Graduate Studies
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Item Role of Mycoplasma pneumoniae in the exacerbation of childhood asthma in Sri Lanka(Faculty of Graduate Studies, University of Kelaniya Sri Lanka, 2022) Wijesooriya, L. I.; Chalker, V. J.; Perera, P.; Sunil Chandra, N. P.Asthma is a major public health concern, particularly in children. Exacerbation of asthma (EOA) is lifethreatening and respiratory infections (RIs) play a key role. Pediatric RIs are empirically treated with macrolides aiming M. pneumoniae. Although EOA and M. pneumoniae have been reported in many countries, no published data on them is in Sri Lanka. The present study aimed to identify the role of M. pneumoniae in EOA in children in Sri Lanka. A case-control study was conducted in the pediatric unit of North Colombo Teaching Hospital, Sri Lanka involving children between 3-15 years. Caseschildren with EOA. Controls-children with stable asthma without exacerbation. Each group consisted of 100 children. Sputum/throat swabs were tested for M. pneumoniae using GeneProof M. pneumoniae RT-PCR kit, which targets community-acquired respiratory distress syndrome (CARDS) toxin. Age distribution-80% of cases and 87% of controls were 5-10 years. Males and females were equally distributed in cases while it was 47% and 53% respectively in the control group. Of the samples, 78% were sputum and 22% were throat swabs in cases and 100% were throat swabs in controls. Macrolides were used to treat 42% of cases. As per M. pneumoniae RT- PCR data, 1/100 were positive from cases and none was positive from the control group. M. pneumoniae was uncommon in cases (1%) and absent from the control group. Macrolides are used widely in children for RIs aiming M. pneumoniae. Yet, it does not seem a major contributing factor to asthma exacerbation in the study cohort. However, a large proportion of cases receiving macrolides may have reduced the detection of M. pneumoniae. Empiric use of antibiotics in children with asthma may be better targeted with microbiological screening to inform treatment. Inappropriate use may result in the development of resistance to other common respiratory pathogens.Item Precipitating factors of acute severe asthma among children of 3–15 years: A descriptive cross-sectional study(Faculty of Graduate Studies, University of Kelaniya Sri Lanka, 2022) Wijesooriya, L. I.; Perera, P.; Sunil Chandra, N. P.Despite a better understanding of pathophysiology and novel treatment modalities, children presenting with acute exacerbation of asthma (AEA) are still common. Descriptive information on asthma and factors precipitating AEA would provide a better understanding of the reasons for AEA. The present study aimed to identify such factors in a cohort of children in Sri Lanka. A descriptive cross-sectional study was conducted at the Teaching Hospital, Ragama, Sri Lanka involving children between 3-15 years. The sample consisted of 100 children admitted with AEA. Events that led to AEA were obtained from the mother. Data were obtained using a questionnaire from parents/guardians/children and analyzed using R-statistical software. Around 80% of the recruited children were in the 5–10-year range, and there was no significant gender difference. Of the descriptive data, potential risk factors identified for AEA were indoor smoking 12%, use of mosquito coils 28%, use of joss sticks 43%, and specific foods such as goat milk, yogurt, curd, ice cream, etc.- 30% and use of firewood for cooking 39%. Regarding the risk factors for AEA, the intake of specific foods was significantly higher in association compared to indoor smoking (P=0.011). Sixty-six children had a full blood count which showed leukocytosis in 33.4%, neutrophilia in 62.1%, lymphocytosis in 6.1%, and eosinophilia in 9.1%. Neutrophilia was significantly higher compared to lymphocytosis (P=0.000) and eosinophilia (P=0.000) in the study cohort. CRP was available in six patients, of which three had increased levels. Blood cultures were available in 11 patients, but all were negative. None of the children had a microbiological diagnosis. Of the 21 children who underwent chest x-rays, only one had evidence of pneumonia. Fifty-two percent of children presenting with AEA were on regular inhaler therapy. Identified main risk factors for EOA were indoor smoking and burning of Joss sticks or firewood. In nearly one-third of the patients, food items were the precipitating factor. Though respiratory tract infections are implicated as a major cause of AEA, only a smaller percentage had evidence of infections. This may be because routine microbiological investigations were not employed. More than half of the children presenting with AEA were on regular inhaler therapy raising the question of the appropriateness of the medication used and the compliance with treatment.Item Virus infections in the exacerbation of asthma in children from a pediatric setting in Sri Lanka(Faculty of Graduate Studies, University of Kelaniya Sri Lanka, 2022) Wijesooriya, L. I.; Perera, P.; Sunil Chandra, N. P.Acute exacerbation of asthma (AEA) is a potentially life-threatening condition, which is often precipitated by respiratory infections. Particularly