Browsing by Author "Premaratna, B.A.H.R."

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Annotated checklist of chigger mites (Trombidiformes: Leeuwenhoekiidae, Trombiculidae and Walchiidae) in Sri Lanka
(Elsevier, 2022) Ashani, M.L.S.; Gunathilaka, P.A.D.H.N.; Premaratna, B.A.H.R.; Chandrasena, T.G.A.N.; Jacinavicius, F.C.; Silva, R.B.
Chigger mites (Leeuwenhoekiidae, Trombiculidae, and Walchiidae) are parasites of any terrestrial vertebrate. The present study updates the list of chigger mite (Trombiculidae, Leeuwenhoekiidae, and Walchiidae) species recorded from Sri Lanka along with taxonomic classification based on previous investigations since 1946 to date and our observations in western and southern parts of the country. This checklist listed 15 species in 9 genera within the three chigger families. For now, murid species were the host most sampledparasitized by chiggers in Sri Lanka. However, further studies are required to increase the diversity of chigger mites in Sri Lanka and probably the description of new species, which will be possible with morphological and molecular characterization.
Antibiotic sensitivity patterns among extended spectrum β-lactamase (ESBL) producing organisms causing urinary tract infections in Sri Lanka
(Sri Lanka Medical Association, 2016) Luke, W.A.N.V.; Fernando, S.C.; Wickremasinghe, R.D.S.S.; Sebastiampillai, B.S.; Gunathilake, M.P.M.L.; Miththinda, J.K.N.D.; Silva, F.H.D.S.; Premaratna, B.A.H.R.
INTRODUCTION AND OBJECTIVES: ESBLs are enzymes that confer resistance to all penicillins, cephalosporins, and aztreonam. ESBL producing organisms causing urinary tract infections (ESBL-UTI) are increasing in incidence and pose a major burden to health care requiring treatment with expensive antimicrobials and prolonged hospital stay. Documented antibiotic susceptibility of ESBL organisms include meropenem (95-100%) and aminoglycosides (45-60%). This study evaluated the antibiotic sensitivity patterns of ESBL-UTI in Sri Lanka. METHOD: Patients with ESBL-UTI admitted to Professorial Medical Unit, Colombo North Teaching Hospital (CNTH) from January – June 2015 were recruited to the study. Their Urine culture and ABST reports were evaluated after obtaining informed written consent. RESULTS: Of 61 culture positive ESBL-UTIs, E. coli accounted for 53 (86.8%), followed by Klebsiella in the 8 (13.1%). The ESBL organisms were mostly sensitive to carbapenems; 58 (95%) to Meropenem and 45 (73.7%) to Imipenem. The other sensitivity patterns were 37 (60.6%) to Amikacin, and 28 (45.9%) to Nitrofurantoin. Meropenem resistance was observed in 3 (4.9%) and were E.coli. These three patients had received multiple antibiotics including meropenem in the recent past for recurrent UTI. CONCLUSIONS: It is evident from the above data that Carbapenems remain as the first line therapy for the majority of ESBL-UTI in the local setting. However 4.9 % prevalence of meropenem resistance is alarming compared to 0.4% prevalence in Pakistan and 0.02% prevalence in Germany. Such high prevalence of meropenem resistance should draw attention of clinicians and needs to implement measures to prevent emergence and spread of carbapenum resistant ESBL organisms in the country.
Antibiotic sensitivity patterns of Extended-Spectrum β-Lactamase urinary tract infections in Sri Lanka
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Sebastiampillai, B.S.; Premaratna, B.A.H.R.; Luke, W.A.N.V.; Wickramasinghe, R.D.S.S.; Gunathilake, M.P.M.L.; Miththinda, J.K.N.D.
