Journal/Magazine Articles
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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
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Item Causes, complications and short-term outcome of acute Kidney injury in a resource-limited setting(SAGE-Hindawi Access to Research, 2024-12) Herath, N.; De Silva, S.; Liyanage, P.; Kumara, S.; Devi, S.; Abeysekara, V.; Mallawarachi, R.; Perera, S.; Karunathilaka, I.; Samarasinghe, S.; Weerakoon, K.AIMS The outcome of acute kidney injury (AKI) depends on causes, patient factors and care received. We studied the causes, complications and 90-day outcomes of patients with AKI at a tertiary referral centre in Sri Lanka. METHODS Patients aged 18 years or older with AKI referred to nephrology services were analysed retrospectively. AKI severity was assessed using the KDIGO classification. Information was gathered from hospital and clinic records. RESULTS Of the 464 patients studied, 262 (56.5%) were males. The mean age of the study sample was 57.04 (SD 16.85) years. The majority (212-45.69%) were discharged with normal renal functions, 173 (37.28%) were discharged with impaired functions, and 79 (17.03%) died during hospital stay. There were 377 patients at 3 months follow-up; 331 (87.8%) had normalised renal function, 40 (10.6%) had not recovered fully and 6 (1.6%) had succumbed. Progression of AKI to chronic kidney disease or death was significantly high in patients aged > 60 years (p=0.017). More severe AKI was associated with type 2 diabetes (p=0.0042), hypertension (p < 0.0001) and multiple comorbidities (p=0.0014). Persons with no comorbidities had less severe AKI (p=0.0004). Even in the early stages of AKI, there was significantly high mortality (11% in AKI stages 1 and 2) which doubled in stage 3 (22%). Mortality was low in patients with prerenal causes of AKI (OR: 0.59, 95% CI: 0.35-0.99 and p=0.047). CONCLUSIONS AKI in elderly and comorbid patients has high morbidity and mortality. Identification of individuals who are at high risk of developing AKI is important for its prevention, early diagnosis and proper treatment. Limitations in infrastructure, manpower, local research, reporting and recording of AKI are key challenges in providing optimal care for AKI in Sri Lanka.Item Development and assessment of psychometric properties of model medication adherence (MMA) questionnaire to measure adherence to oral medication among patients with type 2 diabetes mellitus(College of Community Physicians of Sri Lanka, 2023) Perera, S.; Abeysena, C.INTRODUCTION: Medication adherence among patients with type 2 diabetes (DM) is assessed in everyday clinical practice. OBJECTIVES: To develop a questionnaire to measure adherence to oral medication among patients with DM and to assess its psychometric properties METHODS: The “Model Medication Adherence (MMA)” questionnaire was developed using the evidence from literature review and interviews with key stakeholders and patients. Answers were set on a five-point Likert scale that scored from 1 to 5, with 15-73 as the possible range of the total score. MMA was drafted in English and translated to Sinhala language by forward- backward translation. A descriptive cross-sectional study was carried out among adult patients with type 2 DM who attended clinics in Gampaha District General Hospital (DGH). A sample of 150 patients was recruited consecutively. The construct validity of MMA was assessed by Exploratory Factor Analysis (EFA) through Principal Component Analysis (PCA) with Varimax rotation RESULTS: EFA yielded four factors; sick role behaviour, autonomy, forgetfulness, and barriers that explained 64.36% of the variance of the total score of MMA. Internal consistency was acceptable (Cronbach’s alpha 0.73). The testretest reliability coefficient was 0.85 (p=0.01). Acceptability of the MMA was established by non-response items (none) and the time taken to complete (20 minutes). CONCLUSIONS & RECOMMENDATIONS: MMA is a simple valid questionnaire that adds a novel concept to the adherence literature; sick role and autonomy. It has a good factor structure with established construct validity and is recommended to be used in the clinical setting.Item Hemitruncus arteriosus: A rare congenital cardiac anomaly diagnosed and treated during the neonatal period(Sri Lanka College of Paediatricians, 2023) Pathiraja, H.; de Livera, R.; Wickramaratne, S.; Perera, S.; Mugunthan, M.S.; Mettananda, S.No abstract availableItem Real-time laboratory surveillance of Dengue antigen (NS1) - Best proposed early warning and response system for Dengue in Sri Lanka? - Results from a pilot study(The Sri Lanka Medical Association, 2021) Ranwala, L.; Wedisinghe, Y.; Perera, S.; Jayamanne, D.Introduction: During the recent past, dengue fever and associated complications have been the most important concern for health policy makers of Sri Lanka. The current notification system has considerable inevitable delays in preventive measures. Objectives: Implementing a laboratory-based real-time antigen(NS1) surveillance