in children, viral respiratory tract infections are a common cause of acute exacerbation of asthma. There are limited Sri Lankan data on the role of viruses in acute respiratory tract infections among children. However, there are no data related to the role of viral infections causing acute exacerbation of asthma in Sri Lankan children needing hospital admission. A case-control study was conducted at the university pediatric unit, North Colombo Teaching Hospital, Ragama, Sri Lanka. Children between 3-15 years, admitted with AEA were recruited for the study as cases, along with another 100 children with a history of asthma without exacerbation as controls. Each group consisted of 100 children. Sputum/throat swabs were tested for the presence of antigens to five common viruses causing upper respiratory tract infections namely, adenovirus, influenza A virus, influenza B virus, parainfluenza viruses (1-3), and respiratory syncytial virus using commercially available indirect immunofluorescence assay (D3 Ultra DFA Respiratory Virus Screening & ID Kit by The Diagnostic Hybrids, Inc, Athens, USA). This part of the study of collecting samples was done throughout the years 2019 and 2020. The mean age of cases was nine years and 9.5 years in the control group. There was no significant difference in the gender distribution between the two groups (P>0.05). Sputum samples were collected from 78% of the cases, and the rest had throat swabs. Only throat swabs were taken from the children in the control group. Immunofluorescence was used to identify respiratory viruses. In cases, adenovirus, influenza A virus, influenza B virus, parainfluenza viruses, and respiratory syncytial virus were detected at 9%, 1%, 2%, 5%, and 3% respectively; in the control group, it was 2%, 1%, 1%, 5%, and 2%. There was a significantly higher detection rate of adenovirus in the cases compared to the controls (P = 0.040), but no significant difference was noted for other viruses. Children admitted with acute exacerbation of asthma were having significantly high infection rates with adenovirus compared to control groups. Hence, adenovirus infections seem to be an important causative factor for AEA. Other viruses identified from both cases and controls in the order of frequency were parainfluenza virus, respiratory syncytial virus, influenza B virus, and influenza A virus.Item Influence of Corporate Governance on Leverage Structure in Sri Lankan Manufacturing Companies(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Perera, P.; Perera, P.R.M.R.Leverage structure of manufacturing companied provide an indication of the financial health of the company, while number of factors affect the leverage structure decision. Governance is the mechanism that controls decisions of the company that includes leverage structure decisions. The objective of this study is to examine the influence of corporate governance on leverage structure decision making in Sri Lankan manufacturing firms. Data collected from annual reports of manufacturing sector companies for the period from 2014 to 2018 were analyzed using panel data. The study identified board size, board composition, managerial ownership, board independence, institutional ownership and CEO duality as corporate governance attributes to measure their influence on leverage structure decision making. Firm Size and profitability were employed for control purpose. Findings of the study reveal a significant influence of corporate governance attributes of CEO duality and board independence on leverage structure with a moderate effect of firm Size and profitabilityItem Firm Characteristics and Intellectual Capital Disclosure: Evidence from Sri Lanka(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Weerawickrama, V.; Perera, P.The purpose of this study is to examine the level of voluntary intellectual capital disclosure (ICD) by Sri Lankan listed companies and to evaluate four main company characteristics; industry type, listing age, leverage and auditor type on ICD. In current context ICD has identified as one of the most significant factors in creating and maintaining stakeholder value and gaining competitive advantages for the organization. Majority of these disclosures are qualitative, non-financial and historical oriented. In this study the level of ICD is examined in all non-financial traded companies (222) listed in the Colombo Stock Exchange using content analysis for the period of 2016 to 2018. The results of the study show that; the industry type has a significant impact on the disclosure level while, listing age and leverage did not show any significant influence on ICD. Further, knowledge-intensive and high technology-based industries as well as companies with Big Four auditors showed higher level of ICD than other companies. All other companies except previously mentioned, showed a homogeneous disclosure patterns over time. This study contributes new insights to the existing literature on ICD in Sri Lanka as the first study to consider all listed non-financial companies, while inviting future researchers to conduct more ICD related research for a considerable time period with different content analysis techniques.