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Sisira Siribaddana
Rajarata University of Sri Lanka

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Journal article
Published: 22 March 2021 in International Journal of Environmental Research and Public Health
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Extensive use of herbicides is common among rural agricultural workers in Sri Lanka. Recent studies have postulated their role in the development of chronic kidney disease of unknown etiology (CKDu). Paraquat and glyphosate are leading herbicides used by sugarcane farmers (SF), hence occupational exposure is inevitable. This study examined the expression of urinary paraquat, glyphosate and biomarkers among residential SF in CKDu emerging regions, Warunagama (WA) and Rahathangama (RH), in the Uva Province with non-endemic Matara (MA) in the Southern Province of Sri Lanka. Urinary glyphosate, Paraquat, kidney injury molecule -1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL) and β2-microglobulin (B2M) were determined using enzyme-linked immunosorbent assays (ELISA). Urinary creatinine, microalbumin, serum creatinine (SCr), serum cystatin C, estimated glomerular filtration rate (eGFR), and albumin creatinine ratio (ACR) were also assessed. Generally, herbicide residues and kidney injury biomarkers were higher in SF compared to the non-endemic MA. Creatinine-adjusted urinary glyphosate and paraquat levels were significantly higher in WA compared to MA. ACR in RH (median 14.9; IQR 5.4–393.1 mg/g) and WA (23.7; 11.5–64.6) was significantly higher than MA (4.3; 2.2–6.7). This study reports 39 individuals with impaired kidney function among SF in Sri Lanka for the first time. Urinary NGAL levels were significantly higher in both WA (median 2.14; IQR 1.28–6.15 ng/mg Cr) and RH (3.09; 1.15–9.09) compared to MA (1.28; 0.56–2.81). However, urinary KIM-1 levels in RH (3.2; 1.29–106.1 ng/g Cr) and WA (3.6; 1.94–115.1) were not significantly higher in MA (1.74; 0.76–116.9). Urinary NGAL (r = 0.493), eGFR (r = −0.147) and ACR (r = 0.171) significantly correlated with urinary glyphosate, but not with urinary paraquat levels. Urinary KIM-1 levels did not correlate with either urinary glyphosate or paraquat, while urinary B2M and serum cystatin C levels showed significant correlation with urinary glyphosate levels. The current study reports higher urinary herbicide levels among sugarcane farmers in WA and RH, and that is potentially linked to the subsequent decline in kidney function, as indicated by ACR, eGFR, and NGAL. We posit that these indicators may serve as markers to detect renal injury among herbicide-exposed SF in Rural Sri Lanka.

ACS Style

K.S.M. Abdul; P. De Silva; E.M.D.V. Ekanayake; W.A.K.G. Thakshila; S.D. Gunarathna; T.D.K.S.C. Gunasekara; S.S. Jayasinghe; H.B. Asanthi; E.P.S. Chandana; G.G.T. Chaminda; S.H. Siribaddana; Nishad Jayasundara. Occupational Paraquat and Glyphosate Exposure May Decline Renal Functions among Rural Farming Communities in Sri Lanka. International Journal of Environmental Research and Public Health 2021, 18, 3278 .

AMA Style

K.S.M. Abdul, P. De Silva, E.M.D.V. Ekanayake, W.A.K.G. Thakshila, S.D. Gunarathna, T.D.K.S.C. Gunasekara, S.S. Jayasinghe, H.B. Asanthi, E.P.S. Chandana, G.G.T. Chaminda, S.H. Siribaddana, Nishad Jayasundara. Occupational Paraquat and Glyphosate Exposure May Decline Renal Functions among Rural Farming Communities in Sri Lanka. International Journal of Environmental Research and Public Health. 2021; 18 (6):3278.

Chicago/Turabian Style

K.S.M. Abdul; P. De Silva; E.M.D.V. Ekanayake; W.A.K.G. Thakshila; S.D. Gunarathna; T.D.K.S.C. Gunasekara; S.S. Jayasinghe; H.B. Asanthi; E.P.S. Chandana; G.G.T. Chaminda; S.H. Siribaddana; Nishad Jayasundara. 2021. "Occupational Paraquat and Glyphosate Exposure May Decline Renal Functions among Rural Farming Communities in Sri Lanka." International Journal of Environmental Research and Public Health 18, no. 6: 3278.

Research article
Published: 18 March 2021 in PLOS Neglected Tropical Diseases
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Leptospirosis is a ubiquitous zoonotic disease and a major clinical challenge owing to the multitude of clinical presentations and manifestations that are possibly attributable to the diversity of Leptospira, the understanding of which is key to study the epidemiology of this emerging global disease threat. Sri Lanka is a hotspot for leptospirosis with high levels of endemicity as well as annual epidemics. We carried out a prospective study of Leptospira diversity in Sri Lanka, covering the full range of climatic zones, geography, and clinical severity. Samples were collected for leptospiral culture from 1,192 patients from 15 of 25 districts in Sri Lanka over two and half years. Twenty-five isolates belonging to four pathogenic Leptospira species were identified: L. interrogans, L. borgpetersenii, L. weilii, and L. kirschneri. At least six serogroups were identified among the isolates: Autumnalis (6), Pyrogenes (4), Icterohaemorrhagiae (2), Celledoni (1), Grippotyphosa (2) and Bataviae (1). Seven isolates did not agglutinate using available antisera panels, suggesting new serogroups. Isolates were sequenced using an Illumina platform. These data add 25 new core genome sequence types and were clustered in 15 clonal groups, including 12 new clonal groups. L. borgpetersenii was found only in the dry zone and L. weilii only in the wet zone. Acute kidney injury and cardiovascular involvement were seen only with L. interrogans infections. Thrombocytopenia and liver impairment were seen in both L. interrogans and L. borgpetersenii infections. The inadequate sensitivity of culture isolation to identify infecting Leptospira species underscores the need for culture-independent typing methods for Leptospira.

ACS Style

Dinesha Jayasundara; Indika Senavirathna; Janith Warnasekara; Chandika Gamage; Sisira Siribaddana; Senanayake Abeysinghe Mudiyanselage Kularatne; Michael Matthias; Jean-François Mariet; Mathieu Picardeau; Suneth Agampodi; Joseph M. Vinetz. 12 Novel clonal groups of Leptospira infecting humans in multiple contrasting epidemiological contexts in Sri Lanka. PLOS Neglected Tropical Diseases 2021, 15, e0009272 .

AMA Style

Dinesha Jayasundara, Indika Senavirathna, Janith Warnasekara, Chandika Gamage, Sisira Siribaddana, Senanayake Abeysinghe Mudiyanselage Kularatne, Michael Matthias, Jean-François Mariet, Mathieu Picardeau, Suneth Agampodi, Joseph M. Vinetz. 12 Novel clonal groups of Leptospira infecting humans in multiple contrasting epidemiological contexts in Sri Lanka. PLOS Neglected Tropical Diseases. 2021; 15 (3):e0009272.

Chicago/Turabian Style

Dinesha Jayasundara; Indika Senavirathna; Janith Warnasekara; Chandika Gamage; Sisira Siribaddana; Senanayake Abeysinghe Mudiyanselage Kularatne; Michael Matthias; Jean-François Mariet; Mathieu Picardeau; Suneth Agampodi; Joseph M. Vinetz. 2021. "12 Novel clonal groups of Leptospira infecting humans in multiple contrasting epidemiological contexts in Sri Lanka." PLOS Neglected Tropical Diseases 15, no. 3: e0009272.

