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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Importance of private health sector in malaria surveillance: a case study in Nuwara-Eliya district, Sri Lanka(Sri Lanka College of Microbiologists, 2002) Kusumawathie, P.H.D.; Wickremasinghe, A.R.; Karunaweera, N.OBJECTIVE: To determine the Utilization of public and private health facilities by suspected malaria cases in Divisional Director of Health Services (DDHS) area Hanguranketha in Nuwara-eliya district (from July 2000 to June 2001). DESIGN, SETTING AND METHODS: Two state hospitals, DH Rikillagaskada and RH Gonagantenna were selected as public health facilities. Seven clinics at Rikillagaskada and Gonagantenna in which government medical officers engaged in private practice after duty hours were selected as private health facilities. The number of cases blood filmed for malaria at public facilities was obtained from hospital records. Data for the private sector was obtained using a pre designed form. Reporting from the private sector was done on a monthly basis. RESULTS: Among 572 cases blood filmed at government hospitals, 22 were positive for P.vfvax. In the private sector. 634 cases of suspected malaria were reported and treated on clinical grounds. During the study period, 40 P.vivax and 65 P.falciparum cases were detected by examining 1270 blood films collected by Active Case Detection and Special Malaria Clinics, conducted in the villages with risk of malaria transmission within the study area. Of the microscopically confirmed malaria cases, 15.4% of P.falciparum infections were resistant to chloroquine. Investigation of malaria cases revealed 66.7% of cases were indigenous while 33.3% were imported. If the Slide Positive Rate (SPR) of the government facilities is applied to the data of the private sector, 610 cases would have been given chloroquine without actually having malaria. CONCLUSIONS: According to this study, 52.57% of suspected malaria cases had sought treatment at private health facilities. Incorporating the private health sector in malaria surveillance would be helpful in correct treatment and control of malaria in malarious areas. Unnecessary anti malarial therapy should be reduced by provision of laboratory facilities at private health centers. ACKNOWLEDGEMENTS: Assistance provided by the Provincial Director Health Services, Central Province and Deputy Provincial Director Health Services, Kandy, and the Director Anti-Malaria Campaign is acknowledged.Item Extrathymic T cells in human malaria patients(Elsevier, 1998) Watanabe, W.; Weerasinghe, A.; Miyaji, C.; Sekikawa, H.; de Silva, N.R.; Gunawardena, S.; Ratnayake, H.; Kobayashi, J.; Thoma, H.; Sato, Y.; Abo, T.Item A Mixed infection of Plasmodium falciparum and Plasmodium malariae: the first report of a Plasmodium malariae infection after 37 years of its absence in Sri Lanka(2008) Hapuarachchi, H.A.C.; Abeysundara, S.; Gunawardena, N.K.; Manamperi, A.; Senevirathne, M. P.; Leemingsawat, S.; Chavalitshewinkoon-petmitr, P.; de Silva, N.R.; Abeyewickreme, W.Malaria has been endemic in Sti Lanka for several centuries. Currently, only Plasmodium falciparum and P. vivax are present in the country. P. malariae infections have not .been reported in Sri Lanka since 1969. The objective is to determine the presence of malaria species in a patient returned from Malawi. The clinical history of intermittent high fever for 2 weeks accompanied by severe headache, myalgia, arthralgia, vomitimg, loss of appetite and backache with ictetus and mild hepatosplenomegaly suggested malaria in this 51 year old patient. Apart from the basic biochemical investigations, presence of malarial species was determined by light microscopy and confirmed by Real-Time Polymerase Chain Reaction (PCR) technology. Biochemical investigations showed a high serum bilirubin (4.8 mg/di) and liver enzyme (SGOT = >125 units, SGPT = >250 units) levels. Serum haemoglobin level (12.8 g%) was normal. Except for the presence of ptoteinuria (albumin = ++), bile (+) and red blood corpuscles (RBC) in his urine, renal functions were normal. Microscopical examination of Giemsa stained thin and thick blood smears showed an asexual parasite density of 120,000 per ul of blood. Infected RBCs were not enlarged, The presence of double-chromatin and applique form trophozoites, occasionally invading multiple RBCs suggested P. falciparum infection. In addition, there were characteristic band form trophozoites of P. malariae. Real-Time PCR protocol confirmed the presence of both P. falciparum and P. malariae in this patient. This is the first case of P. malariae reported in Sri Lanka after 4 decades, though the infection had been acquired from Malawi. Clinical and biochemical evidence indicated liver dysfunction and a transient glomerulonephritis, both of which subsided after treatment with quinine. This case report emphasizes the need of physicians to be more vigilant about the presence of malaria among immigrants, despite the drastic reduction of malaria in the country in recent years. Hence, this report highlights the importance of a proper programme in Sri Lanka to screen immigrants for infectious diseases.Item Genetic evidence of emerging sulfadoxine-pyrimethamine resistance of Plassmodium falciparum isolates in an operational area in the Northern Province of Sri Lanka(Sri Lanka Association for the Advancement of Science, 2004) Hapuarachchi, H.A.C.; Dayanath, M.Y.D.; Abeysundara, S.; Bandara, K.B.A.T.; Abeyewickreme, W.; de