Medicine
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Item Epidemiological patterns and trends of paediatric snakebites in Sri Lanka(Biomed Central, 2024-12) Dayasiri, K.; Caldera, D.; Suraweera, N.; Thadchanamoorthy, V.; Hettiarachchi , M.; Denipitiya, T.; Bandara, S.OBJECTIVES This study aimed to analyse the epidemiological patterns of paediatric snake bites in Sri Lanka over a 4-year period (2020-2024).METHODS A multi-centre, retrospective observational study was conducted from June 2020 to June 2024 across nine governmental hospitals in seven provinces of Sri Lanka. Data were collected based on 757 children presenting with snake bites. The snake bites were analysed based on age, gender, and seasonal variations. Data on the type of snake involved, geographic variations and the temporal trends in snake bite occurrences were also analysed.RESULTS The mean age of the 757 children recruited to the study was 10.3 years (SD-5.00, range-0.1-17 years). Males (57.7%) were significantly more affected than females (42.3%) (p < 0.05). Visual identification confirmed the snake species in 58.4% of cases. The hump-nosed viper (16.7%), Russell's viper (14.7%), and common krait (12.9%) were the most common medically important snakes identified in the study. Seasonal peaks in snake bites occurred in May-July and November-December. An increasing trend in snake bite incidence was noted over the first three years, with a slight decline in the final year.CONCLUSION Paediatric snake bites in Sri Lanka show significant age, gender, and seasonal patterns. Targeted public health interventions are needed to mitigate the impact on children.Item Comparative Analysis of Albumin Measurement by Bromocresol Green Versus Capillary Zone Electrophoresis(College of Chemical Pathologists of Sri Lanka, 2024) Harshanee, T.; Jayasekara, D.; Fernando, K.; Kulasinghe, M.; Silva, P.; Bandara, S.; Dayanath, B.K.P.T.INTRODUCTION Quantitative assessment of albumin and globulins in serum protein electrophoresis (SPE) relies on the calculation derived from total protein measurements obtained from the biuret assay. Validation of these results involves comparing sample albumin concentration assessed using the bromocresol green (BCG) method to those obtained from capillary zone electrophoresis (CZE). This study aimed to assess the relationship between albumin values derived from SPE and routine spectrophotometric analysis with BCG method, and to establish a cut-off value to identify significant differences between the two values in SPE validation process. METHODS 187 serum samples were subjected to total protein assessment by biuret method, albumin assessment by BCG method, and SPE by CZE method. SPE derived albumin level using total protein values and BCG method indicated albumin values were analyzed by correlation analysis. The standard error for the difference (SEdif) between the two albumin results were calculated, with statistical significance set at p <0.05. Internal and external quality assessments were deemed acceptable for all three analytical procedures. RESULTS Mean albumin levels obtained via BCG and CZE methods were 38.3 mg/dL and 33.2 mg/dL, respectively, indicating a negative bias for the latter method. A strong correlation (r=0.844, p<0.001) was observed between albumin levels measured by BCG and CZE methods, with Bland-Altman analysis revealing an average negative bias of 5 mg/dL. Using SEdif at 95% significance, the maximum acceptable difference between the two albumin values was determined to be -5.4 mg/dL. CONCLUSIONS BCG method yielded higher albumin results compared to CZE method. This positive bias could be attributed to potential lack of specificity of BCG assay for albumin. A maximum allowable difference of 5.5 mg/dL between the two methods is suggested. Exceeding this threshold indicates potential issues with either the BCG albumin assay, biuret total protein assay, or SPE assay, necessitating further investigation for assay reliability, particularly in reporting SPE by CZE.Item Spondylometaphyseal dysplasia in a 2-year-old Sri Lankan girl(The Sri Lanka Collage of Paediatricians, 2024) Madawala, P.; Lokuhewage, C.; Bandara, S.; Randeny, S.; Mettananda, S.No abstract availableItem Lysinuric protein intolerance presenting as pancytopenia and splenomegaly mimicking acute leukaemia: a case report(BioMed Central, 