Theses and Dissertations

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Start date: 2020Has files: No

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    Impact of medication counselling by pharmacists in patients with diabetes,attending rural and urban outpatient clinics in Sri Lanka.
    (University of Kelaniya, 2020) Mamunuwa, A.M.V.G.N.
    Introduction & Objective: The intervention of pharmacists in the management of diabetes is well studied throughout the world. Many countries include this practice to achieve target treatment outcomes of patients with diabetes. Our study assessed the effectiveness of pharmacist counselling on outpatient management of diabetes. Despite the high and rising prevalence of diabetes in Sri Lanka, this is the first study to evaluate a clinic-based pharmacy counseling service in the Sri Lankan diabetes population. Methods: 800 participants with diabetes attending outpatient clinics of two Sri Lankan hospitals were assigned to either intervention group (IG) or control group (CG). IG received pharmacist counseling for four consecutive monthly visits in addition to standard care. CG received standard care only. The effectiveness of the intervention was assessed in terms of glycaemic control, adherence to medicines, patients* knowledge regarding medicines and disease. Quality of life (QoL) and the detection and resolving of drug related problems. Data was analyzed using Statistical Package fbr the Social Science (SPSS) software. Nonparametric tests were used as the data did not follow normal distribution. Results: Age ranged from 23 to 87 years. 67. 25% were female. At the end of the study, 359 and 360 participants remained in the control and intervention groups respectively. The IG had a median HbAlc of 7.2% (IQR 1.5%) post-inte^ention compared with the CG median of 7.7% (IQR 1.95%) (p<0.05%). The IG had a median adherence score of 5 out of 8 (IQR 6-3.3) at baseline which increased to 7 (IQR 8-6) post-intervention (p<0.05). CG median score was 5.3 (IQR 7-4) and 5 (IQR 7-4.2) at baseline and post-intervention respectively. The IG had a median score of 53% (IQR 64% - 34%) for the medication related knowledge domain, which increased to 73.3% (IQR 81% - 65%) post-inte^ention (p<0.001) The CG score was 50% (IQR 63% - 34.25%) at baseline and 50% (IQR 63% ・ 33.47%) post¬intervention (P=0.84I). The IG had a median percentage score of 50.48% (IQR 59% -41%) for the QoL questionnaire, which increased to 51.13% (IQR 61% - 42.5%) post-inten^ention (P=0.001). The CG score was 49.19% (IQR 59% - 39%) at baseline and 49.06% (IQR 59% - 39%) post-intervention (P =0.659). A total of 252 DRPs were detected. Acceptance of pharmacy interventions was high with 75.64% of problems being totally or partially solved. Conclusion: Pharmacist counselling improved medication adherence, glycaemic control, patients' knowledge regarding medication management and quality of life of the patients. It is helpful in addressing and resolving the drug related problems. Thus, pharmacist counseling can effectively be used to improve the outpatient management of diabetes in Sri Lanka.
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    Factors associated with symptom frequency and health seeking behaviour of the general population, Gampaha district -Sri Lanka
    (University of Kelaniya, 2022) Withana, S.S.
    Public outpatient department (OPD) visits are estimated to increase from 55 million in 2014 to 100 million in 2027. With the private sector handling a similar share, this will be an unsustainable burden to the healthcare system. High illness sensitivity of the population and increase in healthcare seeking associated with socio-demographic factors could be some of the reasons fbr increasing OPD visits. This study from the Gampaha district describes the symptom frequency, healthcare-seeking pattern, associated socio-demographic characteristics, factors associated with selection between public or private sectors and methods of sei-care practised by the study population. Using a community-based prospective study design, the data collection was done in Ragama(urban) and Mirigama(rural) areas fbr one month. Participant-held symptom diary combined with interviews were used to collect patient data. From Ragama and Mirigama, six midwife areas were randomly chosen. Clusters of 15-20 households were selected from 5-6 random locations in each area. The study population was 2046 individuals, majority females (n=l 127,55.1%) from 557 households. The majority were from Mirigama (rural) 1207(59%). Symptoms were reported by 1919(93.8%). Phlegm (7.0%), leg pain (6.6%) and cough (5.3%) were top symptoms. Adult males were less likely to have symptoms [p=0.016,OR=0.46,95%CI(0.244-0.865)]. Healthcare was sought by 924(45.1%) and the majority (n=763,37.3%) preferred the allopathic system. Urban children [p<0.001 ,OR=0.546,95%C1(0.389・0.767)], and adults [p=0.004,OR=0.663 95%CI(0.502-0.877)] were less Hkely to seek care than their rural counterparts. For OPD care, the majority preferred the private (n=515,25.2%) compared to the public sector (n=330,16.1%). Having a regular doctor increased health-seeking in the private sector in children [p<0.001,OR=5.86,95%CI(3.28-10.486)]. For adults, regular doctor [p<0.001 ,OR=4.105,95%CI(2.098-8.03 l)]and income [p=0.037,OR=5.177,95%CI (1.102-24.317)] increased private sector visits. Of the 47(2.3%) that needed in-ward care, 42 were admitted to public hospitals, of which 19 were to teaching hospitals. Only 4 were admitted to private institutions. Having a regular doctor reduced the admissions [p=0.08,OR=0.397 95%CI(0.201- 0.785)]. The majority practised Allopathic self-care methods. The study population had high symptom reporting and high healthcare-seeking behaviour which may explain the increasing trend of outpatient visits. The majority preferred private sector fbr outpatient care and having a regular doctor and income, increased private-sector visits. Public hospitals were the choice of the majority fbr admissions.
