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Sri Jayewardenepura Kotte, Sri Lanka

Taira B.R.,Stony Brook University Medical Center | Cherian M.N.,World Health Organization | Yakandawala H.,World Health Organization | Kesavan R.,World Health Organization | And 2 more authors.
World Journal of Surgery | Year: 2010

Background: Three decades of internal conflict in the North and East of Sri Lanka have taken a toll on the health care system in that area. Methods: We proposed to quantify the current status of capacity to deliver emergency, anesthesia, and surgical interventions in the conflict affected areas of Sri Lanka. The World Health Organization (WHO) Tool for Situational Analysis to Assess Emergency and Essential Surgical Care (EESC) was used to evaluate 47 health facilities. Results: Although most have trained health care providers capable of basic procedures, infrastructure and supplies were severely lacking. Conclusion: These data can be used as a basis for the recovery and rebuilding of EESC capacity in conflict-affected areas of Sri Lanka. © 2009 Société Internationale de Chirurgie. Source

Malavige G.N.,University of Sri Jayawardanapura | Malavige G.N.,Weatherall Institute of Molecular Medicine | Ogg G.S.,Weatherall Institute of Molecular Medicine
Journal of Clinical Virology | Year: 2013

Dengue viral infections are the commonest mosquito borne viral infection in the world, affecting more than 100 countries and 390 million individuals annually. Currently, there are no effective antiviral drugs or an effective vaccine to prevent infection. A main hurdle in developing a safe and effective vaccine has been our poor understanding of the complex nature of the protective immune response in acute dengue infection and the presence of four dengue virus (DV) serotypes that are highly homologous. The role of DV specific T cells in the pathogenesis of severe clinical disease in not clear. It has been speculated that highly cross reactive T cells for the previous infecting heterologous DV serotype, which produce pro-inflammatory cytokines, contribute to disease pathogenesis. These cross reactive T cells are believed to be suboptimal in clearing the infection with the current DV-serotype. However, other studies have shown that cross-reactive DV-specific T cells are absent or present in very low frequency during acute infection, appearing only during the convalescent period in the majority of patients. Furthermore, significant apoptosis of T cells occurs in severe acute clinical disease. Overall therefore, it is unclear what role T cells play in contributing to disease pathogenesis during acute dengue infection. Existing data have been complicated by cross-reactivity in T cells assays. These findings can now be re-evaluated in the light of novel technologies to identify serotype-specific T cell responses. © 2013 Elsevier B.V. Source

Crack L.R.,Weatherall Institute of Molecular Medicine | Jones L.,Weatherall Institute of Molecular Medicine | Malavige G.N.,University of Sri Jayawardanapura | Patel V.,Weatherall Institute of Molecular Medicine | Ogg G.S.,Biomedical Research Center
Clinical and Experimental Dermatology | Year: 2012

Background. There is mounting evidence that antimicrobial peptides have an important role in cutaneous defence, but the expression of these antimicrobial peptides in atopic eczema (AE) is still unclear. There are several families of antimicrobial peptides, including cathelicidins and human β-defensins. Patients with AE are more susceptible to severe cutaneous viral infections, including varicella zoster virus (VZV). Aim. To characterize the functional activity of the antimicrobial peptides LL-37 (human cathelicidin) and human β-defensin (hBD)-2 keratinocytes were infected with VZV, in a skin-infection model. Methods. Flow-cytometry analysis was used to investigate LL-37 expression in normal human keratinocytes, and quantitative PCR was used to determine viral loads in infected HaCaT keratinocytes and B cells, with and without exogenous LL-37 and hBD-2. Results. LL-37 expression was present in keratinocytes, and both exogenous LL-37 and hBD-2 significantly reduced VZV load in infected keratinocytes and B cells. Specific antibodies blocked the antiviral action exhibited by these antimicrobial peptides. Preincubation of VZV with LL-37, but not hBD-2, further reduced VZV load. Conclusions. Both LL-37 and hBD-2 have an antiviral effect on VZV replication in the keratinocyte HaCaT cell line and in B cells, but their mechanism of action is different. Evidence of the relationship between antimicrobial peptide expression and higher susceptibility to infections in AE skin is still emerging. Developing novel antiviral therapies based on antimicrobial peptides may provide improved treatment options for patients with AE. © The Author(s) CED © 2012 British Association of Dermatologists. Source

Sinhabahu V.P.,Special Care Baby Unit | Sathananthan R.,Special Care Baby Unit | Malavige G.N.,University of Sri Jayawardanapura
BMC Research Notes | Year: 2014

Background: Dengue in pregnancy is associated with many maternal and foetal outcomes including perinatal transmission of dengue infection. Case Presentation: A baby was born by emergency caesarean section due to foetal distress and meconium stained liquor, to a 27-year old primi-gravidae, Sinhalese female, who was febrile during and 2 days prior to labour. The baby had evidence of respiratory distress due to meconium aspiration and was cared for in the special care baby unit for 3 days. On the 4th day he developed fever and serial blood counts showed a gradual rise in the haematocrit (>20% of baseline value) and lowering of platelet counts. The baby was treated for sepsis and as Sri Lanka was experiencing a massive dengue epidemic was also tested for dengue. His dengue NS1 antigen test was strongly positive and the dengue IgM antibodies weakly positive on day 3 of illness. The mother was positive for both dengue IgM and IgG antibodies. Conclusion: Although rare, vertical transmission of the dengue virus has been reported and the baby most likely developed dengue due to perinatal transmission of dengue. Source

Paranavitane S.A.,University of Sri Jayawardanapura | Gomes L.,University of Sri Jayawardanapura | Kamaladasa A.,University of Sri Jayawardanapura | Adikari T.N.,University of Sri Jayawardanapura | And 6 more authors.
BMC Infectious Diseases | Year: 2014

Background: Early detection of complications significantly reduces dengue associated mortality and morbidity. We set out to determine if the NS1 rapid antigen detection test could be used as a point of care test to predict severe disease. Methods: 186 adult patients with confirmed dengue were enrolled during day 3-8 of illness. Clinical and laboratory parameters were recorded during the course of the illness and NS1 antigen levels were determined using both the Panbio dengue early ELISA (Panbio, Australia) and a NS1 rapid antigen detection kit (SD Bioline, South Korea). Results: 59.1% of patients presented to hospital on day 5-6 of illness when NS1 antigen positivity was significantly (p = 0.008) associated with severe dengue (odds ratio 3.0, 95% CI 1.39 to 6.47) and the NS1 antigen levels were significantly higher (p = 0.03) in those who went on to develop shock. Serum NS1 antigen levels significantly (p < 0.0001) and inversely correlated with the total white cell counts and lymphocyte counts. The bedside NS1 test showed comparable sensitivity (97.4%) and specificity (93.7%) to the laboratory NS1 test in our setting and cohort. Conclusion: NS1 antigen positivity is associated with a higher risk of developing severe dengue especially when positive beyond day 5 of illness in our cohort, and while further validation studies are required, the test can therefore potentially be used as a bedside point of care test as a warning sign of severe dengue. Source

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