Journal article
Published: 31 December 2020 in Anuradhapura Medical Journal
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ACS Style

D. S. Satharasinghe; H. Atukorale; S. Siribaddana; C. Sarathchandra; S. Pilapitiya. Eosinophilic granulomatosis with polyangiitis: easy to miss at an early stage; easy to halt progression if caught early; a success story presented as a case report. Anuradhapura Medical Journal 2020, 14, 1 .

AMA Style

D. S. Satharasinghe, H. Atukorale, S. Siribaddana, C. Sarathchandra, S. Pilapitiya. Eosinophilic granulomatosis with polyangiitis: easy to miss at an early stage; easy to halt progression if caught early; a success story presented as a case report. Anuradhapura Medical Journal. 2020; 14 (2):1.

Chicago/Turabian Style

D. S. Satharasinghe; H. Atukorale; S. Siribaddana; C. Sarathchandra; S. Pilapitiya. 2020. "Eosinophilic granulomatosis with polyangiitis: easy to miss at an early stage; easy to halt progression if caught early; a success story presented as a case report." Anuradhapura Medical Journal 14, no. 2: 1.

Review
Published: 18 December 2020 in International Journal of Environmental Research and Public Health
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Chronic Kidney Disease (CKD) is a globally prevalent non-communicable disease with significant mortality and morbidity. It is typically associated with diabetes and hypertension; however, over the last two decades, an emergence of CKD of unknown etiology (CKDu) has claimed thousands of lives in several tropical agricultural communities. CKDu is associated with gradual loss of renal function without initial symptoms until reaching complete kidney failure and eventually death. The most impacted are young adult males of lower socio-economic strata. Since the disease progression can be successfully attenuated through early detection, the development of superior screening and management measures is of utmost importance. In contrast to the conventional biomarkers, novel biomarkers with improved sensitivity and specificity are being discussed as promising tools for early diagnosis of the disease. This review summarizes emerging novel biomarkers used in assessing CKD and discusses the current utility and diagnostic potential of such biomarkers for CKDu screening in clinical settings of different communities impacted by CKDu. Our goal is to provide a framework for practitioners in CKDu impacted regions to consider the use of these novel biomarkers through this synthesis. The increased use of these biomarkers will not only help to validate their diagnostic power further and establish potential prognostic value but may also provide critical insights into sites and mechanisms of renal damage.

ACS Style

T.D.K.S.C. Gunasekara; P. Mangala C.S. De Silva; Chula Herath; Sisira Siribaddana; Nipuna Siribaddana; Channa Jayasumana; SudheerA Jayasinghe; Maria Cardenas-Gonzalez; Nishad Jayasundara. The Utility of Novel Renal Biomarkers in Assessment of Chronic Kidney Disease of Unknown Etiology (CKDu): A Review. International Journal of Environmental Research and Public Health 2020, 17, 9522 .

AMA Style

T.D.K.S.C. Gunasekara, P. Mangala C.S. De Silva, Chula Herath, Sisira Siribaddana, Nipuna Siribaddana, Channa Jayasumana, SudheerA Jayasinghe, Maria Cardenas-Gonzalez, Nishad Jayasundara. The Utility of Novel Renal Biomarkers in Assessment of Chronic Kidney Disease of Unknown Etiology (CKDu): A Review. International Journal of Environmental Research and Public Health. 2020; 17 (24):9522.

Chicago/Turabian Style

T.D.K.S.C. Gunasekara; P. Mangala C.S. De Silva; Chula Herath; Sisira Siribaddana; Nipuna Siribaddana; Channa Jayasumana; SudheerA Jayasinghe; Maria Cardenas-Gonzalez; Nishad Jayasundara. 2020. "The Utility of Novel Renal Biomarkers in Assessment of Chronic Kidney Disease of Unknown Etiology (CKDu): A Review." International Journal of Environmental Research and Public Health 17, no. 24: 9522.

Research article
Published: 30 November 2020 in PLOS Neglected Tropical Diseases
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Delays in treatment seeking and antivenom administration remain problematic for snake envenoming. We aimed to describe the treatment seeking pattern and delays in admission to hospital and administration of antivenom in a cohort of authenticated snakebite patients. Adults (> 16 years), who presented with a confirmed snakebite from August 2013 to October 2014 were recruited from Anuradhapura Hospital. Demographic data, information on the circumstances of the bite, first aid, health-seeking behaviour, hospital admission, clinical features, outcomes and antivenom treatment were documented prospectively. There were 742 snakebite patients [median age: 40 years (IQR:27–51; males: 476 (64%)]. One hundred and five (14%) patients intentionally delayed treatment by a median of 45min (IQR:20-120min). Antivenom was administered a median of 230min (IQR:180–360min) post-bite, which didn’t differ between directly admitted and transferred patients; 21 (8%) receiving antivenom within 2h and 141 (55%) within 4h of the bite. However, transferred patients received antivenom sooner after admission to Anuradhapura hospital than those directly admitted (60min [IQR:30-120min] versus 120min [IQR:52-265min; p

ACS Style

Anjana Silva; Jiri Hlusicka; Nipuna Siribaddana; Subodha Waiddyanatha; Senaka Pilapitiya; Prasanna Weerawansa; Niroshan Lokunarangoda; Sujeewa Thalgaspitiya; Sisira Siribaddana; Geoffrey K. Isbister. Time delays in treatment of snakebite patients in rural Sri Lanka and the need for rapid diagnostic tests. PLOS Neglected Tropical Diseases 2020, 14, e0008914 .

AMA Style

Anjana Silva, Jiri Hlusicka, Nipuna Siribaddana, Subodha Waiddyanatha, Senaka Pilapitiya, Prasanna Weerawansa, Niroshan Lokunarangoda, Sujeewa Thalgaspitiya, Sisira Siribaddana, Geoffrey K. Isbister. Time delays in treatment of snakebite patients in rural Sri Lanka and the need for rapid diagnostic tests. PLOS Neglected Tropical Diseases. 2020; 14 (11):e0008914.

Chicago/Turabian Style

Anjana Silva; Jiri Hlusicka; Nipuna Siribaddana; Subodha Waiddyanatha; Senaka Pilapitiya; Prasanna Weerawansa; Niroshan Lokunarangoda; Sujeewa Thalgaspitiya; Sisira Siribaddana; Geoffrey K. Isbister. 2020. "Time delays in treatment of snakebite patients in rural Sri Lanka and the need for rapid diagnostic tests." PLOS Neglected Tropical Diseases 14, no. 11: e0008914.

Journal article
Published: 10 November 2020 in Ceylon Medical Journal
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Anuranga Prabuddhi Senanayake; Duminda Indrakantha; Saranga Sumathipala; Kamani Wanigasuriya; Senanayake Kularathne; Sarath Lekamwasam; Saroj Jayasinghe; Hithanadura Janaka De Silva; Sisira Siribaddana. Features of Covid-19 patients detected during community screening: A study from a rural hospital in Sri Lanka. Ceylon Medical Journal 2020, 65, 67 .

AMA Style

Anuranga Prabuddhi Senanayake, Duminda Indrakantha, Saranga Sumathipala, Kamani Wanigasuriya, Senanayake Kularathne, Sarath Lekamwasam, Saroj Jayasinghe, Hithanadura Janaka De Silva, Sisira Siribaddana. Features of Covid-19 patients detected during community screening: A study from a rural hospital in Sri Lanka. Ceylon Medical Journal. 2020; 65 (3):67.

