Browsing by Author "de Silva, L."

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Central nervous system infections in a tertiary care hospital: disease patterns and difficulties in diagnosis
(Sri Lanka Medical Association, 2011) Ranawaka, U.K.; Harshani, M.L.; Fonseka, V.N.R.M.; Hathagoda, K.L.W.; Nawaratne, A.N.H.M.U.K.G.D.B.; Weerasooriya, W.A.L.K.; Samarakoon, S.M.S.B.; Thirumawalawan, K.; Premawansa, G.; Fernando, M.A.M.; de Silva, L.; Perera, K.V.H.K.K.; Dassanayake, K.M.M.P.; Wijesooriya, T.; Rajindrajith, E.G.D.S.
INTRODUCTION AND OBJECTIVES: Central nervous system (CNS) infections produce high morbidity and mortality, and effective treatment and outcome depend on precise microbiological diagnosis. We aimed to describe the pattern of CNS infections and accuracy of diagnosis in patients presenting to a tertiary care hospital. METHODS: We prospectively studied patients with suspected CNS infection admitted to medical and paediatric units of Colombo North Teaching Hospital over three years. Data related to demographic and clinical features, laboratory findings, treatment and immediate outcome. Diagnosis of CNS infection was categorised as definite, probable, possible, and uncertain. RESULTS: 426 patients (293 adults, 133 children) were studied [57.2% males, mean age (SD) years-adults 44(20), children 4(3.15)]. Of them, 27.5% had received antibiotics before admission. Blood cultures were done in 149 (35%) and only 14 were positive. Lumbar puncture was done in 347 (81.4%). CSF culture was positive only in two patients. CSF Gram stains and TB-PCR were all negative. The likely diagnosis was meningitis in 35.4%, encephalitis in 10.6% and a non-specific 'meningo-encephalitis' in 16.7%. A 'definite' microbiological diagnosis was made only in five patients. Diagnosis was considered 'probable' in, 53.7%, 'possible' in 8.7%, and 'uncertain' in 14.8%. An alternative diagnosis was found in 22% (13.6% adults, 40.6% children). Intravenous antibiotics (86.8%) and acyclovir (42.5%) were widely used on empiric grounds. CONCLUSIONS: Diagnosis of CNS infections is highly unsatisfactory with available facilities, even in a tertiary care setting. Better facilities are needed to improve aetiological diagnosis, and are likely to improve care and minimise treatment costs.
Clinical Charasteristics of paediatric rickettsioses
(Sri Lanka Medical Association, 2013) Premaratna, R.; Karunasekara, K.A.W.; Fernando, M.A.M.; de Silva, L.; Chandrasena, T.G.A.N.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Rickettsioses are re-emerging in Sri Lanka. Both children and adults are vulnerable to these infections. Data on paediatric rickettsioses in the country are sparse. Objectives were to study the clinical characteristics of paediatric rickettsioses based on data received by the Rickettsail Disease Diagnostic and Research Laboratory (RDDRL), Faculty of Medicine, University of Kelaniya, over the last two years. METHODS: All clinical and laboratory data of confirmed rickettsioses were analyzed. RESULTS: Out of 46 requests received by the RDDRL, 22 were positive for acute rickettsioses in diagnostic titres IFA-IgD>1:128 (all>256). Of the positives, 16 were positive for spotted fever group rickettsioses (SFG), 5 for scrub thypus (ST) and 1 for both. 4/5 ST had eschars. The mean age was 56.59 months. (43.9); the youngest affected was aged 5 months. Of the sample 12 (54.5%) were male. Fever was present in all; mean duration was 9.81 (4.5) days; fever intensity was 102.80F (1.03); frequency of spikers per day was 2.33 (0.67). clinical features were headache 12 (54.5%), body aches 9 (40.9%), joint pains 6 (27.3%), cough 14 (63.6%), shortness of breath 5 (22.7%), rash 14 (63.6%); macular popular rash 13, diarrhea 4 (18.2%), lymphadenopathy 7 (31.8%), palpable liver 4, palpable spleen 1. Total WBC 11.1x109/L (SD-4.8); neurophils-84.8% (SD-13.8) lymphocytes 40.5% (17.2). ESR 1st Hr 46.3mm (SD-26.7) CRP 42.1mg/dl (40.6) SGOT 51.2iu/L (32.1) SGPT 50.2iu/L (51.4). ECG was normal in all, Chest x-ray showed patchy shadows in 4. CONCLUSIONS: SFG rickettsioses were commoner than ST, among children living in the Gampaha and Kurunegale districts. Clinical features were similar to adults. Diagnostic investigations were requested late in the febrile illness.
