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Wijewickrama A, Idampitiya D, Karunarathne M, Pahalagamage S, Sellahewa K, Govindapala D, Kalambarachchi H, Sooriyarachchi R, Chandrarathne N, Goonaratna C, Perera J. Efficacy and safety of Link Natural Sudarshana, an Ayurvedic herbal preparation in COVID-19 patients: A phase II multicenter double-blind randomized placebo-controlled trial. J Ethnopharmacol 2024; 323:117535. [PMID: 38070837 DOI: 10.1016/j.jep.2023.117535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/03/2023] [Accepted: 11/28/2023] [Indexed: 01/13/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE In vitro and in vivo studies have shown anti-viral and immunomodulatory actions in components of many traditional medicines. Various constituents of traditional medicines have been found to be effective against coronavirus disease (COVID-19) in several clinical trials and in-silico studies. Sudarshana cúrna, a polyherbal Ayurvedic medicine, has been used over thousands of years for a variety of infectious fevers. AIMS OF THE STUDY This study aimed to evaluate the efficacy and safety of Link Natural Sudarshana (LNS) tablets, in patients with COVID 19 disease. LNS is a polyherbal preparation comprising 49 medicinal plants included in the Sudarshana cúrna. MATERIALS AND METHODS A randomized parallel-group double-blind placebo-controlled multi-center phase II clinical trial was conducted in patients with mild to moderate COVID-19 disease. They were randomly allocated to intervention and control groups. The intervention group received LNS tablets whereas the control group received placebo tablets for 10 days or until the patient was discharged from the hospital. All patients received standard symptomatic treatment. The primary outcome, a reduction in mean log viral load was assessed at day 5 of treatment. The secondary outcomes, clinical progression and safety, were assessed by, monitoring changes in symptoms daily on a Likert scale ranging from 1 to 4 and laboratory tests respectively. RESULTS A total of 171 patients (treatment group 83, control group 88) completed the trial. There were no significant differences between the baseline status of the two groups except that body mass index was significantly higher in the placebo group. The mean log viral load reduction at day 5 was higher in the treatment group (2.20 ± 1.67) compared to the placebo group (1.93 ± 1.80), with a mean difference of -0.278. This difference was not statistically significant at the 5% significant level. Reduction of mean cumulative symptom score, which included 16 symptoms graded according to severity, was higher in the treatment group compared to the placebo group. This difference was not statistically significant. None of the study participants developed hypoxia. Among the 7 lymphopenia patients in the placebo group, 3 continued to have lymphopenia at day 10, whereas 9 lymphopenia patients in the treatment group, reverted to normal counts. C reactive proteins (CRP) showed a greater reduction in the treatment group. None reported adverse effects. No significant changes occurred in hematological and biochemical parameters that assessed safety. CONCLUSIONS LNS is safe to use in COVID-19 patients and accelerated the decline in viral load, relieved symptoms, reduced CRP levels and reversed lymphopenia earlier, when compared to the placebo.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Nadeeka Chandrarathne
- Faculty of Medicine, Department of Community Medicine, University of Colombo, Sri Lanka
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Galagoda GCS, Perera J, de Silva R, Wickramasinghe HT, Dasanayake D, Bravo L, Ismail Z, Goh DYT, Nelson EAS. ASVAC2022 : 8 th Asian Vaccine Conference. Hum Vaccin Immunother 2023; 19:2165360. [PMID: 36655357 PMCID: PMC9980669 DOI: 10.1080/21645515.2023.2165360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Aiming to further the Immunization Partners in Asia Pacific (IPAP)'s vision of a world where no one suffers from a vaccine preventable disease, the 8th Asian Vaccine Conference (ASVAC 2022) was held in Colombo, Sri Lanka and virtually from 15 to 18, September 2022 (www.asianvaccine.com). This conference followed those held in Siem Reap, Cambodia (2009), Manila, Philippines (2010), Jakarta, Indonesia (2011), Cebu, Philippines (2013), Hanoi, Vietnam (2015), Singapore (2017) and Naypyidaw and Yangon, Myanmar (2019). The ASVAC2022 themed "Immunization: in Era of Pandemics," commenced with the EPI Managers' Workshop, followed by pre-conference workshops and Vaccinology Masterclass, followed by the main conference featuring 5 plenary lectures, 6 partner-led symposia, free paper and poster presentations, and industry-supported lunch and evening sessions. There were over 1830 registered participants, with 112 attending in person and 998 virtually from 63 countries. The conference was organized by IPAP and hosted by the Vaccine and Infectious Disease Forum of Sri Lanka, Sri Lanka College of Pediatricians, Sri Lanka College of Microbiologists and College of General Practitioners of Sri Lanka, with the support of the Ministry of Health, Sri Lanka. The 9th ASVAC is scheduled to be held in Davao City, Philippines in late 2023.
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Affiliation(s)
| | - Jennifer Perera
- Department of Medical Microbiology and Immunology, University of Colombo, Colombo, Sri Lanka
| | - Rajiva de Silva
- Department of Immunology, Medical Research Institute, Colombo 8, Sri Lanka
| | - H T Wickramasinghe
- Department of Paediatrics, Neville Fernando Teaching Hospital, Colombo, Sri Lanka
| | | | - Lulu Bravo
- Department of Pediatrics, University of the Philippines Manila, Manila, Philippines
| | - Zulkifli Ismail
- Department of Paediatrics, KPJ Selangor Specialist Hospital, Shah Alam, Malaysia.,Graduate School, KPJ Healthcare University College, Nilai, Malaysia
| | - Daniel Y T Goh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - E Anthony S Nelson
- School of Medicine, The Chinese University of Hong Kong, Shenzhen, Guangdong, PR China.,Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong, PR China
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Georghiou SB, Rodwell TC, Korobitsyn A, Abbadi SH, Ajbani K, Alffenaar JW, Alland D, Alvarez N, Andres S, Ardizzoni E, Aubry A, Baldan R, Ballif M, Barilar I, Böttger EC, Chakravorty S, Claxton PM, Cirillo DM, Comas I, Coulter C, Denkinger CM, Derendinger B, Desmond EP, de Steenwinkel JE, Dheda K, Diacon AH, Dolinger DL, Dooley KE, Egger M, Ehsani S, Farhat MR, Fattorini L, Finci I, Le Ray LF, Furió V, Groenheit R, Gumbo T, Heysell SK, Hillemann D, Hoffmann H, Hsueh PR, Hu Y, Huang H, Hussain A, Ismail F, Izumi K, Jagielski T, Johnson JL, Kambli P, Kaniga K, Eranga Karunaratne G, Sharma MK, Keller PM, Kelly EC, Kholina M, Kohli M, Kranzer K, Laurenson IF, Limberis J, Grace Lin SY, Liu Y, López-Gavín A, Lyander A, Machado D, Martinez E, Masood F, Mitarai S, Mvelase NR, Niemann S, Nikolayevskyy V, Maurer FP, Merker M, Miotto P, Omar SV, Otto-Knapp R, Palaci M, Palacios Gutiérrez JJ, Peacock SJ, Peloquin CA, Perera J, Pierre-Audigier C, Pholwat S, Posey JE, Prammananan T, Rigouts L, Robledo J, Rockwood N, Rodrigues C, Salfinger M, Schechter MC, Seifert M, Sengstake S, Shinnick T, Shubladze N, Sintchenko V, Sirgel F, Somasundaram S, Sterling TR, Spitaleri A, Streicher E, Supply P, Svensson E, Tagliani E, Tahseen S, Takaki A, Theron G, Torrea G, Van Deun A, van Ingen J, Van Rie A, van Soolingen D, Vargas Jr R, Venter A, Veziris N, Villellas C, Viveiros M, Warren R, Wen S, Werngren J, Wilkinson RJ, Yang C, Yılmaz FF, Zhang T, Zimenkov D, Ismail N, Köser CU, Schön T. Updating the approaches to define susceptibility and resistance to anti-tuberculosis agents: implications for diagnosis and treatment. Eur Respir J 2022; 59:2200166. [PMID: 35422426 PMCID: PMC9059840 DOI: 10.1183/13993003.00166-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/05/2022] [Indexed: 11/07/2022]
Abstract
Approximately 85 000 deaths globally in 2019 were due to drug-resistant tuberculosis (TB), which corresponds to 7% of global deaths attributable to bacterial antimicrobial resistance [1]. Yet concerns have been mounting that drug-resistant TB was being underestimated because the approaches to define susceptibility and resistance to anti-TB agents had not kept up with those used for other major bacterial pathogens [2–9]. Here, we outline the recent, evidence-based initiatives spearheaded by the World Health Organization (WHO) and others to update breakpoints (traditionally referred to as critical concentrations (CCs)) that are used for phenotypic antimicrobial susceptibility testing (AST), also called drug susceptibility testing in the TB literature. Inappropriately high breakpoints have resulted in systematic false-susceptible AST results to anti-TB drugs. MIC, PK/PD and clinical outcome data should be combined when setting breakpoints to minimise the emergence and spread of antimicrobial resistance. https://bit.ly/3i43wb6
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Perera J, Hoskin P. Adjuvant Therapy for High-risk Endometrial Carcinoma. Clin Oncol (R Coll Radiol) 2021; 33:560-566. [PMID: 34112584 DOI: 10.1016/j.clon.2021.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/29/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022]
Abstract
About one-fifth of endometrial cancers are 'high risk', which carries a poorer prognosis. Management strategies to optimise their survival have been under investigation for many years. Despite recent advances, their overall survival remains relatively poor. The definition of high risk in endometrial cancers has been based on clinicopathological factors until recently, when molecular profiling has shown greater discrimination. There is, however, poor correlation between traditional clinicopathological factors and their molecular profile. This is the subject of ongoing trials to better individualise adjuvant post-hysterectomy treatment. The management of high-risk tumours is traditionally based on surgery followed by radiotherapy, despite no proven overall survival benefit in early stages. The place of chemotherapy remains under investigation, with recent trials showing benefit in more advanced stages. The Post Operative Radiation Therapy in Endometrial Carcinoma (PORTEC) and Gynecologic Oncology Group trials support the use of chemoradiation and chemotherapy for stage III and adverse histological subgroups. In addition, there is now early evidence of correlation between benefit from adjuvant chemotherapy based on molecular alterations in the tumour cells. In this review, we look at the current evidence on management strategies in the evolving era of molecular diagnosis and stratification.