2023) Lokuhewage, C.; Pathiraja, H.; Madawala, P.; Bandara, S.; Mettananda, S.BACKGROUND: Lysinuric protein intolerance is a rare inherited metabolic disease due to autosomal recessive mutations of the SLC7A7 gene. The affected patients commonly present with protein-rich food intolerance, failure to thrive, hepatosplenomegaly, muscle hypotonia and lung involvement due to impaired intestinal absorption and excessive urinary excretion of dibasic amino acids. Presentation with splenomegaly and cytopenia without other features has not been reported. Here we report a Sri Lankan girl with lysinuric protein intolerance presenting with pancytopenia and splenomegaly mimicking acute leukaemia. CASE PRESENTATION: Two years and six months old Sri Lankan girl presented with persistent pancytopenia following a viral illness. She was asymptomatic without vomiting, diarrhoea, abdominal pain or irritability. Physical examination revealed pallor and isolated firm splenomegaly of 2 cm. Growth parameters and other system examinations were normal. Full blood count revealed anaemia, leukopenia and thrombocytopenia. The blood picture showed a mixture of hypochromic microcytic and normochromic normocytic red cells with occasional pencil cells and macrocytes. Bone marrow examination was normal except for occasional megaloblasts; however, serum vitamin B12 and red blood cell folate were normal. The metabolic screen showed a high anion gap compensated metabolic acidosis, high lactate and ketosis. Genetic mutation analysis using whole exome sequencing revealed compound heterozygous variants of the SLC7A7 gene, confirming the diagnosis of lysinuric protein intolerance. CONCLUSION: We report a child with lysinuric protein intolerance presenting with pancytopenia and splenomegaly without other disease features. This case report adds to the heterogenic presentations of lysinuric protein intolerance, which is considered a multifaceted disease.Item The epidemiological trend of cutaneous leishmaniasis in Kegalle district, Sri Lanka: A newly established disease focus and assessment of bioclimatic suitability for disease establishment using ecological niche modelling(Elsevier, 2023) Wijerathna, T.; Wickramasinghe, K.; Gunathilaka, N.; Perera, A.; Bandara, S.Cutaneous leishmaniasis is prevalent in Sri Lanka since 1992. It remains as a health issue with increasing numbers and spreading from endemic to non-endemic areas in the county. Kegalle district is a new disease focus, which notified the first case in 2016. However, there is no documented evidence of the vector distribution, abundance and potential risk factors in this district. Two Medical Officer of Health (MOH) areas (Rambukkana and Warakapola) that had reported the highest numbers of cases in the Kagalle district was selected and recorded cases (2016-2020) were obtained. The patients were visited and socio-economic, demographic, environmental and awareness-related information was collected using an interviewer-administered questionnaire. Entomological surveys were conducted from July 2019- July 2020 using three standard entomological techniques. Bioclimatic suitability for the disease transmission was evaluated using ecological niche modelling. A total of 107 patients were reported from both MOH areas and 88 were recruited for the study. The study showed that leishmaniasis in the Kegalle district progressed to an outbreak level within 3 years after reporting the first case. School students (n = 22, 25%, P < 0.05) and individuals between 11 and 20 years of age (n = 33, 37.5%, P<0.05) were identified as the main risk groups, while the presence of composting sites (n = 65, 73.9%, P < 0.05), abandoned lands (n = 63, 71.6%, P < 0.05) in the surrounding and suboptimal (dark or normal) lighting conditions (n = 87, 98.8%, P < 0.05) in the house were identified as main risk factors. Areas closer to the adjacent district (Kurunegala), which is a known endemic district for leishmaniasis indicated a high probability (0.3-0.5) for disease transmission. Sergentomyia zeylanica (n = 164, 56.94%), was identified as the predominant sand fly species followed by Phlebotomus argentipes (n = 121, 42.01%), Sergentomyia babu insularis (n = 2, 0.69%) and Sergentomyia punjabensis (n = 1, 0.35%). Phlebotomus argentipes was captured mostly for outdoor resting sites and S. zeylanica was recoded from both indoor and outdoor. The presence of vectors