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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Comparison of four low-cost carbapenemase detection tests and a proposal of an algorithm for early detection of carbapenemase-producing Enterobacteriaceae in resource-limited settings(Public Library of Science, 2021) Kumudunie, W.G.M.; Wijesooriya, L.I.; Wijayasinghe, Y.S.ABSTRACT: Rapidly progressing antibiotic resistance is a great challenge in therapy. In particular, the infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are exceedingly difficult to treat. Carbapenemase production is the predominant mechanism of resistance in CRE. Early and accurate identification of carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) is extremely important for the treatment and prevention of such infections. In the present study, four phenotypic carbapenemase detection tests were compared and an algorithm was developed for rapid and cost-effective identification of CP-CRE. A total of 117 Enterobacteriaceae (54 CP-CRE, 3 non-CP-CRE, and 60 non-CRE) isolates were tested for carbapenemase production using modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), Carba NP test (CNPt), and CNPt-direct test. The overall sensitivity/specificity values were 90.7%/92.1% for MHT, 100%/100% for mCIM, 75.9%/100% for CNPt, and 83.3%/100% for CNPt-direct. OXA-48-like enzymes were detected with 93.2% sensitivity by MHT and >77.3% sensitivity by two Carba NP tests. MHT could only detect half of the NDM carbapenemase producers. CNPt-direct exhibited enhanced sensitivity compared to CNPt (100% vs 25%) for detection of NDM producers. Considering these findings we propose CNPt-direct as the first test followed by mCIM for rapid detection of CP-CRE. With this algorithm >80% of the CP-CRE could be detected within 24 hours from the time the sample is received and 100% CP-CRE could be detected in day two. In conclusion, mCIM was the most sensitive assay for the identification of CP-CRE. CNPt-direct performed better than CNPt. An algorithm consisting CNPt-direct and mCIM allows rapid and reliable detection of carbapenemase production in resource-limited settings.Item Prevalence of asthma and comparison of ventilator capacity of asthmatics (when free of asthma) and non asthmatics among workers in selected garment factories(College of the Community Physicians of Sri Lanka, 2009) Abeysena, C.; Jayawardana, P.; Wickramasinha, W.P.K.; Dassanayake, I.S.INTRODUCTION: Asthma has been reported to be common among garment factory workers. Objective: To determine the prevalence of asthma and to compare the lung functions among asthmatics and non asthmatics among garment factory workers. METHODS: A descriptive comparison study was conducted among 774 workers of selected garment factories in the Ekala Industiral Area, Ja ela. All workers who have served for a minimum period of one year in the factory were included in the study. An interviewer administered questionnaire was used to assess personal details and presence of wheezing, dysponoea and cough and other relevant data. All those with wheezing and those with presence of both cough and dyspnoea in the absence of wheezing during the past one year were considered as asthmatics. Spirometry was performed using an electronic spirometer. Forced Vital Capacity (FVC), Forced Expiratory Volume in first second of FVC (FEV) and Peak Expiratory Flow Rate (PEFR) were assessed. The ventilatory capacity was compared among asthmatics and non asthmatics using Student T test, Mann Whitney U test or chi-squired test. Results: The prevalence of asthma was 30% (95%CI: 26.7%, 33%). The mean ventilator capacity of asthmatics and non asthmatics respectively were as follows FVC: 2.24 L versus 2.39 L (p<0.05), FEV-i.o: 2.17 L versus 2.37 L (p<0.001), PEFR {geometric mean): 5.87 L/sec versus 7.17 L/sec (p<0.001). The mean difference between the predicted normal values and observed values among asthmatics and non asthmatics were as follows: FVC: 0.53 L versus 0.58 L (p>0.05), FEVro: 0.30 L versus 0.25 L (p>0.05), PEFR (median): 1.21 L/sec versus 0.45 L/sec (p<0.001). Ninety three (40.3%) of asthmatics and 149 (27.5%) non-asthmatics had PEFR <80% of the predicted which was statistically significant (p<0.001). CONCLUSION: Prevalence of asthma was high among garment factory workers. Ventilatory capacity and predicted normal values of asthmatics when free of asthma were affected in comparison to non asthmatics.Item Is Past exposure to hepatitis a protective against progressive fibrosis in non-alcoholic fatty liver disease?