DSpace Collection:
http://repository.kln.ac.lk/handle/123456789/6564
2024-03-28T12:41:10ZMolecular characterization of carbapenemase producing enterobacteria (CPE) isolated from a tertiary care teaching hospital in Sri Lanka and validation of a rapid CPE detection protocol
http://repository.kln.ac.lk/handle/123456789/27530
Title: Molecular characterization of carbapenemase producing enterobacteria (CPE) isolated from a tertiary care teaching hospital in Sri Lanka and validation of a rapid CPE detection protocol
Authors: Kumudunie, W.G.M.
Abstract: INTRODUCTION: The emergence and spread of carbapenem-resistant Enterobacteriaceae (CRE) is in dramatic increase, resulting in failure of almost all the available antibiotics and hence limit the effective therapeutic options. Therefore, accurate and timely detection of carbapenemase-producing enterobacteria (CPE) is essential to streamline the optimum antibiotic therapy. This study was carried out to determine the current status of CRE in Sri Lanka and to evaluate the performances of CPE detection methods. METHODOLOGY: A cross-sectional study was conducted at Colombo North Teaching Hospital during 2017-2018. Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) and CRE were identified by the disc diffusion method. CRE isolates were identified up to species level using a rapid identification kit. Four CPE detection methods, namely Carba NP test (CNPt), CNPt-direct, modified carbapenem inhibition method (mCIM), and modified hodge test (MHT) were evaluated. The genetic background of CPE was determined by PCR. RESULTS: The estimated overall prevalence of ESBL-PE and CRE were found to be 26.0% and 9.6%, respectively. The highest prevalence of ESBL-PE and CRE were found amongst uropathogenic (30.8%) and respiratory infections producing (20.8%) Enterobacteriaceae, respectively. K. pneumoniae (80.7%), E.coli (5.3%), C.freundii (7.0%), P. rettgeri (3.5%), E. cloacae (1.7%), and E. aerogenes (1.7%) were identified in CRE cohort. OfCRE, 94.7% were found to be CPE. The carbapenemase encoding genes detected were of blaKPc, blCINDM. and blaoXA-48-Iike and, blaoXA-48-Iike (88.9%) was the most prevalent. The overall sensitivity and specificity of CPE detection tests were as; MHT-90.7%, 92.1%, mCIM- 100%, 100%, CNPt-75.9%, I 00%, and CNPt-direct-83.3%, 100%, respectively. Only amikacin showed reasonable sensitivity (>50%) for CRE among the routine antibiotic panel whereas a higher level of susceptibility was noted for fosfomycin (92.9%), ceftazidime-avibactam (85.9%), and colistin (92.9%). CONCLUSION: K pneumoniae was the most prevalent CRE species. Carbapenemases production was the major resistance mechanism in CRE and b/aoXA-48-like was the most prevalent gene type. The first occurrence of blaKPc was recognized in Sri Lanka. MCIM and MHT had higher sensitivity compared to both CNP tests for the detection of CPE. However, when a prompt decision is needed, CNP tests can be a viable option since their results can be obtained within two hours.
Description: Thesis2021-01-01T00:00:00ZSocial anxiety disorder among university students in Sri Lanka : prevalence, associated risk factors, and culturally adapted cognitive behavioural group therapy
http://repository.kln.ac.lk/handle/123456789/27157
Title: Social anxiety disorder among university students in Sri Lanka : prevalence, associated risk factors, and culturally adapted cognitive behavioural group therapy
Authors: de Silva, B.G.R.