that can transmit leishmaniasis in these areas along with the potential risk factors could increase the transmission risk and disease establishment in new areas that are ecologically favourable for disease transmission. Therefore, vector control entities should undertake immediate measures to stop spreading the disease into new areas.Item A comparative study of subjective experiences related to driving among outpatient psychotropic users and controls in Ragama, Sri Lanka(Sri Lanka College of Psychiatrists, 2016) Chandradasa, M.; Champika, L.; Amarasuriya, M.; Wijelakshman, P.; Bandara, S.; Ranaweera, T.; Fernando, L.Aim: To identify and explore the impact of illness and medications on the driving of patients visiting an outpatient clinic. Method: A retrospective-cohort design was used. The data was collected using a semi-structured, intervieweradministered questionnaire among consecutive patients with schizophrenia or bipolar disorder. An age, gender and vehicle matched control group was obtained. Result: A total of 2887 consecutive clinic patients were asked about driving and 57 (1.9%) who had driven a vehicle regularly during the last 12 months were included in the study group. A majority were in the 30-45 year category (47%). All were men and a majority were motor-bike riders (53%). Collision-accidents were experienced by 42% of participants during the last 12 months. Conclusion: The patient group had lower hours of driving per week, less subjectively claimed earning per day and more with at least one collision-accident during the past year compared to the control group.Item Neonatal hypothermia and associated factors in a special care baby unit(Sri Lanka Medical Association, 2012) Krishnapradeep, S.; Kumarendran, B.; Bandara, S.INTRODUCTION: Neonatal hypothermia is known to result in many adverse consequences. Aims: To estimate the incidence and associated factors of neonatal hypothermia METHODS: This cohort study followed up 125 neonates consecutively admitted to Special Care Baby Unit of Teaching Hospital, Peradeniya from November 2011 to January 2012. A paediatric registrar interviewed parents using a structured-questionnaire and direct observation using a check list. On admission, axillary body temperature was measured and graded using WHO classification. Results: Of the 125 neonates, 96 were admitted within first day of birth (78.6%) and 72 had low birth weight (57.6%). Neonates were admitted from operation theater (58, 46.4%), postnatal ward (34, 27.2%) and labour room (23, 18.4%). Median temperature on admission was 36.2 °C with 38.4% having moderate hypothermia (n=48), 19.2% cold-stress (n=24) and none with severe hypothermia. Risk of hypothermia was increased by prematurity (OR = 9.9, 95% CI: 4.2 - 23), low birth weight (OR= 6.8, 3.1 -15.1), being delivered by caesa-pean section (OR=4, 1.8 - 9.1), admission from operation theatre or labour room (OR =9.1, 3.9 - 21.4) and cold delivery room ( p < 0.001). Caesarean rate was higher among neonates admitted to PBU than all the children delivered (OR = 3.35, 2.2 - 5.1). Hypothermia increases risk of poor activity (OR =1.8, 1.4 - 2.4), poor feeding (OR= 7.2, 1.5 - 34.9), poor cry (OR = 1.9, 1.5 - 2.4), respiratory distress (OR= 1.5, 1.1 - 2.0) and hypoglycemia (OR = 1.6, 1.2 - 2.0).Item Dengue vector surveillance in a dengue hot-spot in Sri Lanka(Faculty of Tropical Medicine, Mahidol University, 2007) Sumanadasa, S.D.M.; Hapugoda, M.D.; Perera, D.; Bandara, S.; Mansoor, M.A.; Peris, I.; Abeyewickreme, W.BACKGROUND: In South Asia, dengue has been declared as one of the most, fast-spreading vector-borne diseases. Therefore, mosquito surveillance is important for early detection of outbreaks along with implementation of prompt control activities. OBJECTIVES: To identify entomological risk factors with regard to transmission of dengue in a dengue hot-spot. Seventy five human dwellings in Vehara in the Kurunegala District of the Western Province were selected based on high disease incidence during 2000-2004, high Aedes as well as human population density and increased building activities. Entomological surveillance was done during May-August, 2007. RESULTS: The house Index ranged from 2.67% to 5.33% for Aedes aegypti while it for Aedes albopictus was 1.33% to 6.60%. The container index ranged from 23.67% to 29.33% for Ae. aegypti and from 1.33% to 18% for