system for notification coupled with a rapid preventive response within the Colombo district as a pilot project and compare the notifications with existing national surveillance systems. Methods: An online notification platform was established with a centralized database. Seven main laboratories of the private sector linked with the notification system, where they can create new notifications at the central database, whenever the NS1 test detected as positive. Relevant Medical Officers of Health should update action implemented to complete the response process. A dashboard was designed to visualize each notification and its status with a predefined color code. Results: Patients from 14 Medical Officer of Health (MOH) areas out of 15 were captured. The immediate preventive response was recorded from the field preventive staff for 90% of the reportings. All most all attended patients have given health advice on awareness, prevention, and source reduction through premise inspection by trained field staff with 24hrs of notification. Conclusions: Salient features of the novel system are notification of antigen-positive patients, the rapidity of notification(real-time) and response, user-friendliness, access to multiple stakeholders simultaneously without data duplication, early involvement of the field staff, the ability to trace the cases using checklists and a color-coding system from a dashboard.Item A Systematic review on diagnostic methods of red cell membrane disorders in Asia(Blackwell Scientific Publications, 2022) Silva, R.; Amarasinghe, D.; Perera, S.; Premawardhena, A.Membranopathies are a group of inherited blood disorders where the diagnosis could form a challenge due to phenotype-genotype heterogeneity. In this review, the usage and limitations of diagnostic methods for membranopathies in Asian countries were evaluated. A systematic review was done using articles from PubMed, Google Scholar, and EBSCO from 2000 to 2020. Thirty-six studies conducted in seven Asian countries had used different diagnostic methods to confirm membranopathies. In 58.3% of studies, full blood count (FBC), reticulocyte count, and peripheral blood smear (PBS) were used in preliminary diagnosis. The combination of the above three with osmotic fragility (OF) test was used in 38.8%. The flowcytometric osmotic fragility (FC-OF) test was used in 27.7% where it showed high sensitivity (92%-100%) and specificity (96%-98%). The eosin-5-maleimide (EMA) assay was used in 68.1% with high sensitivity (95%-100%) and specificity (93%-99.6%). About 36.1% of studies had used sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) as a further diagnostic method to detect defective proteins. Genetic analysis to identify mutations was done using Sanger sequencing, next-generation sequencing (NGS), and whole-exome sequencing (WES) in 33.3%, 22.2%, and 13.8% of studies, respectively. The diagnostic yield of NGS ranged from 63% to 100%. Proteomics was used in 5.5% of studies to support the diagnosis of membranopathies. A single method could not diagnose all membranopathies. Next-generation sequencing, Sanger sequencing, and proteomics will supplement the well-established screening and confirmatory methods, but not replace them in hereditary hemolytic anemia assessment.Item Oxidative status in the β-thalassemia syndromes in Sri Lanka; a cross-sectional survey(Elsevier Science-Pergamon Press, 2021) Allen, A.; Perera, S.; Mettananda, S.; Rodrigo, R.; Perera, L.; Darshana, T.; Moggach, F.; Crawford, A.J.; Heirene, L.; Fisher, C.; Olivieri, N.; Rees, D.; Premawardhena, A.; Allen, S.ABSTRACT: In the β-thalassemias, oxidative stress, resulting from chronic hemolysis, globin chain imbalance, iron overload and depleted antioxidant defences, likely contributes to cell death, organ damage, anemia, hypoxia and inflammation. We assessed variations in these parameters in β-thalassemia syndromes in Sri Lanka. Between November 2017 and June 2018, we assessed children and adults attending two thalassemia centres in Sri Lanka: 59 patients with HbE β-thalassemia, 50 β-thalassemia major, 40 β-thalassemia intermedia and 13 HbS β-thalassemia. Median age was 26.0 years (IQR 15.3-38.8), 101 (62.3%) were female and 152 (93.8%) of Sinhalese ethnicity. Methemoglobin, plasma hemoglobin, heme and ferritin were measured as sources of oxidants; plasma total antioxidant capacity, haptoglobin, hemopexin and vitamins C and E assessed antioxidant status; plasma thiobarbituric acid reactive substances and 8-hydroxy-2'-deoxyguanosine assessed oxidative damage; hemoglobin, plasma erythropoietin and transferrin receptor assessed anemia and hypoxia and plasma interleukin-6 and C-reactive protein assessed inflammation. Fruit and vegetable intake was determined by dietary recall. Physical fitness was investigated using the six-minute walk test and measurement of handgrip strength. Oxidant sources were frequently increased and antioxidants depleted, with consequent oxidative damage, anemia, hypoxia and inflammation. Biomarkers were generally most abnormal