(Wiley-Blackwell, 2008) de Silva, A.P.; Kasturiratne, A.; Liyanage, D.L.; Karunanayaka, T.K.; Hewavisenthi, S.J.de S.; Dassanayake, A.S.; Farrell, G.C.; de Silva, H.J.No Abstract AvailableItem The Outcome of preterm labour and preterm prelabour rupture of membranes after oral salbutamol or nifedipine SR(Sri Lanka College of Obstetricians and Gynaecologists, 2005) Padumadasa, S.; Goonewardene, M.RATIONALE: Preterm labour (PTL) and preterm prelabour rupture of membranes (FT - PLROM) are still a problem. Several tocolytics with varying doses have been tried in the treatment. OBJECTIVE: To compare the effectiveness and safety of oral salbutamol and nifedipine SR in the management of PTL and PT - PLROM. DESIGN AND SETTING: A randomised controlled trial from 15 May 2002 to 30 April 2003 at the University Obstetric Unit, Teaching Hospital, Galle. SUBJECTS AND METHOD: One hundred and fourteen consecutive women who presented with PT - PLROM or fulfilled the diagnostic criteria for PTL-more than one uterine contraction occurring within ten minutes and the cervix effaced and greater than 1cm, and without any contraindications for tocolysis, were randomly assigned to receive either oral salbutamol 4 mg 8 hourly or nifedipine SR 20 mg 12 hourly for 48 hours. The first author was unaware of the treatment regimen until the final analysis. Three doses of dexamethasone 8 mg 12 hourly were also given. MAIN OUTCOME MEASURES: The time interval upto delivery, birth weight of the baby, admissions to premature baby unit, perinatal deaths and adverse maternal effects were assessed. RESULTS: Forty-eight women received salbutamol and 66 received nifedipine SR. Between the two groups there were no significant differences in the basic characteristics, the mean period of gestation, the frequency of uterine contractions and the cervical dilatation in the subjects. Delivery occurred after a mean of 9.7 days SD 14.7 (salbutamol group) and 14.6 days SD 21.0 (nifedipine SR group) (P=0.2). In the salbutamol group 75% delivered within 9.5 days while in the Nifedipine SR group it took 28.0 days for 75% of the subjects to deliver. The mean birth weight of the babies in the nifedipine SR group (2.47 kg, SD 0.68) was significantly higher (P=0.04) than that of the babies in the salbutamol group (2.18 kg, SD 0.67). There were six perinatal deaths in the salbutamol group but only two deaths in the nifedipine SR group (P=0.06). Adverse effects were more common with salbutamol; tremors (54% versus 5%), palpitations was significantly higher (P=0.04) than that of the babies in the salbutamol group (2.18 kg, SD 0.67). There were six perinatal deaths in the salbutamol group but only two deaths in the nifedipine SR group (P=0.06). Adverse effects were more common with salbutamol; tremors (54% versus 5%), palpitations (46% versus 9%), nausea (10% versus 5%) compared to nifedipine SR. Headache was commoner with nifedipine SR (26% versus 10%). CONCLUSIONS: If oral to colytics are used in women with preterm labour or preterm prelabour rupture of membranes nifedipine SR is apparently better than salbutamol with regard to adverse maternal effects. There may be a delay in delivery and an increase of the birth weight of the baby with nifedipine SR treatment. (46% versus 9%), nausea (10% versus 5%) compared to nifedipine SR. Headache was commoner with nifedipine SR (26% versus 10%). CONCLUSIONS: If oral tocolytics are used in women with preterm labour or preterm prelabour rupture of membranes nifedipine SR is apparently better than salbutamol with regard to adverse maternal effects. There may be a delay in delivery and an increase of the birth weight of the baby with nifedipine SR treatment.Item Intestinal parasitoses and the nutritional status of Veddah children in Sri Lanka(SEAMEO Regional Tropical Medicine and Public Health Project, 2004) Chandrasena, T.G.A.N.; Premaratna, R.; de Alwis, A.C.; de Silva, L.D.R.; Morel, R.P.; de Silva, N.R.This study describes and compares the intestinal parasitoses and nutritional statuses of primary school children of Veddah (local indigenous population) and Sinhalese (more advanced society) in rural Sri Lanka. Children attending years 1-3 (age range 6-15 years) at Dambana Primary School (Veddah) and Wewatta Primary School (Sinhalese) were included in the study. Stools and blood samples were examined for evidence of intestinal parasites and anemia. The heights and weights of the children were measured and anthropometric indices calculated. There was a high prevalence of G. intestinalis and B. hominis (Giardia 7.8.percent and 6.2.percent; Blastocystis 17.2.percent and 17.3.percent at Dambana and Wewatta, respectively) in both communities, the predominant helminth being N. americanus (20.3.percent at Dambana and 14.8.percent at Wewatta; pgreater than 0.05). Other geohelminth infections were scarce in both communities. A greater proportion of boys than girls were underweight and stunted in both communities. Wasting and anemia was significantly high among the Veddah children.Item Cost accounting in a surgical unit in a teaching hospital--a pilot study(Sri Lanka Medical Association, 2003) Malalasekera, A.P.; Ariyaratne, M.H.J.; Fernando, R.; Perera, D.; Deen, K.I.INTRODUCTION: Economic constraints remain one of the major limitations on the quality of health care even in industrialised countries. Improvement of quality will require optimising facilities within available resources. Our objective was to determine costs of surgery and to identify areas where cost reduction is possible. PATIENTS AND METHODS: 80 patients undergoing routine major and intermediate surgery during a period of 6 months were selected at random. All consumables used and procedures carried out were documented. A unit cost was assigned to each of these. Costing was based on 3 main categories: preoperative (investigations, blood product related costs), operative (anaesthetic charges, consumables and theatre charges) and post-operative (investigations, consumables, hospital stay). Theatre charges included two components: fixed (consumables) and variable (dependent on time per operation). RESULTS: The indirect costs (e.g. administration costs, 'hotel' costs), accounted for 30%, of the total and were lower than similar costs in industrialised nations. The largest contributory factors (median, range) towards total cost were, basic hospital charges (30%; 15 to 63%); theatre charges fixed (23%; 6 to 35%) and variable (14%; 8 to 27%); and anaesthetic charges (15%; 1 to 36%). CONCLUSION: Cost reduction in patients undergoing surgery should focus on decreasing hospital stay, operating theatre time and anaesthetic expenditure. Although definite measures can be suggested from the study, further studies on these variables are necessary to optimise cost effectiveness of surgical unitsItem Effect of pollution on health of residents in an industrial area in Sri Lanka(American Medical Association, 2002) Premaratna, R.; Pathmeswaran, A.; Chandrasekara, B.; Dissanayake, A.S.; de Silva, H.J.The authors conducted a cross-sectional comparative prevalence study to evaluate the effect of pollution on individuals who lived in an industrial zone in Sri Lanka. In this study, 81 male and female children who were 1-12 yr of age and 158 adults (51 males, 107 females) in the industrial zone were matched with 73 children (32 males, 41 females) and 146 adults (58 males, 88 females), respectively, who lived in a nonindustrialized area and whose ages were similar to those of the exposed individuals. The authors used a pretested questionnaire and a detailed clinical examination, including peak expiratory flow rate measurements, to assess the prevalence of illness. Children in the industrial area were 2.3 times more likely to have unexplained episodic cough (95% confidence interval [CI] = 0.98, 10.3) and 2.8 times more likely to have rhinitis (95% CI = 1.1, 7.1). The adult population was 2.1 times more likely to have unexplained episodic cough (95% CI = 1.13, 7.09), 3.7 times more likely to have unexplained headaches (95% CI = 2.2, 6.3), and adults had a significantly greater reduction in expiratory flow (peak expiratory flow rate = 446 - 92x [industrial area] + 91x [male] - 0.8x [years lived in the area]).Item Evaluation of the ICT whole-blood antigen card test to detect infection due to Wuchereria bancrofti in Sri Lanka(Oxford University Press, 