BACKGROUND: Extended-spectrum β-lactamase (ESBL) producing organisms causing urinary tract infections (UTI) are increasing in incidence and poses a major burden to health care requiring treatment with expensive antimicrobials and prolonged hospital stay. The prevalence of ESBL producing organisms particularly in the Asian region remains unknown. OBJECTIVES: To identify common ESBL producing organisms and to evaluate the antibiotic sensitivity patterns of ESBL UTIs in Sri Lanka. METHODS: Patients admitted with ESBL-UTI to Professorial Medical Unit, Colombo North Teaching Hospital, Ragama over a period of 6 months from January 2015 were recruited. Their Urine culture and ABST reports were analysed after obtaining informed written consent. RESULTS: Of the 52 patients who consented to be on the study, 30 (57.7%) were males. Mean age was 64.11 (SD=12.59) years. E. coli was the commonest organisms (84.6%; n=44), causing the ESBL-UTI followed by Klebsiella (15.4%; n=8). Fifty (96.2%) patients were sensitive to meropenem, 38 (73.1%) to imipenem, 30 (57.7%) to amikacin and 24 (46.2%) to nitrofurantoin. Meropenem resistance was found in 2 (3.8%) cases which were due to infection with E. coli.These two patients had received multiple antibiotics including meropenem in the recent past for recurrent UTI. CONCLUSIONS: While E. coli and Klebsiella are the commonest ESBL producing organisms causing UTI, carbapenems remain as the first line therapy. However 3.8% prevalence of meropenem resistance among the study population should draw attention of clinicians and needs implementation of measures to prevent emergence of carbapenum resistant ESBL organisms.
Awareness of Rickettsial Infections (Typhus Fever) in a High Endemic Community in Hambantota District, Sri Lanka
(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Ashani, M.L.S.; Chandrasena, T.G.A.N.; Gunathilaka, P.A.G.N.; Premaratna, B.A.H.R.
Rickettsial infections are re-emerging in Sri Lanka with an average annual incidence of 1500 patients. Low awareness and the scarcity of proper diagnostic tools has resulted in delayed disease diagnosis and negligence towards the disease leading to extended morbidity in Sri Lanka. Community awareness of the disease is important for timely diagnosis and control. Hambantota district in Southern Province of Sri Lanka, which records the fourth highest incidence of typhus, was selected for the study. Households (n= 204) situated around index cases of typhus fevers were randomly selected for the survey. An interviewer-administered questionnaire was used to gather data on illness awareness (disease aetiology, symptoms, transmission, disease associations) by selecting a consenting representative from each household. Descriptive and inferential analysis of the data was carried out using SPSS IBM statistical software. Of the 204 interviewed, only one (0.5%) identified the illness as “typhus”. Majority identified the disease as “Peacock fever” (43.12%; n= 88) followed by “tick fever” (14.71%; n=30). It is interesting to note that 41.67% (n=85) of the households were not aware of the disease even though they are living in a disease endemic area. None were aware of the etiological agents of typhus fever. Among those with awareness, 65.55% (n=78), believed that infection was tick-borne and the vector ticks were harbored by peacocks. About 27.73% (n=33) believed that the transmission was directly from peacocks, followed by other birds (2.52%; n=3). Majority 82.35 %, (n=98) were unaware of symptomatology while only 1.77%, (n=14) recognized it only as a febrile illness and myalgia (4.20%; n=5). Of those who were aware, 73.95 %, (n=88) had received information through acquaintances, 25.21% (n=30) from health personnel and one through mass media. None were aware of preventive measures. The results of the present study highlight the lack of proper awareness of the disease condition, which may adversely impact on disease control efforts
Clinical profile and difficulties in diagnosis of central nervous system infections in adult patients in a tertiary care hospital
(Sri Lanka Medical Association, 2013) Ranawaka, U.K.; Rajindrajith, E.G.D.S.; Perera, K.V.H.K.K.; Dassanayake, K.M.M.P.; Premaratna, B.A.H.R.; de Silva, H.J.
Comparison of methods for diagnosis of bancroftian filariasis
(Sri Lanka Medical Association, 2000) Chandrasena, T.G.A.N.; Premaratna, B.A.H.R.; Abeyewickreme, W.; de Silva, N.R.
