Theses - Faculty of Medicine

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Activity and bionomic aspects of primary and secondary vectors for dengue transmission in Gampaha district, Sri Lanka
(University of Kelaniya, Sri Lanka, 2022) Dalpadado, C.P.R.D.
Sri Lanka had experienced periodic dengue epidemics every two to three years for the last two decades. In this scenario, understanding bionomics aspects, and the prevalence of dengue vector species in varied settings will help to develop more accurate and focused vector control approaches. Thus, the current study is intended to elucidate the bionomics of Aedes aegypti and Ae. albopictus, in urban (Negombo, Wattala, Kelaniya), suburban (Attanagalla, Gampaha, Minuwangoda) and rural (Dompe, Meerigama, Divulapitiya) areas of the Gampaha District, Sri Lanka from April 2017 to December 2019. The effectiveness of the insecticide space spraying depends on susceptibility status and the behaviour of the targeted species, hence a part of this study included testing susceptible levels of Ae. aegypti and Ae. albopictus against malathion and deltamethrin insecticides. The study also sought to establish area-specific threshold values for determining the risk of dengue transmission based on larval indices, and a forecasting model for predicting impending dengue outbreaks within the district. Total 19,835 possible breeding habitats were investigated at 13,563 premises where Aedes larvae were identified in 11.03% of premises and 1856 habitats were positive for larvae (Ae. aegypti; 9.8%; Ae. albopictus; 90.2 %). Results showed that Ae. aegypti prefers urban locations while Ae. albopictus is the predominant vector in all spatial settings. Ae. albopictus (54.5%; n= 999) dominated the adult collection, followed by Ae. aegypti (45.5%; n= 835), with a 1:4 male to female ratio. Ae. aegypti mosquitoes demonstrated endophilic resting behaviour, whereas Ae. albopictus were exophilic (Chi-square analysis between the two species; P < 0.001). Resting places of Aedes aegypti recorded as on cloth hangings (36.9%, n=308) and under furniture (40.4%) predominantly in bedrooms (40.4%) and living rooms (24.8%) while Ae. albopictus preferred to rest on outdoor vegetation Xxix 46%(n=460). The majority (43.7 %; n=801) of Aedes mosquitoes rest 1-2 m above ground, and 34.4 % (n=399) rested 1 m or less. The host-seeking cycle of Ae. albopictus was bimodal, with morning peak occurring between 05:00 and 11:00 and afternoon peak between 14:00 and 19:00. While that of Aedes aegypti was with a minor peak between 05:00 and 09:00 and a major peak between 13:00 and 19:00. Physicochemical parameters of mosquito breeding water changed significantly across breeding categories (Kruskal—Willi’s statistics, p < 0.001) showing the change of mosquito susceptibility status. There was a strong positive association between rainfall, larval vector density, and the likelihood of high dengue incidence. When Breteau Index for Ae. aegypti (BIA) exceeds 3.00 and relative humidity exceeds 80%, an early epidemic alert is triggered while BIA > 6.0, case incidence reached an epidemic level in urban areas. In suburban areas, when BI for Ae. albopictus (BIB) > 14.0 an early epidemic alert is triggered. At the BIB > 20, case incidence reached epidemic levels even in absence of Ae. aegypti. Case incidence exceeds the epidermic level in rural areas when the BI for Ae. albopictus is 10 with a one-month latency. In conclusion, area-based entomological thresholds and rational use of insecticides can be proposed for future control of rising dengue epidemics in the Gampaha district based on vector biology/bionomic related evidence through regular monitoring.
Age related changes of the lumber spine and a study of causes and predisposing factors from low backache
(University of Kelaniya, 2002) Karunanayake, A. L.
Chronic low backache is an important health problem amongst Sri Lankans. The present study was undertaken to [i) determine the causes and risk factors for low backache.[ii) to describe age related changes in the number of cartilage cells in lumbar discs, intima media thickness of lumbar arteries and atherosclerosis of abdominal aorta and lumbar artery openings. I. [iii) to determine the association between such changes in the lumbar arteries and in the abdominal aorta with the number of cartilage cells in lumbar discs. iv) to describe the gross anatomical features of lumbar arteries. Initially, a case control study was carried out among 459 cases (patients with low backache) and 502 controls. Data was collected using a pretested structured interviewer administered questionnaire. Poor posture (OR=128.2), lack of exercise (24.5), positive family history (OR=16.2), education to less than the sixth grade (OR=2.2), daily alcohol consumption (OR =3.4), BMI\>24.9 (OR=1.5) and monthly income of more than Rs.20,000 (OR=2.6) were found to be significant independent risk factors for low backache. Another case control study was done on 130 cases (patients with low backache) and 133 controls assessing postero-anterior and lateral radiographs of the lumbar-sacral spine. Disc space narrowing (OR=16.9) and an Antero Posterior ratio of lumbar vertebra less than 0.9 (OR =10.1) were found to be significantly associated with low backache. Vertebral osteophytes and spondylolisthesis were not significantly associated with low backache. A descriptive cross sectional study was done on 31 adult postmortem specimens. Histological sections of the fourth lumbar discs and fourth lumbar arteries were prepared. The number of cartilage cells in lumbar discs (r= -0.45) and Intima Media Thickness (IMT) of lumbar arteries (r=-0.74) had a significant negative association with age. When compared to individuals under 43 years (median age of sample), individuals over this age were 12.5 times more likely to have atherosclerotic changes in abdominal aorta and lumbar artery openings. IMT of lumbar arteries and atherosclerotic changes in lumbar arteries did not have a significant association with the number of cartilage cells in the intervertebral discs when age was taken into account. Dissections were done on 109 adult cadavers to describe gross anatomical features of lumbar arteries. First to the fourth pair of lumbar arteries arose from a common single stem in 12 percent of cadavers and passed anterior to the crura of the diaphragm in 17 percent. There were several variations in the gross anatomical features of lumbar arteries from what is described in the literature. According to results of the present study, risk factors for backache among Sri Lankans are similar to risk factors found in other countries. In this study vertebral osteophytes and spondylolisthesis were not significantly associated with low backache. The present study was able to identify a new cut off value for A/P ratio that had a significant association with low backache, and for the first time demonstrate an association between the number of cartilage cells in annulus fibrosus and age of the subject. Several gross anatomical variations of lumbar arteries found in this study have also not been documented previously.
Assessment of background radiation and frequency of micronuclei formation in two selected populations in Sri Lanka.
(University of Kelaniya, 2019) Weerakkody, W.A.T.L.