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Affiliation(s)
- J Perera
- Mount Vernon Cancer Centre, Northwood, UK
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK.
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Lee TH, Lye DC, Chung DR, Thamlikitkul V, Lu M, Wong AT, Hsueh PR, Wang H, Cooper C, Wong JG, Shimono N, Pham VH, Perera J, Yang YH, Shibl AM, Kim SH, Hsu LY, Song JH. Antimicrobial stewardship capacity and manpower needs in the Asia Pacific. J Glob Antimicrob Resist 2021; 24:387-394. [PMID: 33548495 DOI: 10.1016/j.jgar.2021.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 12/03/2020] [Accepted: 01/23/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Antimicrobial stewardship is a strategy to combat antimicrobial resistance in hospitals. Given the burden and impact of antimicrobial resistance in the Asia Pacific, it is important to document capacity and gaps in antimicrobial stewardship programmes (ASP). We aimed to understand existing capacities and practices, and define the resources needed to establish antimicrobial stewardship where it is lacking. METHODS An anonymous online survey, consisting of questions on antimicrobial control at country, hospital and programme levels, was circulated to healthcare providers in the field of infectious diseases and microbiology through Asian Network for Surveillance of Resistant Pathogens, ReAct Group and the Australasian Society for infectious Diseases. RESULTS 139 participants from 16 countries or regions completed the survey. The majority of participants were adult infectious diseases physicians (61/139, 43.9%) and microbiologists (31/139, 22.3%). Participants from 7 countries reported that antimicrobials can be obtained without prescriptions. Despite the high percentage (75.5%) of respondents working in large hospitals, only 22/139 participants (15.8%) from Australia, China, Singapore, Taiwan, Thailand and Vietnam reported having more than 10 infectious diseases physicians. Hospital empiric antimicrobial guidelines for common infections were available according to 110/139 (79.1%) participants. Pre-authorisation of antimicrobials was reported by 88/113 (77.9%) respondents while prospective audit and feedback was reported by 93/114 (81.6%). Automatic stop orders and culture-guided de-escalation were reported by only 52/113 (46.0%) and 27/112 (24.1%) respectively. CONCLUSION The survey reveals a wide range of ASP development in Asia Pacific. Establishing national workgroups and guidelines will help advance antimicrobial stewardship in this diverse region.
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Affiliation(s)
- Tau Hong Lee
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Department of Infectious Diseases, National Centre for Infectious Diseases, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - David C Lye
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Department of Infectious Diseases, National Centre for Infectious Diseases, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Doo Ryeon Chung
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Asia Pacific Foundation for Infectious Diseases, Seoul, Republic of Korea
| | | | - Min Lu
- Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Andrew Ty Wong
- Infectious Disease Control Training Centre, Hospital Authority, Hong Kong
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hui Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Celia Cooper
- Department of Infectious Diseases, Women's and Children's Hospital, South Australia, Australia
| | - Joshua Gx Wong
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - Nobuyuki Shimono
- Center for the Study of Global Infection, Kyushu University Hospital, Japan
| | - Van Hung Pham
- School of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam
| | - Jennifer Perera
- Department of Microbiology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Yong-Hong Yang
- Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Atef M Shibl
- Department of Microbiology and Immunology, College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
| | - So Hyun Kim
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Asia Pacific Foundation for Infectious Diseases, Seoul, Republic of Korea
| | - Li Yang Hsu
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore; Department of Infectious Diseases, National Centre for Infectious Diseases, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jae-Hoon Song
- Asia Pacific Foundation for Infectious Diseases, Seoul, Republic of Korea; CHA Bio Group, Gyeonggi-do, Republic of Korea
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Karunaratne RE, Wijenayaka LA, Wijesundera SS, De Silva KMN, Adikaram CP, Perera J. Use of nanotechnology for infectious disease diagnostics: application in drug resistant tuberculosis. BMC Infect Dis 2019; 19:618. [PMID: 31299893 PMCID: PMC6626415 DOI: 10.1186/s12879-019-4259-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 07/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The increased transmission of multidrug-resistant (MDR) tuberculosis (TB) poses a challenge to tuberculosis prevention and control in Sri Lanka. Isoniazid (INH) is a key element of the first line anti tuberculosis treatment regimen. Resistance to INH may lead to development of MDR TB. Therefore, early detection of INH resistance is important to curb spread of resistance. Due to the limited availability of rapid molecular methods for detection of drug resistance in Sri Lanka, this study was aimed at developing a simple and rapid gold nanoparticle (AuNP) based lateral flow strip for the simultaneous detection of the most common INH resistance mutation (katG S315 T, 78.6%) and Mycobacterium tuberculosis (MTb). METHODS Lateral flow strip was designed on an inert plastic backing layer containing a sample pad, nitrocellulose membrane and an absorption pad. Biotin labeled 4 capture probes which separately conjugated with streptavidin were immobilized on the nitrocellulose. The test sample was prepared by multiplex PCR using primers to amplify codon 315 region of the katG gene and MTb specific IS6110 region. The two detection probes complementary to the 5' end of each amplified fragment was conjugated with gold nanoparticles (20 nm) and coupled with the above amplified PCR products were applied on the sample pad. The hybridization of the amplified target regions to the respective capture probes takes place when the sample moves towards the absorption pad. Positive hybridization is indicated by red colour lines. RESULTS The three immobilized capture probes on the strip (for the detection of TB, katG wild type and mutation) were 100 and 96.6% specific and 100 and 92.1% sensitive respectively. CONCLUSION The AuNP based lateral flow assay was capable of differentiating the specific mutation and the wild type along with MTb identification within 3 h.