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    Translation and validation of liebowitz social anxiety scale and a randomized controlled trial investigating the effectiveness of group cognitive behavior therapy versus a wait list control of university students with social phobia.
    (University of Kelaniya, 2020) Hapangama, A.
    Background: Despite being one of the most prevalent psychiatric disorders, social phobia remains to be under-diagnosed. To date no instrument to measure social phobia in available in Sinhalese. Cognitive Behavior Group Therapy (CBGT) has not only been proven effective but also cost-effective in other countries fbr adults with social phobia. Objective: to translate and validate the Liebowitz Social Anxiety Scale- self-rated (LSAS-SR) in to Sinhalese and to determine the effectiveness of CBGT as compared to a waitlist control of university students with social phobia. Method: Translation, adaptation and validation followed the standard procedure. DSM IV was used as the gold standard to diagnose social phobia. A single-blind randomized controlled trial consisting of an 8-week treatment phase with a modified form of CBGT versus a waitlist control was conducted among consenting university students with social phobia. Results: Cut- off of 39 had the best sensitivity and specificity. The Cronbach's alpha between the totals of avoidance and fear subscales was 0.919. The test-retest reliability fbr the fear subscale, avoidance subscale and the total score were 0.998, 0.999 and 0.994 respectively with a correlation significant at 0.01. Repeated measure analysis of the total scores of the Sinhala version of LSAS-SR in CBGT arm showed statistically significant (p<0.001) reduction in the total scores (13.6222) when compared to the scores in the waitlist arm. Conclusions: Cutoff value of 39 fbr the Sinhala translation of the LSAS-SR supports findings of other studies with regard to psychometric properties. CBGT is effective in treating university students with social phobia in Sri Lanka. Larger scale studies among other people with social phobia also looking at cost-effectiveness may provide more light on this.
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    The role of virgin coconut oil in the treatment of alzheimer's disease
    (University of Kelaniya, 2021) Fernando, M.G.
    Alzheimer disease (AD) is the most common cause of dementia and one of the leading causes of morbidity and mortality in aging population. Virgin coconut oil (VCO) is an emerging approach to improve cognition of AD patients. This double-blind placebo- controlled trial was designed to investigate the effect of VCO on memory and cognition of mild-to-moderate AD patients and to investigate the association of Apolipoprotein E (APOE) genotypes on the outcome. Subjects were 120 Sri Lankan mild-to-moderate AD patients aged >65 years and were randomly allocated to the treatment and control groups. Treatment group was fed 30 mL/ day of VCO and control group with a same amount of canola oil for 24 weeks. Memory and cognition were assessed by Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MOCA), and executive clock drawing task (CLOX) at the baseline and at the end of the intervention. Blood samples were collected and lipid profile and HbAlC at the baseline and at the post- intervention were analyzed. APOE genotype tests were performed. There was no significant difference in changes of memory scores, lipid profile and HbAlC between the treatment and control groups. However, MMSE scores were improved among A POE-4 carriers compared to the non-carriers (2.37, p=0.021) who had VCO, whereas APOE-4 status did not influence the memory scores of patients who had canola oil. In conclusion, oral supplementation with VCO for 24 weeks did not result an improvement in MMSE and MOCA scores in patients with mild-moderate AD compared to canola oil. However, intervention with VCO improved MMSE scores in patients who had APOE-4 allele compared to those did not have it. VCO supplementation did not compromise fasting lipid profile and HbAlC.