This study assessed background radiation and frequency of micronuclei formation in persons living in Norochcholai and Ragama. Ninety-six healthy individuals (20-59 years of age) from both sexes were selected for the study, comprising 50 from Norochcholai (area closest to the power plant) and 46 from Ragama (control). Ten milliliters of venous blood was drawn and the cytokinesis—block micronuclei assay was performed. Thousand binucleate cells were assessed; the median spontaneous micronuclei formation was estimated. Background radiation was measured using an Automess dose rate meter 6150AD. There was no significant difference in the median micronuclei (MN) frequency between the two sexes (p= 0.538) and the two study areas (p=0.539). There was no correlation between background radiation and MN frequency. Fifty-four water samples (26 from Norochcholai and 28 from Ragama) were analyzed by gamma spectrometry and radioactivity was not detected in any of the water samples. Fifty-one soil samples (25 from Norochcholai and 26 from Ragama) were analyzed by gamma spectrometry. The median radioactivity concentration (IQ range) of 232 Th, 40 K, 226Ra and 210Pb in Norochcholai were 50.0Bqkg-l (31.3-91.2), 99Bqkg-1 (84.0-111.3), 22Bqkg-l (14.3-40.3Bqkg-l) and 27Bqkg-l (23-44Bqkg-l) respectively; in Ragama, the median radioactivity concentrations (IQ range) of were significantly higher in Norochcholai than that of Ragama area exceþt for 40K.The gamma ray absorbed dose rates in soil samples of Norochcholai varied between 32.1 nGyh-l and 81.1 nGyh-l with an average of 51.2nGy h-l which is lower than the global average of 57 nGyh-l; in Ragama, this varied between 27.8-40. lnGyh-1. The mean Raeq of Norochcholai was 149.7 Bqkg-l. A radium equivalent activity above 370, the limit set by the Nuclear Energy Agency group of experts as safe to be used in building materials, was observed in 2 soil samples from Norochcholai. All the soil samples from Ragama had a Raeq below 370Bq/kg. The median Raeq was 73.7 Bq/kg. The median annual effective dose in Norochcholai was 0.062 mSv.y-l and in Ragama it was 0.040mSvy-l. They were within the safe limit of ImSv/y. Hex of all the samples were below I. Thus the soil from both the study areas are safe for human health. Pb were 38.4Bq/kg (26.4-52.1), 100.7Bq/kg (93.1-163.9), 11.7Bq/kg (10.1-16.3) and 25.9 Bq/kg (19.8-47.5) respectively. 232Th activity concentration in both were higher than the world average. Activity concentrations of all the radionuclides. The results of this study can be used as baseline data to monitor exposure to radiation in the selected population in the future. This is important for monitoring radiation hazards and will be useful in case of a nuclear accident. KEYWORDS: Background radiation, micronuclei, Nuclear accident, baseline data, gamma spectrometry
Assessment of risk factors for transmission of malaria in Ampara and Batticaloa Districts in Sri Lanka
(University of Kelaniya, 2015) Fernando, M.A.S.T.
Malaria is a major public health concern in the world. Sri Lanka has achieved a significant reduction in malaria incidence since 2000. Anopheles culicifacies (Giles) complex is well established as the predominant vector of malaria in Sri Lanka. Anopheles subpictus is considered as the secondary vector in Sri Lanka. Assessment of the risk factors for transmission of malaria and sibling species complex of An. culicifacies have not been studies in Ampara and Batticaioa district in Sri Lanka due to the situation in the country during the past three decades. The current study was carried out in above two districts from March 2011 to August 2012. Adult mosquito collection using Cattle Baited Hut Trap, Cattle Baited Net Trap, Window Trap, Hand Catch and Larval Surveillance were carried out on a monthly basis in 28 localities of Ampara and Batticaioa Districts while monitoring the climatic factors correlate with the Anopheles density variations. A sociological survey was also carried out in above 28 localities to assess the risk factors for malaria. An. culicifacies samples collected from the study were checked for their sibling species status based on mitochondrial CO II subunits using Polymerase Chain Reaction method. Results showed that even though An. culicifacies recorded was with low density An. subpictus was recorded with a high density in both Districts. Among the climatic factors, rainfall significantly correlated with the anopheline density in both districts. Also it was revealed that the people in the area have been ignoring malaria due to its low transmission. Sibling species status of the An. culicifacies needs to be studied further in order to determine whether there is new sibling species of An. culicifacies. Continuous entomological surveillance should be done in order to monitor the malaria vector prevalence in the area. People in the area should be educated on malaria particularly about the possibility of migrant populations from malarious countries reintroducing parasite to the country. Malaria vector control measures should be implemented based on the rainfall pattern in the area since the vector continues to breed in usual breeding sites which are clear stagnant water collections.
The association between asthma and functional abdominal pain disorders in paediatric population: common pathophysiological mechanisms causing this association
(University of Kelaniya, 2019) Kumari, A.M.M.V.
Asthma and functional abdominal pain disorders (FAPDs) are common paediatric disorders affecting quality of life. Though the association of asthma with irritable bowel syndrome has been reported, association with other FAPDs and possible underlying pathophysiological mechanisms have not been well described. This thesis describes the association between asthma and FAPDs (Phase I) and investigation of a possible pathophysiological mechanism using gastric motility and lung function tests (Phase II) in a cohort of children. In phase I, a cross-sectional survey was conducted among randomly selected adolescents. The validated Rome HI, and International Study on Asthma and Allergies in Childhood (ISAAC) questionnaires were utilized to identify adolescents with FAPDs and asthma respectively. Health-related quality of life (HRQoL) was evaluated using the Paediatric Quality of Life Inventory. Logistic regression showed independent association between asthma and functional abdominal pain [odds ratio (OR) 3.1, 95% confidence interval (CI) 1.6-6.0], functional dyspepsia (OR 3.9, 95% CI 1.1-13.5) and abdominal migraine (OR 10.2, 95% CI 2.6-39.5). HRQoL was significantly impaired among adolescents with both disorders. In phase II, an extensive review identified shared pathophysiological mechanisms; smooth muscle dysfunction, immune dysfunction, hypersensitivity, mucosal inflammation and barrier dysfunction, followed by a laboratory-based study involving 100 children (age 7-12 years), recruited into 4 groups of 25 each; asthma only, FAPDs only, asthma and FAPDs, and healthy controls. Asthma was diagnosed using clinical history and spirometry, and FAPDs by Rome III criteria. All subjects underwent real-time ultrasonography and spirometry. Gastric emptying rate, amplitude of antral contractions and antral motility index were significantly impaired in children with either disorder or both compared to controls (p<0.05). Antral motility index correlated with FEVi/FVC ratio (r=0.60, p=0.002) and FEF25%-75% (r=0.49,p=0.01) in children with both disorders. In conclusion, a strong independent association was noted between asthma and FAPDs. Gastric motility was significantly impaired in children with either disorder or both. Motility index measuring overall gastric motor function, shov/ed significant positive correlation with lung function parameters that measured airflow limitation. Primary disturbance of smooth muscle activity in airways and the gastrointestinal wall could be a possible pathophysiological mechanism for this association between asthma and FAPDs.