Chicago/Turabian Style

Anuranga Prabuddhi Senanayake; Duminda Indrakantha; Saranga Sumathipala; Kamani Wanigasuriya; Senanayake Kularathne; Sarath Lekamwasam; Saroj Jayasinghe; Hithanadura Janaka De Silva; Sisira Siribaddana. 2020. "Features of Covid-19 patients detected during community screening: A study from a rural hospital in Sri Lanka." Ceylon Medical Journal 65, no. 3: 67.

Journal article
Published: 16 October 2020 in Asian Journal of Psychiatry
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A significant minority (5 %) of adolescents develop posttraumatic stress disorder (PTSD) after trauma exposure. These adolescents are likely to experience many other mental health problems and have related impaired functioning. This study examined the co-occurrence of Emotional and Behavioral Problems (EBP) with PTSD symptoms and investigated the effect of PTSD symptoms on EBP-related impaired functioning. The initial sample (T1) comprised 729 Sri Lankan adolescents, age 12–16 years, living in an area impacted by the 2004 tsunami. In 2008, participants (T1) completed measures of trauma exposure, PTSD symptoms, EBP and related functional impairment. Sixteen months later a subsample of 90 adolescents (T2) underwent diagnostic interview for PTSD and co-occurrence of mental health morbidity. In the 58.2 % of the T1 sample reporting any trauma exposure, 23.7 % met criteria for full or partial PTSD. Among all participants, 13.4 % had borderline to abnormal levels of EBP. EBP was significantly higher among PTSD-positive participants compared to PTSD-negative and non-traumatized subgroups (p < 0.001). In the T2 sample, all four cases with diagnosed PTSD had coexisting psychological problems. Further, PTSD symptoms exacerbated the impact of EBP on functional impairment. Findings support the conclusion that researchers and practitioners should be alert to EBP among trauma-exposed adolescents, because such general psychological problems are common and, in combination with PTSD symptoms, are associated with even greater impairment. Moreover, identifying the presence of these trauma associated problems is of crucial clinical importance.

ACS Style

Thyagi Ponnamperuma; Athula Sumathipala; Sisira Siribaddana. Posttraumatic stress and co-occurrence of mental health problems in Sri Lankan adolescents. Asian Journal of Psychiatry 2020, 54, 102444 .

AMA Style

Thyagi Ponnamperuma, Athula Sumathipala, Sisira Siribaddana. Posttraumatic stress and co-occurrence of mental health problems in Sri Lankan adolescents. Asian Journal of Psychiatry. 2020; 54 ():102444.

Chicago/Turabian Style

Thyagi Ponnamperuma; Athula Sumathipala; Sisira Siribaddana. 2020. "Posttraumatic stress and co-occurrence of mental health problems in Sri Lankan adolescents." Asian Journal of Psychiatry 54, no. : 102444.

Other
Published: 01 September 2020
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Leptospirosis is a ubiquitous disease and a major clinical challenge owing to the multitude of clinical presentations and manifestations that are possibly attributable to the diversity of Leptospira, the understanding of which is key to study the epidemiology of this emerging global disease threat. Sri Lanka is a hotspot for leptospirosis with high levels of endemic disease as well as annual epidemics. We carried out a prospective study of Leptospira diversity in Sri Lanka, covering the full range of climatic zones, geography, and clinical severity. Samples were collected for leptospiral culture from 1192 patients from 15 of 25 districts in Sri Lanka over two and half years period. Twenty-five isolates belonging to four pathogenic Leptospira species were identified: L. interrogans, L. borgpetersenii, L. weilii, and L. kirschneri. At least six serogroups were identified among the isolates: Autumnalis (6), Pyrogenes (4), Icterohaemorrhagiae (2), Celledoni (1), Grippotyphosa (2) and Bataviae (1). Seven isolates did not agglutinate using available antisera panels, suggesting new serogroups. Isolates were sequenced by Illumina. These data add 25 new core genome sequence types and were clustered in 15 clonal groups, including 12 new clonal groups. L. borgpetersenii was found only in the dry zone and L. weilii only in the wet zone. Acute kidney injury and cardiovascular involvement were seen only with L. interrogans infections. Thrombocytopenia and liver impairment were seen in both L. interrogans and L. borgpetersenii infections. The inadequate sensitivity of culture isolation to identify infecting Leptospira species underscores the need for culture-independent typing methods for Leptospira. Author Summary There is a huge diversity in pathogenic Leptospira species worldwide, and our knowledge of the currently circulating species is deficient owing to limited isolation and identification of Leptospira species from endemic countries. This prospective study reveals the wide pathogen diversity that causes human leptospirosis in Sri Lanka, representing four species, more than eight serogroups, and fifteen clonal groups. Further, the different geographic and climatic zone distributions and clinical manifestations observed underscores the need for prospective studies to expand the molecular epidemiological approaches to combat leptospirosis

ACS Style

Dinesha Jayasundara; Rmisk Senavirathna; Janith Warnasekara; Chandika Gamage; Sisira Siribaddana; Sam Kularatne; Michael Matthias; Jean Francois Mariet; Mathieu Picardeau; Suneth Buddhika Agampodi; Joseph Vinetz. 12 Novel Clonal Groups of Leptospira Infecting Humans in Multiple Contrasting Epidemiological Contexts in Sri Lanka. 2020, 1 .

AMA Style

Dinesha Jayasundara, Rmisk Senavirathna, Janith Warnasekara, Chandika Gamage, Sisira Siribaddana, Sam Kularatne, Michael Matthias, Jean Francois Mariet, Mathieu Picardeau, Suneth Buddhika Agampodi, Joseph Vinetz. 12 Novel Clonal Groups of Leptospira Infecting Humans in Multiple Contrasting Epidemiological Contexts in Sri Lanka. . 2020; ():1.

Chicago/Turabian Style

Dinesha Jayasundara; Rmisk Senavirathna; Janith Warnasekara; Chandika Gamage; Sisira Siribaddana; Sam Kularatne; Michael Matthias; Jean Francois Mariet; Mathieu Picardeau; Suneth Buddhika Agampodi; Joseph Vinetz. 2020. "12 Novel Clonal Groups of Leptospira Infecting Humans in Multiple Contrasting Epidemiological Contexts in Sri Lanka." , no. : 1.

Study protocol
Published: 27 August 2020 in Trials
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Background The first case of a coronavirus 2019 (COVID-19) infection in a Sri Lankan was reported on March 11, 2020. The situation in Sri Lanka changed with the rapid increase of personnel contracting COVID-19 in a naval base camp that housed more than 4000 people. This provided a unique opportunity to study the effectiveness of hydroxychloroquine (HCQ) for post-exposure prophylaxis (PEP), while taking stringent, non-pharmacologic, public health measures to prevent spread. Our aim is to study the effectiveness and safety of HCQ for PEP among naval personnel with exposure to COVID-19-positive patients. Methods/design This is a placebo-controlled, randomized, clinical trial carried out in the naval base camp and quarantine centers of the Sri Lanka Navy, Ministry of Defense, Sri Lanka. Navy personnel who are exposed to a patient with confirmed COVID-19 infection but test negative for the virus on reverse real-time polymerase chain reaction (rRT-PCR) at recruitment will be randomized, 200 to each arm, to receive HCQ or placebo and monitored for the development of symptoms or rRT-PCR positivity for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus for 14 days. Discussion This trial will provide high-quality evidence of the effectiveness and safety of HCQ as PEP for COVID-19. The study design is unique due to the circumstances of the outbreak in a confined area among otherwise healthy adults, at a relatively early stage of its spread. Trial registration Sri Lanka Clinical Trials Registry (SLCTR) SLCTR/2020/011. Registered on 04 May 2020

ACS Style

Madunil A. Niriella; Dileepa S. Ediriweera; Arjuna P. De Silva; Ranjan Premarathne; Priyantha Balasooriya; Kaluthanthri D. Duminda; Neelika G. Malavige; Kamani Wanigasuriya; Sarath Lekamwasam; Senanayake A. Kularathne; Sisira Siribaddana; Hithanadura J. De Silva; Saroj Jayasinghe. Hydroxychloroquine for post-exposure prophylaxis of COVID-19 among naval personnel in Sri Lanka: study protocol for a randomized, controlled trial. Trials 2020, 21, 1 -6.

