Medicine
Permanent URI for this communityhttp://repository.kln.ac.lk/handle/123456789/12
This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
Browse
160 results
Search Results
Item Progress in the prevention and control of schistosomiasis and soil-transmitted helminthiasis(Societa Italiana di Medicina Tropicale, 2002) Albonico, M.; Engels, D.; Montresor, A.; Cromptons, D.W.T.; de Silva, N.R.; Savioli, L.ABSTRACT: In the last two decades important progress have been made in the understanding the epidemiology and the disease burden of schistosomiasis and soil-transmitted nematodes infection. In addition, practical tools for disease control have been developed and a strategy for the prevention and control of morbidy of schistosomaisis and soil-transmitted nematodes infection has been endorsed by the World Health Organization. This paper presents the recent progress in the prevention and control of these infections: the estimates of chronic and subtle morbidity in high risk groups and the evidence that these chronic and severe sequelae of infections can be reversed by appropriate treatment; the use of anthelminthic drugs during pregnancy and lactation; the relevance to control morbidity due to these infections also in pre-school children; the efficacy of anthelminthic drugs and the possible threat of drug resistance; price, quality and accessibility of treatment by delivering drugs through the school system and ways of reaching also non enrolled school-age children. Finally, the strategy, targets and recommendations of the World Health Organization for the control of schistosomiasis and soil-transmitted nematodes infection are described.Item Lapses of professionalism occurring among Sri Lankan medical students: How should they be remediated?(Sri Lanka Medical Association., 2019) Ellawala, A.T.; Chandratilake, M.N.; de Silva, N.R.INTRODUCTION & OBJECTIVES: Early recognition and correction of lapses of professionalism occurring during 'the undergraduate period is vital. This study aimed to explore the lapses of professionalism occurring among local medical students and identify appropriate remedial measures. METHODS: The study was conducted in two phases. In Phase I, in-depth interviews and focus group discussions were conducted with medical teachers, clinicians, deans, students, nurses and patients (n= 129) to explore lapses they had witnessed. Conversations were audio-recorded, transcribed and analysed inductively. Description by multiple groups was considered an indicator of prevalence of a behaviour. In Phase II, a consensus conference with medical teachers, clinicians, deans and students (n=3 I), was conducted to achieve consensus on remediation strategies for identified lapses occurring as a first-time offence or a repeated behaviour pattern. Degree of consensus was based on modal distribution of responses. RESULTS: In Phase I, over 100 types of misconduct were described. The most common behaviours included, 'not doing allocated ward work', 'not contributing to group work' and 'several students examining a patient at the same time'. In Phase II, it was possible to achieve an acceptable level of agreement (50% or higher consensus) regarding remediation strategies for over 70% of the items, including almost all lapses identified as most common. Strategies ranged from 'ignore' to 'expulsion' and included measures such as discussion with peers, remedial work and counselling. CONCLUSION: Sri Lankan medical students exhibit a wide range of professionalism lapses of varying severity. The value of correcting such behaviour in a standardized manner is recognised.Item The Diversity of Human Dirofilariasis in Western Sri Lanka(Hindawi Pub. Co, 2019) Chandrasena, T.G.A.N.; Premaratna, R.; Mallawaarachchi, C.H.; Gunawardena, N.K.; Gunathilaka, P.A.D.H.N.; Abeyewickrama, W.Y.; de Silva, N.R.BACKGROUND:Human dirofilariasis is an emerging zoonosis in many countries. Dirofilariasis caused by Dirofilaria repens may present with diverse clinical manifestations in humans due to aberrant localization of worm lesions causing diagnostic dilemmas. The aim of this retrospective study was to describe and update the demography and clinical spectrum of human dirofilariasis in western Sri Lanka. Nematode or nematode fragments isolated from excision biopsies that were confirmed as D. repens at the Department of Parasitology, Faculty of Medicine, University of Kelaniya, Sri Lanka, between 2012 and 2018 were included. Data on age, gender, and clinical details were obtained from case files. Identity of worms was established by morphometry and cuticle characteristics on wet-mount preparation. Specimens from unusual case presentations were further analyzed by PCR with specific primers for internal transcribed spacer region 2 (ITS2) of the ribosomal DNA. RESULTS:Sixteen nematode specimens isolated from subconjunctiva (n=2), subcutaneous (n=13) and intramuscular (n=1) locations were identified as D. repens by morphometry (average length 11.5 cm) and the characteristic longitudinal striations on cuticle visualized by microscopy. The age distribution of cases ranged from 1 to 65 years with a mean of 21.5. Females were more frequently affected (n=10, 62.5%) and worm locations were commonest in the orbital region (5/16) and scrotum (3/16). Imaging techniques were of use in detecting infections in deeper tissue levels. PCR analysis of DNA extracted from a worm in an intramuscular granuloma of the temporal region elicited the expected band at 484bp for D. repens. CONCLUSIONS: Human dirofilariasis is on an upward trend in incidence. Imaging techniques were of use in clinical diagnosis and molecular speciation in establishing