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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Sensitization patterns of allergens among asthmatics in Sri Lanka(Lippincott Williams & Wilkins, 2007) Weerasinghe, A.; Weerasinghe, S.; Amarasena, M.; Medagoda, K.; Katelaris, C.H.Introduction: The sensitization pattern among asthmatics in Sri Lanka is unknown. Objectives: To determine the sensitization pattern among asthmatics in Sri Lanka. Methodology: The study was carried out in forty physician-diagnosed asthmatic patients. Twenty two non-asthmatics were recruited as controls. Sensitization to 12 allergens was assessed by skin prick test using standardized allergen extracts. A skin wheal diameter, 3mm greater than the negative control was considered a positive reaction. Results: The mean age of asthmatics was 32.4 years (range 9Y59) and 57.5% were males. The mean age of controls was 32.2 years (range 14Y58) and 59.1% were males. The analysis of the data showed that 97.5% asthmatics had positive skin reaction to at least one allergen compared to 72.7% prevalence in the control group. The common allergens among asthmatics were Dermatophagoides pteronyssinus (77.5%), blomia (65.5%), cockroach (55%), storage mite (35%), latex (20%)), cat fur (17.5%), aspergillus (12.5%), grass pollen (12.5%), cow’s milk (12.5%) egg white (10%) cereals (7.5%) and dog hair (5.%). The pattern of sensitization among non-asthmatics was Dermatophagoides pteronyssinus (54.5%), cockroach (50%), blomia (36.4%), aspergillus (36.4%), grass pollen (27.3%), storage mite (22.7%), cow`s milk (18.2%), latex (13.6%), egg white (13.6%), cereals (13.6%), dog hair (9.1%) and cat fur (9.1%). Sixty two percent (n = 25) of the asthmatics had at least one other allergic manifestation while non-asthmatics with other allergic manifestation were 36.4% (n = 8). Other allergic manifestations in the asthmatic group were rhinitis alone 22 (55%), eczema alone 1(2.5%) and both rhinitis & eczema 2(5%) whereas in the non-asthmatic group it was rhinitis alone 7 (31%), eczema alone 0% and both rhinitis and eczema 1(4.5%). The pattern of sensitization for mites alone, cockroaches alone and mites and cockroaches in the asthmatic group with rhinitis (n = 24) was 23 (57%), 11(27%) and 11(27%) and in the non-asthmatic group with rhinitis (n = 7) was 3 (13%), 4 (18%) and 3 (13%) respectively. Conclusion: The results show that mites, and cockroaches are the most common sensitizing allergens in asthmatics and the commonest association of asthma was rhinitis in Sri Lanka.Item Long-term survival of a patient with single atrium and single ventricular heart: a case report(Sri Lanka Medical Association, 2018) Lohithalingam, P.; Lakmini, K.M.S.; Weerasinghe, S.; Pereira, T.; Premaratna, R.Item Protection against malaria in toque mokeys immunized with p.cynomolgi MSP1inv in alum(Sri Lanka Association for the Advancement of Science, 2000) Amaratunga, C.; Nandasiri, K.; Weerasinghe, S.; Manamperi, A.; Holm, I.; Longacre, S.; Handunnetti, S.Immunization of toque monkeys with baculovirus-expressed, His-tagged recombinant plasmodium cynomoigi ceylonensis (Pcc) C-terminal 19 kDa proteins of the major merozoite surface protein 1 (MSP1inv) with Freunds adjuvant, mediates long-term protection against homologous and heterologous p. cynomolgi blood-stage challenge infection. However, Freunds adjuvant is unsuitable for use in humans, which necessitates the testing of alternative adjuvants. Antigen-alum formulation and binding was optimized for the new preparation of matalloaffinity-purified MSP1inv antigen, under conditions acceptable for human trails, including 800ug aluminium per dose, in accordance with the permitted FDA maximum. This formulation was used in an immunization trial using the p. cynomolgi-toque monkeys system, which is analogous to the p.vivax-human system. Group 1 comprising 4 animals were immunized with alum+MSP1inv , and group 2 comprising 3 monkeys received alum alone. Four doses of immunization were given intramuscularly at 0,1,3 and 4 month intervals. After immunization, the anti-MSP1inv antibody titres of immunized animals reached 2.8x104 . all animals were given a homologous Pcc challenge infection one month after the last dose of immunization. One of the four immunized animals was completely protected while the other 3 animals showed low patent parasitaemia, resulting In an overall partially protective effect (p=0.02). immunization with alum did not result in sterile immunity, as seen with Freunds, where antibody titres range from 106 - 107 . Following treatment, the animals were given a second heterologous, blood-stage challenge infection of p.cynomolgi Gombak, (PcG) four months after the first challenge infection. Sequence analysis of PcG DNA reveald a single amino acid differing from that of Pcc. The substitution which occurs at the nt 207 position in the C-terminal 19-kDa sequence changes the amino acid glutamate into lysine. Statistically significant partial protection was observed in the immunized animals (p=0.04), despite having a lower titre of antibodies (3.3x103) at the time of re-challenge. Together with sequence data, this documents the ability of recombinant MSG1inv to protect against a heterologous infection.Item Protection against malaria in toque monkeys immunized with P. cynomolgi MSPI-19 in alum(The royal society of tropical medicine and hygiene, British society for parasitology, The American society of tropical medicine and hygiene, 2000) Amaratunga, C.; Nandasiri, K.; Weerasinghe, S.; Manamperi, A.; Longacre, S.; Holm, I.; Handunnetti, S.In a pre-clinical trail of a vaccine against P.vivax malaria, toque monkeys were immunized with matalloaffinity-purified baculovirus-expressed. His-tagged