Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Chracterisation of beta giobin mutations in Sri Lankan patients with betathalassaemia intermedia(Sri Lanka Medical Association, 2013) Perera, S.; Silva, D.P.S.I.; Hapugoda, M.; Wickramarathne, M.N.; Wijesirwardhena, I.; Efremove, D.G.; Fisher, C.A.; Weatherall, D.J.; Premawardhena, A.P.INTRODUCTION AND OBJECTIVES: Patients with beta thalassaemia intermedia account for a third of patients attending thalassaemia clinics in Sri Lanka. They show immense phenotypic diversity, the genetic basis for which has not been identified so far. Objective were to characterise beta globin gene mutations in Sri Lankan thalassaemia intermedia patients and to determine how it to influences disease severity. METHODS: We identified 64 thalassaemia intermedia patients from the five main thalassaemia centers; Anuradhapura (n= 6), Kuruncgala (n= 4), Ragama (n= 42), Badulla (n=7) and Chilaw (n=5). Their beta globin DNA sequences were analyzed using ABI PRISM 313lx genetic analyser. RESULTS: Of sixteen patients identified to be homozygous for beta mutations, eleven carried mild beta alleles, IVSI 5 G_C (n= 10) and a rare homozygous promoter mutation - 90 C_T (N=l). Other five were shown to have different types of severe iputations in homozygous state. Nearly half the sample (n=39) was heterozygous for beta mutations. Of them 33 showed mild to severe mutation in one of the alleles IVSI-5 G_C (n=12), IVSI-1 G_A (n= 11) were the commonest. Two patients who were hetcrozygones for beta mutation had a highly unstable Hb variant haemoglobin Mizuho causing severe haemolytic anacma. Hb variants Hb G-Szuhu and Hb G-Coushatta were identified in two patients. CONCLUSIONS: We identified types of beta mutations in some patients with thalassaemia intermedia, which account for the clinical severity.Item Biocontrol potential of six locally available fish species as predators of Aedes aegypti in Sri Lanka(Elsevier Ltd, 2021) Ranathunge, T.; Kusumawathie, P.H.D.; Abeyewickreme, W.; Udayanga, L.; Fernando, T.; Hapugoda, M.ABSTRACT: This study was conducted to evaluate the potential of six locally abundant fish species to control Aedes mosquito larvae and thereby manage dengue epidemics in a sustainable, cost-effective and environmentally friendly manner. The biocontrol efficacy of six larvivorous fish species, namely, Poecilia reticulata, Rasbora daniconius, Aplocheilus dayi, Oriochromis mossambicus, O. niloticus and Puntius bimaculatus, was evaluated under laboratory and field conditions. Five size-matched fish (of the same species) were introduced into separate tanks (replicates) containing 2 L of dechlorinated water and 200 third instar larvae of Aedes aegypti (L.). The number of larvae consumed by each fish species was recorded at three-hour intervals for 24 h. Acclimatized fish were introduced into a total of eighteen artificial breeding habitats located in the Gampola Medical Officer of Health (MOH) area at the species level with three replications. In addition, three breeding sites without fish were monitored as controls. Aedes larvae were monitored by dipping and siphoning methods in each breeding habitat at weekly intervals for three months and the number of fish surviving in each habitat was tallied. Over 24 h under laboratory conditions, O. mossambicus showed the highest predation rate, consuming 320.2 ± 14.5 larvae per day, with a predatory efficiency of 87.5 ± 3.5%. In comparison, O. niloticus consumed 264.6 ± 12.2 larvae per day with consumption efficiciency of 78.1 ± 3.7%, whereas R. daniconius had the lowest larval consumption (33.2 ± 2.7 larvae per day) and predatory efficiency (33.2 ± 3.2%). Over 12 weeks of observation under field conditions, breeding sites with Ap. dayi had the lowest Aedes larval counts, followed by Po. reticulata. Considering predation efficiency and survival under field conditions, Ap. dayi and Po. reticulata were considered to be the best potential candidates for biological control of Ae. aegypti. Further studies under field settings are warranted to evaluate the survival and predatory potential of the selected candidates under more varied environmental conditions.Item Use of cyclopoid copepods