Comparison of clinical and laboratory parameters between Rickettsiosis positive and negative children
(Sri Lanka Medical Association, 2013) Premaratna, R.; Karunasekara, K.A.W.; Fernando, M.A.M.; de Silva, L.; Chandrasena, T.G.A.N.; de Silva, H.J.; Miththinda, J.K.N.D.; Mufeena, M.N.F.; Madeena, K.S.K.; Bandara, N.K.B.K.R.G.W.
INTRODUCTION AND OBJECTIVES: Identification of clinical or biochemical parameters that differentiate rickettsioses from other fevers would help in clinical practice to reduce morbidity and mortality associated with childhood rickettsioses. METHODS: Clinical and laboratory parameters of 22 confirmed paediatric rickettsioses (SFG-16/22, ST-5/22, Mixed-1) were compared with those of 24 with fever who were negative for rickettsioses, based on data received by the Rickettsial Disease Diagnostic and Research Laboratory (RDDRL), Faculty of Medicine, University ofKelaniya. Results: Comparisons of clinical and laboratory parameters between rickettsioses vs non-rickettsioses were mean(SD); age in months 56.59 (43.9) vs 78.13 (42.08) (p=0.1); fever duration 9.81 days (4.5) vslO.68 days (8.79) (p-0.68); fever intensity 102.80F (1.03) vs 102.440F (1.23) (p=0.4); fever spikes per day 2.33 (0.67) vs 2.68 (0.75) (p=0.186); headache 12/22 vs 11/24 (p=0.64); body-aches 9/22 vs 9/24 (p-0.52); pain in arms and legs 6/9 vs 7/9 (p=0.5); joint pains 6/22 vs 7/24 (p=O.S9); cough 14/22 vs 9/24 (p=0.0*7); shortness of breath 5/22 vs 2/24 (p=0.19); eschar (all ST) 4/22 vs 0/24 (p=0.02); rash 14/22 vs 14/24 (p=0.69); maculo-papular rash!3/14 vs 12/14 (p=0.91); diarrhoea 4/22 vs 4/24 (p-0.89); lymphadenopathy 7/22 vs 8/24 (p=0.913); spleenl/22 vs 5/24 (p=0.18); total WBC 11.U109/L (4.8) vs 9.8xl09/L (4.8) (p=0.36); N-84.8% (13.8) vs 5.4(2) (p=0.29); ESR IstHr 46.3mm (26.7) vs 81.8mm (10.2) (p=0.37); CRP 42.1mg/dl vs 56.7mg/dl (6.7) (p=0.46); SCOT 51.2iu/L (32.1) vs 248.7iu/L (678) (p=0.43); SGPT 50.2iu/L (51.4) vs 170.7iu/L (404) (p=0.44). CONCLUSIONS: In paediatric patients, no clinical or biochemical parameter could differentiate rickettsioses from other aetiologies. Presence of eschars would help to diagnose scrub typhus. However laboratory confirmation is needed to differentiate SFG from other fevers.
Food environment and diabetes mellitus in South Asia: A geospatial analysis of health outcome data
(Public Library of Science,San Francisco, 2022) Kusuma, D.; Atanasova, P.; Pineda, E.; Anjana, R.M.; de Silva, L.; Hanif, A.A.; Hasan, M.; Hossain, M.M.; Indrawansa, S.; Jayamanne, D.; Jha, S.; Kasturiratne, A.; Katulanda, P.; Khawaja, K.I.; Kumarendran, B.; Mridha, M.K.; Rajakaruna, V.; Chambers, J.C.; Frost, G.; Sassi, F.; Miraldo, M.