in HbE β-thalassemia and least abnormal in β-thalassemia intermedia but also varied markedly between individuals with the same thalassemia syndrome. Oxidative stress and damage were also more severe in splenectomized patients and/or those receiving iron chelation therapy. Less than 15% of patients ate fresh fruits or raw vegetables frequently, and plasma vitamins C and E were deficient in 132/160 (82.5%) and 140/160 (87.5%) patients respectively. Overall, physical fitness was poor in all syndromes and was likely due to anemic hypoxia. Studies of antioxidant supplements to improve outcomes in patients with thalassemia should consider individual patient variation in oxidative status both between and within the thalassemia syndromes. KEYWORDS: antioxidants; oxidative damage; oxidative stress; thalassemia; vitamins C and E.Item A "One-Stop" screening protocol for hemoglobinopathy traits and iron deficiency in Sri Lanka(Lausanne : Frontiers Media S.A., 2019) Allen, A.; Perera, S.; Perera, L.; Rodrigo, R.; Mettananda, S.; Matope, A.; Silva, I.; Hameed, N.; Fisher, C. A.; Olivieri, N.; Weatherall, D. J.; Allen, S.; Premawardhena, A.INTRODUCTION: The high frequencies of carriers of severe haemoglobinopathies and of iron deficiency in Southeast Asia require reliable and affordable tests to improve on current screening procedures. OBJECTIVES: We evaluate a "one stop" approach using the THALCON dichlorophenolindophenol (DCIP) and one-tube osmotic fragility (OF) tests and measurement of Zinc Protoporphyrin (ZPP) to detect and distinguish HbE and β-thalassaemia traits from iron deficiency. We compare findings with current screening practice in Sri Lanka that relies on the identification of low mean red cell volume and/or mean red cell hemoglobin for this purpose.METHODS: Between November 2017 and May 2018, we undertook a cross-sectional survey of secondary school students in Gampaha district, Sri Lanka. The THALCON-DCIP and OF tests were compared to capillary electrophoresis (CE), used as a gold standard to detect haemoglobinopathies. ZPP was measured in whole blood. Plasma ferritin and C-reactive protein (CRP) were measured in students with a raised ZPP concentration. RESULTS: We collected venous blood samples from 1,324/1,332 (99.4%) students. The median age of the students was 17 (IQR 16-18) years, all were Sinhalese and 814/1,324 (61.5%) were female. CE identified 3 students with HbE trait and 26 students with β-thalassaemia trait. The THALCON-DCIP test was positive only in the 3 students with HbE (sensitivity 100%, 95% CI 29.2-100.0; specificity 100%, 95% CI 99.7-100.0). The THALCON-OF test identified all 26 students with β-thalassaemia trait (sensitivity = 100%, 95% CI 86.8-100.0) and 287 students with a normal CE result (specificity = 77.9%; 95% CI 75.5-80.1). It was also positive in 2/3 (66.7%) students with HbE trait. Iron deficiency (ZPP > 70 μmol/mol heme) was present in 118/1,240 (9.5%) students with a normal hemoglobin genotype, all of whom had plasma ferritin <15 ng/ml and CRP <5 mg/L. CONCLUSION: This one-stop approach offers reliable and affordable population screening for both haemoglobinopathy traits and iron deficiency in resource-limited settings where these conditions are common and ensures that iron supplements are targeted only to those who require them. Further work is warranted to refine the OF test to reduce the number of false positive resultsItem Genotype-phenotype association analysis identifies the role of α globin genes in modulating disease severity of β thalassaemia intermedia in Sri Lanka(Nature Publishing Group, 2019) Perera, S.; Allen, A.; Silva, I.; Hapugoda, M.; Wickramarathne, M.N.; Wijesiriwardena, I.; Allen, S.; Rees, D.; Efremov, D.G.; Fisher, C.A.; Weatherall, D.J.; Premawardhena, A.β thalassaemia intermedia (βTI) are a heterogeneous group of disorders known to be extremely phenotypically diverse. This group is more complex to manage as no definitive treatment guidelines exist unlike for β thalassaemia major (βTM). There are only a few studies looking at genotype phenotype associations of βTI outside the Mediterranean region. The reasons for the diverse clinical phenotype in βTI are unknown. We categorized fifty Sri Lankan patients diagnosed with βTI as mild, moderate or severe according to published criteria. DNA samples were genotyped for β thalassaemia mutations, α globin genotype and copy number and known genetic modifiers of haemoglobin F production. There were 26/50 (52.0%) in mild group and 12/50 (24.0%) each in moderate and sever categories. 18/26 (69.2%) classified as mild were β heterozygotes and 17/18 (94.4%) had excess α globin genes. 11/12 (91.6%) classified as moderate were β heterozygotes and 8/11 (72.2%) had excess α globin genes. In contrast, 8/12 (66.7%) classified as severe were β homozygotes and 7/8(87.5%) had α globin gene deletions. In Sri Lanka, co-inheritance of either excess α globin genes in β thalassaemia heterozygotes or α globin gene deletions in β thalassaemia homozygotes is a significant factor in modulating disease severity