Abstract: Social Anxiety Disorder (SAD), one of the most common mental health disorders globally, demonstrate early-onset, chronic course, and debilitating dysfunction in all social spheres, especially in education. There is a scarcity of information on SAD in Sri Lanka, and none among university students. Therefore, the study objectives were to determine prevalence and associated risk factors among university students in Sri Lanka. A cross-sectional study was conducted among 1137 students from five state universities. The Liebowitz Social Anxiety Scale — Sinhala version and a Psychosocial Correlates Questionnaire for SAD developed for this study, were used as instruments. The analysis included bivariate analysis such as chi-square tests for independence, and Spearman’s r correlations to identify significant associations. Identified variables at p<0.05 were entered in to binary logistic regression models to determine factors associated with social anxiety disorder. Of the 985 who completed the questionnaires, 57.1% screened positive for SAD. In terms of demographic factors and _ clinical characteristics, female gender(AOR=1.41,95%CI 1.10-1.84, p= 0.01) and a history of mental health issues(AOR=2.79, 95%CI 1.90-4.10, p<0.001), and in terms of negative family and adverse childhood experiences, experiences of emotional abuse(AOR=1.31, 95% CI 1.11- 1.54, p=0.001), parent dissatisfaction (AOR=1.07, 95% CI 1.01- 1.13, p<0.05) and overcontrol by parents(AOR=1.08,95%CI1.02-1 .15,p<0.05) remained significantly associated risk factors for SAD. Further, | body dissatisfaction (AOR=1 .05, 95% CI 1.05 — 1.10, p<0.05) , and dissatisfaction with breasts (AOR=.60, 95% CI .46 — .77, p<0.001) were identified as associated significant factors of SAD. Additionally, in terms of school experiences, experiences of humiliation, not being accepted or rejection by school friends (AOR=1.63,95% Cr 1.29-2.05, p<0.001) and rejection, invalidation or isolation due to social connections(AOR=1.3, 95% Cl 1.08- 1.58, p<0.001) , while in university experiences, experiences of humiliation, not being - accepted or rejection by friends(AOR=1.31,95%CI1.09-1.60,p<0.05), experiences of mental harassment(AOR=1.47,95%CI 1.12-1.92,p<0.05), and viewing the medium of study as a challenge,(AOR=1.55,95%CI1.16-2.10,p<0.05) remained independently and significantly associated with SAD. The study recognizes a high prevalence rate of SAD and associated risk factors among university students in Sri Lanka. Although, diagnostic interviews were not conducted — and the actual prevalence rates may be lower, this is an under-recognized issue which needs further exploration as students with SAD will be challenged in their academic and occupational pursuits.; Social Anxiety Disorder (SAD), one of the most common mental health disorders globally, demonstrate early-onset, chronic course, and debilitating dysfunction in all social spheres if left untreated. While previous research notes high prevalence of SAD among university students in Sri Lanka, there is a dearth is culturally valid psychological treatment. Further, cultural adaptation of psychotherapy notes high engagement and effectiveness of treatment outcomes among non-western cultures. Therefore, the objectives of this study were to identify and evidence-based treatment and to culturally adapt it to suit the local university student context. The methodology constituted of six steps. Step one to identify the intervention and protocol information, step two to carry out discussions with experts in the field and to review the identified intervention for validity in the local university student context, step three to incorporate modifications and address any implications to protocol. Step four was to review the treatment for validity with stakeholders and integrate cultural elements, step five to translate and review of material, and finally the sixth step to test the culturally adapted treatment for effectiveness. The Cognitive Behavioral Group Therapy (CBGT) protocol developed by Heimberg & Becker (2002) was identified as an evidence-based treatment for SAD. Then, modifications were made to program length and time, facilitators, clients, language to Sinhala, and an addition of a psychoeducation module. Following which, modifications were reviewed with implications addressed for each proposed change in protocol. In step four, cultural elements were developed in terms of an ice breaker, psychoeducation content, metaphors, mindfulness-based activity, and an ending ritual. Complementary worksheets were also developed in the Sinhala language. Validity of the newly development content was reviewed with a cohort of Sinhala literate university students. In step five, intervention manual was translated to Sinhala, and subjected to a Delphi validation methodology with bilingual mental health experts in Sri Lanka, Finally, the culturally adapted treatment was administered within a randomized waitlisted control study and determined as an effective treatment. While providing an effective culturally valid psychological treatment for SAD among Sri Lankan university students, the study creates a foundation for future studies related to cultural adaption of psychotherapy in Sri Lanka.2022-01-01T00:00:00ZBiochemical,inflammatory, and histopathological changes in wistar rats given dug well water from high and low disease prevalent villages for chronic kidney disease of unknown etiology (CKDu) in north central province of Sri Lanka
http://repository.kln.ac.lk/handle/123456789/27156
Title: Biochemical,inflammatory, and histopathological changes in wistar rats given dug well water from high and low disease prevalent villages for chronic kidney disease of unknown etiology (CKDu) in north central province of Sri Lanka
Authors: Thammitiyagodage, M.G.