Background: The global epidemic of type 2 diabetes mellitus (T2DM) renders its prevention a major public health priority. A key risk factor of diabetes is obesity and poor diets. Food environments have been found to influence people's diets and obesity, positing they may play a role in the prevalence of diabetes. Yet, there is scant evidence on the role they may play in the context of low- and middle-income countries (LMICs). We examined the associations of food environments on T2DM among adults and its heterogeneity by income and sex. Methods and findings: We linked individual health outcome data of 12,167 individuals from a network of health surveillance sites (the South Asia Biobank) to the density and proximity of food outlets geolocated around their homes from environment mapping survey data collected between 2018 and 2020 in Bangladesh and Sri Lanka. Density was defined as share of food outlets within 300 m from study participant's home, and proximity was defined as having at least 1 outlet within 100 m from home. The outcome variables include fasting blood glucose level, high blood glucose, and self-reported diagnosed diabetes. Control variables included demographics, socioeconomic status (SES), health status, healthcare utilization, and physical activities. Data were analyzed in ArcMap 10.3 and STATA 15.1. A higher share of fast-food restaurants (FFR) was associated with a 9.21 mg/dl blood glucose increase (95% CI: 0.17, 18.24; p < 0.05). Having at least 1 FFR in the proximity was associated with 2.14 mg/dl blood glucose increase (CI: 0.55, 3.72; p < 0.01). A 1% increase in the share of FFR near an individual's home was associated with 8% increase in the probability of being clinically diagnosed as a diabetic (average marginal effects (AMEs): 0.08; CI: 0.02, 0.14; p < 0.05). Having at least 1 FFR near home was associated with 16% (odds ratio [OR]: 1.16; CI: 1.01, 1.33; p < 0.05) and 19% (OR: 1.19; CI: 1.03, 1.38; p < 0.05) increases in the odds of higher blood glucose levels and diagnosed diabetes, respectively. The positive association between FFR density and blood glucose level was stronger among women than men, but the association between FFR proximity and blood glucose level was stronger among men as well as among those with higher incomes. One of the study's key limitations is that we measured exposure to food environments around residency geolocation; however, participants may source their meals elsewhere. Conclusions: Our results suggest that the exposure to fast-food outlets may have a detrimental impact on the risk of T2DM, especially among females and higher-income earners. Policies should target changes in the food environments to promote better diets and prevent T2DM.
Food environments and obesity: A geospatial analysis of the South Asia Biobank, income and sex inequalities
(Elsevier Ltd, 2022) Atanasova, P.; Kusuma, D.; Pineda, E.; Anjana, R.M.; de Silva, L.; Hanif, A.A.M.; Hasan, M.; Hossain, M.M.; Indrawansa, S.; Jayamanne, D.; Jha, S.; Kasturiratne, A.; Katulanda, P.; Khawaja, K.I.; Kumarendran, B.; Mrida, M.K.; Rajakaruna, V.; Chambers, J.C.; Frost, G.; Sassi, F.; Miraldo, M.
Introduction: In low-middle income countries (LMICs) the role of food environments on obesity has been understudied. We address this gap by 1) examining the effect of food environments on adults' body size (BMI, waist circumference) and obesity; 2) measuring the heterogeneity of such effects by income and sex.Methods: This cross-sectional study analysed South Asia Biobank surveillance and environment mapping data for 12,167 adults collected between 2018 and 2020 from 33 surveillance sites in Bangladesh and Sri Lanka. Individual-level data (demographic, socio-economic, and health characteristics) were combined with exposure to healthy and unhealthy food environments measured with geolocations of food outlets (obtained through ground-truth surveys) within 300 m buffer zones around participants' homes. Multivariate regression models were used to assess association of exposure to healthy and unhealthy food environments on waist circumference, BMI, and probability of obesity for the total sample and stratified by sex and income.Findings: The presence of a higher share of supermarkets in the neighbourhood was associated with a reduction in body size (BMI, β = - 3∙23; p < 0∙0001, and waist circumference, β = -5∙99; p = 0∙0212) and obesity (Average Marginal Effect (AME): -0∙18; p = 0∙0009). High share of fast-food restaurants in the neighbourhood was not significantly associated with body size, but it significantly increased the probability of obesity measured by BMI (AME: 0∙09; p = 0∙0234) and waist circumference (AME: 0∙21; p = 0∙0021). These effects were stronger among females and low-income individuals.Interpretation: The results suggest the availability of fast-food outlets influences obesity, especially among female and lower-income groups. The availability of supermarkets is associated with reduced body size and obesity, but their effects do not outweigh the role of fast-food outlets. Policies should target food environments to promote better diets and reduce obesity.