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Affiliation(s)
- Roshanthi Eranga Karunaratne
- Department of Microbiology, Faculty of Medicine, University of Colombo, box 271, Kynsey Road, Colombo, PO, 08, Sri Lanka.
| | - Lahiru A Wijenayaka
- Sri Lanka Institute of Nanotechnology (SLINTEC), Mahenwatte, Pitipana, Homagama, Sri Lanka.,Department of Chemistry, Faculty of Natural Sciences, The Open University of Sri Lanka, Nawala, Sri Lanka
| | - Sandya Sulochana Wijesundera
- Department of Molecular Biology and Biochemistry, Faculty of Medicine, University of Colombo, Colombo, 08, Sri Lanka
| | - K M Nalin De Silva
- Sri Lanka Institute of Nanotechnology (SLINTEC), Mahenwatte, Pitipana, Homagama, Sri Lanka.,Department of Chemistry, University of Colombo, Colombo, 03, Sri Lanka
| | - Chamila Priyangani Adikaram
- Central Public Health Laboratories, National Tuberculosis Reference Laboratory, Ministry of Health, Muscat, Sultanate of Oman
| | - Jennifer Perera
- Department of Microbiology, Faculty of Medicine, University of Colombo, box 271, Kynsey Road, Colombo, PO, 08, Sri Lanka
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Wijesooriya LI, Kok T, Perera J, Tilakarathne Y, Sunil-Chandra NP. Mycoplasma pneumoniae DNA detection and specific antibody class response in patients from two tertiary care hospitals in tropical Sri Lanka. J Med Microbiol 2018; 67:1232-1242. [PMID: 30074476 DOI: 10.1099/jmm.0.000813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Respiratory tract infections are a major cause of global morbidity and mortality. Pneumonia is the ninth leading cause of mortality in Sri Lanka. Atypical pathogens cause about one-fifth of community-acquired pneumonia, while Mycoplasma pneumoniae accounts for about 50 %. This study aimed to determine the seroprevalence of M. pneumoniae respiratory tract infections in Sri Lanka while attempting to understand the relationships between the serology and PCR. METHODOLOGY Paired sera from 418 adult patients (pneumonia, n=97; bronchitis, n=183; pharyngitis, n=138) and 87 healthy controls were studied. IgM, IgG and IgA antibodies were tested by M. pneumoniae enzyme-linked immunosorbent assay (ELISA). Positive IgM and or IgG seroconversion was considered to be seropositive. M. pneumoniae DNA were tested by PCR in age and gender-matched seropositives and seronegatives. RESULTS M. pneumoniae IgG was in 14.4 % (14/97), 6.0 % (11/183) and 1.5 % (2/138) of pneumonia, bronchitis and pharyngitis patients, respectively, whilst IgM was in 6.2 % (6/97), 1.1 % (2/183) and 0 % (0/138), respectively. Amongst the pneumonia seropositives, 64.7 % (11/17) showed IgG alone, 17.5 % (3/17) showed IgM alone and 17.5 % (3/17) showed IgM and IgG. Amongst the bronchitis seropositives, 84.6 % (11/13) had IgG alone and 15.4 % (2/13) had IgM alone. In the pharyngitis seropositives, only IgG was detected 100 % (2/2). M. pneumoniae DNA was in 52.2 % (12/23) of seropositives and 15.4 % (4/26) of seronegatives. In pneumonia or bronchitis patients, specific DNA was in 77.8 % (7/10) and 50 % (6/12) of patients, respectively. M. pneumoniae DNA was not found in pharyngitis patients. Of the seropositive PCR-negative pneumonia patients, 66.7 % (2/3) showed IgG alone and 33.3 % (1/3)showed IgM alone. In bronchitis patients, 83.3 % (5/6) showed IgG alone and 16.7 % (1/6) showed IgM alone. Of the seronegative PCR-positive patients, 16.7 % (2/12) had pneumonia and 18.2 % (2/11) had bronchitis. CONCLUSION The serological evidence for M. pneumoniae infection in Sri Lanka comprised the following prevalences: 17.5 % (17/97), 7.1 % (13/183) and 1.4 % (2/138) in adults with pneumonia, bronchitis or pharyngitis, respectively. M. pneumoniae DNA was in 52.2 % (12/23) of seropositives and 15.4 % (4/26) of seronegatives. IgG was predominant in PCR positives and negatives.
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Affiliation(s)
| | - Tuckweng Kok
- 2Department of Microbiology and Infectious Diseases, School of Biological Sciences, University of Adelaide, Institute of Medical and Veterinary Science (IMVS), Adelaide, SA 5005, Australia
| | - Jennifer Perera
- 3Department of Microbiology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Y Tilakarathne
- 4Department of Medicine, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | - N P Sunil-Chandra
- 1Department of Medical Microbiology, Faculty of Medicine, University of Kelaniya, Sri Lanka
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Karunaratne GHRE, Wijesundera SS, Vidanagama D, Adikaram CP, Perera J. Significance of Coexisting Mutations on Determination of the Degree of Isoniazid Resistance in Mycobacterium tuberculosis Strains. Microb Drug Resist 2018; 24:844-851. [PMID: 29683767 DOI: 10.1089/mdr.2017.0330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The emergence and spread of drug-resistant tuberculosis (TB) pose a threat to TB control in Sri Lanka. Isoniazid (INH) is a key element of the first-line anti-TB treatment regimen. Resistance to INH is mainly associated with point mutations in katG, inhA, and ahpC genes. The objective of this study was to determine mutations of these three genes in INH-resistant Mycobacterium tuberculosis (MTb) strains in Sri Lanka. Complete nucleotide sequence of the three genes was amplified by polymerase chain reaction and subjected to DNA sequencing. Point mutations in the katG gene were identified in 93% isolates, of which the majority (78.6%) were at codon 315. Mutations at codons 212 and 293 of the katG gene have not been reported previously. Novel mutations were recognized in the promoter region of the inhA gene (C deletion at -34), fabG1 gene (codon 27), and ahpC gene (codon 39). Single S315T mutation in the katG gene led to a high level of resistance, while a low level of resistance with high frequency (41%) was observed when katG codon 315 coexisted with the mutation at codon 463. Since most of the observed mutations of all three genes coexisted with the katG315 mutation, screening of katG315 mutations will be a useful marker for molecular detection of INH resistance of MTb in Sri Lanka.
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Affiliation(s)
| | | | | | | | - Jennifer Perera
- 1 Department of Microbiology, Faculty of Medicine, University of Colombo , Colombo, Sri Lanka
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Son S, Thamlikitkul V, Chokephaibulkit K, Perera J, Jayatilleke K, Hsueh PR, Lu CY, Balaji V, Moriuchi H, Nakashima Y, Lu M, Yang Y, Yao K, Kim SH, Song JH, Kim S, Kim MJ, Heininger U, Chiu CH, Kim YJ. Prospective multinational serosurveillance study of Bordetella pertussis infection among 10- to 18-year-old Asian children and adolescents. Clin Microbiol Infect 2018; 25:250.e1-250.e7. [PMID: 29689428 DOI: 10.1016/j.cmi.2018.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/11/2018] [Accepted: 04/16/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Bordetella pertussis continues to cause outbreaks worldwide. To assess the role of children and adolescent in transmission of pertussis in Asia, we performed a multinational serosurveillance study. METHODS From July 2013 to June 2016, individuals aged 10 to 18 years who had not received any pertussis-containing vaccine within the prior year were recruited in 10 centres in Asia. Serum anti-pertussis toxin (PT) IgG was measured by ELISA. Demographic data and medical histories were obtained. In the absence of pertussis immunization, anti-PT IgG ≥62.5 IU/mL was interpreted as B. pertussis infection within 12 months prior, among them levels ≥125 IU/mL were further identified as infection within 6 months. RESULTS A total of 1802 individuals were enrolled. Anti-PT IgG geometric mean concentration was 4.5, and 87 (4.8%) individuals had levels ≥62.5 IU/mL; among them, 73 (83.9%) had received three or more doses of pertussis vaccine before age 6 years. Of 30 participants with persistent cough during the past 6 months, one (3.3%) had level ≥125 IU/mL. There was no significant difference in proportions with anti-PT IgG ≥62.5 IU/mL among age groups (13-15 vs. 10-12 years, 16-18 vs. 10-12 years), between types of diphtheria, pertussis and tetanus (DTP; whole cell vs. acellular), number of doses before age 6 years within the DTP whole-cell pertussis vaccine (five vs. four doses) or acellular pertussis vaccine (five vs. four doses) and history of persistent cough during the past 6 months (yes vs. no). CONCLUSIONS There is significant circulation of B. pertussis amongst Asian children and adolescents, with one in 20 having serologic evidence of recent infection regardless of vaccination background.