OBJECTIVE: Evaluate a rapid format immuno-chromatographic card test (ICT Diagnostics, Australia) in the diagnosis of bancroftian filariasis. METHOD: Thick night blood films (TBF), Nuclepore membrane filtration (NMF) and ICT were performed on venous blood collected from 226 individuals selected from highly endemic localities in Colombo [n~153 (63%)] and Gampaha [n=73 (32.3%)] districts. Blood was collected between 20.00 and 23.00 hours. 60ul of non-heparinised blood, 1ml and lOOpl of heparinised blood were used in TBF, NMF and ICT tests respectively. A self-administered questionnaire (expert validated) was used to screen for clinical manifestations. RESULTS: The mean age of the study population was 34-8yrs (range 14-76, SD 16.78); the male: female ratio was 98: 128. NMF was positive in 66/226 (29%), with a mean microfilariae count of 343/ml (range 9-1782, SD 422). All 66 were positive by ICT (sensitivity = 100%) but only 63 by TBF (sen.sitivity=95%). 59/226 (26.1%) had one or more filariasis specific symptoms (lymphoedema, hydrocoele, lymphadenitis, lymphangitis, fever, night cough and red spots). Of the 59, 25 (42.3%) were positive by the ICT, 24 (40.6%) were positive by NMF. The other 34 were negative in both tests. Out of the 166 asymptomatics, 42 were positive in both NMF and ICT, but there were 13 more positives with ICT. CONCLUSIONS: ICT card test was more sensitive in detecting microfilaria compared to venous thick night blood film. Both ICT and NMF were positive in only in about 40% of individuals with symptoms suggestive of filariasis.
Compliance with the mass chemotherapy program for lymphatic filariasis
(Sri Lanka Medical Association, 2001) Kasturiratne, K.T.A.A.; Premaratna, B.A.H.R.; Pathmeswaran, A.; de Silva, N.R.; de Silva, H.J.
OBJECTIVE: To evaluate compliance with the single dose mass chemotherapy program for control of filariasis, and to determine factors influencing compliance in the Gampaha district. DESIGN: A prospective study employing a pre-tested self-administered questionnaire. METHODS: Four groups comprising individuals over one year old with residence in the Gampaha district for over one year were surveyed. Data collection was started two weeks after the mass chemotherapy program. RESULTS: 2300 questionnaires were distributed, 1983 (86.2 percent) were returned, and 1935 (84.1 percent) were sufficiently complete for analysis (857 males; mean age 39 years, SD equal 19.5). Over 96 percent had heard of filariasis and the mass chemotherapy program, but only 60.3 percent of those over 11 years of age were aware of asymptomatic carriage of the parasite. 1289 (66.6percent) out of the total sample surveyed (1935 individuals) had obtained the diethylcarbamazine tablets, and 1221 (63.1 percent) had taken the drug. Of the possible demographic factors that could have influenced compliance only educational level seemed to play an independent significant role, compliance being lowest at both extremes of educational level. The main problem with compliance was obtaining the drug from distribution centres. CONCLUSIONS: Compliance with the mass chemotherapy program to control filariasis needs improvement. Strategies should include a better system for distributing the drug, and altering the content of the publicity material used by the program to target less compliant groups, and improve aspects of knowledge regarding filariasis that seem inadequate at present.
Dengue and leptospirosis infection during the coronavirus 2019 outbreak in Sri Lanka
(Oxford University Press, 2021) Niriella, M.A.; Ediriweera, D.S.; de Silva, A.P.; Premaratna, B.A.H.R.; Jayasinghe, S.; de Silva, H.J.
ABSTRACT: A significant decrease in dengue fever cases and a contrasting increase in leptospirosis cases were reported for the second quarter of 2020 compared with 2019 in Sri Lanka. In the absence of significant environmental and weather-related differences to account for these changes in incidence, we investigated the possibility that the effects of the COVID-19 pandemic on public health, social behaviour and the restrictions imposed during the lockdown influenced the fluctuations in dengue and leptospirosis infections. KEYWORDS: COVID-19; dengue fever; leptospirosis; pandemic; tropical infections.