for control of Anopheles (Diptera: Culicidae) mosquito larvae to prevent re-emergence of malaria in Sri Lanka(Malaria Research Centre, Indian Council of Medical Research, 2019) Ranathunge, T.; Abeyewickreme, W.; Iqbal, M. C. M.; Hapugoda, M.BACKGROUND & OBJECTIVES: Although malaria is eliminated from Sri Lanka, there is a possible risk of spread from infected persons coming from malaria endemic countries. The presence of major and potential vectors in several parts of the country along with drug resistance, necessitates the identification of effective and novel control methods. The present study focused on identifying effective biological control agents for anopheline larvae using carnivorous copepods under laboratory and field conditions to prevent re-introduction of malaria in the country. METHODS: Three copepod species, namely Mesocyclops scrassus, Cyclops varicans and C. languides collected from different areas in the country were cultured by adding supplementary food, and their predatory efficacy was evaluated under laboratory and field conditions. RESULTS: Significant variation (p <0.05) was observed in predation rates of studied copepod species. The species M. scrassus showed the highest predacious efficiency, and consumed the highest number of anopheline larvae under laboratory and field conditions. Further, M. scrassus had higher survival rate than C. varicans and C. languides. INTERPRETATION & CONCLUSION: The results of the study suggest that the predatory copepod M. scrassus can be used as a bio-control agent for the control of Anopheles mosquitoes to prevent re-emergence of malaria in the country. Additional research is suggested to identify naturally available copepod species and their predatory efficacy. KEYWORDS: Anopheles; Sri Lanka; biological control; copepods; malaria vectors; predatory efficacy.Item Entomological surveillance with viral tracking demonstrates a migrated viral strain caused dengue epidemic in July, 2017 in Sri Lanka.(Public Library of Science, 2020) Withanage, G.P.; Hapuarachchi, H.C.; Viswakula, S.D.; Gunawardene, Y.I.N.S.; Hapugoda, M.BACKGROUND: Dengue is the most important mosquito-borne viral infection disease in Sri Lanka triggering extensive economic and social burden in the country. Even after numerous source reduction programmes, more than 30,000 incidences are reporting in the country every year. The last and greatest dengue epidemic in the country was reported in July, 2017 with more than 300 dengue related deaths and the highest number of dengue incidences were reported from the District of Gampaha. There is no Dengue Virus (DENV) detection system in field specimens in the district yet and therefore the aim of the study is development of entomological surveillance approach through vector survey programmes together with molecular and phylogenetic methods to identify detection of DENV serotypes circulation in order to minimize adverse effects of imminent dengue outbreaks. Entomological surveys were conducted in five study areas in the district for 36 months and altogether, 10,616 potential breeding places were investigated and 423 were positive for immature stages of dengue vector mosquitoes. During adult collections, 2,718 dengue vector mosquitoes were collected and 4.6% (n = 124) were Aedes aegypti. While entomological indices demonstrate various correlations with meteorological variables and reported dengue incidences, the mosquito pools collected during the epidemic in 2017 were positive for DENV. The results of the phylogenetic analysis illustrated that Envelope (E) gene sequences derived from the isolated DENV belongs to the Clade Ib of Cosmopolitan genotype of the DENV serotype 2 which has been the dominant stain in South-East Asian evidencing that a recent migration of DENV strain to Sri Lanka.Item Development of recombinant protein antigens using a bacterial expression system for the detection of anti-Chikungunya (CHIK) antibodies(Sri Lanka College of Microbiologists, 2013) Athapaththu, A.M.M.H.; Khanna, N.; Inouve, S.; Gunasena, S.; Abeyewickreme, W.; Hapugoda, M.INTRODUCTION AND OBJECTIVE: Laboratory confirmation of Chikungunya (CHIK) virus is very useful as clinical symptoms of