AMA Style

Madunil A. Niriella, Dileepa S. Ediriweera, Arjuna P. De Silva, Ranjan Premarathne, Priyantha Balasooriya, Kaluthanthri D. Duminda, Neelika G. Malavige, Kamani Wanigasuriya, Sarath Lekamwasam, Senanayake A. Kularathne, Sisira Siribaddana, Hithanadura J. De Silva, Saroj Jayasinghe. Hydroxychloroquine for post-exposure prophylaxis of COVID-19 among naval personnel in Sri Lanka: study protocol for a randomized, controlled trial. Trials. 2020; 21 (1):1-6.

Chicago/Turabian Style

Madunil A. Niriella; Dileepa S. Ediriweera; Arjuna P. De Silva; Ranjan Premarathne; Priyantha Balasooriya; Kaluthanthri D. Duminda; Neelika G. Malavige; Kamani Wanigasuriya; Sarath Lekamwasam; Senanayake A. Kularathne; Sisira Siribaddana; Hithanadura J. De Silva; Saroj Jayasinghe. 2020. "Hydroxychloroquine for post-exposure prophylaxis of COVID-19 among naval personnel in Sri Lanka: study protocol for a randomized, controlled trial." Trials 21, no. 1: 1-6.

Case report
Published: 05 August 2020 in BMC Nephrology
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Background Familial distal renal tubular acidosis (dRTA) associated with mutations of solute carrier family 4 membrane − 1 (SLC4A1) gene could co-exist with red cell membrane abnormality, Southeast Asian ovalocytosis (SAO). Although this association is well described in Southeast Asian countries, it is less frequently found in Sri Lanka. Case presentation We describe six patients who had dRTA co-existing with SAO. All of them initially presented with severe hypokalemia and paralysis. They presented within a period of six months to the Teaching Hospital Anuradhapura, Sri Lanka. All had metabolic acidosis indicated by low serum bicarbonate. Three of them were having underlying chronic kidney disease as well. Those three patients had mixed high and normal anion gap metabolic acidosis indicated by low delta ratio. In all dRTA was confirmed by presence of normal anion gap, hyperchloraemia, high urine pH and positive urine anion gap. Examination of blood films of all of them revealed presence of stomatocytes and macro-ovalocytosis compatible with SAO. In relation to complications of dRTA, two patients had medullary nephrocalcinosis. Three patients had biochemical evidence of osteomalacia, with two of them having radiological evidence of diffuse osteosclerosis. One patient had secondary hyperparathyroidism and a pathological fracture. Conclusions Erythrocyte in SAO is exceptionally rigid and this abnormality is said to be evolved as it protects against Plasmodium vivax malaria and cerebral malaria cause by Plasmodium falciparum. Although two families of SAO was described earlier, SAO and dRTA combination was reported only once in a patient from Anuradhapura district. Distal renal tubular acidosis, SAO combination and its related complications including nephrocalcinosis, chronic kidney disease and metabolic bone disease was not described in Sri-Lankan literature. This case series emphasize the importance of investigating recurrent/ chronic hypokalemia to diagnose dRTA and its associations, as early correction of acidosis could prevent development of chronic kidney disease and metabolic bone disease.

ACS Style

Wmsn Gunaratne; Dmdib Dissanayake; Kads Jayaratne; Np Premawardhana; Sisira Siribaddana. A case series of distal renal tubular acidosis, Southeast Asian ovalocytosis and metabolic bone disease. BMC Nephrology 2020, 21, 1 -10.

AMA Style

Wmsn Gunaratne, Dmdib Dissanayake, Kads Jayaratne, Np Premawardhana, Sisira Siribaddana. A case series of distal renal tubular acidosis, Southeast Asian ovalocytosis and metabolic bone disease. BMC Nephrology. 2020; 21 (1):1-10.

Chicago/Turabian Style

Wmsn Gunaratne; Dmdib Dissanayake; Kads Jayaratne; Np Premawardhana; Sisira Siribaddana. 2020. "A case series of distal renal tubular acidosis, Southeast Asian ovalocytosis and metabolic bone disease." BMC Nephrology 21, no. 1: 1-10.

Other
Published: 29 November 2019
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OBJECTIVEResearch testing the validity of the metabolic syndrome (MetS) as a clinical construct associated with cardiovascular disease risk has produced inconsistent results. This study tested the existence of the MetS, explored alternative cardiometabolic risk characterisations, and examined the relative influence of genetic and environmental factors in a South Asian sample.RESEARCH DESIGN AND METHODSData came from the Colombo Twin and Singleton follow-up Study, CoTaSS-2 (N=3969). Latent class analysis tested the clustering of MetS indicators (waist circumference, high-density-lipoprotein cholesterol (HDL-C), triglycerides (TG), blood pressure, fasting plasma glucose (FPG), medications and diabetes). Regression analyses tested cross-sectional associations between identified latent classes and covariates. Structural equation modelling estimated genetic and environmental influences on these classes. Analyses were stratified by gender (n=1681 men, n=2288 women).RESULTSThree classes were identified in men: 1) “Healthy” (52.3%), 2) “Central obesity, high TG, high FPG” (40.2%), and 3) “Central obesity, high TG, diabetes” (7.6%). Four classes were identified in women: 1) “Healthy” (53.2%), 2) “Very high central obesity, low HDL-C, raised FPG” (32.8%), 3) “Very high central obesity, diabetes” (7.2%) and 4) “Central obesity, hypertension, raised FPG” (6.8%). Older age in men and women, and high socioeconomic status in men, was associated with cardiometabolic risk categories, compared to the “Healthy” classes. In men, individual differences in cardiometabolic class membership were due to environmental effects. In females, genetic differences significantly predicted class membership.CONCLUSIONSThe findings did not support the MetS construct. Instead, distinct clinical profiles were identified in men and women, suggesting different aetiological pathways.

ACS Style

Lisa Harber-Aschan; Ioannis Bakolis; Nicholas Glozier; Khalida Ismail; Kaushalya Jayaweera; Gayani Pannala; Carmine Pariante; Fruhling Rijsdijk; Sisira Siribaddana; Athula Sumathipala; Helena M.S. Zavos; Patricia Zunszain; Matthew Hotopf. Does the metabolic syndrome exist? The identification of cardio-metabolic profiles in a South Asian population study. 2019, 19012195 .

AMA Style

Lisa Harber-Aschan, Ioannis Bakolis, Nicholas Glozier, Khalida Ismail, Kaushalya Jayaweera, Gayani Pannala, Carmine Pariante, Fruhling Rijsdijk, Sisira Siribaddana, Athula Sumathipala, Helena M.S. Zavos, Patricia Zunszain, Matthew Hotopf. Does the metabolic syndrome exist? The identification of cardio-metabolic profiles in a South Asian population study. . 2019; ():19012195.