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Affiliation(s)
- S Son
- Samsung Medical Center, Sungkyunkwan University, Department of Pediatrics, Seoul, South Korea
| | - V Thamlikitkul
- Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Medicine, Bangkok, Thailand
| | - K Chokephaibulkit
- Faculty of Medicine Siriraj Hospital, Mahidol University, Department of Medicine, Bangkok, Thailand
| | - J Perera
- University of Colombo, Department of Microbiology, Colombo, Sri Lanka
| | - K Jayatilleke
- Sri Jayewardenepura General Hospital, Department of Microbiology, Nugegoda, Sri Lanka
| | - P-R Hsueh
- National Taiwan University Hospital, Departments of Laboratory Medicine and Internal Medicine, Taipei, Taiwan
| | - C-Y Lu
- National Taiwan University Hospital, Department of Pediatrics, Taipei, Taiwan
| | - V Balaji
- Christian Medical College & Hospital, Department of Clinical Microbiology, Vellore, India
| | - H Moriuchi
- Graduate School of Biomedical Sciences, Nagasaki University, Department of Molecular Microbiology and Immunology, Nagasaki, Japan
| | - Y Nakashima
- Graduate School of Biomedical Sciences, Nagasaki University, Department of Molecular Microbiology and Immunology, Nagasaki, Japan
| | - M Lu
- Shanghai Children's Hospital, Department of Pulmonary Medicine, Shanghai, China
| | - Y Yang
- Beijing Children's Hospital, Capital Medical University, Department of Microbiology and Immunology, Beijing, China
| | - K Yao
- Beijing Children's Hospital, Capital Medical University, Department of Microbiology and Immunology, Beijing, China
| | - S H Kim
- Asia Pacific Foundation for Infectious Diseases (APFID), Division of Infectious Disease, Seoul, South Korea
| | - J H Song
- Asia Pacific Foundation for Infectious Diseases (APFID), Division of Infectious Disease, Seoul, South Korea
| | - S Kim
- Samsung Medical Center, Statistics and Data Center, Seoul, South Korea
| | - M-J Kim
- Samsung Medical Center, Statistics and Data Center, Seoul, South Korea
| | - U Heininger
- University of Basel Children's Hospital, Pediatric Infectious Diseases and Vaccinology, Basel, Switzerland
| | - C-H Chiu
- Chang Gung Children's Hospital, Chang Gung University, Department of Pediatrics, Taoyuan, Taiwan.
| | - Y-J Kim
- Samsung Medical Center, Sungkyunkwan University, Department of Pediatrics, Seoul, South Korea.
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Affiliation(s)
- Dana B Gal
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Julianne Wojciak
- Department of Pediatric Cardiology, University of California, San Francisco, San Francisco, California
| | - Jennifer Perera
- Department of Pediatric Cardiology, University of California, San Francisco, San Francisco, California
| | - Ronn E Tanel
- Department of Pediatric Cardiology, University of California, San Francisco, San Francisco, California
| | - Akash R Patel
- Department of Pediatric Cardiology, University of California, San Francisco, San Francisco, California
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Abayasekara LM, Perera J, Chandrasekharan V, Gnanam VS, Udunuwara NA, Liyanage DS, Bulathsinhala NE, Adikary S, Aluthmuhandiram JVS, Thanaseelan CS, Tharmakulasingam DP, Karunakaran T, Ilango J. Detection of bacterial pathogens from clinical specimens using conventional microbial culture and 16S metagenomics: a comparative study. BMC Infect Dis 2017; 17:631. [PMID: 28927397 PMCID: PMC5606128 DOI: 10.1186/s12879-017-2727-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 09/12/2017] [Indexed: 12/27/2022] Open
Abstract
Background Infectious disease is the leading cause of death worldwide, and diagnosis of polymicrobial and fungal infections is increasingly challenging in the clinical setting. Conventionally, molecular detection is still the best method of species identification in clinical samples. However, the limitations of Sanger sequencing make diagnosis of polymicrobial infections one of the biggest hurdles in treatment. The development of massively parallel sequencing or next generation sequencing (NGS) has revolutionized the field of metagenomics, with wide application of the technology in identification of microbial communities in environmental sources, human gut and others. However, to date there has been no commercial application of this technology in infectious disease diagnostic settings. Methods Credence Genomics Rapid Infection Detection™ test, is a molecular based diagnostic test that uses next generation sequencing of bacterial 16S rRNA gene and fungal ITS1 gene region to provide accurate identification of species within a clinical sample. Here we present a study comparing 16S and ITS1 metagenomic identification against conventional culture for clinical samples. Using culture results as gold standard, a comparison was conducted using patient specimens from a clinical microbiology lab. Results Metagenomics based results show a 91.8% concordance rate for culture positive specimens and 52.8% concordance rate with culture negative samples. 10.3% of specimens were also positive for fungal species which was not investigated by culture. Specificity and sensitivity for metagenomics analysis is 91.8 and 52.7% respectively. Conclusion 16S based metagenomic identification of bacterial species within a clinical specimen is on par with conventional culture based techniques and when coupled with clinical information can lead to an accurate diagnostic tool for infectious disease diagnosis. Electronic supplementary material The online version of this article (10.1186/s12879-017-2727-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Jennifer Perera
- Dean and Chair Professor of Microbiology, Faculty of Medicine, University of Colombo, P.O. box 271, Colombo, Sri Lanka.,Credence Genomics Pvt. Ltd, 12 - 3/2, Sunethradevi Road, Kohuwala, Nugegoda, Sri Lanka
| | - Vishvanath Chandrasekharan
- Department of Chemistry, Faculty of Science, University of Colombo, Colombo, Sri Lanka.,Credence Genomics Pvt. Ltd, 12 - 3/2, Sunethradevi Road, Kohuwala, Nugegoda, Sri Lanka
| | - Vaz S Gnanam
- Credence Genomics Pvt. Ltd, 12 - 3/2, Sunethradevi Road, Kohuwala, Nugegoda, Sri Lanka
| | - Nisala A Udunuwara
- Credence Genomics Pvt. Ltd, 12 - 3/2, Sunethradevi Road, Kohuwala, Nugegoda, Sri Lanka
| | - Dileepa S Liyanage
- Credence Genomics Pvt. Ltd, 12 - 3/2, Sunethradevi Road, Kohuwala, Nugegoda, Sri Lanka
| | | | - Subhashanie Adikary
- Credence Genomics Pvt. Ltd, 12 - 3/2, Sunethradevi Road, Kohuwala, Nugegoda, Sri Lanka
| | | | | | | | - Tharaga Karunakaran
- Credence Genomics Pvt. Ltd, 12 - 3/2, Sunethradevi Road, Kohuwala, Nugegoda, Sri Lanka
| | - Janahan Ilango
- Credence Genomics Pvt. Ltd, 12 - 3/2, Sunethradevi Road, Kohuwala, Nugegoda, Sri Lanka
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Adikaram CP, Wijesundera SS, Perera J. RFLP clusters of rifampicin resistant and susceptible Mycobacterium tuberculosis strains in Western province of Sri Lanka. J Infect Dev Ctries 2017; 11:619-625. [PMID: 31085823 DOI: 10.3855/jidc.7684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 05/30/2016] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Continuous studies on genetic diversity of Mycobacterium tuberculosis could enhance the awareness on transmission, control and prevention of tuberculosis (TB). In this study, we investigated current genetic diversity of TB and rifampicin resistant TB by, Restriction Fragment Length Polymorphism (RFLP) based on fingerprinting of the IS6110 insertion sequence, in the Western province of Sri Lanka, the famous touristic destination with the highest TB burden in the country. METHODOLOGY Genomic DNA extracted from susceptible and rifampicin resistant TB strains (confirmed for rpoB gene point mutations) were digested with PvuII restriction enzyme, electrophoresed and subjected to Southern transfer. The blots were hybridised with IS6110 probe and visualized using a chemiluminescence detection. RESULTS The number of copies of IS6110 per isolate varied from 1 to 14. The dendrogram revealed a total of 68 distinct strains among 77 TB isolates and they belonged to nine clusters. Both rifampicin resistant and susceptible strains were distributed in all clusters. This evaluation revealed the absence of genetically identical or strong relatedness between susceptible and resistant isolates. However, clonal expansion was detected in transmission of both TB and rifampicin resistant TB. In addition, the resistant isolates having the novel mutation had no clonal relatedness. CONCLUSION This is the first observational study regarding clonal expansion of TB in Sri Lanka. Thus, further investigation on genotypes, clonal expansion and transmission of drug resistance using additional markers would be useful for controlling TB.