CHIK can overlap with other diseases. Chikungunya virus specific antigen, which shows high specificity, sensitivity and low cross reactivity with other related diseases, is required for laboratory confirmation. Objective of this study was to develop and compare two recombinant protein antigens for detection of anti-CHIK antibodies. DESIGN, SETTING AND METHODS: Recombinant CHIK protein antigens were prepared using Envelope (E1 and E2) regions of the CHIK virus. The genes were custom designed and chemically synthesized with a 6X His tag. Bacterial expression systems [BL21 (DE3)] were used to clone and express the recombinant proteins. The recombinant proteins were purified with >95% of purity per liter of culture using Ni-NTA columns under denature conditions. In this study, two antigens were evaluated for detection of anti-CHIK antibody by using novel optimized in-house IgM and IgG ELISAs, using a panel of well characterized serum samples obtained from the Dept. of Virology (WHO Reference Center for Viral Reference and Research) Institute of Tropical Medicine, Nagasaki University, Japan. RESULTS: Atotal of 55 serum samples confirmed as positives and 186 confirmed as negatives by HA! test, IgM capture ELISA and indirect IgG ELISA using the purified CHIK antigen were used to evaluate the antigens using novel IgM ELISA. A total of 78 serum samples confirmed as positives and 148 (E1) or 227 (E2) (148 + extra 79) confirmed ac negatives were used to evaluate the antigens using novel IgG ELISA. The E1 recombinant protein showed 5% (3/ 55) sensitivity and 99% (184/186) specificity for IgM ELISA and 60% (47/78) sensitivity and 63% (94/148) specificity for IgG ELISA. The E2 recombinant protein showed 65% (36/55) sensitivity and 70% (131/186) specificity for IgM ELISA and 83% (65/78) sensitivity and 86% (195/227) specificity for IgG ELISA. CONCLUSION: Recombinant CHIK-E2 protein antigen showed higher specificity and sensitivity in detection of both IgM and IgG antibodies. Thus the E2 recombinant protein antigen used in this study could be expressed in an eukaryotic expression system to achieve much higher results. ACKNOWLEDGMENT: International Center for Genetic Engineering and Biotechnology (ICGEB CRP SRL 08/02), National Science Foundation (NSF/RG/2009/BT/01) and International Atomic Energy Authority (lAEA/SRL/5/042) are gratefully acknowledged.Item Molecular and entomological studies on dengue(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Hapugoda, M.A novel molecular-based assay (Reverse Transcription-Polymerase Chain Reaction-based Liquid Hybridization (RT-PCR-LH)) was developed and validated for early detection of dengue virus in clinical specimens. Possible risk factors affecting transmission of dengue were studied in dengue hot-spots. Soluble fragment of dengue virus in clinical samples were sequenced and gene and protein sequences were compared with available sequences. The novel assay was found to be more sensitive than the other diagnostic techniques for early and definitive laboratory diagnosis. Further, the assay could detect dengue virus in field-caught Aedes albopictus specimens. Ae. albopictus acts as an important vector of dengue in some urban and semi-urban areas. Some socio-ecomonic and other factors directly affect transmission of dengue in the hot-spot. Risk maps developed in the study are important to predict impending dengue epidemics so that limited resources could be utilized in a cost effective manner to control the disease. Sequence analysis of dengue virus indicated that dengue 2 serotype of Indian ancestry had been introduced to Sri Lanka. All districts in Sri Lanka were hyperendemic to dengue with signs of rapid rate of in situ evolution of dengue 3 serotype.Item Laboratory studies on larvivorous potential of five fish species against Aedes ageypti (Linnaeus) and Ae. albopictus (Skuse)(Molecular Medicine Unit, Faculty of Medicine, University of Kelaniya, Sri Lanka, 2015) Kusumawathie, P.H.D.; Jayasooriya, G.A.J.S.K.; Gunathilaka, P.A.D.H.N.; Hapugoda, M.; Abeyewickreme, W.BACKGROUND: The dengue vectors, namely, Aedes aegypti (Linnaeus) and Ae. albopictus (Skuse) are container breeders, thus, container management is