Chicago/Turabian Style

Lisa Harber-Aschan; Ioannis Bakolis; Nicholas Glozier; Khalida Ismail; Kaushalya Jayaweera; Gayani Pannala; Carmine Pariante; Fruhling Rijsdijk; Sisira Siribaddana; Athula Sumathipala; Helena M.S. Zavos; Patricia Zunszain; Matthew Hotopf. 2019. "Does the metabolic syndrome exist? The identification of cardio-metabolic profiles in a South Asian population study." , no. : 19012195.

Articles
Published: 25 August 2019 in Global Public Health
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Harmful alcohol drinking can have health and socio-economic consequences. However, consumption is also associated with pleasure and symbolic meanings. Alcohol intake is increasing in Sri Lanka. In-depth explorations of alcohol patterns are needed to inform interventions and policies. Qualitative data were collected over 11 months in 2014 and 2015 in the North Central Province of Sri Lanka. Ten focus group discussions were conducted in gender, age and geographically (rural and semi-urban) segregated groups. Observations were conducted at alcohol selling establishments and social gatherings. Bourdieu’s concepts practice, habitus, symbolic capital and distinction were used for the analysis. Three groups of consumers emerged: moderate consumers, abstainers and heavy drinkers. They each exercised distinctions through social codes of conduct within and towards other groups of consumers. Symbolic capital was expressed through choice of alcohol. Norms of ‘acceptable consumption’ were defined as ‘moderate drinking’ in covert, social and contained settings. Public, uncontrolled and solitary consumption violated norms of appropriate consumption. Young consumers communicated a ‘modern lifestyle’ through their consumption. This study found that alcohol practices mirrored social norms in this Sri Lankan setting. Alcohol and drug prevention and intervention efforts should take this into account.

ACS Style

Jane Brandt Sørensen; Flemming Konradsen; Thilini Agampodi; Birgitte Refslund Sørensen; Melissa Pearson; Sisira Siribaddana; Thilde Rheinländer. A qualitative exploration of rural and semi-urban Sri Lankan men’s alcohol consumption. Global Public Health 2019, 15, 678 -690.

AMA Style

Jane Brandt Sørensen, Flemming Konradsen, Thilini Agampodi, Birgitte Refslund Sørensen, Melissa Pearson, Sisira Siribaddana, Thilde Rheinländer. A qualitative exploration of rural and semi-urban Sri Lankan men’s alcohol consumption. Global Public Health. 2019; 15 (5):678-690.

Chicago/Turabian Style

Jane Brandt Sørensen; Flemming Konradsen; Thilini Agampodi; Birgitte Refslund Sørensen; Melissa Pearson; Sisira Siribaddana; Thilde Rheinländer. 2019. "A qualitative exploration of rural and semi-urban Sri Lankan men’s alcohol consumption." Global Public Health 15, no. 5: 678-690.

Clinical trial
Published: 31 July 2019 in Twin Research and Human Genetics
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The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.

ACS Style

K. Silventoinen; A. Jelenkovic; Y. Yokoyama; Reijo Sund; M. Sugawara; M. Tanaka; S. Matsumoto; L. H. Bogl; D. L. Freitas; J. A. Maia; Jacob Hjelmborg; S. Aaltonen; M. Piirtola; Antti Latvala; L. Calais-Ferreira; Vinicius Cunha Oliveira; P. H. Ferreira; F. Ji; F. Ning; Z. Pang; J. R. Ordoñana; J. F. Sánchez-Romera; Lucía Colodro Conde; S. A. Burt; K. L. Klump; N. G. Martin; S. E. Medland; G. W. Montgomery; Christian Kandler; T. A. McAdams; T. C. Eley; A. M. Gregory; K. J. Saudino; L. Dubois; M. Boivin; M. Brendgen; G. Dionne; F. Vitaro; A. D. Tarnoki; D. L. Tarnoki; Claire Haworth; Robert Plomin; Sevgi Yurt Oncel; F. Aliev; Emanuela Medda; Lorenza Nisticò; V. Toccaceli; J. M. Craig; R. Saffery; Sisira Siribaddana; Matthew Hotopf; A. Sumathipala; F. Rijsdijk; H.-U. Jeong; T. Spector; Massimo Mangino; G. Lachance; M. Gatz; D. A. Butler; W. Gao; C. Yu; Lintao Li; G. Bayasgalan; D. Narandalai; Kathryn Harden; E. M. Tucker-Drob; K. Christensen; Axel Skytthe; Kirsten Ohm Kyvik; C. A. Derom; R. F. Vlietinck; Ruth Loos; W. Cozen; A. E. Hwang; T. M. Mack; M. He; X. Ding; J. L. Silberg; H. H. Maes; T. L. Cutler; J. L. Hopper; Patrik Magnusson; Nancy Pedersen; A. K. Dahl Aslan; L. A. Baker; C. Tuvblad; M. Bjerregaard-Andersen; H. Beck-Nielsen; Morten Sodemann; V. Ullemar; C. Almqvist; Qihua Tan; D. Zhang; G. E. Swan; R. Krasnow; K. L. Jang; Ariel Knafo-Noam; D. Mankuta; L. Abramson; P. Lichtenstein; R. F. Krueger; M. McGue; Shandell Pahlen; P. Tynelius; Finn Rasmussen; G. E. Duncan; D. Buchwald; R. P. Corley; Brooke Huibregtse; T. L. Nelson; K. E. Whitfield; C. E. Franz; W. S. Kremen; M. J. Lyons; S. Ooki; I. Brandt; T. S. Nilsen; J. R. Harris; J. Sung; H. A. Park; J. Lee; S. J. Lee; Gonneke Willemsen; Meike Bartels; Toos van Beijsterveldt; C. H. Llewellyn; A. Fisher; Esther Rebato; A. Busjahn; R. Tomizawa; F. Inui; M. Watanabe; C. Honda; N. Sakai; Y.-M. Hur; T. I. A. Sørensen; D. I. Boomsma; J. Kaprio. The CODATwins Project: The Current Status and Recent Findings of COllaborative Project of Development of Anthropometrical Measures in Twins. Twin Research and Human Genetics 2019, 22, 800 -808.