Atopy, allergic diseases and soil transmitted nematode infections in children in Sri Lanka
(University of Kelaniya, 2009) Amarasekera, N.D.D.M.
Allergic diseases in children are a common paediatric problem affecting approximately one third of children worldwide. Attempts have been made to explain the rising prevalence of allergic diseases, of which the "Hygiene Hypothesis" gained much attention. Though an inverse association between a variety of infection and allergy has been demonstrated, the relationship between helminth infections and allergy remains unclear. A cross-sectional study was carried out in 640 school children selected by stratified random sampling from schools in the Western Province. Data regarding allergic diseases was collected using a validated questionnaire. Children were assessed for intestinal helminth infections by examining their stool samples using the modified Kato-Katz technique. Total IgE and specific IgE for a panel of five allergens (Dermatophagoides pteronyssinus, Blomia tropicalis, cockroach, cat dander and grass pollen) were studied using ImmunoCAP technique in a sub sample of 203. Prior exposure to Toxocara was determined using a commercially available ELISA kit, which detected IgG antibodies. A prevalence of 33.7% for allergic diseases (asthma, rhinitis and eczerna) was observed. Rhinitis was the commonest disease (21.4%). 15.5% of children had one or more intestinal nematode infections. 66.7% of children had antibodies indicative of prior exposure to Toxocara, while 30.6% had evidence of recent infection with Toxocara. Total IgE levels in our study population were intermediate between African and Western populations, but higher than other Asians. The levels were higher in children with intestinal nematode infections and those who were exposed to Toxocara. Total IgE correlated poorly with allergic disease status in the presence of helminth infections. 80.3% of children were found to be sensitized to one or more of the allergens tested; most commonly to dust mites. Children with rhinitis or eczema (but not asthma) were more likely to be sensitized to cat dander. No association was found between sensitization and helminth infections in our study population. Multivariate analysis using logistic regression showed that after adjusting for sex and atopy, children with intestinal nematode infections (especially trichuriasis) had a lower risk of having atopic diseases, especially asthma. Seropositivity for Toxocara spp. was not found to be associated with any atopic disease or atopy.
Background radiation and micronuclei in lymphocytes of residents in the vicinity of the mineral sand processing factory in Pulmoddai, Sri Lanka
(University of Kelaniya, 2016) Warnakulasuriya, D. T. D.
Lanka Mineral Sands Ltd (LMS), a government owned company, has been mining mineral sands at Pulmoddai since 1957. The mineral sands that are mined include monazite which contains thorium (Th). Th emits alpha particles on decay and gamma rays are emitted by the daughter products. Biological dosimetry has been established as a sensitive method to estimate exposure to ionizing radiation by using different techniques and the cytokinesis blocked micronuclear (MN) assay is popular for large scale exposure studies as it is an easier, faster and reliable method. The objective of the study was to determine the frequency of MN among the persons residing in the vicinity of LMS and to determine radiation levels in the area. A cross sectional study was conducted from November 2012 to September 2016 among persons 35-45 years of age. Eligible persons were invited to participate after administering a screening questionnaire A detailed questionnaire was used to gather sociodemographic and other details 10 ml of venous blood was drawn under aseptic conditions using disposable equipment by trained personnel after obtaining informed written consent. Background radiation measurements and soil samples for gamma spectrometry were collected from residences of participants. 53 employees of LMS factory, 25 residents within 5 kms from LMS, 25 residents 20- 25 kms from LMS and 29 residents from >50 kms away from LMS were included in the study Six soil samples from the LMS, 64 samples from the residences of participants and 23 samples along highways to Pulmoddai town making a total of 93 soil samples were analysed. Background radiation levels measured by the survey meter, 232Th, 226Ra and 210Pb , concentrations of soil samples were highest in the samples collected from the LMS; the background radiation levels and concentrations of 232Th and 226Ra concentrations were significantly higher in samples from the LMS than in samples of the other groups The median 4°K concentration was highest in the samples collected >50kms away from the LMS. The distance from the LMS was negatively correlated with background radiation measured by the survey meter and the activity concentrations of 232Th (r=-0.305, p=0.003), 226Ra (r=-0.422, p<0.001) and 210Pb (r=-0.369, p<0.001). 4°K activity concentration was significantly positively correlated with the distance from LMS (r=0.456, p<0.00 I). The highest median frequency of MN per 1000 BN cells was in the group residing within 5 krns from LMS with a median (IQ range) of 0.67 (0 17-2.17) There was no significant difference in the MN frequency between employees of LMS and the group residing within 5 krns from LMS. Being a resident of Pulmoddai and being exposed to X-rays were significant predictors of MN formation. Pulmoddai area had a higher background radiation level probably due to the mining of mineral sand at LMS. Residing within 5 kms from LMS was a risk factor for MN formation irrespective of employment status at LMS. Although radiation levels within the LMS were high as compared to the other areas, the risk of long term adverse health effects were low as the dose levels were much smaller than the recommended safe levels.
Biochemical,inflammatory, and histopathological changes in wistar rats given dug well water from high and low disease prevalent villages for chronic kidney disease of unknown etiology (CKDu) in north central province of Sri Lanka
(University of Kelaniya, Sri Lanka, 2021) Thammitiyagodage, M.G.
Chronic Kidney Disease of unknown etiology (CKDu) is prevalent in the North Central Province (NCP) of Sri Lanka. Ingestion of groundwater is identified as one of the causative factors. The einfonley of the population consumes un-boiled dug well water. The objectives of the study were to find out the biochemical, haematological, and immunological changes in Wistar rats that ingested dug well water from high and low disease prevalent areas from the NCP and low disease prevalent Colombo and correlate the findings with their histopathological changes. Sex balance 3 months old Wistar rats (n=60) were used for the study. Their WBC/ DC, cpt CD** gerum cytokines, creatinine, ALT, AST, BUN levels and Microalbumin: creatinine ratios were measured. Rats were randomly divided into 6 groups by assigning 10 rats per group. Groups 1, 2, and 3 were given water from high disease prevalent New Town Medirigiriya (NTM), Bisobandaragama (BB), and Divuldamana (DD) respectively. Group 4 was given boiled water from NTM (NTMB). Groups 5 and 6 were given water from low disease prevalent Huruluwewa (HW) from NCP and tap water from low disease prevalent Colombo (CO) adlibitum quantity. Serum cytokines (IL1β; IL6, TNFα) were measured after 8 months and CD 4+ and CD 8+ counts were measured after 14 months. Histopathology was performed in kidney and liver tissues. Serum TNFα levels were significantly elevated in rats from DD and BB (p<0.05) but hepatic TNFα levels were significantly elevated only in rats from DD (p<0.05)). Rats from high disease prevalent NTM had significantly high CD4+ and CD8+ cells than those from low disease prevalent HW and CO. Immunological findings. were correlated with the histopathological changes. There was a correlation between the kidney Tubular Interstitial (TI) Lesion index and liver lesions. Serum TNFα and CD4+ and CD8+ lymphocytes were closely correlated with renal damage. Rats with severe TI lesions reported a high percentage of portal tracts and parenchymal lesions in the liver and this expression was minimum in CO. It was evident that boiling water was effective against liver damage but not renal damage. The present study is supportive of an immune therapy targeting the CD4+ and CD8+, and TNFα in reducing renal damage in the early stages of the disease. In conclusion, peritubular nonsuppurative interstitial cell infiltrations in kidney tissues were common in all the experimental groups irrespective of the toxicant sicient in water bodies. Observed kidney damage may mediate via cytokine triggered immune response by high sodium, fluoride, calcium and some other unmeasured toxic agents present in NCP water. anid toxicant present in DD from NCP can directly damage the kidney tubules leading to fibrosis.