Silva, N.R.Item Cost analysis of application of Poecilia reticulata (guppy) and temephos in anopheline mosquito control in river bed pools below the major dams in Sri Lanka(Sri Lanka Association for the Advancement of Science, 2004) Kusumawathie, P.H.D.; Wickremasinghe, A.R.; Karunaweera, N.D.; Wijeyaratne, M.J.S.Item Analysis of genetic polymorphism of Plasmodium vivax duffy binding protein ligand domain of Sri Lankan isolates(Sri Lanka Association for the Advancement of Science, 2008) Premaratne, P.H.; Aravinda, R.; Manamperi, A.; Randeniya, P.V.Interaction of Plasmodium vivax Duffy Binding Protein region II (PvDBPII) critical binding motif (CBM) with its erythrocyte receptor is critical for maintaining blood stage infections, rendering PvDBP a leading vaccine candidate. Since the efficacy of a vaccine based on a polymorphic antigen, such PvDBP, is influenced by the local host immune response, characterization of the GD among local parasite strains is important in specific geographic settings. GD of the PvDBPII-CBM was assessed for the first time among field isolates from Sri Lanka. Forty single clonal P. vivax infections identified from two malaria endemic areas (Anuradhapura and Kataragama) and from a non-endemic area (Colombo), were used to generate nucleotide sequence data of CBM of PvDBPII (aa 285 to 521) by nested PCR amplification followed by direct sequencing. Twenty dimorphic sites, 20 nucleotide polymorphisms and 15 haplotypes (haplotype diversity = 0.890) were identified at the CBM of PvDBPII compared to Sal-1 sequence. Genetic polymorphism in terms of pair wise diversity (p) and Tamura's three parameter model (d) were calculated to be 0.00950 (S.D.=0.00072) and 0.00959 (S.D.= 0.00052), respectively, consistent with published data from world wide isolates. Eighteen non-synonymous(NS) and 02 synonymous(S) mutations were identified, and the ratio of NS (0.01086) to S (0.00458) mutation rates was significantly >1, suggesting that positive selection acts on the CBS of PvDBPII. Residues essential for erythrocyte binding on PvDBPII-CBR were conserved in these 40 isolates. Six polymorphic residues recorded in high frequencies in worldwide isolates were also present among Sri Lankan isolates. Polymorphisms occurring at higher frequencies than Papua New Guinea isolates, of three amino acid residues involved in resistance to binding inhibitory antibodies were also detected. Thus, even under low and unstable transmission conditions prevalent in the island, relatively high allelic diversity and positive selection acting on CBM of PvDBPII, possibly due to immune pressure were detected in Sri Lankan P. vivax field isolates. Financial support by the National Science Foundation (Grant numbers NSF/SCH/2004/07 and NSF/RG/2005/HS/06) and the National Research Council (Grant numbers 05-34) is acknowledged.Item Evidence for emerging sulfadoxine-pyrimethamine resistance of Plasmodium falciparum isolated in the Northern Province of Sri Lanka(Sri Lanka Association for the Advancement of Science, 2005) Hapuarachchi, H.A.C.; Dayanath, M.Y.D.; Abeysundara, S.; Bandara, K.B.A.T.; Abeyewickreme, W.; de Silva, N.R.Item Molecular markers of chloroquine resistance in Plasmodium falciparum in Sri Lanka:frequency before revision of the antimalarial drug policy(Academic Press, 2009) Hapuarachchi, H.A.C.; Abeysundara, S.; Dayanath, M.Y.D.; Manamperi, A.; Abeyewickreme, W.; de Silva, N.R.No Abstract AvailableItem An Indigenous case of Plasmodium ovale infection in Sri Lanka(American Society of Tropical Medicine and Hygiene, 2008) Wickremasinghe, R.; Galappaththi, G.N.; Fernando, W.A.; de Monbrison, F.; Wijesinghe, R.S.; Mendis, K.N.; Picot, S.; Ringwald, P.; Wickremasinghe, A.R.Plasmodium ovale, which is generally prevalent only in the African region, has been emerging in the Asian and southeast Asian regions. It has not been reported in Sri Lanka. We report, to our knowledge, an indigenous case of P. ovale infection in Sri Lanka. This patient, who was diagnosed by a polymerase chain reaction, had no history of travel overseas or receipt of a transfusion of blood or any blood products, which makes this a likely caseof indigenous transmission. This incidental finding of a P. ovale infection has implications for malaria control in the country and highlights the need to rigorously monitor malaria incidence, as well as prevalent Plasmodium species, with newer and more reliable diagnostics.Item Genotyping of Plasmodium vivax infections in Sri Lanka using Pvmsp-3 alpha and Pvcs genes as markers:a preliminary report(Malaysian Society of Parasitology and Tropical Medicine, 2008) Manamperi, A.; Sanath, M.; Fernando, D.; Wickremasinghe, R.; Anura, B.; Hapuarachchi, C.; Abeyewickreme, W.; Wickremasinghe, A.R.Plasmodim vivax malaria accounts for more than 90% of malaria cases in Sri Lanka. There is limited information on the genetic heterogeneity of P. vivax in endemic areas of the country. Here we have assessed the potential of two P. vivax genes as genetic markers for their use in genotyping parasites collected from the field. DNA extracted from Geimsa-stained P. vivax positive slides were genotyped at two polymorphic loci: the P. vivax merozoite surface protein 3- alpha (Pvmsp-3alpha) and circumsporozoite protein (Pvcs). Analysis of these two genetic markers revealed 11 distinguishable variant types from the two genetic markers: 4 for Pvcs and 7 for Pvmsp-3alpha. The results indicate that the P. vivax parasite population is highly diverse in Sri Lanka, despite the low level of transmission.