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Affiliation(s)
| | | | - Jennifer Perera
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
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Sigera S, Perera J, Rasarathinam J, Samaranayake D, Ediriweera D. Seroprevalence of Bordetella pertussis specific Immunoglobulin G antibody levels among asymptomatic individuals aged 4 to 24 years: a descriptive cross sectional study from Sri Lanka. BMC Infect Dis 2016; 16:729. [PMID: 27905894 PMCID: PMC5133742 DOI: 10.1186/s12879-016-2068-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 11/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background In Sri Lanka pertussis continues to circulate in the community and cases among adolescents and adults have been reported despite 95% coverage of the four dose pertussis vaccination during early childhood. Waning of immunity following natural infection or immunization may contribute to the persistent circulation. An adolescent booster dose is not included in the national immunization schedule of Sri Lanka, although this is routine practice in many countries. Therefore information on immunity to pertussis in the adolescent group is needed prior to considering vaccination schedule changes. Methods The quantitative determination of specific Immunoglobulin G antibodies to Bordetella pertussis toxin was done using a commercially available validated ELISA method. The antibody values were categorized into groups according to the interpretive criteria provided by the manufacturer. The values were <55 IU/mL, negative; 55–<60 IU/mL, borderline; 60–125 IU/mL, positive; >125, strongly positive respectively. Sera of 385 asymptomatic individuals aged 4 to 24 years admitted to surgical units of Lady Ridgeway Hospital, Colombo and Colombo South Teaching Hospital were used for the study. Mann-Whitney U and Kruskal-Wallis tests were used in analysis of results and p ≤0.05 was considered as statistically significant. Details of epidemiological variables were collected using a questionnaire and correlation with significant levels of pertussis antibodies was determined. Results Median age of the study population was 12 years with 212 (55.1%) females. The median anti PT antibody level was 3.31 IU/mL and 352 (91%) had anti PT levels ≤55 IU/mL. Median of anti PT levels were 3.18 IU/mL for 4–7 years, 1.43 IU/mL (IQR 0.336–6.27) for 8–11 years, 4.28 IU/mL (IQR 0.978–13.39) for 12–15 years, 6.14 IU/mL for 16–19 years and 4.89 IU/mL for 20–24 years and the differences were statistically significant (p = 0.000). Females (p < 0.003) and those having a sibling aged ≥12 years (p = 0.017) had significantly higher anti PT levels. Conclusions The majority of the study population, especially 8 to 11 year age group had low anti PT IgG levels. The higher antibody titers in the 12–15 year age group seem to indicate infection in early adolescence. A booster dose of acellular pertussis vaccine need to be considered.
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Affiliation(s)
- Shamithra Sigera
- Department of Microbiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Jennifer Perera
- Department of Microbiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | | | - Dulani Samaranayake
- Department of Community Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Dileepa Ediriweera
- Department of Community Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
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Jayasuriya-Illesinghe V, Nazeer I, Athauda L, Perera J. Role Models and Teachers: medical students perception of teaching-learning methods in clinical settings, a qualitative study from Sri Lanka. BMC Med Educ 2016; 16:52. [PMID: 26861676 PMCID: PMC4746782 DOI: 10.1186/s12909-016-0576-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 02/02/2016] [Indexed: 05/17/2023]
Abstract
BACKGROUND Medical education research in general, and those focusing on clinical settings in particular, have been a low priority in South Asia. This explorative study from 3 medical schools in Sri Lanka, a South Asian country, describes undergraduate medical students' experiences during their final year clinical training with the aim of understanding the teaching-learning experiences. METHODS Using qualitative methods we conducted an exploratory study. Twenty eight graduates from 3 medical schools participated in individual interviews. Interview recordings were transcribed verbatim and analyzed using qualitative content analysis method. RESULTS Emergent themes reveled 2 types of teaching-learning experiences, role modeling, and purposive teaching. In role modelling, students were expected to observe teachers while they conduct their clinical work, however, this method failed to create positive learning experiences. The clinical teachers who predominantly used this method appeared to be 'figurative' role models and were not perceived as modelling professional behaviors. In contrast, purposeful teaching allowed dedicated time for teacher-student interactions and teachers who created these learning experiences were more likely to be seen as 'true' role models. Students' responses and reciprocations to these interactions were influenced by their perception of teachers' behaviors, attitudes, and the type of teaching-learning situations created for them. CONCLUSIONS Making a distinction between role modeling and purposeful teaching is important for students in clinical training settings. Clinical teachers' awareness of their own manifest professional characterizes, attitudes, and behaviors, could help create better teaching-learning experiences. Moreover, broader systemic reforms are needed to address the prevailing culture of teaching by humiliation and subordination.
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Affiliation(s)
| | | | - Lathika Athauda
- Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.
| | - Jennifer Perera
- Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
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Baek JY, Park IH, So TMK, Lalitha MK, Shimono N, Yasin RM, Carlos CC, Perera J, Thamlikitkul V, Hsueh PR, Van PH, Shibl AM, Song JH, Ko KS. Prevalence and characteristics of Streptococcus pneumoniae "putative serotype 6E" isolates from Asian countries. Diagn Microbiol Infect Dis 2015; 80:334-7. [PMID: 25439447 DOI: 10.1016/j.diagmicrobio.2014.08.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 08/26/2014] [Accepted: 08/31/2014] [Indexed: 11/26/2022]
Abstract
The prevalence, antimicrobial susceptibility, and genotypes of Streptococcus pneumoniae “putative serotype 6E” isolates from Asian countries were investigated. A total of 244 S. pneumoniae serogroup 6 isolates obtained from 11 Asian countries were included in this study. Of the 244 serogroup 6 isolates, 101 (41.4%) were typed as "putative serotype 6E," followed by serotypes 6A, 6B, 6C, and 6D (27.0, 20.1, 5.7, and 5.7%, respectively). Multilocus sequence typing revealed that clonal complex (CC) 90, including ST90 and its variants, was the most prevalent clonal group of "putative serotype 6E" isolates (n = 63; 62.4%). CC146 and CC315 were also found frequently in some of the countries. Most of the "putative serotype 6E" isolates showed very high resistance rates against cefuroxime, erythromycin, azithromycin, clarithromycin, clindamycin, and trimethoprim/sulfamethoxazole, probably due to their highly resistant to antimicrobials clone, CC90. Our results indicate that “putative serotype 6E” is prevalent in Asian countries. The clonal dissemination of "putative serotype 6E" isolates was also identified.