Effect of propranolol and nitrates on cardio-respiratory function in cirrhotic patients
(Sri Lanka Medical Association, 2000) Premaratna, B.A.H.R.; Sathischandra, H.; Thilakaratne, Y.; Shantharaj, W.S.; de Silva, H.J.
Abstracts Available
Effects of pollution on health of residents in an industrial area in Sri lanka
(Sri Lanka Medical Association, 2000) Premaratna, B.A.H.R.; Chandrasekera, K.A.B.; Dissanayake, A.S.D.; de Silva, H.J.
INTRODUCTION: The effect of industrialisation on the health of people living in industrial areas of Sri Lanka is not known. METHOD: A cross sectional comparative prevalence study was done in two randomly selected populations [population 1: from Ekala industrial zone (I), and 2; from nonindustrialised suburban area (Controls)] using Illnesses related interview (using a pre-tested questionnaire), clinical examination and peak expiratory flow rate measurement. RESULTS: Population: Age 1-12y; I: n=81 (male: female=36:45), C: n=73 (male:female = 32:41); Age >12y; I: n=158 (male:female = 51:107), C: n=146 (male:female=58:88). There was no difference in demographic characteristics between the two populations. In the l-12y age group; prevalence of cough I: 15/81 (191%) and C: 5/73 (7%) [OR: 3.09 (Cl; 0.98 -10.3), p= 0.05] and rhinitis I: 18/81 (22%) and C: 5/73 (7%) [OR: 3.09 (CI; 0.9840.3) p=0.01). In the >12y group; unexplained cough L 22/158 (14%) and C: 8/146 (5.4%) [OR: 2.79 (CI; 1.13-7.09), p=0.02], unexplained headache I: 60/158 (38%) and C: 33/146 (23%) [OR 2.1(CI; 1.23-3.58), P-0.003], rhinitis L 20/158 (13%) and C: 9/14 (6.2%) [OR: 2.21 (CI; 0,91-5.44) p=0.08], PEF; females (<4201/min) I: 43/91 (47%) and C: 22/8] (27%) [OR: 2.4 (CI; 1,21-4-8) p= 0.006] and males (<4701/min) I: 16/32 (50%) and C: 8/40 (20%) [OR: 4 (CI; 1,26-12.9) p=0.01). There were no significant differences in frequency of medical consultations, miscarriages, birth defects, wheezing, and skin conditions. CONCLUSIONS: Both children and adults living in the industrial zone seem to be more at risk of respiratory disorders other than bronchial asthma. The occurrence of unexplained headache is a new finding, which needs further evaluation.
Factors associated with urinary tract infections caused by extended spectrum β-lactamase producing organisms (ESBL-UTI) among hospitalized patients in a tertiary care hospital
(Sri Lanka Medical Association, 2016) Fernando, S.C.; Wickramasinghe, R.D.S.S.; Luke, W.A.N.V.; Gunathilake, M.P.M.L.; Sebastiampillai, B.S.; Miththinda, J.K.N.D.; Silva, F.H.D.S.; Premaratna, B.A.H.R.
INTRODUCTION AND OBJECTIVES: Management of infections caused by ESBL producers is a challenge and expensive. Known associations for ESBL-UTI include recent hospitalizations, recent treatment with cephalosporins, quinolones or penicillin, age over 60 years, male gender, diabetes mellitus, recent Klebsiella pneumoniae infection and obstructive uropathy. Associations for ESBL-UTI in Sri Lanka are not known. METHOD: In order to identify associations of urinary tract infections (UTIs) caused by ESBL producers (ESBL-UTI),a descriptive cross-sectional study was carried out in patients with culture positive ESBL-UTIs admitted to the Professorial Medical unit, Colombo North Teaching Hospital. Patients’ medical records and an interviewer administered questionnaire were used to obtain data. RESULTS: There were 61 patients, 30 (49.1%) males with a mean age of 64.1 years. Of them, 54 (88.5%) had diabetes mellitus,38 (62.2%) had hypertension and 10 (16.3%) had chronic liver disease (CLD). 21 (34.4%) had acute pyelonephritis, 19 (31.1%) had evidence of chronic kidney disease,8 (13%) had obstructive uropathy by ultrasonography. A history of constipation was given in 27 (44.2%), hospitalization during the past 3 months in 30 (49.2%), urinary catheterization in 20 (32.7%) and antibiotic treatment within the past 3 months in 39 (63.9%). CONCLUSION: Most associations for ESBL-UTI in Sri Lanka were similar to that had been previously described. However the observed higher incidence of CLD, hypertension and CKD needs further evaluation. The fact that 50.8% did not have a history of recent hospitalization and 36.1% did not have recent antibiotic therapy suggest high community prevalence of ESBL producing organisms.