Ae. aibopictus. Man biting rates of 0.43-5.78 bites/man/hour were estimated for Ae, aegypti, while it ranged between 0.49 and 1.33 for Ae. aibopictus. The most common breeding place for Aedes species was plastic baskets (16%, n=12). DISCUSSIONS: Vector surveillance showed that the predominant vector species present in the study area was Ae. ageypti. Aedes mosquito larval densities and adult biting rates were sufficient to promote outbreaks of dengue in this study area. Community must be educated regarding effective measures to protect them from dengue. Their cooperation should be elicited in the early detection and elimination of vector species by source reduction, environmental management and personal protection measures.Item Surveillance for dengue vector mosquito in Kurunegala district, Sri Lanka(Elsevier, 2008) Sumanadasa, S.D.M.; Hapugoda, M.D.; Peiris, I.; Perera, D.; Bandara, S.; Mansoor, M.A.C.M.; Abeyewickreme, W.BACKGROUND: Dengue vector surveillance is an important tool to determine the time and area/s to initiate control action. Our objective was to identify entomological risk factors with regard to transmission of dengue in a dengue hot-spot. METHODS: In the study 75 human dwellings in a dengue hot-spot in the District of Kurunegala was selected based on high disease incidence during 2000—2004, high Aedes as well as human population density and increased building activities. House to house mosquito surveillance was carried out from 08.00 am to 12.00 noon during May—August, 2007. Larvae and adult Aedes mosquitoes were collected indoors and outdoors using normal larval surveillance and human landing diurnal collection techniques respectively. Environmental and sociological data were obtained from households by interviewer administered questionnaires and observations. RESULTS: The house index for Aedes aegypti and Aedes albopictus ranged from 1.33%—6.60% and 2.67%—5.33% respectively. The Breatu index ranged between 23.67%—29.33% for Ae. aegypti and 1.33%—18% for Aedes albopictus. Man biting rates of 0.43—5.78 bites/man/hour were estimated for Ae. aegypti, while it ranged from 0.49—1.33 for Ae. albopictus. The most common breeding place for Aedes species was plastic baskets (16%, n = 12). More than half of the households (61%, n = 45) stored water in large cement tanks for their daily activities. Majority of the group (99%, n = 74) had a basic knowledge on dengue mosquito breeding places (97%, n = 73), their life cycle (95%, n = 71) and mode of transmission (99%, n = 74). Domestic waste of majority of households was carried away daily by the local authorities (n = 69). CONCLUSION: These results suggest that a vector control program should be adopted to reduce Aedes population levels below dengue transmission thresholds. Discarded containers of various types were identified as potential mosquitoes breeding habitats. Therefore, community must be educated on effective vector control measures to contain the transmission levels. © 2008 Elsevier Inc.Item Cross-sectional study to assess risk factorsfor leishmaniasis in an endemic region in Sri Lanka(American Society of Tropical Medicine and Hygiene, 2013) Ranasinghe, S.; Wickremasinghe, R*.; Munasinghe, A.; Hulangamuwa, S.; Sivanantharajah, S.; Seneviratne, K.; Bandara, S.; Athauda, I.; Navaratne, C.; Silva, O.; Wackwella, H.; Matlashewski, G.; Wickremasinghe, R.Sri Lanka reports significantly more cutaneous leishmaniasis (CL) cases than visceral leishmaniasis (VL) cases, both of which are caused by Leishmania donovani MON-37. A cross-sectional study conducted in an area with a high prevalence of CL prevalent included 954 participants of an estimated population of 61,674 to estimate the number of CL cases, ascertain whether there is a pool of asymptomatic VL cases, and identify risk factors for transmission. A total of 31 cases of CL were identified, of whom 21 were previously diagnosed and 10 were new cases. Using rK39 rapid diagnostic test to detect antibodies against Leishmania spp., we found that only one person was seropositive but did not have clinical symptoms of CL or VL, which indicated low transmission of VL in this area. χ(2) test, independent sample t-test, and multivariate analysis of socio demographic and spatial distribution of environmental risk factors showed that living near paddy fields is associated with increased risk for transmission of CL (P ≤ 0.01).