Bionomics and control effects of anopheles stephensi in Mannar and Jaffna districts of Sri Lanka
(University of Kelaniya, Sri Lanka, 2023) Jude, P.J.
BACKGROUND: Sri Lanka was declared as a country that eliminated malaria disease in 2016 by the World Health Organization. Recent report of Anopheles stephensi as an invasive vector in the northern part of Sri Lanka is one of the challenges to maintain themalaria free states in the country. METHODS: Entomological surveys were conducted at three selected localities in Jaffna and Mannar Districts of Sri Lanka from January 2019 to January 2020 using three entomological techniques. Detailed biology and life cycle related information namely were assessed. Further, effectiveness of insecticide based control efforts (novaluron andtemephos) and application of larvivorous fish Poecilia reticulata were evaluated under laboratory set-up. The Vectorial Capacity (VC) was calculated using a mathematical-based approach. RESULTS: According to the egg morphology, Mysorensis biotype (47%) was the predominant followed by type (38.1%) and intermediate (14.9%). The mating success was 80.7 + 4.45%. The mean hatching period was 1.9 + 0.03 days, with a hatching rate of 86.2 + 0.77%. Overall, 8.0 + 0.14 days were irequired for larval development and 30.3 + 0.14 h were spent in \4e pupal stage. The pupation success was 94.5 + 0.37%, and the majority were males (53.1 + 0.73%). The mean fecundity was 106.5 + 6.38 eggs and a gonotrophic cycle of 3.4 + 0.06 days. The female survival rate was 43.2 + 2.4%, with a mean biting frequency of 66.6 + 3.5%. The average VC of adult An. stephensi was estimated to be 18.7. Significant variations in adult emergence were observed from both larval stages at different salinity levels (P < 0.05). The lowest survival rate was reported as 15.8 2.47% at 25 ppt. The highest mortality rate (100%) at a 1-hour exposure period was observed from temephos at >100 ppm. The nortality rates varied significantly for different concentrations and larvicides (P < 0.05). At 24-h of the exposure period, the 100% mortality of An. stephensi larvae were observed from Bi h temephos and novaluron even at 0.04 ppm. In larvivorous fish study, the survival rate of P. reticulata in both Jaffna and Mannar Districts was significantly different at different chlorine levels (P80% even at 0.75 mg/L. At the 24-hours, the mean survival rates of 70.0+ 5.8% (Jaffna) and 81.7 + 4(Mannar) were observed at 0.75 mg/L. At 48 hours, the fish survived only at 0.75 mg/Lindicating a higher survival rate from Mannar (81.7 + 4.4%), while the fish from Jaffna denoted 70.0 + 5.8% of survival. CONCLUSIONS: The type biotype, which: is an effective vector in the Indian subcontinent is present in Sri Lanka. Anopheles stephensi indicated a vectorial capacity of over 18. There is a high potential of increasing density of An. stephensi in coastal ecosystems. The temephos and novaluron can be recommended as effective larvicides for chemical-based control of An. stephensi in Jaffna, Sri Lanka. The fish captured from Mannar demonstrated a higher tolerance to chlorine levels.
Coagulation changes during mild hypothemia in neonates on extra corporeal membrane oxygenation(ECMO)
(University of Kelaniya, 2011) Harischandra, D.V.T.
Hypothermia is a promising intervention for reducing cerebral ischaemic damage. Neonates who need extracorporeal membrane oxygenation (ECMO) are inherently ill and are at risk of cerebral damage. Studies have shown hypothermia to be neuroprotective, but its effect on coagulation incorporating conventional and temperature adjusted blood tests have not been studied. We aimed to look for a difference in coagulation between neonates who undergo ECMO at mild hypothermia (34°C) and those at normothermia (37°C). A prospective, single-centre study was done from October 2006 to November 2008: Babies were randomised to "cooled" and "non-cooled" groups. Blood sampling was done at six time points. Thromboelastography (TEG) values at 34°C and 37°C, routine coagulation tests and cytokines were studied. Requirements of blood products and heparin and clinical effects were noted. There were 16 neonates and eight were cooled. Mean age was 1.2 days; mean weight, 3.4 kg and total ECMO, time 1877 (mean 117.3) hours. Eight (50%) were males. Mortality was one (6.3%). Data was analysed using the Mann-Whitney Test. Mild hypothermia caused reduced platelet count (p=0.00l) and function (p=0.03) at 12 hours post- ECMO and reduced clot formation by 24 hours (p=0.0£), after which differences disappeared. Temperature adjusted functional coagulation tests were needed to detect these effects. Heparin requirement was less in the cooled group (p=0.002). No differences in cytokines were evident. No adverse effects were noted due to hypothermia. This is the first study of functional and conventional coagulation tests during mild hypothermia in neonates on ECMO
Design, implementation and evaluation of a community intervention to improve utilisation of healthy lifestyle centres in two districts of Sri Lanka
(University of Kelaniya, Sri Lanka, 2022) Herath, H.M.T.P.