Factors influencing urinary tract infections caused by extended spectrum β-lactamase producing organisms among a cohort of hospitalized patients in Sri Lanka
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Luke, W.A.N.V.; Premaratna, B.A.H.R.; Fernando, S.C.; Silva, F.H.D.S.; Sebastiampillai, B.S.; Wickramasinghe, R.D.S.S.; Gunathilake, M.P.M.L.
BACKGROUND: Urinary tract infections (UTI) caused by extended-spectrum β-lactamase (ESBL)-producing organisms are a management challenge and a health care burden. OBJECTIVES: To describe factors that influence ESBL UTI among hospitalized patients. METHODS: Fifty two consecutive patients who were admitted with culture positive ESBL UTI to the Professorial Medical Units, Colombo North Teaching Hospital, Ragama over a period of 6 month since January 2015 were recruited. Data was collected by an interviewer administered questionnaire and patients medical records after obtaining informed written consent. RESULTS: Among all 52 ESBL UTI patients, 46 (88.5%) had diabetes mellitus, 32 (61.5%) hypertension, 10 (19.2%) chronic liver disease, 18 (34.6%) a history of constipation. Four (7.7%) patients each were detected to have either hydronephrosis, hydroureter or prostatomegaly in USS assessment. Thirty two (61.5%) had received antibiotic treatment within the last 3 months: 18 (34.6%) has had penicillins and 16 (30.8%), 3rd generation cephalosporins, Twenty four (46.2%) had hospitalization in the last 3 months and 16 (30.8%) had a history of urinary catheterization. CONCLUSIONS: Diabetes, recent antibiotic treatment, hospitalization and catheterization were observed to influence ESBL UTIs. However the fact that 53.8% patients who developed ESBL UTI did not have a history of recent hospitalization, suggests high existence of community acquired ESBL.
Liver dysfunction and its outcome in patients with dengue infection
(Sri Lanka Medical Association, 2010) Kumarasena, R.S.; de Silva, A.P.; Keragala, B.S.D.P.; Premaratna, B.A.H.R.; Premawardhena, A.P.; Jayamanna, S.F.; de Silva, H.J.; de Silva, S.T.
OBJECTIVES: To determine the frequency and severity of liver dysfunction due to dengue infection among hospitalised patients. METHOD: A retrospective, descriptive study was done at University Medical Unit, Colombo North Teaching Hospital. Records of all serologically confirmed dengue (IgM antibody positive) patients admitted from 1/1/09-31/1/10 were analysed. Results of blood tests, imaging and serology were noted. A diagnosis of acute liver failure was made in patients with an INR >1.5 together with hepatic encephalopathy. Patients on hepatotoxic drugs, alcohol abusers and patients with known chronic liver diseases (total 14 patients) were excluded from the analysis. RESULTS: Of 328 patients (58.5% female), aged 14-68 years (mean 38) with confirmed dengue, 169 (51.5%) had dengue fever, 147 (34.2%) dengue haemorrhagic fever (grade 1 and 2) and 47 (14.3%) dengue shock syndrome. 257 (78.4%) had elevated hepatic transaminases of whom 153 (46.6%) had minimal elevation (<3 times upper limit) and 38 (11.6%) had >1000 IU/1. Of those with elevated transaminases, 94% had AST: ALT >1. Thirteen (3.9%) with transaminases >1000 IU /I developed acute liver failure of whom 2 died. In 3 patients of whom 1 died, ischaemic liver injury (prolonged shock followed by rapid rise in ALT>AST) probably accounted for abnormal transaminases. Presence of nausea or vomiting at the time of AST/ALT>1000 was the only independent risk factor for development of acute liver failure (pO.OOl) on multivariate analysis. CONCLUSION: Abnormal liver function was common among hospitalised dengue patients. Liver failure was uncommon, and nausea or vomiting at the time of AST/ALT>1000 predicted its development.
