Graduate Studies
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Item Awareness of Rickettsial Infections (Typhus Fever) in a High Endemic Community in Hambantota District, Sri Lanka(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Ashani, M.L.S.; Chandrasena, T.G.A.N.; Gunathilaka, P.A.G.N.; Premaratna, B.A.H.R.Rickettsial infections are re-emerging in Sri Lanka with an average annual incidence of 1500 patients. Low awareness and the scarcity of proper diagnostic tools has resulted in delayed disease diagnosis and negligence towards the disease leading to extended morbidity in Sri Lanka. Community awareness of the disease is important for timely diagnosis and control. Hambantota district in Southern Province of Sri Lanka, which records the fourth highest incidence of typhus, was selected for the study. Households (n= 204) situated around index cases of typhus fevers were randomly selected for the survey. An interviewer-administered questionnaire was used to gather data on illness awareness (disease aetiology, symptoms, transmission, disease associations) by selecting a consenting representative from each household. Descriptive and inferential analysis of the data was carried out using SPSS IBM statistical software. Of the 204 interviewed, only one (0.5%) identified the illness as “typhus”. Majority identified the disease as “Peacock fever” (43.12%; n= 88) followed by “tick fever” (14.71%; n=30). It is interesting to note that 41.67% (n=85) of the households were not aware of the disease even though they are living in a disease endemic area. None were aware of the etiological agents of typhus fever. Among those with awareness, 65.55% (n=78), believed that infection was tick-borne and the vector ticks were harbored by peacocks. About 27.73% (n=33) believed that the transmission was directly from peacocks, followed by other birds (2.52%; n=3). Majority 82.35 %, (n=98) were unaware of symptomatology while only 1.77%, (n=14) recognized it only as a febrile illness and myalgia (4.20%; n=5). Of those who were aware, 73.95 %, (n=88) had received information through acquaintances, 25.21% (n=30) from health personnel and one through mass media. None were aware of preventive measures. The results of the present study highlight the lack of proper awareness of the disease condition, which may adversely impact on disease control effortsItem Scrub Typhus, Its potential zoonotic hosts and vectors in Sri Lanka: A preliminary report(International Postgraduate Research Conference 2019, Faculty of Graduate Studies, University of Kelaniya, Sri Lanka, 2019) Ashani, M.L.S.; Chandrasena, T.G.A.N.; Gunathilaka, P.A.G.N.; Premaratna, B.A.H.R.Scrub typhus or tsutsugamushi disease is an acute febrile infectious disease endemic in the “tsutsugamushi triangle” of Southeast Asia, the Asian Pacific rim, and Northern Australia, with approximately one billion individuals at risk of infection. Currently one million new infections occur annually. The term scrub typhus is descriptive of the typical habitat endemic to the vector, although its existence is not limited to such niches. It is caused by a Gram-negative, obligate intracellular bacterium Orientia tsutsugamushi, of the Rickettsiaceae family, transmitted to humans following an accidental bite by an infected larval trombiculid mite commonly known as chiggers. Chiggers are a group of ectoparasites prevalent on a variety of mammals, mainly small mammals like rodents. Clinical cases of scrub typhus are documented in almost all ecological zones including both rural and urban Sri Lanka, as year-round sporadic cases or as outbreaks. However, the reservoir hosts in Sri Lanka and transmitting vector species are yet to be identified. Such knowledge is important for effective implementation of control measures of this re-emerging infection. Therefore, this study was designed to live capture small rodent/mammal hosts and identify chigger mite species present in the country. Traps designed to live capture small rodents/mammals were placed in peri-domestic areas of clinically confirmed scrub typhus patients in southern province, Sri Lanka. Traps baited with fried coconut were placed around residences and in pre-selected sites with scrubby vegetation and rodent burrows, one hour before sunset and were retrieved the next day morning. The captured animals were anaesthetized with ketamine/xylazine and inspected for the presence of vector mites. Collected mites were preserved in 70% alcohol and identified by microscopy using standard morphological keys. Collected data were analyzed using chi square test, MINITAB 17 statistical software. Rodents belonging to Rattus norvegicus (n=15; 56%), Rattus rattus (n= 10; 37%) and shrews of Suncus murinus (n=2, 7.4%) were captured during the study over 6 months and a total of 147 mites were