INTRODUCTION: Healthy Lifestyle Centres (HLCs) are underutilised in Sri Lanka. Effectiveness of empowering communities to improve utilisation of HLCs by its target f population (adults aged 35 to 65 years) is not explored. OBJECTIVE: To design, implement and evaluate a community intervention to improve utilisation of HLCs in two districts (Gampaha and Kalutara) of Sri Lanka. METHODS: Phase I, a mixed-methods descriptive study comprising: a qualitative study using grounded theory to explore reasons for the utilisation of HLCs using interviews and a cross-sectional study to assess the profile of users and nonusers and determine associated factors. A multistage cluster sampling method was used to recruit 1727 individuals. Data collected using an interviewer-administered questionnaire were analysed using bivariate and multivariable analysis. Phase II: a quasi-experimental study in six grama niladari divisions each from the catchment areas of two selected HLCs as Intervention (IG) and Comparison Groups (CG). Health Promotion Approach was used to empower Community Support Groups (CSGs) to address underutilisation. Phase III: a pre-post design to evaluate the outcomes. A random sample of 498 from each group was assessed and the primary outcome was the improvement in utilisation (Utilisation of the HLC by a study participant as a first time or as a follow-up client at the time of data collection). RESULTS: The rate of utilisation of the HLCs was 11.3% (n=195, 95% CI:9.80-12.8). HLC utilisation was found to be significantly associated with 14 factors. The factors with highest Odds Ratios (OR) were perceiving screening as useful (OR=10.2, 95% CI: 4.04-23.4) and perceived susceptibility to NCDs (OR= 6.78, 95% CI: 2.79- 16.42). The qualitative study revealed that negative past experiences and attitudes related to staff and services in state health care institutions and HLCs, and employment-related barriers negatively influenced HLC utilisation. The HLC utilisation, which was similar among the IG and CG in the pre assessment (p=0.056), showed a significant improvement in the post assessment (p<0.001). The HLC utilisation in IG increased by 29.5% (pre: 5.85% ; 95% Cl: [3.74-7.95], post: 35.3%; 95% CI: [30.9-39.8]). The CG did not show a significant difference in use. CONCLUSION AND RECOMMENDATIONS: HLC utilisation can be improved through empowering CSGs. The developed intervention model is recommended for use after accounting for contextual differences.
Determination of risk factors and development of mathematical models to forecast case incidence of dengue in Gampaha District, Sri Lanka.
(University of Kelaniya, 2019) Withanage, G. P. W. K.
ABSTRACT: Dengue is one of the most important mosquito-borne viral infection in Sri Lanka and the disease is caused by any of the four antigenically distinct Dengue Viruses (DENV). Aedes aegypti (Linnaeus) and Ae. albopictus (Skuse) are considered as vectors transmitting the virus in the country. The second highest number of dengue incidences are reported from the District of Gampaha, next to Colombo, since 2010. Overall objective of the current study was identification of risk factors, development of risk maps and prediction models for transmission of dengue and identification of efficacy of lethal ovitraps to control dengue vectors in the District of Gampaha. During the COMPONENT 1 of the study, identification of risk factors affecting transmission of dengue in selected sites in the District of Gampaha was performed. Based on epidemiological situation during the period of 2005-2014, four Medical Officer of Health (MOH) areas with highest number of dengue incidences reported, namely Kelaniya, Mahara, Negombo and Wattala, were selected as study areas. Mirigama MOH area, which had a very low level of dengue incidence, was selected as the control area. Differences in entomological indices were observed in study areas during the analysis of studied risk factors, however the study variables in high risk study areas were clustered together when compared to the control area. Broadly, socio-economic factors viz. size of the homestead, years of living in the same area, number of persons in household, monthly family income and type of premise, Entomological factors, viz. surrounding cleanliness, vegetation coverage and source of water and Knowledge, Attitude and Practices (KAP) measures, viz. waste disposal method, mosquito control measures, effects of previous dengue control projects and role of Public Health Inspector (PHI) play significant role in transmission of dengue in the high risk study areas. Transmission of DENV serotype/s and genotype/s by field-caught dengue vector mosquitoes was detected using molecular-based assays. Phylogenetic analysis of the positive mosquito pools, collected during the dengue epidemic in 2017, revealed that the causative agent for the epidemic is a migrated virus belongs to DENV-2 Cosmopolitan Clade lb strain. Under the COMPONENT 2 of the study, development of mathematical and Geographic Information System (GlS)-based models to forecast impending dengue epidemics and GIS-based risk maps to study on transmission of dengue in the District of Gampaha were performed. During mathematical modelling, rainfall, rainy days, temperature and Relative Humidity (RH) were identified as significant climatic factors affecting for the transmission of dengue. Further, number of dengue incidence in the previous month exponentially contributed to the dengue incidence in the current month. The best time series regression model developed forecasted correctly with mean absolute errors of 95.65 and 532.39 for training and validation periods, respectively. The Pierce skill score of the model was 0.49. Receiver operating characteristic of the selected model was 86% and the sensitivity was 92%. The developed random forest model forecasted dengue incidences correctly with mean absolute errors of 90.73 and 1308.56 for training and validation periods and the model demonstrated the increase of dengue incidences since March, 2017 which lead to the epidemic peak in July. GIS-based risk maps were developed to identify dengue risks in each MOH area in the district and models were developed to identify risk localities in the studied dengue high-risk areas. Positive correlations were observed with breeding containers, roads and land use during spatial correlation analysis in the high risk study areas. During COMPONENT 3 of the study, identification of dengue vector mosquito species and other mosquito species was performed. Different mosquito species were collected from the field and complete 'Folmer region' Cytochrome c Oxidase (COI) DNA barcodes were developed for 21 species of mosquitoes belong to six genera in Sri Lanka. When COI barcodes analyses utilizing distance and phylogenetic methods compared with morphological identification revealed that the mean inter-species Kimura-2-parameter pairwise divergence ranged from 7.0% to 25.4%, while that for intra-species ranged from 0.0% to 1.4%. The developed COI-based DNA barcoding approach can be used to discriminate mosquito species in the district and the study reported the presence of Culex pipiens mosquito for the first time in Sri Lanka. During COMPONENT 4 of the study, development of an Autocidal Gravid Ovitraps (AGO) with an Insect Growth Regulator (IGR) to control dengue vector mosquitoes was performed. The optimum field dosage of Novaluron in the developed Autocidal Gravid Ovitraps (AGO) was 2 ppm and the residual effect was 28 days. In the field experiments, significantly higher mortality counts of mosquito larvae were recorded in the treated area in both indoor and outdoor ovitraps. Two factor repeated measures Analysis of Variation (ANOVA) followed by the Tukey’s test confirmed that the mean mortality count is high for the developed AGOs in both indoor and outdoor settings. - Even though the mode of action of Novaluron is 100% clear, molecular docking experiments indicated that Novaluron shows greater affinity towards chitin synthase and interacts with tryptophan (try) residue at 872 position. KEYWORDS: Dengue, District of Gampaha, Phylogeny and phylogeography, Mathematical and GIS modelling, DNA barcoding, Autocidal Gravid Ovitrap, Molecular modelling
Determination of the quality of coconut oil and the effects of selected coconut products on serum metabolic parameters of Wistar Rats.
(University of Kelaniya, 2018) Samaranayake, H. A. E.