a key element for elimination of vector breeding sites. Use of predator fish is a potential tool for dengue vector control in some container habitats. However, in order to select suitable fish species, larvivorous potential of different fish species needs to be determined. Therefore, the objective of the study was to determine the larvivorous potential of some fresh water fish species against the dengue vectors. METHODOLOGY: Five fish species, namely: Poecilia reticulata, Aplocheilus dayi, Oreochromis niloticus, Rasbora daniconius and Puntius bimaculatus were collected from their natural breeding places during the field surveillance conducted from January-October, 2015. Each fish species was placed in separate fish stock cement tanks at the Regional Office of the Anti- Malaria Campaign in Kandy until they were used for the study. In order to determine the larvivorous potential of the fish, each species was placed in separate enamel trays containing de-chlorinated water and allowed to acclimatize for 30 minutes. A batch of 25 Ae. aegypti and Ae. albopictus larvae was introduced to each tray superlatively and the number of larvae remaining was counted after 24 hours of observation period. Once all the batch of larvae consumes by the fish species, another batch of 25 larvae from respective species was introduced during the observation period. The whole experiment was repeated for 6 times. RESULTS: The mean values of Ae. aegypti larvae consumed by one fish of O. niloticus, P. reticulata, A. dayi, R. daniconius and P. bimaculatus were 97.6, 66.9, 49.3, 62.5 and 47.5 respectively while, one fish of O. niloticus, P. reticulata, A. dayi, R. daniconius and P. bimaculatus consumed 98.4, 62.3, 51.2, 62.5 and 45.4 of mean Ae. albopictus larvae respectively. CONCLUSIONS: All five fish species showed larvivorous activity. However, O. niloticus showed the highest larvivorous potential followed by P. reticulata. Therefore, these two fish species may be considered as a supplementary method to control immature stages of dengue vectors.Item Molecular diagnosis and transmission of dengue in Sri Lanka(Molecular Medicine Unit, Faculty of Medicine, University of Kelaniya, Sri Lanka, 2015) Hapugoda, M.; Abeyewickreme, W.; de Silva, N.R.; Gunasena, S.; Meegoda, D.; Manamperi, N.BACKGROUND: Dengue virus is an important vector-borne viral infection in Sri Lanka. Laboratory confirmation of suspected dengue cases is important for over/under estimation of cases. Early rapid diagnosis of dengue viral infection helps monitoring the disease, hospital admission when necessary and reduces case fatality. Detection of dengue viruses in mosquitoes is useful for studies on transmission of dengue virus. Study on risk factors for dengue is useful to understand spatial and temporal dynamics of transmission the disease. METHODOLOGY: A novel molecular-based assay; Reverse Transcription-Polymerase Chain Reaction-based Liquid Hybridization (RT-PCR-LH) was developed and validated for detection of dengue virus in clinical and mosquito specimens. Severity of dengue with circulating serotype was also analyzed. Wild-caught mosquito samples were collected from 236 dengue case-reported stations during outbreaks and a hot-spot during a period of 31 months. Epidemiological, environmental and entomological and other possible risk factors affecting transmission of dengue were analyzed. RESULTS: As an early (<5 days of fever) laboratory diagnostic method for dengue virus, the novel assay had 100% and 46% sensitivity for detection of confirmed and suspected dengue patients respectively. The assay developed in this study was found to be more sensitive than the other diagnostic techniques for early definitive laboratory diagnosis of dengue infection. Patients with definitive dengue correlated only with few signs and symptoms, indicating that laboratory confirmation is critical to avoid over estimation. A high sensitivity of 2 fluorescent focus unit of dengue virus/reaction was achieved and the assay was highly specific for dengue virus. The assay could detect dengue virus in 7% of field-caught Aedes albopictus specimens. A high density of Ae. albopictus was also associated with the dengue case-reported