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Perera J, Nakhshiniev B, Gonzales H, Yoshikawa K. Effect of Hydrothermal Treatment on Macro/Micro Nutrients Extraction from Chicken Manure for Liquid Organic Fertilizer Production. ACTA ACUST UNITED AC 2015. [DOI: 10.9734/bjecc/2015/15434] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Perera J, Kirthinanda DS, Wijeratne S, Wickramarachchi TK. Descriptive cross sectional study on prevalence, perceptions, predisposing factors and health seeking behaviour of women with stress urinary incontinence. BMC Womens Health 2014; 14:78. [PMID: 24985068 PMCID: PMC4094634 DOI: 10.1186/1472-6874-14-78] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 06/25/2014] [Indexed: 11/17/2022]
Abstract
Background Stress urinary incontinence (SUI) leads to considerable physical and psychological morbidity. The highest prevalence reported was found in Caucasian Americans (range 23% -67%) and the lowest in Singaporean females (4.8%). The study assessed the prevalence, perceptions, predisposing factors and health seeking behaviour of women with SUI in an Asian setting which may have different sociocultural implications. Methods 400 consecutive women >20 years of age attending the outpatient department of a tertiary care hospital in Sri Lanka, for non-urinary conditions were studied over a 3 week period using an interviewer administered questionnaire. SUI was diagnosed on clinical history alone when leakage of urine occurred either with coughing, sneezing, walking or lifting heavy objects. The severity was graded using the Finnish Gynaecological Society’s Urinary Incontinence Severity Score (UISS). Data were analysed using SPSS version 20. Odds ratios were calculated using univariate and multivariate analysis. Results Ninety three (23.33%) had SUI and only 12 (12.9%) had sought treatment. The prevalence among women >50 years of age was 34.71% ( n = 121) compared to 18.28% (n = 279) in those ≤50 years. 25 (26.88%) had mild SUI, 66 (70.97%) moderate and 2 (2.15%) severe as per UISS. SUI was perceived as an illness by 210 (52.5%). SUI was significantly associated with pregnancy, parity, vaginal delivery, complicated labour, diabetes mellitus, chronic cough, constipation and faecal incontinence (p < 0.05). Among those affected main reasons for not seeking medical advice included; being embarrassed (n = 27, 33.33%), not knowing that it is remediable (n = 23, 28.40%), perceiving SUI to be a normal consequence of childbirth (n = 19, 23.46%) and having to attend to needs of the family (n = 12, 14.81%). None who had been pregnant (n = 313) had received advice on postnatal pelvic floor exercises. SUI interfered with social activities (71;76.34%), sexual function (21; 22.58%) and resulted in despair (67; 72.09%). It was associated with clinically diagnosed candidiasis (50; 53.76%) and soreness in the perineal region (49; 52.69%). Conclusions SUI is a common and neglected gynaecological problem with poor healthcare seeking behaviour. Community based education may help to minimize the occurrence and improve the quality of life of those affected.
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Affiliation(s)
- Jennifer Perera
- Department of Microbiology, Faculty of Medicine, University of Colombo, P O Box 271, Colombo, Sri Lanka.
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Adikaram CP, Perera J, Wijesundera SS. DNA probe based colorimetric method for detection of rifampicin resistance of Mycobacterium tuberculosis. Journal of Microbiological Methods 2014; 96:92-8. [DOI: 10.1016/j.mimet.2013.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 11/03/2013] [Accepted: 11/05/2013] [Indexed: 10/26/2022]
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Kang CI, Song JH, Kim SH, Chung DR, Peck KR, Thamlikitkul V, Wang H, So TMK, Hsueh PR, Yasin RM, Carlos CC, Van PH, Perera J. Risk factors and pathogenic significance of bacteremic pneumonia in adult patients with community-acquired pneumococcal pneumonia. J Infect 2012; 66:34-40. [PMID: 22922634 DOI: 10.1016/j.jinf.2012.08.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 08/07/2012] [Accepted: 08/18/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study was performed to identify risk factors for the development of bacteremic pneumonia and to evaluate the impact of bacteremia on the outcome of pneumococcal pneumonia. METHODS Using a database from a surveillance study of community-acquired pneumococcal pneumonia, we compared data of the bacteremic group with that of the non-bacteremic group. RESULTS Among 981 adult patients with pneumococcal pneumonia, 114 (11.6%) patients who had documented pneumococcal bacteremia were classified into the bacteremic group. In a multivariable analysis, use of immunosuppressant drugs, younger age (<65 years), and DM were independent risk factors associated with the development of bacteremic pneumonia among patients with pneumococcal pneumonia (all P < 0.05). The mortality rate was significantly higher in the bacteremic group than in the non-bacteremic group (28.6% vs. 8.5%; P < 0.001). The multivariable analysis revealed that concomitant bacteremia was one of the significant risk factors associated with mortality (OR, 2.57; 95% CI, 1.24-5.29), along with cerebrovascular disease and presentation with septic shock (all P < 0.05). CONCLUSIONS Bacteremia was a common finding in pneumococcal pneumonia and was associated with a higher mortality rate. Several clinical variables may be useful for predicting bacteremic pneumonia among patients with pneumococcal pneumonia.
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Affiliation(s)
- Cheol-In Kang
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Kang CI, Song JH, Kim SH, Chung DR, Peck KR, Thamlikitkul V, Wang H, So TM, Hsueh PR, Yasin RM, Carlos CC, Van PH, Perera J. Association of levofloxacin resistance with mortality in adult patients with invasive pneumococcal diseases: a post hoc analysis of a prospective cohort. Infection 2012; 41:151-7. [PMID: 22821428 DOI: 10.1007/s15010-012-0299-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 06/30/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study was conducted to identify risk factors for mortality and to evaluate the impact of antimicrobial resistance on outcome in adult patients with invasive pneumococcal disease (IPD). METHODS A post hoc analysis of an observational cohort study on community-acquired pneumococcal infections was conducted and a total of 136 adult patients with IPD were analyzed in this study. RESULTS Pneumonia was the most common type of infection (n = 84, 61.8 %), followed by primary bacteremia (n = 15, 11.0 %) and meningitis (n = 15, 11.0 %). One hundred and three patients (75.7 %) had concomitant pneumococcal bacteremia. The overall 30-day mortality rate was 26.5 % (36/136), and factors associated with 30-day mortality were corticosteroid use, presentation with septic shock, and development of acute respiratory distress syndrome (ARDS) (all P < 0.05). While penicillin and erythromycin resistance were associated with a lower mortality, an association between levofloxacin resistance and increased mortality was found in the univariate analysis; however, statistical significance was not reached (P = 0.083). Multivariable analysis showed that presentation with septic shock, corticosteroid use, development of ARDS, and levofloxacin resistance were independent factors associated with 30-day mortality. Of the five patients with IPD caused by levofloxacin-resistant Streptococcus pneumoniae, three (60 %) died within 30 days of diagnosis. CONCLUSION Levofloxacin resistance was associated with increased mortality, along with septic shock, prior use of corticosteroids, and development of ARDS, in adult patients with IPD. Our data suggest that the emergence of levofloxacin resistance among invasive pneumococcal isolates is now becoming a challenge for clinicians managing community-acquired bacterial infections.
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Affiliation(s)
- C-I Kang
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 135-710, Korea.
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Adikaram CP, Perera J, Wijesundera SS. Geographical profile of rpoB gene mutations in rifampicin resistant Mycobacterium tuberculosis isolates in Sri Lanka. Microb Drug Resist 2012; 18:525-30. [PMID: 22731859 DOI: 10.1089/mdr.2012.0031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The nature and frequency of mutations in the rpoB gene of rifampicin (RIF) resistant Mycobacterium tuberculosis clinical isolates varies considerably between different geographical regions. The objective of the present study was the identification of rpoB gene mutations responsible for RIF resistance in M. tuberculosis isolates in Sri Lanka. Three regions of the rpoB gene of M. tuberculosis, one corresponding to a 437-bp region, including the rifampicin resistance-determining region (RRDR) and two other regions (1395 bp and 872 bp) spanning the RRDR, were polymerase chain reaction amplified, and were subjected to DNA sequencing. The two mutations found within the RRDR in the 31 RIF resistant strains isolated in this study were at codon 526 (n=15, 48.4%) CAC (His)→TAC (Tyr) and codon 531 (n=3, 9.7%) TCG (Ser)→TTG (Leu). A significant proportion (n=15, 48.3%) showed mutations spanning the RRDR, including two novel mutations at codon 626 (n=13, 41.9%) GAC (Asp)→GAG (Glu) and 184 (n=2, 6.4%) GAC (Asp)→GAT (Asp), a silent mutation. Two isolates revealed double mutations (codons 626+526 and 626+184). The presence of a high frequency of new mutations, and the different frequencies of the universally prevailing mutations, as reported here, emphasizes the need for expanding the geographical database of mutations for effective application of an rpoB-based diagnosis of multidrug resistant tuberculosis.