Although a large number of studies have. been conducted on the health effects of coconut, findings remain inconclusive. This study investigated the quality of commercially available coconut oil (CNO) and the effects of CNO and grated coconut on serum metabolic parameters in Wistar rats. The quality of 52 CNO samples obtained from retail and wholesale outlets in three districts were investigated. Most of the samples were adulterated with palm or coconut paring oil and were of inferior quality. White coconut oil (WCO) had a significantly higher total phenol content and antioxidant activity (p<0.05) as compared to virgin coconut oil (VCO). Effects of WCO and VCO on body weight, fasting blood glucose (FBG), serum lipids and hepatic antioxidant status were investigated using normocholesterolaemic (NC) and hypercholesterolaemic (HC) rats. Seven groups of rats (n=8) were maintained on diets containing WCO or VCO at a concentration of 2% or 4% for 36 weeks. No significant differences were observed in the body weights and FBG levels in any rat group after 36 weeks. In NC rats, no significant changes (p>0.05) were observed in serum lipid parameters including HDL. In HC rats, a significant increase in total cholesterol (TC) was observed in 2%WCO group (p<0.05) while no significant change was observed in 2%VCO comparing with baseline indicating a potential therapeutic effect of VCO in controlling serum TC in HC states. Similar findings were observed in the TC/HDL ratio. HC rats on 2% VCO diets had higher HDL and lower serum triglyceride levels than HC rats fed on 2% WCO, though the differences were not statistically significant (p>0.05). In NC rats, WCO diets resulted in higher hepatic lipid peroxidation (p<0.05) and hepatosteatosis (p<0.05) as compared to VCO diets. Incorporation of grated coconut into diets resulted in a significant hypoglycaemic effect (p<0.05) and lower serum triglyceride levels (p>0.05) as compared to diets ·containing oil only. Key words: WCO, VCO, Quality, Serum lipids, Antioxidant activity
Development and validation of a tool to predict information seeking behaviour of medical undergraduates, Sri Lanka
(University of Kelaniya, Sri Lanka, 2022) Marasinghe, M.P.L.R.
Information seeking behaviour is a set of actions expressing information needs, searching, evaluating, selecting, and utilizing information. This study aimed to develop and validate a tool to measure the information seeking behaviour of medical undergraduates in Sri Lanka. Final year students and the students, who had completed four years of study in the academic programme in medical faculties in universities of Colombo, Kelaniya, Peradeniya, and Eastern University in Sri Lanka were invited for the study. The elements of information seeking behaviour were defined by thentatically analyzing the content of nine focus group discussions with medical undergraduates of the four faculties. The scale was developed based on the Integrated Behavioural Model. The preliminary scale had 60 items and was pretested. The responses ofa field test with the participation of 436 medical undergraduates were subjected to confirmatory factor analysis (CFA) and psychometric analysis. The tool was refined to include 40 items, and the revised version was administered to 645 medical undergraduates. The 40-item tool supported the good model fit using the absolute fit indices (RMSEA= 0.053, SRMR=0.066). The sub-components of the 40-item tool partially matched with the theoretical framework. The reliability of the entire tool was acceptable (Cronbach’s α = (0.744) and domain levels were in the low to the acceptable range. The internal consistency of the domains; “Intention” (Cronbach’s α = 0.634), “Habit” (Cronbach’s α = 0.561) and “Knowledge & skills” (Cronbach’s α = 0.540) was acceptable in reliability and the domains of “Environmental Constraints” (Cronbach’s α = 0.470) and “Salience” (Cronbach’s α = 0.438) was low in reliability in the 40-item tool. The finalized 40-item tool named ‘Kelaniya Measure of Information Seeking Behaviour’ (KMISB) demonstrated an acceptable level of psychometric rigour in terms of XXV ate reliability and structural validity. KMISB can be used to evaluate and predict information seeking behaviour of medical undergraduates effectively. It facilitates identifying the best practices of information seeking and improving the quality of ae higher education.
Development of a quantum dot-based rapid diagnostic assay for the detection of dengue NS1 antigen.
(University of Kelaniya, 2022) Munasinghe, M.M.E.
Dengue is a mosquito bom viral disease which is considered as one of the most important and most prevalent infectious diseases in tropical and sub-tropical world. This is caused by a virus from the genus Flavivirus that has four closely related serotypes. The differentiation of the clinical symptoms of dengue fever (DF) is challenging fbr the clinicians due to its similarity with other febrile illnesses. Diagnosis of the disease as early as possible would improve the patient management, vector controlling and lower the fatality rate. The main objective in this study was to develop a cost effective rapid Lateral Flow Immunoassay (LF1A) using nanotechnology for detection of dengue infection. The specific objectives were to develop monoclonal antibodies against dengue NS1 protein as the capturing agent and to synthesize L-Cysteine capped CdTe quantum dots as the detecting agent. In this study, four serotype specific synthetic peptides (Pl, P2, P3 and P4) were designed from the NS 1 region of the serotype 1, 2, 3 and 4 respectively, considering various factors. These peptides were used to immunize four, female Balb/c mice and fusions were carried out to produce hybridoma clones. Enzyme Linked Immunosorbent Assays (ELISA) were developed to screen the antibodies reacting with peptides as well as the native protein present in clinical samples. The selected antibody was used to anchor on L-Cysteine capped CdTe quantum dots. The quantum dot conjugated antibody was used in the development of LFIA. A total number of 28 IgG secreting hybridoma clones out of 1830 growing clones produced dengue specific monoclonal antibodies. A monoclonal antibody (Pl.18) resulted from the fusion of Pl immunized mice, showed significantly high antibody response fbr all four dengue serotypes. This antibody was used as the detector antibody in LFIA. During the LFIA, a fluorescent band was visible under ultra violet light (UV) fbr the detection of dengue NS1 protein in infected urine samples implying the successful development of a cost effective LFIA fbr detection dengue. Detection of infected blood was not feasible due to fluorescent quenching resulted by high lysozyme concentration present in blood and has to be further optimized. These findings can be further used to develop a user friendly low cost diagnostic test kit fbr detection of dengue infection from urine.
Development of recombinant protiens as diagnostic intermediates for chikungunya infection
(University of Kelaniya, 2013) Athapaththu, A.M.M.H.