isolated. Isolated chigger mites belonged to genus Leptotrombidium (n=90; 67%), Eutrombicula (n=31; 23%), Helenicula (n=24,17 %) and species Leptotrombidium lagone (n=2; 1.5 %). Majority were potential vectors for Orientia tsutsugamushi. It is noted that Rattus norvegicus harbored significantly more chigger mites (mean of 7 per individual; χ2 = 110.35; p <0.001] compared to other species captured. We are currently in the process of molecular speciation of sampled chigger mites and molecular detection of Orientia tsutsugamushi in collected mites in order to determine their vectorial potential.Item A pilot study on virtual patients: Understanding student experiences to facilitate learning(Faculty of Graduate Studies, University of Kelaniya, 2015) Karunaratne, W.C.D.; Chrandratilake, M.N.; Premaratna, B.A.H.R.Virtual patients are web-based interactive clinical scenarios and are being increasingly used globally in undergraduate medical training. Despite its value, virtual patients are not been used widely in the local context. Therefore this pilot study examined student experiences of using a virtual patient with the aim of identifying student acceptance and the possibility of integration into the medical curriculum to enhance student learning. A virtual patient having a linear navigation design was developed in the virtual learning environment (VLE) of the faculty paying meticulous attention to instructional designing, medical education principles and content coverage. 12 immediate graduates of the faculty were recruited to the study following informed consent as they have completed the undergraduate curriculum and in a position to provide meaningful comments on the activity concerned. They were given online access to the virtual patient and were requested to complete the case study followed by an 18 item survey designed on the same platform. The results were analysed using MS Excel. All study participants unanimously agreed to the usefulness of virtual patients for medical undergraduate training. It was identified as a means to practice clinical cases, preparation for clinical training in the ward setting, a guide for assessments, to understand practical aspects of patient management and a means to refresh the knowledge. The most useful features were the multiple choice questions integrated to the case study, immediate feedback and learning points. The essay type questions which require text input were discouraged. It was suggested to impose a time limitation as it mimics the reality and to include more practical aspects. The positive student experiences associated with the interaction of the virtual patient during this study highlighted the need for such innovative methods to facilitate medical undergraduate learning. However, a larger study needs to be conducted on different virtual patient designs before adopting them for student learning.Item Prevalence of osteoporosis and osteopenia in a sample of Sri Lankan adults(University of Kelaniya, 2008) Karunanayake, A.L.; Salgado, L.S.S.; Premaratna, B.A.H.R.; Femando, S.; Herath, H.M.R.P.; Abeysuriya, V.; Kumarendran, B.; Mahavithanage, S.T.C.Introduction: Osteoporosis is characterized by low bone mineral density and deterioration in the micro architecture of bone that increases its susceptibility to fracture. This condition is becoming increasingly common in our country in the elderly, especially in post menopausal women. Objective: To determine the prevalence of osteoporosis and osteopenia in a sample of Sri Lankan adults. Methodology: A descriptive cross sectional study was conducted at the Faculty of Medicine University of Kelaniya from July 2007 to October 2007. The study subjects were selected from 22 grama niladhari divisions of the Ragama MOH area. From each division males and females aged 35 to 64 years were randomly selected from the voters list and recruited for the study. A P-dexa scan was used to measure the BMD of the left middle finger. AT score of S-2.5 was considered as osteoporosis, >-2.5 to -1 as osteopenia. These two categories together were considered as low BMD. A T score of> -1 was considered normal. Results: There were 762 subjects with a mean age (SD) of 52.3 (7.5) comprising 61% females and 39% males. The prevalence of osteoporosis and osteopenia were 14% and 29% respectively. In subjects aged less than fifty years 9% of females and 3% of males had osteoporosis and 31% of females and 18% of males had osteopenia. In subjects aged fifty years or more 33% of females and 3% of males had osteoporosis and 38% of females and 21% of males had osteopenia. Conclusion: the prevalence of osteoporosis and osteopenia were higher among the females. The prevalence of osteoporosis among females aged over fifty years was markedly higher than the females who are less than fifty years.