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Perera J, Mohamadou G, Kaur S. The use of objective structured self-assessment and peer-feedback (OSSP) for learning communication skills: evaluation using a controlled trial. Adv Health Sci Educ Theory Pract 2010; 15:185-193. [PMID: 19757129 DOI: 10.1007/s10459-009-9191-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 08/16/2009] [Indexed: 05/27/2023]
Abstract
Feedback is essential to guide students towards expected performance goals. The usefulness of teacher feedback on improving communication skills (CS) has been well documented. It has been proposed that self-assessment and peer-feedback has an equally important role to play in enhancing learning. This is the focus of this study. Objectively structured self-assessment and peer feedback (OSSP) was incorporated into small group CS teaching sessions of a group of semester one medical students who were learning CS for the first time, to minimise the influence of previous educational interventions. A control group matched for academic performance, gender and age was used to enable parallel evaluation of the innovation. A reflective log containing closed and open ended questions was used for OSSP. Facilitators and simulated patients provided feedback to students in both groups during CS learning as per routine practice. Student perceptions on OSSP and acceptability as a learning method were explored using a questionnaire. CS were assessed in both groups using objective structured clinical examination (OSCE) as per routine practice and assessors were blinded as to which group the student belonged. Mean total score and scores for specific areas of interview skills were significantly higher in the experimental group. Analysis of the questionnaire data showed that students gained fresh insights into specific areas such as empathy, addressing patients' concerns and interview style during OSSP which clearly corroborated the specific differences in scores. The free text comments were highly encouraging as to acceptability of OSSP, in spite of 67% being never exposed to formal self- and peer-assessment during pre-university studies. OSSP promotes effective CS learning and learner acceptability is high.
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Affiliation(s)
- Jennifer Perera
- Department of Pathology, Faculty of Medical Sciences, International Medical University, Kuala Lumpur, Malaysia.
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Abstract
Dengue viral infections are one of the most important mosquito-borne diseases in the world. Presently dengue is endemic in 112 countries in the world. It has been estimated that almost 100 million cases of dengue fever and half a million cases of dengue hemorrhagic fever (DHF) occur worldwide. An increasing proportion of DHF is in children less than 15 years of age, especially in South East and South Asia. The unique structure of the dengue virus and the pathophysiologic responses of the host, different serotypes, and favorable conditions for vector breeding have led to the virulence and spread of the infections. The manifestations of dengue infections are protean from being asymptomatic to undifferentiated fever, severe dengue infections, and unusual complications. Early recognition and prompt initiation of appropriate supportive treatment are often delayed resulting in unnecessarily high morbidity and mortality. Attempts are underway for the development of a vaccine for preventing the burden of this neglected disease. This review outlines the epidemiology, clinical features, pathophysiologic mechanisms, management, and control of dengue infections.
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Affiliation(s)
| | - Pankaj Garg
- From the Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jennifer Perera
- From the Department of Microbiology, University of Colombo, Colombo, Sri Lanka
| | | | - Suranjith L Seneviratne
- From the Department of Clinical Immunology, St. Mary's Hospital and Imperial College, London, UK.
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Heras LFDL, Navarro-Llorens J, García-Pérez E, Drzyzga O, Perera J. Cholesterol oxidases from Rhodococcus spp. Cect 3014. N Biotechnol 2009. [DOI: 10.1016/j.nbt.2009.06.802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Perera J, Perera J, Abdullah J, Lee N. Training simulated patients: evaluation of a training approach using self-assessment and peer/tutor feedback to improve performance. BMC Med Educ 2009; 9:37. [PMID: 19563621 PMCID: PMC2711071 DOI: 10.1186/1472-6920-9-37] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 06/29/2009] [Indexed: 05/13/2023]
Abstract
BACKGROUND Most medical schools use simulated patients (SPs) for teaching. In this context the authenticity of role play and quality of feedback provided by SPs is of paramount importance. The available literature on SP training mostly addresses instructor led training where the SPs are given direction on their roles. This study focuses on the use of peer and self evaluation as a tool to train SPs. METHODS SPs at the medical school participated in a staff development and training programme which included a) self-assessment of their performance while observing video-tapes of their role play using a structured guide and b) peer group assessment of their performance under tutor guidance. The pre and post training performance in relation to authenticity of role play and quality of feedback was blindly assessed by students and tutors using a validated instrument and the scores were compared. A focus group discussion and a questionnaire assessed acceptability of the training programme by the SPs. RESULTS The post-training performance assessment scores were significantly higher (p < 0.05) than the pre-training scores. The degree of improvement in the quality of feedback provided to students was more when compared to the improvement of role play. The acceptability of the training by the SPs was very satisfactory scoring an average of 7.6 out of 10. The majority of the SPs requested the new method of training to be included in their current training programme as a regular feature. CONCLUSION Use of structured self-reflective and peer-interactive, practice based methods of SP training is recommended to improve SP performance. More studies on these methods of training may further refine SP training and lead to improvement of SP performance which in turn may positively impact medical education.
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Affiliation(s)
- Jennifer Perera
- Department of Pathology and Chairperson of Medical Education Research group on student learning, International Medical University (IMU), Kuala Lumpur, Malaysia
| | - Joachim Perera
- Department of Human Biology and chairman of the Medical Education Research group on assessments, IMU, Kuala Lumpur, Malaysia
| | - Juriah Abdullah
- Department of Clinical Sciences, Coordinator Clinical Skills Unit, IMU, Kuala Lumpur, Malaysia
| | - Nagarajah Lee
- Department of Community Medicine, IMU, Kuala Lumpur, Malaysia
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Drzyzga O, Navarro Llorens JM, Fernandez de las Heras L, Garcia Fernandez E, Perera J. Gordonia cholesterolivorans sp. nov., a cholesterol-degrading actinomycete isolated from sewage sludge. Int J Syst Evol Microbiol 2009; 59:1011-5. [DOI: 10.1099/ijs.0.005777-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kuo CY, Su LH, Perera J, Carlos C, Tan BH, Kumarasinghe G, So T, Van PH, Chongthaleong A, Song JH, Chiu CH. Antimicrobial susceptibility of Shigella isolates in eight Asian countries, 2001-2004. J Microbiol Immunol Infect 2008; 41:107-111. [PMID: 18473096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND PURPOSE Shigellosis is a major health problem in developing countries, causing 91 million episodes and 414,000 deaths in Asia annually. Because of increasing trends towards drug resistance, this study was undertaken to monitor local resistance patterns of Shigella isolates from 8 Asian countries. METHODS Ninety eight Shigella isolates collected from 8 centers in 8 Asian countries from July 2001 to July 2004 were analyzed in terms of serogroup distribution and antimicrobial susceptibility. RESULTS The most common serogroup of Shigella isolates was Shigella flexneri (49/98, 50%), followed by Shigella sonnei (44/98, 45%). The highest resistance rate was found for trimethoprim-sulfamethoxazole (81%), followed by tetracycline (74%) and ampicillin (53%). Overall, 76 Shigella isolates (78%) were multidrug-resistant strains; S. flexneri had a higher multidrug resistance rate than S. sonnei (74% vs 23%). Increasing ciprofloxacin and ceftriaxone resistance was observed; approximately 10% and 5% of isolates were resistant to ciprofloxacin and ceftriaxone, respectively. Five ceftriaxone-non-susceptible strains (from Taiwan [3], Hong Kong [1] and The Philippines [1]) and 10 ciprofloxacin-non-susceptible strains (from Hong Kong [2], The Philippines [1], Korea [2], Vietnam [4] and Sri Lanka [1]) were isolated. CONCLUSIONS High rates of multidrug resistance and steady increases in ceftriaxone and ciprofloxacin resistance of Shigella are serious pubic health concerns in Asian countries. Continuous monitoring of resistance patterns among Shigella isolates is necessary.