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    Spatiotemporal methods and applications in neglected tropical diseases
    (University of Kelaniya, 2020) Ediriweera, E.P.D.S.
    In nature, diseases show spatial and temporal variations. The probability of acquiring diseases decline along with increasing distances and time lags. Spatial, temporal and spatiotemporal predictive models are useful to make recommendations in low-resource settings when disease registries are either non-existent or geographically incomplete. The National Snakebite Survey (NSS) was an island-wide, community based survey conducted over 11 months. The survey reported snakebites that occurred in the preceding 12 months, and the number of people surveyed in each month varied. Snakebite showed a spatial correlation between events. Spatial variation of snakebites at cluster level was assessed using purely spatial models after collapsing the time dimension and accounting for spatial correlation between events. Temporal variation of snakebites at each month was assessed using purely temporal models after collapsing the spatial dimension and accounting for recall bias and survey effort. Subsequently, the spatial and temporal models were combined to explain spatiotemporal variation incoiporating individual-level data. Overall, snakebites and envenoming bites showed clear spatial and temporal variations in Sri Lanka. Snakebites were higher in intermediate and wet zones. However, envenomings were higher in the dry zone. At the national level, the highest snakebite incidence was observed from November to December, whilst the highest envenoming incidence occurred from March to April. Snakebite and envenoming hotspots showed dynamic changes throughout the year. The average monthly snakebite and envenoming incidence in Sri Lanka were 39 and 19 per 100,000 respectively. This translates into 110,000 snakebites and 45,000 envenomings each year. The models that were developed were then used to demonstrate the residual confbunding effect and explain the health-seeking behaviour of snakebite victims. Health seeking behaviour of snakebite victims depended on probable envenoming caused by bites. Victims in high endemic areas fbr envenoming sought allopathic treatment over traditional treatment and vice versa. The thesis also presents a case study to illustrate spatial modelling in the absence of spatial correlation between events. The thesis presents some solutions to problems encountered in spatial, temporal and spatiotemporal epidemiology. These results would facilitate informed healthcare decision making in Sri Lanka, and the methods described are replicable for studies of a similar nature.
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    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.
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    The genetic origin(s) and the distribution of the sickle cell gene and the clinical description of sickle cell disease in Sri Lanka
    (University of Kelaniya, 2020) Darshana, L.G.T.
    Case reports and limited case series of Sickle cell disease (SCD) in Sri Lanka have been reported since 1962. Yet, no attempt has been made up till now to undertake a comprehensive genotypic-phenotypic analysis of this "rare" group of patients in Sri Lanka. The national thalassaemia prevention programme in Sri Lanka is currently using Full Blood Count with (FBC) red cell indices as the technique for haemoglobionopathy screening. This approach is likely to miss sickle haemoglobin (Hb S) carriers. Present study intends to describe the clinical picture of SCD in Sri Lanka, analyze its molecular basis, including the effects of genetic modifiers on the phenotype and describe the screening utility of sickling test in identifying sickle carriers among a relatively high-risk population in Hambantota district of Sri Lanka. All accessible sickle patients, totaling 60, including, 51 Sickle p-thalassaemia (SBT) and 9 homozygous sickle patients (Hb SS) were enrolled from seven thalassaemia treatment centres. All the patients were clinically evaluated and details were recorded. P-globin haplotypes, p - thalassaemia mutations, common a+ thalassaemia gene deletions and 5 known Fetal haemoglobin (Hb F) modifiers (rs6545816, rs 1427407, rs66650371, rs9402686, rs7482144) were assessed. Geographically, two prominent patient clusters were identified and the distribution of Hb S in the island contrasted with that of the other haemoglobinopathies. 3/ 9 Hb SS and 3/ 51 SBT patients were receiving regular transfusion. Joint pain was the commonest clinical presentation among all SCD patients (n=39, 65.0%). Dactylitis was significantly more common in Hb SS patients compared with the SBT group (p 0.034). Two genetic backgrounds Hb S mutation were identified and confirmed namely, Arab Indian and Benin. Among the Hb F regulators rs 1427407 G>T seemed to be the most prominent modifier, with a significant association with Hb F levels (p 0.04). Sickling test demonstrated 100 % sensitivity and 100 % specificity. FBC by itself was unreliable to detect Hb S but if combined with sickling test was able to pick up Hb S in addition to most other haemoglobinopathies.