AMA Style

K. Silventoinen, A. Jelenkovic, Y. Yokoyama, Reijo Sund, M. Sugawara, M. Tanaka, S. Matsumoto, L. H. Bogl, D. L. Freitas, J. A. Maia, Jacob Hjelmborg, S. Aaltonen, M. Piirtola, Antti Latvala, L. Calais-Ferreira, Vinicius Cunha Oliveira, P. H. Ferreira, F. Ji, F. Ning, Z. Pang, J. R. Ordoñana, J. F. Sánchez-Romera, Lucía Colodro Conde, S. A. Burt, K. L. Klump, N. G. Martin, S. E. Medland, G. W. Montgomery, Christian Kandler, T. A. McAdams, T. C. Eley, A. M. Gregory, K. J. Saudino, L. Dubois, M. Boivin, M. Brendgen, G. Dionne, F. Vitaro, A. D. Tarnoki, D. L. Tarnoki, Claire Haworth, Robert Plomin, Sevgi Yurt Oncel, F. Aliev, Emanuela Medda, Lorenza Nisticò, V. Toccaceli, J. M. Craig, R. Saffery, Sisira Siribaddana, Matthew Hotopf, A. Sumathipala, F. Rijsdijk, H.-U. Jeong, T. Spector, Massimo Mangino, G. Lachance, M. Gatz, D. A. Butler, W. Gao, C. Yu, Lintao Li, G. Bayasgalan, D. Narandalai, Kathryn Harden, E. M. Tucker-Drob, K. Christensen, Axel Skytthe, Kirsten Ohm Kyvik, C. A. Derom, R. F. Vlietinck, Ruth Loos, W. Cozen, A. E. Hwang, T. M. Mack, M. He, X. Ding, J. L. Silberg, H. H. Maes, T. L. Cutler, J. L. Hopper, Patrik Magnusson, Nancy Pedersen, A. K. Dahl Aslan, L. A. Baker, C. Tuvblad, M. Bjerregaard-Andersen, H. Beck-Nielsen, Morten Sodemann, V. Ullemar, C. Almqvist, Qihua Tan, D. Zhang, G. E. Swan, R. Krasnow, K. L. Jang, Ariel Knafo-Noam, D. Mankuta, L. Abramson, P. Lichtenstein, R. F. Krueger, M. McGue, Shandell Pahlen, P. Tynelius, Finn Rasmussen, G. E. Duncan, D. Buchwald, R. P. Corley, Brooke Huibregtse, T. L. Nelson, K. E. Whitfield, C. E. Franz, W. S. Kremen, M. J. Lyons, S. Ooki, I. Brandt, T. S. Nilsen, J. R. Harris, J. Sung, H. A. Park, J. Lee, S. J. Lee, Gonneke Willemsen, Meike Bartels, Toos van Beijsterveldt, C. H. Llewellyn, A. Fisher, Esther Rebato, A. Busjahn, R. Tomizawa, F. Inui, M. Watanabe, C. Honda, N. Sakai, Y.-M. Hur, T. I. A. Sørensen, D. I. Boomsma, J. Kaprio. The CODATwins Project: The Current Status and Recent Findings of COllaborative Project of Development of Anthropometrical Measures in Twins. Twin Research and Human Genetics. 2019; 22 (6):800-808.

Chicago/Turabian Style

K. Silventoinen; A. Jelenkovic; Y. Yokoyama; Reijo Sund; M. Sugawara; M. Tanaka; S. Matsumoto; L. H. Bogl; D. L. Freitas; J. A. Maia; Jacob Hjelmborg; S. Aaltonen; M. Piirtola; Antti Latvala; L. Calais-Ferreira; Vinicius Cunha Oliveira; P. H. Ferreira; F. Ji; F. Ning; Z. Pang; J. R. Ordoñana; J. F. Sánchez-Romera; Lucía Colodro Conde; S. A. Burt; K. L. Klump; N. G. Martin; S. E. Medland; G. W. Montgomery; Christian Kandler; T. A. McAdams; T. C. Eley; A. M. Gregory; K. J. Saudino; L. Dubois; M. Boivin; M. Brendgen; G. Dionne; F. Vitaro; A. D. Tarnoki; D. L. Tarnoki; Claire Haworth; Robert Plomin; Sevgi Yurt Oncel; F. Aliev; Emanuela Medda; Lorenza Nisticò; V. Toccaceli; J. M. Craig; R. Saffery; Sisira Siribaddana; Matthew Hotopf; A. Sumathipala; F. Rijsdijk; H.-U. Jeong; T. Spector; Massimo Mangino; G. Lachance; M. Gatz; D. A. Butler; W. Gao; C. Yu; Lintao Li; G. Bayasgalan; D. Narandalai; Kathryn Harden; E. M. Tucker-Drob; K. Christensen; Axel Skytthe; Kirsten Ohm Kyvik; C. A. Derom; R. F. Vlietinck; Ruth Loos; W. Cozen; A. E. Hwang; T. M. Mack; M. He; X. Ding; J. L. Silberg; H. H. Maes; T. L. Cutler; J. L. Hopper; Patrik Magnusson; Nancy Pedersen; A. K. Dahl Aslan; L. A. Baker; C. Tuvblad; M. Bjerregaard-Andersen; H. Beck-Nielsen; Morten Sodemann; V. Ullemar; C. Almqvist; Qihua Tan; D. Zhang; G. E. Swan; R. Krasnow; K. L. Jang; Ariel Knafo-Noam; D. Mankuta; L. Abramson; P. Lichtenstein; R. F. Krueger; M. McGue; Shandell Pahlen; P. Tynelius; Finn Rasmussen; G. E. Duncan; D. Buchwald; R. P. Corley; Brooke Huibregtse; T. L. Nelson; K. E. Whitfield; C. E. Franz; W. S. Kremen; M. J. Lyons; S. Ooki; I. Brandt; T. S. Nilsen; J. R. Harris; J. Sung; H. A. Park; J. Lee; S. J. Lee; Gonneke Willemsen; Meike Bartels; Toos van Beijsterveldt; C. H. Llewellyn; A. Fisher; Esther Rebato; A. Busjahn; R. Tomizawa; F. Inui; M. Watanabe; C. Honda; N. Sakai; Y.-M. Hur; T. I. A. Sørensen; D. I. Boomsma; J. Kaprio. 2019. "The CODATwins Project: The Current Status and Recent Findings of COllaborative Project of Development of Anthropometrical Measures in Twins." Twin Research and Human Genetics 22, no. 6: 800-808.

Public health
Published: 09 July 2019 in BMJ Open
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ObjectivesSocial capital which implies ‘features of social organisation, such as trust, norms and networks that can improve the efficiency of society by facilitating coordinated actions’ is rarely assessed in relation to maternal health in low/middle-income countries (LMICs). A main reason for this research gap could be the unavailability of a specific tool to measure social capital in pregnancy. The study developed and validated an instrument to measure social capital among pregnant women.SettingWe developed the tool based on World Bank Social Capital Assessment Tool and its adaptations identified as applicable to LMIC from an initial systematic review. The study was conducted in Anuradhapura district in the North Central Province of Sri Lanka. Validation process was conducted in urban, rural and resettled communities.ParticipantsStudy participants of the cognitive validation included pregnant women from the three communities, and an expert panel including a social scientist, methodological expert, subject expert, public health officers. The psychometric validation was performed on 439 pregnant women permanently residing in the three communities.ResultsThe 24-item Low and middle income countries Social Capital Assessment Tool for Maternal Health (LSCAT-MH) demonstrated high internal consistency (Cronbach’s α=0.94). Factor analytical methods suggested a four-factor model of (1) neighbourhood networks (structural bonding), (2) domestic and neighbourhood cohesion (cognitive bonding), (3) social contribution and (4) social participation (structural bridging). Concurrent validity with antenatal mental ill health was confirmed through a negative correlation with the Edinburgh Postpartum Depression Scale. Test–retest reliability was high with intraclass correlation of 0.71 and a Pearson correlation of 0.83.ConclusionThe LSCAT-MH is a psychometrically valid and reliable tool to measure social capital in pregnancy. Predictive validity was not tested as the study was not a longitudinal follow-up.

ACS Style

Thilini C Agampodi; Suneth Agampodi; Nick Glozier; T A Lelwala; K D P S Sirisena; Sisira Siribaddana. Development and validation of the Social Capital Assessment Tool in pregnancy for Maternal Health in Low and middle income countries (LSCAT-MH). BMJ Open 2019, 9, e027781 .

AMA Style

Thilini C Agampodi, Suneth Agampodi, Nick Glozier, T A Lelwala, K D P S Sirisena, Sisira Siribaddana. Development and validation of the Social Capital Assessment Tool in pregnancy for Maternal Health in Low and middle income countries (LSCAT-MH). BMJ Open. 2019; 9 (7):e027781.