Abstract: Chronic Kidney Disease of unknown etiology (CKDu) is prevalent in the North Central Province (NCP) of Sri Lanka. Ingestion of groundwater is identified as one of the causative factors. The einfonley of the population consumes un-boiled dug well water. The objectives of the study were to find out the biochemical, haematological, and immunological changes in Wistar rats that ingested dug well water from high and low disease prevalent areas from the NCP and low disease prevalent Colombo and correlate the findings with their histopathological changes. Sex balance 3 months old Wistar rats (n=60) were used for the study. Their WBC/ DC, cpt CD** gerum cytokines, creatinine, ALT, AST, BUN levels and Microalbumin: creatinine ratios were measured. Rats were randomly divided into 6 groups by assigning 10 rats per group. Groups 1, 2, and 3 were given water from high disease prevalent New Town Medirigiriya (NTM), Bisobandaragama (BB), and Divuldamana (DD) respectively. Group 4 was given boiled water from NTM (NTMB). Groups 5 and 6 were given water from low disease prevalent Huruluwewa (HW) from NCP and tap water from low disease prevalent Colombo (CO) adlibitum quantity. Serum cytokines (IL1β; IL6, TNFα) were measured after 8 months and CD 4+ and CD 8+ counts were measured after 14 months. Histopathology was performed in kidney and liver tissues. Serum TNFα levels were significantly elevated in rats from DD and BB (p<0.05) but hepatic TNFα levels were significantly elevated only in rats from DD (p<0.05)). Rats from high disease prevalent NTM had significantly high CD4+ and CD8+ cells than those from low disease prevalent HW and CO. Immunological findings. were correlated with the histopathological changes. There was a correlation between the kidney Tubular Interstitial (TI) Lesion index and liver lesions. Serum TNFα and CD4+ and CD8+ lymphocytes were closely correlated with renal damage. Rats with severe TI lesions reported a high percentage of portal tracts and parenchymal lesions in the liver and this expression was minimum in CO. It was evident that boiling water was effective against liver damage but not renal damage. The present study is supportive of an immune therapy targeting the CD4+ and CD8+, and TNFα in reducing renal damage in the early stages of the disease. In conclusion, peritubular nonsuppurative interstitial cell infiltrations in kidney tissues were common in all the experimental groups irrespective of the toxicant sicient in water bodies. Observed kidney damage may mediate via cytokine triggered immune response by high sodium, fluoride, calcium and some other unmeasured toxic agents present in NCP water. anid toxicant present in DD from NCP can directly damage the kidney tubules leading to fibrosis.2021-01-01T00:00:00ZDevelopment and validation of a tool to predict information seeking behaviour of medical undergraduates, Sri Lanka
http://repository.kln.ac.lk/handle/123456789/27155
Title: Development and validation of a tool to predict information seeking behaviour of medical undergraduates, Sri Lanka
Authors: Marasinghe, M.P.L.R.
Abstract: Information seeking behaviour is a set of actions expressing information needs, searching, evaluating, selecting, and utilizing information. This study aimed to develop and validate a tool to measure the information seeking behaviour of medical undergraduates in Sri Lanka. Final year students and the students, who had completed four years of study in the academic programme in medical faculties in universities of Colombo, Kelaniya, Peradeniya, and Eastern University in Sri Lanka were invited for the study. The elements of information seeking behaviour were defined by thentatically analyzing the content of nine focus group discussions with medical undergraduates of the four faculties. The scale was developed based on the Integrated Behavioural Model. The preliminary scale had 60 items and was pretested. The responses ofa field test with the participation of 436 medical undergraduates were subjected to confirmatory factor analysis (CFA) and psychometric analysis. The tool was refined to include 40 items, and the revised version was administered to 645 medical undergraduates. The 40-item tool supported the good model fit using the absolute fit indices (RMSEA= 0.053, SRMR=0.066). The sub-components of the 40-item tool partially matched with the theoretical framework. The reliability of the entire tool was acceptable (Cronbach’s α = (0.744) and domain levels were in the low to the acceptable range. The internal consistency of the domains; “Intention” (Cronbach’s α = 0.634), “Habit” (Cronbach’s α = 0.561) and “Knowledge & skills” (Cronbach’s α = 0.540) was acceptable in reliability and the domains of “Environmental Constraints” (Cronbach’s α = 0.470) and “Salience” (Cronbach’s α = 0.438) was low in reliability in the 40-item tool. The finalized 40-item tool named ‘Kelaniya Measure of Information Seeking Behaviour’ (KMISB) demonstrated an acceptable level of psychometric rigour in terms of XXV ate reliability and structural validity. KMISB can be used to evaluate and predict information seeking behaviour of medical undergraduates effectively. It facilitates identifying the best practices of information seeking and improving the quality of ae higher education.2022-01-01T00:00:00Z