stations/hot-spots. Both vector species were susceptible to the 4 dengue serotypes under the laboratory conditions and DEN-3 under the field conditions. Geographical Information System (GIS) based risk mapping and database including epidemiological, climatic condition and entomological surveillance information were developed for the hot-spot in Kurunegala during the period of 2000-2003, which can be used as an early warning system. In depth study on socio-economic and other related factors affecting transmission of dengue was studied in the District of Gampaha. CONCLUSION: Ae. albopictus acts as an important vector of transmission of dengue in some urban and semi-urban areas. GIS-based risk maps developed are important to predict impending epidemics so that limited resources could be utilized in a cost effective manner to control the disease. Some socio-economic factors directly affecting transmission of dengue.Item Clinical and molecular heterogeneity among Beta Thalassaemia Intermedia in Sri Lanka(Sri lanka Medical Association, 2015) Perera, P.S.; Silva, D.P.S.I.; Hapugoda, M.; Wickramarathne, M.N.; Wijesiriwardena, I.; Efremov, D.G.; Fisher, C.A.; Weatherall, D.J.; Premawardhena, A.INTRODUCTION AND OBJECTIVES: Patients with beta thalassaemia intermedia (Tl) unrelated to haemoglobin E/beta thalassaemia account for an important minority in thalassaemia clinics in Sri Lanka. We investigated the genotypic/phenotypic diversity of this small group of patients. METHOD: Fifty Tl patients identified from five thalassaemia centers were clinically assessed and divided in to severity groups based on agreed criteria. Genetic analysis was done by PCR based techniques. RESULTS: There were 26 mild, 12 moderate and 12 in the severe groups. Ages ranged from 5-65 years. Mean haemoglobin of the whole group was 7.8g/dl. Age at presentation ranged from 3 months - 57 years (mean 16.8yrs) and varied according to severity; 17.8 years in mild to 4.8 years in severe group. 86% were on intermittent transfusions whilst 14% were never transfused. Mean total transfusion load in the three groups ranged from 6, 28 to 89. Majority (60%) had splenomegaly and 12% were splenectomised. The median spleen size of each severity group was 0, 4.5 and 7.5 cm respectively. Thalassaemicfacial features were not_ demonstrable in the majority (86%). Genetic analysis identified the commonest mechanism for Tl to be coexistence of a single beta mutation with excess alpha genes (56%). None of these patients had severe phenotype. Coexistence of two beta mutations with alpha thalassaemia invariably gave rise to severe phenotype. Other mechanisms gave rise to varying disease severity. CONCLUSION: This study highlights the remarkable phenotypic variations in beta Tl in Sri Lanka and identifies some genetic mechanisms which can explain this variation.Item Appearance of Anopheles jeyporiensis James from Sri Lanka; a new species to the mosquito checklist(The Japan Society of Medical Entomology and Zoology, 2015) Gunathilaka, N.; Abeyewickreme, W.; Hapugoda, M.; Wickremasinghe, A.R.Previous records of Sri Lankan Anopheles were most imperfect, and even the number and names of the species present were very doubtful. There was no systematic study conducted for Sri Lankan adult anophelines since 1990. Therefore, the objective of this study was to explore the species abundance and morphological variations of anopheline mosquitoes in Sri Lanka. Entomological surveys were conducted on a monthly basis from June 2010 to December 2013 in Trincomalee District, using five entomological techniques. Entomological surveys identified a total of 131,804 mosquito specimens belong to 18 anopheline species. One of which was An. jeyporiensis, a species that was not in the checklist in Sri Lanka. Its basic morphological features are similar to the members in Myzomyia series under the subgenus Cellia. Following characteristics were used to confirm the species as An. jeyporiensis; Centre of the scutum covered with short oblong white scales extending back to scutellum; Vein R 1 usually with accessory pale spot on preapical dark (PD) area; Foretarsomere 1 with apical pale band nearly 2.0 width of tarsomere diameter.