Chicago/Turabian Style

Thilini C Agampodi; Suneth Agampodi; Nick Glozier; T A Lelwala; K D P S Sirisena; Sisira Siribaddana. 2019. "Development and validation of the Social Capital Assessment Tool in pregnancy for Maternal Health in Low and middle income countries (LSCAT-MH)." BMJ Open 9, no. 7: e027781.

Comparative study
Published: 08 May 2019 in Global Health, Epidemiology and Genomics
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This study investigated the genetic and environmental contributions to emotional overeating (EOE) and depressive symptoms, and their covariation, in a Sri-Lankan population, using genetic model-fitting analysis. In total, 3957 twins and singletons in the Colombo Twin and Singleton Study-Phase 2 rated their EOE behaviour and depressive symptoms, which were significantly associated (men: r = 0.11, 95% confidence interval (CI) 0.06–0.16, women: r = 0.12, 95% CI 0.07–0.16). Non-shared environmental factors explained the majority of variance in men (EOE e2 = 87%, 95% CI 78–95%; depressive symptoms e2 = 72%, 95% CI 61–83%) and women (EOE e2 = 76%, 95% CI 68–83%; depressive symptoms e2 = 64%, 95% CI 55–74%). Genetic factors were more important for EOE in women (h2 = 21%, 95% CI 4–32%) than men (h2 = 9%, 95% CI 0–20%). Shared-environmental factors were more important for depressive symptoms in men (c2 = 25%, 95% CI 10–36%) than women (c2 = 9%, 95% CI 0–35%). Non-shared environmental factors explained the overlap between depressive symptoms and EOE in women but not in men. Results differed from high-income populations, highlighting the need for behavioural genetic research in global populations.

ACS Style

Moritz P. Herle; Carol Kan; Kaushalya Jayaweera; Anushka Adikari; Sisira Siribaddana; Helena Zavos; Milana Smolkina; Athula Sumathipala; Clare Llewellyn; Khalida Ismail; Matthew Hotopf; Janet Treasure; Fruhling Rijsdijk. The association between emotional eating and depressive symptoms: a population-based twin study in Sri Lanka. Global Health, Epidemiology and Genomics 2019, 4, e4 .

AMA Style

Moritz P. Herle, Carol Kan, Kaushalya Jayaweera, Anushka Adikari, Sisira Siribaddana, Helena Zavos, Milana Smolkina, Athula Sumathipala, Clare Llewellyn, Khalida Ismail, Matthew Hotopf, Janet Treasure, Fruhling Rijsdijk. The association between emotional eating and depressive symptoms: a population-based twin study in Sri Lanka. Global Health, Epidemiology and Genomics. 2019; 4 ():e4.

Chicago/Turabian Style

Moritz P. Herle; Carol Kan; Kaushalya Jayaweera; Anushka Adikari; Sisira Siribaddana; Helena Zavos; Milana Smolkina; Athula Sumathipala; Clare Llewellyn; Khalida Ismail; Matthew Hotopf; Janet Treasure; Fruhling Rijsdijk. 2019. "The association between emotional eating and depressive symptoms: a population-based twin study in Sri Lanka." Global Health, Epidemiology and Genomics 4, no. : e4.

Brief research report article
Published: 26 April 2019 in Frontiers in Cellular and Infection Microbiology
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Objective: To undertake the first detailed genomic analysis of methicillin-resistant Staphylococcus aureus (MRSA) isolated in Sri Lanka. Methods: A prospective observational study was performed on 94 MRSA isolates collected over a 4 months period from the Anuradhapura Teaching Hospital, Sri Lanka. Screening for mecA, mecC, and the Panton-Valentine leucocidin (PVL)-associated lukS-PV/lukF-PV genes and molecular characterization by spa typing was undertaken. Whole genome sequencing (WGS) and phylogenetic analysis was performed on selected multilocus sequence type (MLST) clonal complex 5 (CC5) isolates from Sri Lanka, England, Australia, and Argentina. Results: All 94 MRSA harbored the mecA gene. Nineteen spa types belonging to nine MLST clonal complexes were identified. Where origin of the sample was recorded, most isolates were from skin and soft tissue infections (70/91; 76.9%), with fewer causing bacteremia (16/91; 17.6%), empyema (3/91; 3.3%) and osteomyelitis (2/91; 2.2%). Sixty two (65.9%) isolates were PVL positive with the majority (56 isolates; 90.3%) belonging to a dominant CC5 lineage. This lineage, PVL-positive ST5-MRSA-IVc, was associated with both community and hospital-onset infections. Based on WGS, representative PVL-positive ST5-MRSA-IVc isolates from Sri Lanka, England and Australia formed a single phylogenetic clade, suggesting wide geographical circulation. Conclusions: We present the most detailed genomic analysis of MRSA isolated in Sri Lanka to date. The analysis identified a PVL-positive ST5-MRSA-IVc that is prevalent among MRSA causing clinical infections in Sri Lanka. Furthermore, this clone was also found among isolates from the United Kingdom and Australia.

ACS Style

Sharla M. McTavish; Sarah J. Snow; Ellie C. Cook; Bruno Pichon; Sarah Coleman; Geoffrey W. Coombs; Stanley Pang; Cesar A. Arias; Lorena Díaz; Emma Boldock; Steve Davies; Mangala Udukala; Angela Marie Kearns; Sisira Siribaddana; Thushan I. De Silva. Genomic and Epidemiological Evidence of a Dominant Panton-Valentine Leucocidin-Positive Methicillin Resistant Staphylococcus aureus Lineage in Sri Lanka and Presence Among Isolates From the United Kingdom and Australia. Frontiers in Cellular and Infection Microbiology 2019, 9, 123 .

AMA Style

Sharla M. McTavish, Sarah J. Snow, Ellie C. Cook, Bruno Pichon, Sarah Coleman, Geoffrey W. Coombs, Stanley Pang, Cesar A. Arias, Lorena Díaz, Emma Boldock, Steve Davies, Mangala Udukala, Angela Marie Kearns, Sisira Siribaddana, Thushan I. De Silva. Genomic and Epidemiological Evidence of a Dominant Panton-Valentine Leucocidin-Positive Methicillin Resistant Staphylococcus aureus Lineage in Sri Lanka and Presence Among Isolates From the United Kingdom and Australia. Frontiers in Cellular and Infection Microbiology. 2019; 9 ():123.

Chicago/Turabian Style

Sharla M. McTavish; Sarah J. Snow; Ellie C. Cook; Bruno Pichon; Sarah Coleman; Geoffrey W. Coombs; Stanley Pang; Cesar A. Arias; Lorena Díaz; Emma Boldock; Steve Davies; Mangala Udukala; Angela Marie Kearns; Sisira Siribaddana; Thushan I. De Silva. 2019. "Genomic and Epidemiological Evidence of a Dominant Panton-Valentine Leucocidin-Positive Methicillin Resistant Staphylococcus aureus Lineage in Sri Lanka and Presence Among Isolates From the United Kingdom and Australia." Frontiers in Cellular and Infection Microbiology 9, no. : 123.