recombinant Plasmodium cynomolgy ceylonensis (Pcc) C-terminal 19 kDa protiens of the major merozoite surface protein 1 (MSP1p19) with alum, under conditions acceptable for clinical trials. The P. cynomolgi-toque monkey system is highly analogous to P.vivax in humans. Eight animals were immunized with alum+MSP1p19 and 3 monkeys received alum alone. After four doses, the anti-MSP1p19 antibody titres of immunized animals reached 2.8x104. all animals were challenged with Pcc asexual blood stage parasites. The immunized animals showed significant, partial protection (p=0.0024). Four of these animals were given a second heterologous challenge infection of p.cynomolgi Gombak, (PcG) four months after the first challenge infection. Sequence analysis of PcG DNA revealed a single amino acid challenge differing from that of Pcc. The substitution which occurs at the nt 207 position in the C-terminal 19-kDa sequence changes the amino acid glutamate into lysine. Statistically significant protection was observed in the immunized animals (p=0.04), despite having a lower titre of antibodies at the time of re-challenge. This documents the ability of recombinant MSP1p19 with alum to protect against Pcc and PcG infections.Item Influence of non-alcoholic fatty liver disease on the development of diabetes mellitus(Wiley-Blackwell, 2013) Kasturiratne, A.; Weerasinghe, S.; Dassanayake, A.S.; Rajindrajith, S.; de Silva, A.P.; Kato, N.; Wickremasinghe, A.R.; de Silva, H.J.BACKGROUND AND AIM: Non-alcoholic fatty liver disease (NAFLD) is linked to metabolic syndrome, and is known to be associated with impaired fasting glycemia and diabetes mellitus. This prospective community-based study was conducted to determine the association between NAFLD and incidence of diabetes mellitus in an urban adult population in Sri Lanka. METHODS: Participants of the Ragama Health Study cohort were assessed for NAFLD using established ultrasound criteria in 2007. Those who were free of diabetes at baseline were followed up for 3 years. Incidence rates of diabetes mellitus were compared between subjects with and without NAFLD at baseline. RESULTS: Out of 2984 subjects, 926 had NAFLD and 676 had diabetes in 2007. Of the 2276 subjects who were free of diabetes in 2007, 1914 were re-assessed in 2010. After 3 years, 104 out of 528 subjects with NAFLD and 138 out of 1314 subjects without NAFLD had developed diabetes mellitus de novo. Incidence rates of diabetes were respectively 64.2 and 34 per 1000 person-years of follow up for those with and without NAFLD. NAFLD was an independent predictor of developing diabetes mellitus. Other independent predictors were impaired fasting glycemia and dyslipidemia. CONCLUSIONS: Subjects with ultrasonically diagnosed NAFLD have an increased risk of developing diabetes mellitus. Intervention for NAFLD through lifestyle modification may prevent progression of the current diabetes epidemic. © 2012 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.Item Clinically helpful rickettsial disease diagnostic IgG titers in relation to duration of illness in an endemic setting in Sri Lanka(Biomed Central, 2012) Premaratna, R.; Weerasinghe, S.; Ranaweera, A.; Chandrasena, T.G.A.N.; Bandara, N.W.; Dasch, G.A.; de Silva, H.J.BACKGROUND: Although an initial IFA-IgG titer greater or equal to 1/64 or 1/128 is considered positive in presumptive diagnosis, in clinical practice in an endemic setting for rickettsioses in Sri Lanka, some patients with IFA-IgG titer of 1/128 for either spotted fever group (SFG) or scrub typhus (ST) did not respond to treatment. FINDINGS: To determine a clinically helpful diagnostic algorithm, IFA-IgG results of serologically confirmed treatment responders were analyzed in relation to duration of illness at sampling. Of 146 suspected SFG, 3 responders of 25 patients had titers ≤1/128 with < 7 days of illness while all 9 with titers ≥1/256 responded (false negative with 1/256 cutoff was 12%, false positive was 0%). For illness > 7 days, the false negative and positive rates were 4.3% (3/59) and 11.3% (6/53). Of 115 suspected ST, false negative and positive rates with ≥1/256 cutoff at <7 days of illness were 14.2% (2/14) and 0% (0/8) respectively while > 7 days, false negative and positive rates were 2% (1/51) and 0% (0/42). CONCLUSIONS: For clinical decision making, duration of illness at sampling is important in interpreting serology results in an endemic setting. If sample is obtained ≤7 day of illness, an IgG titer of ≤1/128 requires a follow up sample in the diagnosis and > 7 days of illness, a single ≥1/256 titer is diagnostic for all ST and 90% of SFG.Item The Health and nutritional status of school children in two rural communities in Sri Lanka(Blackwell Scientific Publications, 2000) Fernando, S.D.; Paranavitane, S.R.; Rajakaruna, J.; Weerasinghe, S.; Silva, D.; Wickremasinghe, A.R.There is growing evidence of considerable burden of morbidity and mortality due to infectious diseases and undernutrition in school children. This study describes the nutritional status and parasitic infections of school children in two areas of rural Sri Lanka. All children in four primary schools in the Moneragala district of Sri Lanka were included in the study. The height and weight of children were measured and anthropometric indices calculated. Stool and blood samples were examined for evidence of intestinal helminthiasis, malaria and anaemia. A greater proportion of boys than girls were underweight, wasted and stunted. Over 80 percent of the children were anaemic but did not apparently have iron deficiency anaemia according to their blood picture. The prevalence of parasitic infections such as hookworm and Plasmodium spp that may contribute to anaemia was low.