the species identity in unusual case presentations. We suggest a more conservative approach in the management of human dirofilariasis and recommend a one health approach for control.Item Introduction of Recombinase Polymerase Amplification assay based mobile suitcase laboratory as a point of need tool to diagnose cutaneous leishmaniasis in Sri Lanka(Sri Lanka Medical Association, 2018) Gunaratna, G.P.S.; Ranasinghe, P. H. K. I. S.; Manamperi, A.; Pathirana, N.; Pathirana, H.; Wickremasinghe, R.; de Silva, N.R.; Sooriyarachchi, M.; Ahmed, A.E.W.INTRODUCTION AND OBJECTIVES: Cutaneous leishmaniasis (CL) caused by the vector-borne protozoan parasite is now endemic in Sri Lanka. Microscopy of Giemsa stained slit skin smears (SSS), lesion aspirates or scrapings for the presence of amastigotes, is widely used for laboratory confirmation of CL, although the reported sensitivity is low. Facilities for more sensitive culture and molecular techniques are available only in reference laboratories. A newly developed, Recombinase Polymerase Amplification (RPA) assay based Mobile Suitcase Laboratory (MSL) is a promising, molecular point of care test with high sensitivity and specificity for diagnosis of both post-kala• azar dermal leishmaniasis and visceral leishmaniasis. Objective was to assess RPA based MSL as a point of need tool to diagnose CL in Sri Lanka.METHODS: Twenty seven army personnel at Mullaitivu Army camp clinically suspected of having CL were recruited for this pilot study. Two slit skin smears and two punch biopsy specimens were obtained from each of them. Slit skin smears were stained with Giemsa in the field and examined for the presence of amastigotes and RPA was carried out at the point of collection. PCR was performed at the Parasitology Department, Sri Jayewardenepura University. RESULTS: Fifteen patients were confirmed by PCR as having CL and 14 of them were also positive by RPA based MSL conducted in the field (93.33% sensitivity). Only 3/15 were positive with microscopy of SSS (20% sensitivity). CONCLUSION: This pilot study shows RPA based MSL as a promising tool to diagnose CL at point of need.Item Detection of a case of Brugian Filariasis from Anuradhapura, a non-endemic district of Sri Lanka(Sri Lanka Medical Association, 2018) Mallawarachchi, C.H.; Gunaratne, I.E.; Ekanayaka, G.M.G.A.C.; Mallawarachchi, S.M.N.S.M.; Chandrasena, T.G.A.N.; Mendis, D.; de Silva, N.R.INTRODUCTION AND OBJECTIVES: In 2016, the WHO declared that lymphatic filariasis was no longer a public health problem in Sri Lanka. However low-grade persistence of bancroftian filariasis continues in all three endemic provinces, while brugian filariasis has re-emerged. The periodicity pattern of the re-emerged Brugia spp. suggests zoonotic origin. A canine survey done in the district of Anuradhapura found a moderately high prevalence (28.2%) of B. malayi infections in the Thirappane MOH area. Objective of the study was to investigate the threat of zoonotic B.malayi infections to humans in the Thirappane MOH area. METHODS: A cross sectional survey was done among all consenting residents of three randomly selected areas representing the three PHI areas of the Thirappane MOH. Residents were screened between 8.00 pm and 12.00 pm using night blood smears (NBS) and Brugia rapid test (BRT) for presence of anti-Brugia IgG4 antibodies. BRT was done selectively. Ethical and administrative clearance was obtained prior to the survey. RESULTS: A total of 752 individuals were screened by NBS; 176 of them were also screened by BRT. 193, 208 and 351 NBSs were done respectively in Thirappane, Galkulama and Mooriyankadawala PHI areas. One individual, a 25-year-old long-term resident of Mooriyankadawala PHI area was positive for Brugia spp. microfilariae by NBS and by BRT. The microfilariae exhibited nocturnal sub-periodicity. CONCLUSION: Transmission of brugian filariasis appears to occur even outside the traditional endemic belt. The presence of canine reservoirs of infection and water bodies with aquatic vegetation probably favour transmission by Mansonia spp. vector mosquitoes in the study area.Item Intestinal nematodes that migrate through lungs (Ascariasis)(WB Saunders Company, 2000) de Silva, N.R.; Bundy, D.A.P.Item Soil-transmitted helminth infections in Sri Lanka(Federation of Asian Parasitologists, AAA Committee, 2005) de Silva, N.R.No abstract availableItem Control of intestinal helminthiasis in pregnancy – the Sri Lankan experience(World Health Organization, 2003) Ismail, M.M.; Atukorala, T.M.S.; Naotunna, T.S; de Silva, N.R.; Hettiarachchi, I.Item Trichuriasis(Saunders-Elsevier, 2011) de Silva, N.R.; Cooper, E.S.Item The soil-transmitted helminths in Sri Lanka: a review of the recent literature(Sri Lankan Society for Microbiology, 2018) de Silva, N.R.The major soil-transmitted helminth (STH) infections caused by Ascaris lumbricoides, Trichuris trichiura and Necator americanus have been recognized as endemic in Sri Lanka for over a century. Although prevalence rates have declined drastically over this period because of mass deworming programmes and improved housing, these infections are still found in high risk communities with poor access to sanitation. The available scientific literature published on STH infections in Sri Lanka from around the year 2000 onwards is reviewed here in three broad areas: prevalence of STH infections and factors affecting transmission, impact of control activities on prevalence and drug resistance, and the impact of STH infections on the health of infected individuals. In conclusion, an overview of the current control strategy adopted by the Ministry of Health in Sri Lanka is presented.