Review
Published: 31 March 2019 in Toxins
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Long-term effects of envenoming compromise the quality of life of the survivors of snakebite. We searched MEDLINE (from 1946) and EMBASE (from 1947) until October 2018 for clinical literature on the long-term effects of snake envenoming using different combinations of search terms. We classified conditions that last or appear more than six weeks following envenoming as long term or delayed effects of envenoming. Of 257 records identified, 51 articles describe the long-term effects of snake envenoming and were reviewed. Disability due to amputations, deformities, contracture formation, and chronic ulceration, rarely with malignant change, have resulted from local necrosis due to bites mainly from African and Asian cobras, and Central and South American Pit-vipers. Progression of acute kidney injury into chronic renal failure in Russell’s viper bites has been reported in several studies from India and Sri Lanka. Neuromuscular toxicity does not appear to result in long-term effects. Endocrine anomalies such as delayed manifestation of hypopituitarism following Russell’s viper bites have been reported. Delayed psychological effects such as depressive symptoms, post-traumatic stress disorder and somatisation have been reported. Blindness due to primary and secondary effects of venom is a serious, debilitating effect. In general, the available studies have linked a clinical effect to a snakebite in retrospect, hence lacked accurate snake authentication, details of acute management and baseline data and are unable to provide a detailed picture of clinical epidemiology of the long-term effects of envenoming. In the future, it will be important to follow cohorts of snakebite patients for a longer period of time to understand the true prevalence, severity, clinical progression and risk factors of long-term effects of snake envenoming.

ACS Style

Subodha Waiddyanatha; Anjana Silva; Sisira Siribaddana; Geoffrey K. Isbister. Long-term Effects of Snake Envenoming. Toxins 2019, 11, 193 .

AMA Style

Subodha Waiddyanatha, Anjana Silva, Sisira Siribaddana, Geoffrey K. Isbister. Long-term Effects of Snake Envenoming. Toxins. 2019; 11 (4):193.

Chicago/Turabian Style

Subodha Waiddyanatha; Anjana Silva; Sisira Siribaddana; Geoffrey K. Isbister. 2019. "Long-term Effects of Snake Envenoming." Toxins 11, no. 4: 193.

Case report
Published: 15 March 2019 in Toxicon
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The Merrem's hump-nosed viper (H. hypnale) causes many snakebites in South India and Sri Lanka. At present no antivenom is available for envenomings by this snake. A 42-year-old male bitten by a large H. hypnale, presented within 30 min of the bite and had a cardiac arrest soon after admission. This responded to standard advanced life support, but he had an unrecordably high international normalised ratio (INR), activated partial thromboplastin time and unrecordably low fibrinogen, consistent with a complete venom-induced consumption coagulopathy. In the absence of antivenom, a total of 1680ml of fresh frozen plasma (FFP) was transfused 5.5 and 16 h post-bite. The coagulopathy did not improve with the administration of FFP and a further elevation of D-Dimer after FFP suggested consumption of transfused clotting factors. The coagulopathy resolved after 72 h. The patient did not develop any bleeding complications, acute kidney injury or evidence of thrombotic microangiopathy and was discharged 8 days after the bite. This case suggests that early FFP for VICC in H. hypnale envenoming may worsen the coagulopathy in the absence of antivenom and cannot be recommended.

ACS Style

Harendra Kumara; Nimal Seneviratne; Dilini S. Jayaratne; Sisira Siribaddana; Geoffrey K. Isbister; Anjana Silva. Severe coagulopathy in Merrem's hump-nosed pit viper (Hypnale hypnale) envenoming unresponsive to fresh frozen plasma: A case report. Toxicon 2019, 163, 19 -22.

AMA Style

Harendra Kumara, Nimal Seneviratne, Dilini S. Jayaratne, Sisira Siribaddana, Geoffrey K. Isbister, Anjana Silva. Severe coagulopathy in Merrem's hump-nosed pit viper (Hypnale hypnale) envenoming unresponsive to fresh frozen plasma: A case report. Toxicon. 2019; 163 ():19-22.

Chicago/Turabian Style

Harendra Kumara; Nimal Seneviratne; Dilini S. Jayaratne; Sisira Siribaddana; Geoffrey K. Isbister; Anjana Silva. 2019. "Severe coagulopathy in Merrem's hump-nosed pit viper (Hypnale hypnale) envenoming unresponsive to fresh frozen plasma: A case report." Toxicon 163, no. : 19-22.

Journal article
Published: 01 January 2019 in Toxicology Communications
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ACS Style

Anjana Silva; E. Michael Sedgwick; Prasanna Weerawansa; Senaka Pilapitiya; Vajira Weerasinghe; Nicholas Buckley; Sisira Siribaddana; Geoffrey K. Isbister. Sub-clinical neuromuscular dysfunction after envenoming by Merrem’s hump-nosed pit viper (Hypnale hypnale). Toxicology Communications 2019, 3, 23 -28.

AMA Style

Anjana Silva, E. Michael Sedgwick, Prasanna Weerawansa, Senaka Pilapitiya, Vajira Weerasinghe, Nicholas Buckley, Sisira Siribaddana, Geoffrey K. Isbister. Sub-clinical neuromuscular dysfunction after envenoming by Merrem’s hump-nosed pit viper (Hypnale hypnale). Toxicology Communications. 2019; 3 (1):23-28.

Chicago/Turabian Style

Anjana Silva; E. Michael Sedgwick; Prasanna Weerawansa; Senaka Pilapitiya; Vajira Weerasinghe; Nicholas Buckley; Sisira Siribaddana; Geoffrey K. Isbister. 2019. "Sub-clinical neuromuscular dysfunction after envenoming by Merrem’s hump-nosed pit viper (Hypnale hypnale)." Toxicology Communications 3, no. 1: 23-28.

Research article
Published: 29 November 2018 in Environmental Science and Pollution Research
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Higher incidence of diabetes along with increased use of pesticides is seen in Southeast Asia. Recent hypothesis postulated a link between acetylcholinesterase inhibitor insecticides and type 2 diabetes through the GLP-1 pathway. This study compares the GLP-1 response between groups with low and high red blood cell acetylcholinesterase (RBC-AChE) activity. A comparative cross-sectional study was conducted amongst patients who were within 3 months after an acute organophosphate or carbamate poisoning (acute group) and amongst vegetable farmers with low (chronic group) and high (control group) RBC-AChE activity. Acute (366 mU/μM Hb) and chronic (361 mU/μM Hb) groups had significantly lower RBC-AChE activity in comparison to the control (471 mU/μM Hb) group (P < 0.0001). Only the acute group, which has had atropine therapy, showed a significantly lower 120 min value in comparison to the control group (P = 0.0028). Also, the acute group had significantly low late (P = 0.0287) and total (P = 0.0358) responses of GLP-1 in comparison to the control group. The findings of the study allude towards attenuation of GLP-1 response amongst patients after acute organophosphate and carbamate poisoning. The possibility of an atropine-mediated attenuation of GLP-1 response was discussed.

ACS Style

Devarajan Rathish; Indika Senavirathna; Channa Jayasumana; Suneth Agampodi; Sisira Siribaddana. A low GLP-1 response among patients treated for acute organophosphate and carbamate poisoning: a comparative cross-sectional study from an agrarian region of Sri Lanka. Environmental Science and Pollution Research 2018, 26, 2864 -2872.

AMA Style

Devarajan Rathish, Indika Senavirathna, Channa Jayasumana, Suneth Agampodi, Sisira Siribaddana. A low GLP-1 response among patients treated for acute organophosphate and carbamate poisoning: a comparative cross-sectional study from an agrarian region of Sri Lanka. Environmental Science and Pollution Research. 2018; 26 (3):2864-2872.

Chicago/Turabian Style

Devarajan Rathish; Indika Senavirathna; Channa Jayasumana; Suneth Agampodi; Sisira Siribaddana. 2018. "A low GLP-1 response among patients treated for acute organophosphate and carbamate poisoning: a comparative cross-sectional study from an agrarian region of Sri Lanka." Environmental Science and Pollution Research 26, no. 3: 2864-2872.