INTRODUCTION: Chikungunya (CHIK) is an important disease with explosive outbreaks occurring in Sri Lanka. Confirmation of CHIK outbreaks is important for clinicians for proper clinical management of patients and epidemiological studies. There is a need to develop a laboratory diagnostic assay which can be discriminated CHIK from other diseases showing similar symptoms, produced at low cost and easily standardized for use in field settings. At present Enzyme-Linked Immunosorbent Assay (ELISA) is widely used for laboratory diagnosis of CHIK infection because of its rapidity, cost effectiveness and ability to standardize easily for field settings. These currently available ELISAs depend on whole viral lysate antigens which cause biohazard risk, high initial production cost and cross reactivity with other organisms of the same genus/family. A diagnostic intermediate using a single recombinant protein antigen to detect both Immuno globulin (Ig) M and G antibodies of CHIK is important to overcome problems associated with whole viral lysate antigen in ELISA. Overall objective of this study was to assist for clinical management of patients and confirmation of CHIK outbreaks through developing rapid laboratory diagnostic assays. Methodology: Surface proteins of Ribonucleic Acid (RNA) viruses are the targets of neutralizing antibodies. Envelope (E) region of the Chikungunya Virus (CHIKV) is the most immunodominant region of the virus. These protein antigens were prepared using the E region of the Virus. Synthetic genes of CHIK named Envelope 1 (El) and Envelope 2 (E2) were custom designed and chemically synthesized and resulted proteins were expressed in both bacteria (Escherichia coli} and yeast (Pichia pastoris) vector expression systems. Resulted recombinant proteins were purified using a single affinity chromatographic step using Ni- Nitrilotriacetic Acid (NTA) columns and evaluated to be used as a diagnostic intermediate using panels of well characterized serum samples. A total of 55 serum samples confirmed as positives and 186 confirmed as negatives for CHIK IgM antibodies were used to evaluate the antigens using novel IgM ELISA. A total of 78 serum samples confirmed as positives and 227 samples confirmed as negatives for CHIK IgG antibodies were used to evaluate the antigens using novel IgG ELISA. These samples were tested by Heamagglutination Inhibition (HAI) test, IgM Antibody capture (MAC) ELISA and indirect IgG ELISA. RESULTS: The recombinant proteins were purified using Ni-NTA columns under the denature conditions. For the detection of anti-CHIK IgM antibodies, the El recombinant protein expressed in E. coli showed 5% (3/55) sensitivity and 99% (184/186) specificity while the E2 recombinant protein expressed in E. coli showed 65 % (36/55) sensitivity and 70% (131/186) specificity when compared with MAC ELISA using total viral lysate as the antigen. The El recombinant protein expressed in P. pastoris showed 15% (8/55) sensitivity and 97% (181/186) specificity and the E2 recombinant protein expressed in P. pastoris showed 49% (27/55) sensitivity and 78% (146/186) specificity compared with MAC ELISA using total viral lysate as the antigen for detection of IgM antibodies. For the detection of anti-CHIK IgG antibodies, the El recombinant protein expressed in E. coll showed 60 % (47/78) sensitivity and 64% (94/148) specificity while the E2 recombinant protein expressed hi E. coli showed 83 % (65/78) sensitivity and 86% (195/227) specificity compared with the HAI test and indirect IgG ELISA using purified CHIKV. The El recombinant protein expressed in P. pastoris showed 86% (67/78) sensitivity and 61% (90/ 148) specificity and the E2 recombinant protein expressed in P. pastoris showed 76% (59/78) sensitivity and 81% (183/227) specificity compared with the HAI test and indirect IgG ELISA using purified CHIKV for the detection of IgG antibodies. Discussion: When considering El and E2 recombinant antigens, E2 recombinant proteins have showed better performance in identifying both anti-CHIK IgM and IgG antibodies in ELISAs, Here CHIK E2 protein is positioned in a way that it buries much of its partner El in the virus structure giving a CHIK El a less chance of exposure to the human immune system explaining the lower sensitivity and specificity towards detecting anti-CHIK antibodies. The E2 recombinant protein antigens expressed in bacterial expression system have performed better than the E2 recombinant antigens expressed in yeast system. In bacterial expression system the expressed recombinant proteins must have aggregated in cytoplasm in such a way, when denatured, most of the immuno dominant epitopes became linearized and exposed to the outside. CONCLUSION: Recombinant CHIK-E2 protein antigen expressed in E. coli showed higher specificity and sensitivity in detection of both IgM and IgG anti-CHIK antibodies. This type of study on development of diagnostic intermediates have a significant effect for rapid confirmation of outbreaks and take necessary steps to limit the spread of such outbreaks from one geographical area to another. Further, confirmation of disease outbreaks will allow the physicians to provide the necessary treatments rapidly and thereby avoid loss of working hours and socio-economical impact on individuals and government.
Distribution of major and potential malaria vectors in manner trincomelee districs and systematics of anophelines in Sri Lanka
(University of Kelaniya, 2014) Gunathilaka, P.A.D.H.N.
BACKGROUND: Malaria was a major public health problem in Sri Lanka until recent past. Entomological surveillance is used to evaluate control programmes and facilitate interventions. OBJECTIVES: To study on spatial, temporal, ecological, host preferences, and breeding habitats of major and potential malaria vector mosquitoes in selected sentinel sites in the Districts of Mannar (n= 3) and Trincomalee (n= 5) and to revise existing morphological keys of Sri Lankan anopheline mosquitoes. METHODOLOGY: Densities of Anopheles were surveyed for a period of 25 months (June, 2010 to June, 2012) using World Health Organization recommended entomological techniques. Quality of water in breeding habitats was tested for abiotic variables. A multiplex, real-time Polymerase Chain Reaction (PCR) assay was developed to detect the host preference of Anopheles. Morphological identification keys for Sri Lankan anophelines were revised. RESULTS: A total of 161,891 anophelines representing 17 species were recorded from the Districts of Mannar (n=74,181) and Trincomalee (n= 87,710). The most abundant species was Anopheles subpictus (n=91,370). An. culicifacies was recorded only in Trincomalee (1.34%). An, culicifacies and An, subpictus have adapted to breed in a wide range of water bodies including polluted water in urban settings with low dissolved oxygen (<3 mg/1) and high salinity (21,105 ± 1,344 mg/1). Host preference revealed that all anophelines preferred bovine as the host than humans. Anopheline morphological identification keys for both larvae and adults were revised. DISCUSSION: The adaptation of An. culicifacies and An. subpictus to breed in polluted water may lead the emergence of urban malaria in Sri Lanka, a phenomenon that has not been reported on a regular basis as yet. Therefore, continuous monitoring of the breeding of An. culicifacies in polluted water and to what extend it impacts on malaria elimination programmes is to be established. The presence of human blood, in some anopheline species indicates the possibility of transmitting human malaria. The revised morphological identification keys for anophelines can be used as a rapid and convenient guide to identify malaria vectors. CONCLUSION: This investigation adds new information to the knowledge on malaria entomology. Therefore, this study would be beneficial to implement new vector control approaches.
Dynamics of aedes population in western province of Sri Lanka and a study on the feasibility of sterile insect technique (SIT) for controlling aedes albopictus
(University of Kelaniya, Sri Lanka, 2022) Harishchandra, J.
