing the PCR products were purified and sequencing results were analyzed usingLaserGene software. The generated sequences were aligned with retrieved DENV2 sequences available at NCBI database and the phylogenetic trees were developed using MEGA7 software with General Time Reversible (GTR) substitution model with gamma distributed rates. The robustness of clades was determined by using bootstrap analysis of 500 replicates. The result of the phylogenetic analysis illustrates that the E gene sequences of DENV2 obtained from two DENVpositive mosquito poolsbelong to DENV2 Cosmopolitan Clade Ib, which has been the dominant strain in South-East Asia, specially Singapore, Indonesia, Malaysia, and China since August, 2015.The evidence suggests recent introduction of this DENV strain into Sri LankaItem A forecasting model for dengue incidence in the District of Gampaha, Sri Lanka(BioMed Central, 2018) Withanage, G.P.; Viswakula, S.D.; Nilmini Silva Gunawardena, Y.I.; Hapugoda, M.D.BACKGROUND: Dengue is one of the major health problems in Sri Lanka causing an enormous social and economic burden to the country. An accurate early warning system can enhance the efficiency of preventive measures. The aim of the study was to develop and validate a simple accurate forecasting model for the District of Gampaha, Sri Lanka. Three time-series regression models were developed using monthly rainfall, rainy days, temperature, humidity, wind speed and retrospective dengue incidences over the period January 2012 to November 2015 for the District of Gampaha, Sri Lanka. Various lag times were analyzed to identify optimum forecasting periods including interactions of multiple lags. The models were validated using epidemiological data from December 2015 to November 2017. Prepared models were compared based on Akaike's information criterion, Bayesian information criterion and residual analysis. RESULTS: The selected model forecasted correctly with mean absolute errors of 0.07 and 0.22, and root mean squared errors of 0.09 and 0.28, for training and validation periods, respectively. There were no dengue epidemics observed in the district during the training period and nine outbreaks occurred during the forecasting period. The proposed model captured five outbreaks and correctly rejected 14 within the testing period of 24 months. The Pierce skill score of the model was 0.49, with a receiver operating characteristic of 86% and 92% sensitivity. CONCLUSIONS: The developed weather based forecasting model allows warnings of impending dengue outbreaks and epidemics in advance of one month with high accuracy. Depending upon climatic factors, the previous month's dengue cases had a significant effect on the dengue incidences of the current month. The simple, precise and understandable forecasting model developed could be used to manage limited public health resources effectively for patient management, vector surveillance and intervention programmes in the district.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 Breeding habitat diversity and species composition of Anopheles mosquitoes in Trincomalee district, Sri Lanaka(HABITATS Conservation Initiative, 2014) Gunathilaka, P.A.D.H.N.; Fernando, M.A.S.T.; Hapugoda, M.D.; Wijeyerathne, P.; Wickremasinghe, A.R.; Abeyewickreme, W.Entomological studies on the abundance of malaria vector Anopheles mosquitoes have not been studied in some malaria endemic areas of Sri Lanka over past 30 years in view of the security situation. The aim of this study was to explore the habitat diversity and distribution of anopheline species in Trincomalee District in order to prioritize vector breeding habitats for developing timely and cost effective larval controlling measures. Potential larval habitats for Anopheles mosquitoes were surveyed from June 2010 - December 2010, in selected sampling sites in the Trincomalee District; Gomarankadawala, Echchallampaththu, Mollipothana, Thoppur and Padavisiripura, within a radius about 20 km on weekly basis. The species distribution and density were calculated. A total of 3,701 larval specimens representing twelve Anopheles species were reported form 19 breeding habitats (Tank margin, main canal, paddy field, vegetative canal, lake, built