From function and fidelity ; a study of their relationship in the translation of poetry with special reference to the translation of Sinhala poetry
(1987) de Silva, L.
Low uptake of COVID-19 prevention behaviours and high socioeconomic impact of lockdown measures in South Asia: Evidence from a large-scale multi-country surveillance programme
(Elsevier Science, 2021) Kusuma, D.; Pradeepa, R.; Khawaja, K.I.; Hasan, M.; Siddiqui, S.; Mahmood, S.; Ali Shah, S.M.; de Silva, C.K.; de Silva, L.; Gamage, M.; Loomba, M.; Rajakaruna, V.P.; Hanif, A.A.; Kamalesh, R.B.; Kumarendran, B.; Loh, M.; Misra, A.; Tassawar, A.; Tyagi, A.; Waghdhare, S.; Burney, S.; Ahmad, S.; Mohan, V.; Sarker, M.; Goon, I.Y.; Kasturiratne, A.; Kooner, J.S.; Katulanda, P.; Jha, S.; Anjana, R.M.; Mridha, M.K.; Sassi, F.; Chambers, J.C.; NIHR Global Health Research Unit for diabetes and cardiovascular disease in South Asia.
BACKGROUND: South Asia has become a major epicentre of the COVID-19 pandemic. Understanding South Asians' awareness, attitudes and experiences of early measures for the prevention of COVID-19 is key to improving the effectiveness and mitigating the social and economic impacts of pandemic responses at a critical time for the Region. METHODS: We assessed the knowledge, behaviours, health and socio-economic circumstances of 29,809 adult men and women, at 93 locations across four South Asian countries. Data were collected during the national lockdowns implemented from March to July 2020, and compared with data collected prior to the pandemic as part of an ongoing prospective surveillance initiative. RESULTS: Participants were 61% female, mean age 45.1 years. Almost half had one or more chronic disease, including diabetes (16%), hypertension (23%) or obesity (16%). Knowledge of the primary COVID-19 symptoms and transmission routes was high, but access to hygiene and personal protection resources was low (running water 63%, hand sanitisers 53%, paper tissues 48%). Key preventive measures were not widely adopted. Knowledge, access to, and uptake of COVID-19 prevention measures were low amongst people from disadvantaged socio-economic groups. Fifteen percent of people receiving treatment for chronic diseases reported loss of access to long-term medications; 40% reported symptoms suggestive of anxiety or depression. The prevalence of unemployment rose from 9.3% to 39.4% (P < 0.001), and household income fell by 52% (P < 0.001) during the lockdown. Younger people and those from less affluent socio-economic groups were most severely impacted. Sedentary time increased by 32% and inadequate fruit and vegetable intake increased by 10% (P < 0.001 for both), while tobacco and alcohol consumption dropped by 41% and 80%, respectively (P < 0.001), during the lockdown. CONCLUSIONS: Our results identified important knowledge, access and uptake barriers to the prevention of COVID-19 in South Asia, and demonstrated major adverse impacts of the pandemic on chronic disease treatment, mental health, health-related behaviours, employment and household finances. We found important sociodemographic differences for impact, suggesting a widening of existing inequalities. Our findings underscore the need for immediate large-scale action to close gaps in knowledge and access to essential resources for prevention, along with measures to safeguard economic production and mitigate socio-economic impacts on the young and the poor. KEYWORDS: COVID-19; Preventative measures; Socioeconomic impact; South Asia; Surveillance system.
Multisystem inflammatory syndrome in children: A Sri Lankan case series
(Sri Lanka College of Paediatricians, 2021) Sandakelum, U.; Samararathna, R.; Pathiraja, H.; de Silva, L.; Balasubramaniam, R.; de Abrew, G.; Adihetty, D.; Fernando, M.; Randeny, S.; Mettananda, S.
No Abstract Available
Natural history of haemoglobin E/beta thalassaemia: the impact of splenectomy on growth and steady state hemoglobin levels
(American Society of Hematology, 1999) Sharma S.; Premawardhena, A.P.; Fathihu, F.; de Silva, S.; de Silva, L.; Vichinsky, E. P.; Weatherall, D. J.; Olivieri, N. F.
Parallels in Poetry: 1450-1650 Sri Lanka and England
(University of Kelaniya, 1987) de Silva, L.