2002) Chandrasena, T.G.A.N.; Premaratna, R.; Abeyewickreme, W.; de Silva, N.R.The sensitivity, specificity and cost effectiveness of an immunochromatographic card test (ICT, AMRAD) for the diagnosis of bancroftian filariasis were estimated against 2 standard parasitological techniques: thick blood film (TBF) and Nuclepore membrane filtration (NMF). Individuals were selected from endemic localities in the Western Province (n = 213) and from the non-endemic Central Province (n = 29) of Sri Lanka. Blood was collected between 21:00 and midnight. Sixty microlitre of non-heparinized blood, and 1 mL and 100 microL of heparinized blood were used in TBF, NMF andICT, respectively. NMF was positive in 31.5% (67/213) of the endemic group, with a mean microfilaria (mf) count of 343/mL (range 8-1782, SD 422). All 67 were positive by ICT (sensitivity 100%), but only 63 by TBF (sensitivity 94%). Among the endemic population there were 12 who were mf negative but antigen positive by ICT. There were, however, no false positives among the non-endemic controls, indicating the possibility that the ICTmay in fact be more sensitive and 100% specific. Thus, ICT filariasis test appears to be more effective (both sensitive and specific) than TBF or NMF in diagnosing infection in lymphatic filariasis. The direct unit recurrent costs of the 2 survey tools, TBF and ICT, were US$ 0.30 (Rs. 27/=) and US$ 2.75 (Rs. 248/=), respectively. The high cost of the ICT may be offset by other factors that are difficult to cost.Item Abnormal functions of pottasium channels in the platelets of patients with Alzheimer's disease(Lancet Publishing Group, 1998) de Silva, H.A.; Aronson, J.K.; Grahame-Smith, D.G.; Jobst, K.A.; Smith, A.D.BACKGROUND:Reports of abnormalities of potassium-channel function in various cultured cells of Alzheimer's disease patients led us to attempt to characterise the pharmacological characteristics of the abnormal channel.METHODS: We studied platelets from 14 patients with Alzheimer-type dementia and 14 non-demented controls matched for age and sex. The effects of specific inhibitors of K+ channels on the efflux of rubidium-86 ions, a radioactive analogue of K+, from the platelets were measured.FINDINGS: Normal platelets contain three types of K+ channel, sensitive to the inhibitory actions of apamin (small-conductance calcium-dependent potassium channels), charybdotoxin (of less specificity, but probably intermediate-conductance calcium-dependent K+ channels), and alpha-dendrotoxin (voltage-sensitive K+ channels). However, 8Rb+ efflux from the platelets of patients with Alzheimer-type dementia was not inhibited by either apamin or charybdotoxin. By contrast, inhibition by alpha-dendrotoxin did occur. INTERPRETATION: Our results suggest that calcium-dependent K+ channels in platelets are selectively impaired in Alzheimer's disease. A similar abnormality in neurons could contribute to the pathophysiology of the disorder.Item Superoxide dismutase and pyruvate ferrodoxin oxidoreductase involvement in mechanisms of metronidazole resistance in Entamoeba histolytica(Oxford University Press, 1997) Samarawickrema, N.A.; Brown, D.M.; Upcroft, J.A.; Thammapalerd, N.; Uproft, P.Metronidazole resistance has been induced in an axenic strain of Entamoeba histolytica (HTH-56:MUTM) following continuous exposure to steadily increasing drug concentrations. The drug-resistant line is routinely maintained in normally lethal levels of metronidazole (10 microM).Resistance to this concentration of drug was developed over 177 days. Decreased pyruvate:ferredoxin oxidoreductase (PFOR) activity in anaerobic organisms is one mechanism of metronidazole resistance but in entamoeba, PFOR activity was not decreased in metronidazole-resistant parasites as determined by immunofluorescent assays and immunoblotting studies. 2-Oxoacid oxidoreductase activity, which appeared to be due to a single enzyme, PFOR, was evident with pyruvate as well as the alternative substrates, alpha-ketobutyrate, alpha-ketoglutarate and oxaloacetate. A marked increase in superoxide dismutase (SOD) activity was detected in metronidazole-resistant E.histolytica. Increased SOD activity has not previously been documented as a mechanism of drug resistance although SOD has been associated with a range of stress situations in other organisms.