A pilot study on virtual patients: Understanding student experiences to facilitate learning
(Faculty of Graduate Studies, University of Kelaniya, 2015) Karunaratne, W.C.D.; Chrandratilake, M.N.; Premaratna, B.A.H.R.
Virtual patients are web-based interactive clinical scenarios and are being increasingly used globally in undergraduate medical training. Despite its value, virtual patients are not been used widely in the local context. Therefore this pilot study examined student experiences of using a virtual patient with the aim of identifying student acceptance and the possibility of integration into the medical curriculum to enhance student learning. A virtual patient having a linear navigation design was developed in the virtual learning environment (VLE) of the faculty paying meticulous attention to instructional designing, medical education principles and content coverage. 12 immediate graduates of the faculty were recruited to the study following informed consent as they have completed the undergraduate curriculum and in a position to provide meaningful comments on the activity concerned. They were given online access to the virtual patient and were requested to complete the case study followed by an 18 item survey designed on the same platform. The results were analysed using MS Excel. All study participants unanimously agreed to the usefulness of virtual patients for medical undergraduate training. It was identified as a means to practice clinical cases, preparation for clinical training in the ward setting, a guide for assessments, to understand practical aspects of patient management and a means to refresh the knowledge. The most useful features were the multiple choice questions integrated to the case study, immediate feedback and learning points. The essay type questions which require text input were discouraged. It was suggested to impose a time limitation as it mimics the reality and to include more practical aspects. The positive student experiences associated with the interaction of the virtual patient during this study highlighted the need for such innovative methods to facilitate medical undergraduate learning. However, a larger study needs to be conducted on different virtual patient designs before adopting them for student learning.
Prevalence of osteoporosis and osteopenia in a sample of Sri Lankan adults
(University of Kelaniya, 2008) Karunanayake, A.L.; Salgado, L.S.S.; Premaratna, B.A.H.R.; Femando, S.; Herath, H.M.R.P.; Abeysuriya, V.; Kumarendran, B.; Mahavithanage, S.T.C.
Introduction: Osteoporosis is characterized by low bone mineral density and deterioration in the micro architecture of bone that increases its susceptibility to fracture. This condition is becoming increasingly common in our country in the elderly, especially in post menopausal women. Objective: To determine the prevalence of osteoporosis and osteopenia in a sample of Sri Lankan adults. Methodology: A descriptive cross sectional study was conducted at the Faculty of Medicine University of Kelaniya from July 2007 to October 2007. The study subjects were selected from 22 grama niladhari divisions of the Ragama MOH area. From each division males and females aged 35 to 64 years were randomly selected from the voters list and recruited for the study. A P-dexa scan was used to measure the BMD of the left middle finger. AT score of S-2.5 was considered as osteoporosis, >-2.5 to -1 as osteopenia. These two categories together were considered as low BMD. A T score of> -1 was considered normal. Results: There were 762 subjects with a mean age (SD) of 52.3 (7.5) comprising 61% females and 39% males. The prevalence of osteoporosis and osteopenia were 14% and 29% respectively. In subjects aged less than fifty years 9% of females and 3% of males had osteoporosis and 31% of females and 18% of males had osteopenia. In subjects aged fifty years or more 33% of females and 3% of males had osteoporosis and 38% of females and 21% of males had osteopenia. Conclusion: the prevalence of osteoporosis and osteopenia were higher among the females. The prevalence of osteoporosis among females aged over fifty years was markedly higher than the females who are less than fifty years.