INTRODUCTION - Dengue is the most important vector-borne disease in Sri Lanka. Controlling dengue vectors is a challenge which needs multiple approaches. Sterile Insect Technique (SIT), which has been successfully applied in other countries, is a potential candidate for integrated control of dengue vectors in Sri Lanka. This study aimed to determine the dynamics of Aedes populations and to study the feasibility of SIT for controlling Aedes albopictus (Skuse) under laboratory and semi-field settings. METHODOLOGY - Dynamics of dengue vector populations were studied in two study areas in dengue high burdened districts, Colombo and Gampaha, in relation to climatic factors. Study area in the District of Gampaha where only a single dominant Aedes species reported was selected for the further studies. Size of the wild male population, survival and dispersal of Ae. albopictus were studied in Gampaha using Mark-Release-Recapture (MRR) method. A protocol for application of SIT for Ae. albopictus was developed including rearing, blood feeding, separation of male pupae, optimum radiation dose for sterilization and optimum release ratios of sterile males. RESULTS - The study revealed the presence of both Ae. aegypti and Ae. albopictus in Colombo and Ae. albopictus in Gampaha with a seasonal pattern. Significant correlations of entomological indices were found with rainfall, rainy days and relative humidity. Released males survived and dispersed up to 15 days and 200m respectively. Optimal radiation dose giving 99% induced sterility was 50Gy. Mating competitiveness quantified using Fried Competitiveness Index (FCI) of irradiated males against non-irradiated wild males resulted 0.5 which has met the international standards for competitiveness of Sri Lankan mosquitoes for application of SIT. Further, approximately 1245 male mosquitoes per hectare (ha) need to be released based on the density of the wild population. CONCLUSION - Densities of dengue vectors correlate with key climatic factors. Study area in the District of Gampaha where the presence of a single dominant Aedes species was selected for future SIT field trials. Developed protocols and study on behaviour of the selected mosquito species in the field will be useful for future application of SIT in integrated management of Ae. albopictus in Sri Lanka.
Effect of indoor air pollution due to solid fuel combustion on respiratory diseases,growth and development of children under 5 years in Ragama MOH area. Sri Lanka
(University of Kelaniya, 2016) Ranathunga, R. A. N.
Indoor air pollution from combustion of solid fuels for cooking is one of the ten most important risk factors of global burden of disease There is compelling evidence linking indoor smoke to acute respiratory infections in children In 2012, firewood was the principal type of cooking fuel in 78% of households in Sri Lanka. Air pollution. is a multifaceted environmental toxin affecting CNS through diverse pathways This study investigated the association between indoor air pollution and prevalence of childhood respiratory tract diseases and effects of indoor air pollution on physical growth and neuro-development of preschool children.Study was conducted in Ragama MOH area from June 2011 to June 2013. Households were selected from MOH clinics covering all the PHM areas A total of 262 children were followed up for respiratory symptoms and assessment of development. Weight and height was measured at baseline and development was assessed using the Denver development tool. Exposure was defined as "high” and "low"; the "high" group comprised households using biomass fuel or kerosene as the principal cooking fuel for cooking and the "low" group comprised households using LPG and electricity as the principal fuel for cooking Air quality measurements were done in a sub sample of households for carbon monoxide (CO), particulate matter2.5(PM2 s) and carbon dioxide(CO2). Houses in high exposure group had significantly higher concentrations of CO (mean 2.770 vs 1.44) and PM2.5(mean 1.09 vs 0.30) as compared to houses in low exposure group. CO2 levels were similar in both exposure groups. The incidence of infection induced asthma (RR=l.77, 95% CI; 1.098 - 2.949) was significantly higher among children in the high exposure group as compared to children of the low exposure group after adjusting for con-founders. Children from high exposure group had a significantly lower mean z-scores for weight for –height (p=0.047). height=for-age(p=0.004) and weight-for-age(p=0.001) as compared to children from low exposure group after adjusting for con-founders. Z scores of weight-for- age, height-for-age and weight-for- height were negatively correlated with the levels of CO (p=0.001,0.018,0.020 respectively) and PM2.5 (p<0.001,p=0.024,p=0.008 respectively). Developmental assessment showed a significant delay in language and gross motor development domains in high exposure group as compared to low exposure group (OR=2.4;95% CI-1.00-5.42 and OR=2.3;95% CI-1.11-5.17, respectively). delays in developmental domains were correlated : fine motor and language -(r=0.50;p<0.001); fine motor and gross motor -(r=0.40;p<0.001); fine motor and social develpoment-(r=0.19;p=0.005); language and gross motor -(r=0.49;p<0.001),language and social development(r=0.22;p=0.001); and gross motor and social development(r=0.18; p=0.007). CO and PM2.5 were significantly higher in households using biomass fuel for cooking. There was a 1.6 fold higher risk of lower respiratory tract infections and two times higher risk of infection induced asthma among children in high exposure group. There was higher prevalence of stunning, wasting and under-nutrition among children in high exposure group, even after controlling for con-founders. Language and gross motor development scores were less in children living in households using biomass fuel for cooking. CO and PM2.5 were correlated with language and gross motor development scores.
Effectiveness of early stretching exercises for range of motion of the shoulder joint,state of axillary scar and quality of recovery in burnt patients admitted to burns unit of the national hospital of Sri Lanka
(University of Kelaniya, 2016) Perera, G. A. D.;
BACKGROUND: Burn injuries can result in long term impairment, limitation and restriction in participation in various activities in a patient’s life. The majority of burns occur in low- and middle-income countries and almost half occur in the Asian and south-east Asian regions. Axillary or shoulder burns often develop scar contracture with subsequent loss of shoulder movements and function. PURPOSE: This study was done to evaluate the effects of early stretching exercises programme on the range of' motion of the shoulder joint, state of axillary scar and quality of recovery in burnt patients in comparison to a control group. METHODS: A randomized controlled study was conducted in National hospital of Sri Lanka. Patient, from 15 to 55 years of age admitted to the burns unit with a total burn injury surface area (TBSA) of 10% to 45% involving the shoulder joint with axilla were selected. The subjects were randomized into two groups; intervention and a usual care control group. There were 110 patients in each group. A Study protocol was used in the management of intervention group for 14 days. The control group was subjected to usual protocol currently used in the unit.Range of Motion (ROM) was measured with a Universal Goniometer. Functional recovery (FR) was assessed with the Quick DASH questionnaire and the Abduction ladder. State of the axillary scar was assessed with the Vancouver Scar Scale (VSS). Data were obtained before and after the intervention phase on 3, 6 and 12 months of post burn period.RESULTS: The mean (SD) age of intervention group and control group were 29.76 [9. 81] and 30.3 l [9.45] respectively. The mean (SD) TBSA% of intervention group and control group were 26.15[9.45] and 24.60[9.56] respectively. There is a significant beneficial difference (p=0.000) in ROM, FR and the state of the axillary scar between the Intervention group and the control group. After 12 months of post burn, all the ROM which had been measured was h igher in subjects who were in the intervention group than in the control group. Mean scores of Quick DASH and the VSS values were less in the intervention group Compared to the control group. CONCLUSION: This study demonstrated that early sustained stretching exercise regime Significantly improved the ROM and functional recovery of the shoulder joint and scar condition of the axil1a after a severe axillary burn.