well, burrow pit, distribution canal, pond, rock pool, canal, un-built well, common well, river margin, sand pool, animal foot print, rain water collection, quarry pit and marshy land). Ten habitats were categorized under structurally complex group based on the presence of biotic communities. Only An. subpictus can be regarded as constant according to Distribution (C) (C= 80.1-100%).An. nigerrimus, An. peditaeniatus, An. pallidus and An. vagus were frequent (C= 60.1 – 80%). An. varuna, An. barbirostris, An. annularis and An. barbumbrosus were shown as infrequent species (C= 20.1 – 40%) and other namely An. aconitus, An. culicifacies and An. jamesii can be categorized under sporadic appearance (C= 0 – 20%). According to Density (D) criterion, five species (An. subpictus, An. nigerrimus, An. varuna, An. pallidus, An. barbumbrosus) were within the dominant class (D > 5%). Four species (An. vagus, An. peditaeniatus, An. annularis, An. aconitus) were in the subdominant class (1< D <5%). Only An. jamesii and An. culicifacies were the satellite species (D < 1%).Item Entomological investigations on malaria vector studies in earlier conflict areas of Sri lanka after 30 years(University of Peradeniya, 2014) Gunathilaka, P.A.D.H.N.; Fernando, M.A.S.T.; Hapugoda, M.D.; Wijeyerathne, P.; Wickremasinghe, A.R.; Abeyewickreme, W.Entomological investigations on the abundance of malaria vector mosquitoes have not been studied in northern and eastern parts of the Sri Lanka over the past 30 years due to the separatist war. The main aim of this study was to explore diversity and abundance of Anopheles mosquitoes in earlier conflict areas in Sri Lanka. Monthly entomological monitoring was carried out at 60 possible malaria sensitive localities situated approximately 12 km apart in 15 selected sentinel sites in Ampara (4), Batticaloa (3), Mannar (3) and Trincomalee (5) districts for 32 months (June 2010 to August 2013). Adult mosquitoes were collected by WHO recommended techniques. Out of 701,356 anophelines collected, An. culicifacies was noted only in Ampara, Batticaloa and Trincomalee Districts. Although the main vector An. culicifacies (n= 1,876) was low in numbers, the presence of secondary vectors including An. subpictus (n= 205,594) were high in these areas. An. nigerrimus (n= 227,057), An. barbirostris (n= 35,150), An. vagus (n= 21,161), An. pallidus (n= 17,403), An. annularis (n= 4,882), An. varuna (n= 3151), An. tessellatus (n= 718) and An. aconitus (n= 591) were the other species reported. There was a change in breeding habitats of An. culicifacies and An. subpictus. They were found more conducive to breeding in built wells, brackish water habitats and waste water collections which were below 3 mg/l of dissolved oxygen (2.85 ± 0.03). These results indicate that particularly An. culicifacies has adapted to breed in wide range of water bodies including waste water collections although they were earlier considered to breed in clean and clear water with high dissolved oxygen. The adaptation of the major and subsidiary vector mosquitoes to widespread water bodies (along with increase in imported cases) could be a potential factor for the increase in the incidence of malaria in the future even though reported cases are low at present. Further, entomological surveillance detected the presence of An. jeyporiensis from the country after 106 years. Hence, more classical entomological studies are required to describe species currently found in the country; revision of morphological identification keys is a step in this direction. Financial assistance given by the Global Fund for Aids, Tuberculosis and Malaria (GFATM-Round 8-SRL809G11M.) through TEDHA malaria elimination program is acknowledged.Item Role of Aedes albopictus in transmitting dengue virus in some endemic areas in Kurunegala District.(University of Kelaniya, 2003) Hapugoda, M.D.; de Silva, N.R.; Abeysundara, S.; Bandara, K.B.A.T.; Dayanath, M.Y.D.; Abeyewickreme, W.Abstract AvailableItem A Preliminary study of genetic estimates of population structure of Aedes aegypti populations in three districts, Sri Lanka(Sri Lanka Association for the Advancement of Science, 2014) Fernando, H.S.D; Hapugoda, M.D.; de Silva, B.G.D.N.K.