Prevalence of osteoporosis in a sample of Sri Lankan urban population
(Sri Lanka Medical Association, 2008) Karunanayake, A.L.; Salgado, L.S.S.; Abeysuriya, V.; Fernando, S.; Herath, H.M.R.P.; Kumarendran, B.; Premaratna, B.A.H.R.; Mahawithanage, S.T.C.
BACKGROUND: Osteoporosis is characterized by low bone mineral density and deterioration in the micro architecture of bone. It predisposes individuals to increased risk of fractures of the hip, spine and other skeletal sites. Peripheral DEXA (P-DEXA) scans are ideal for mass screening of bone mineral density (BMD). OBJECTIVE: To determine the prevalence of osteoporosis and osteopenia in a sample of urban Sri Lankans. DESIGN, SETTING AND METHODS: A descriptive cross sectional study was conducted at the Faculty of Medicine, University ofKelaniya from July 2007 to October 2007. The study subjects were selected from 22 Gramasevaka Niladhari Divisions of the Ragama MOH area. From each division, people aged 35 to 65 years were randomly selected from the voters list and invited to participate in the study. A P-DEXA scan was used to measure the BMD of the left middle finger. A T score of <-2.5 was considered as osteoporosis, -1 to -2.5 as osteopenia. These two categories together were considered low BMD. A T score of > -1 was considered normal. RESULTS: There were 731 subjects with a mean age (SD) of 52.5 (7.5) comprising 60% females. The prevalences of osteoporosis and osteopenia were 14% and 29% respectively. 20% of females and 6% of males were affected with osteoporosis. The prevalence of osteoporosis was 7% among those <50 years and 20% among those >50 years. CONCLUSION: There was a high prevalence of low BMD in this urban population. Prevalence of low BMD was higher among females and those over fifty years.
Prevalence of rickettsial infections in acute coronary syndromes in Sri Lanka: a case control study
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Mettananda, K.C.D.; Danansuriya, D.S.T.; Bandara, N.K.B.K.R.G.W.; Premaratna, B.A.H.R.
Background: Place of infection in atherosclerosis and or coronary heart disease has recently drawn interest. Rickettsiae are a group of obligate intracellular pathogens who invade vascular endothelial cells leading to vasculopathy. A study conducted in Thaiwan, scrub typhus was found to increase the risk of acute coronary syndromes (ACS) by 37% compared to general population after adjusting for age, sex and other known independent risk factors. Objective: To assess the prevalence of Rickettsial infections in patients with ACS residing in Western province, Sri Lanka. Methods: Patients admitted with ACS to Professorial-Medical-unit, were studied for serological prevalence of Rickettsial infections and were compared with a matched control group; who had no fever or ACS. 2ml serum samples were obtained at enrolment and 2weeks after and were assessed for IFA-IgG antibody titres against Orientiatsutsugamushi (OT) and Spotted-fever-group-rickettsioses (SFG). An IgG titre>1:128 or a rising/declining titre were considered positive for acute rickettsioses. A static titre was considered to be due to previous exposure to rickettsioses. Results: 46 ACS patients (males-23.9%, mean age 61.1 [SD=13.1] years) and 52 controls (male-50%, mean age 56.0[SD=13.6] years) were studied. None had evidence of acute Rickettsiel infection. Sero-prevalence of IgG-OT was 6.4% and IgG-SFG was 15.2% among ACS patients. Same for control group were 3.8% and 11.5% respectively. There was no significant difference in sero-prevalence of OT [OR =0.74; CI: 0.28-10.93; p=0.66] or SFG [OR=1.376; CI:0.43-4.44; p=0.59] in patients with ACS compared to controls. Conclusions: No significant difference was observed in sero-prevalence of rickettsioses in patients with acute coronary syndromes compared to controls in this study.
Rickettsial diseases: revisiting an old enemy
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Premaratna, B.A.H.R.
The history of rickettsioses in Sri Lanka dates back to 1930-1940s. Since of late, rickettsial infections have re-emerged in many parts of the world, including Sri Lanka. We observed patients presenting with serious complications such as encephalitis, myocarditis, pneumonitis and multi-organ involvement carrying high morbidity and mortality due to rickettsioses. Such presentations made us realize the importance of establishing diagnostic facilities in the country in order to face the challenge posed by rickettsioses. After initial collaborative work with the Centers for Disease Control and Prevention, Atlanta, USA, we established IFA based diagnostics in the Faculty in 2008. Subsequently we were able to describe the epidemiological pattern, different clinical presentations, and new serological cut-off points for IFA-IgG based serological diagnostics based on sero-prevalence. Thereafter, in collaboration with the University of Texas Medical Branch at Galveston, USA, we were able to describe the diverse distribution of scrub typhus serotypes in two different localities in Sri Lanka. Subsequently, in collaboration with ImmuneMed diagnostic laboratory at Incheon, South Korea, we were able to identify antibody-based rapid diagnostic tests which could be employed for rapid diagnosis and identification of scrub typhus strains in Sri Lanka.
Role of antioxidants in filar1al infection
(Sri Lanka Medical Association, 2000) Premaratna, B.A.H.R.; Chandrasena, T.G.A.N.; Senerath, G.L.C.S.; Chandrasena, L.G.; de Silva, N.R.; de Silva, H.J.
Abstracts Available
Scrub Typhus, Its potential zoonotic hosts and vectors in Sri Lanka: A preliminary report
(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Ashani, M.L.S.; Chandrasena, T.G.A.N.; Gunathilaka, P.A.G.N.; Premaratna, B.A.H.R.
Scrub typhus or tsutsugamushi disease is an acute febrile infectious disease endemic in the “tsutsugamushi triangle” of Southeast Asia, the Asian Pacific rim, and Northern Australia, with approximately one billion individuals at risk of infection. Currently one million new infections occur annually. The term scrub typhus is descriptive of the typical habitat endemic to the vector, although its existence is not limited to such niches. It is caused by a Gram-negative, obligate intracellular bacterium Orientia tsutsugamushi, of the Rickettsiaceae family, transmitted to humans following an accidental bite by an infected larval trombiculid mite commonly known as chiggers. Chiggers are a group of ectoparasites prevalent on a variety of mammals, mainly small mammals like rodents. Clinical cases of scrub typhus are documented in almost all ecological zones including both rural and urban Sri Lanka, as year-round sporadic cases or as outbreaks. However, the reservoir hosts in Sri Lanka and transmitting vector species are yet to be identified. Such knowledge is important for effective implementation of control measures of this re-emerging infection. Therefore, this study was designed to live capture small rodent/mammal hosts and identify chigger mite species present in the country. Traps designed to live capture small rodents/mammals were placed in peri-domestic areas of clinically confirmed scrub typhus patients in southern province, Sri Lanka. Traps baited with fried coconut were placed around residences and in pre-selected sites with scrubby vegetation and rodent burrows, one hour before sunset and were retrieved the next day morning. The captured animals were anaesthetized with ketamine/xylazine and inspected for the presence of vector mites. Collected mites were preserved in 70% alcohol and identified by microscopy using standard morphological keys. Collected data were analyzed using chi square test, MINITAB 17 statistical software. Rodents belonging to Rattus norvegicus (n=15; 56%), Rattus rattus (n= 10; 37%) and shrews of Suncus murinus (n=2, 7.4%) were captured during the study over 6 months and a total of 147 mites were isolated. Isolated chigger mites belonged to genus Leptotrombidium (n=90; 67%), Eutrombicula (n=31; 23%), Helenicula (n=24,17 %) and species Leptotrombidium lagone (n=2; 1.5 %). Majority were potential vectors for Orientia tsutsugamushi. It is noted that Rattus norvegicus harbored significantly more chigger mites (mean of 7 per individual; χ2 = 110.35; p <0.001] compared to other species captured. We are currently in the process of molecular speciation of sampled chigger mites and molecular detection of Orientia tsutsugamushi in collected mites in order to determine their vectorial potential.