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Affiliation(s)
- Chen-Yen Kuo
- Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
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Magana-Arachchi D, Perera J, Gamage S, Chandrasekharan V. Low cost in-house PCR for the routine diagnosis of extra-pulmonary tuberculosis. Int J Tuberc Lung Dis 2008; 12:275-280. [PMID: 18284832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
SETTING Conventional methods for the identification of mycobacteria are slow and labour intensive. DNA amplification methods offer rapid sensitive and specific diagnosis. OBJECTIVE To determine the feasibility of an in-house polymerase chain reaction (PCR) method to detect Mycobacterium tuberculosis in clinical samples. DESIGN The present study focused mainly on diagnosing extra-pulmonary tuberculosis (EPTB) using an in-house PCR method in 465 clinical samples. This study also compared the efficacy of a standard phenol-chloroform (PC) extraction procedure and the guanidine thiocyanate with diatomaceous silica (GTCS) method of DNA extraction and purification. A subsample of patients was used for the validation of results based on the final diagnosis. RESULTS Among 373 patients with suspected EPTB, 75 specimens were positive by PCR, four by microscopy and six by culture. Of the 25 PCR-positive patients, 95% had a final diagnosis of TB. Globally, the GTCS method was found to be superior to the PC method for DNA extraction and removal of inhibitors from clinical specimens. CONCLUSION The DNA amplification method was found to be significantly more sensitive and rapid compared to culture and microscopy for a reliable final diagnosis of EPTB.
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Affiliation(s)
- D Magana-Arachchi
- Department of Microbiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
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Perera J, Lee N, Win K, Perera J, Wijesuriya L. Formative feedback to students: the mismatch between faculty perceptions and student expectations. Med Teach 2008; 30:395-399. [PMID: 18569661 DOI: 10.1080/01421590801949966] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Formative assessments and other learning tools are ineffective in the absence of formative feedback. METHODS A study was carried out on preclinical students and teachers using mixed methods approach that included questionnaire surveys, focus group discussions and post survey discussions to determine perceptions and expectations of students on feedback and those of teachers. RESULTS Students expected formative feedback to be incorporated into all teaching activities from the beginning of the course in medicine to promote self regulated and self directed learning. Students stated that provision of model answers and grades in assessments are inadequate but require teacher student dialogue sessions to clarify issues. Students considered immediate feedback or feedback within two weeks on a written activity, simple but focused, by a content expert would be the best form. In contrast, the teachers perceived the feedback provided using a model answer by a non content expert to be acceptable. Students also believed that formative feedback is of particular importance in salvaging poor performers. CONCLUSIONS There is a need to create awareness among teachers on the usefulness of this tool in higher education and for moulding teaching practices by including training on this aspect of teaching-learning, in routine faculty development activities. The study showed the importance of including feedback as a generic feature in all learning activities, and this may require incorporating into institutional policy for successful implementation.
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Affiliation(s)
- Jennifer Perera
- Department of Pathology, International Medical University, Kuala Lumpur, Malaysia.
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Affiliation(s)
- Suranjith L Seneviratne
- Department of Clinical Immunology, John Radcliffe Hospital, Oxford, UK, and Department of Microbiology, University of Colombo, Sri Lanka.
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Seneviratne SL, Perera J, Wijeyaratne C. Dengue infections and pregnancy: caution in interpreting high rates of premature deliveries and maternal mortality. Southeast Asian J Trop Med Public Health 2007; 38:195-6. [PMID: 17539267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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Abstract
PROBLEM Atrial fibrillation is the most common persistent arrhythmia in adults and carries an increased risk of thromboembolism and stroke. Electrical (DC) cardioversion is an effective treatment, but logistical difficulties in many institutions lead to problems providing a prompt service. This reduces the rate of long term success, delays relief of symptoms, and increases the burden on anticoagulation clinics. DESIGN Prospective audit of introduction of a collaborative, nurse led DC cardioversion service in a day surgery unit. SETTING Day surgery unit 5 km from an acute hospital in southeast London. KEY MEASURES FOR IMPROVEMENT Waiting times, success of procedures, and complication rates. STRATEGIES FOR CHANGE Collaborative working across traditional specialty boundaries; empowerment of patients within the process; using a nurse consultant as a single point of reference to coordinate the service. EFFECTS OF CHANGE Sinus rhythm was restored in 131 (92%) of the first 143 patients treated. Three patients needed hospital admission; all were discharged uneventfully within 24 hours. No important complications occurred. Waiting times were reduced from 27 weeks to eight weeks for patients eligible for the service. LESSONS LEARNT Elective DC cardioversion under general anaesthesia can be safely done by an appropriately trained nurse in a day surgery unit remote from an acute general hospital. This model of care is effective and can reduce waiting times and relieve pressure on acute beds and junior doctors.
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Affiliation(s)
- M P Currie
- Department of Cardiology, Bromley Hospitals NHS Trust, Princess Royal University Hospital, Orpington, Kent BR6 8ND.
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Perera J, de Silva T, Gange H. Knowledge, behaviour and attitudes on induced abortion and family planning among Sri Lankan women seeking termination of pregnancy. ACTA ACUST UNITED AC 2004; 49:14-7. [PMID: 15255322 DOI: 10.4038/cmj.v49i1.3278] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In Sri Lanka over 500 induced abortions are done daily in spite of restrictive legislation. Experiences in other countries show that liberal laws alone have not solved the issues of induced abortions which may harm a woman's physical and mental health. OBJECTIVE To determine the socio-demographic features of women seeking termination of pregnancy, and their knowledge, attitude and behaviour with respect to induced abortion and family planning. METHODS A prospective study on a randomly selected group of 210 women attending a clinic in Colombo requesting termination of pregnancy. A pre-tested interviewer-administered questionnaire was used for data collection. RESULTS Over 80% of women seeking abortion were between 20 and 40 years of age. All religions were represented. 13% were single and 10% wanted to postpone a pregnancy. 38.6% had three or more children. In 90% the period of gestation was less than 10 weeks. Presence of a young child was the commonest reason for termination, followed by poverty. Only 0.9% were due to incest and foetal abnormality. 96% were not aware of adverse effects of abortion. 91% thought that induced abortion was immoral and 94% did not know that it was illegal. 29% had previous terminations and post-abortion contraception counselling was poor. Although 78% were knowledgeable on at least one method of contraception, only 16.3% were using it regularly. DISCUSSION A majority used induced abortion as a family planning method. Improving accessibility and the quality of family planning services is of paramount importance. Every encounter of a woman with a health care worker should be an opportunity for counselling.
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Affiliation(s)
- Jennifer Perera
- Department of Microbiology, Faculty of Medicine, University of Colombo, Sri Lanka.
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Song JH, Jung SI, Ko KS, Kim NY, Son JS, Chang HH, Ki HK, Oh WS, Suh JY, Peck KR, Lee NY, Yang Y, Lu Q, Chongthaleong A, Chiu CH, Lalitha MK, Perera J, Yee TT, Kumarasinghe G, Jamal F, Kamarulzaman A, Parasakthi N, Van PH, Carlos C, So T, Ng TK, Shibl A. High prevalence of antimicrobial resistance among clinical Streptococcus pneumoniae isolates in Asia (an ANSORP study). Antimicrob Agents Chemother 2004; 48:2101-7. [PMID: 15155207 PMCID: PMC415617 DOI: 10.1128/aac.48.6.2101-2107.2004] [Citation(s) in RCA: 261] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A total of 685 clinical Streptococcus pneumoniae isolates from patients with pneumococcal diseases were collected from 14 centers in 11 Asian countries from January 2000 to June 2001. The in vitro susceptibilities of the isolates to 14 antimicrobial agents were determined by the broth microdilution test. Among the isolates tested, 483 (52.4%) were not susceptible to penicillin, 23% were intermediate, and 29.4% were penicillin resistant (MICs >/= 2 mg/liter). Isolates from Vietnam showed the highest prevalence of penicillin resistance (71.4%), followed by those from Korea (54.8%), Hong Kong (43.2%), and Taiwan (38.6%). The penicillin MICs at which 90% of isolates are inhibited (MIC(90)s) were 4 mg/liter among isolates from Vietnam, Hong Kong, Korea, and Taiwan. The prevalence of erythromycin resistance was also very high in Vietnam (92.1%), Taiwan (86%), Korea (80.6%), Hong Kong (76.8%), and China (73.9%). The MIC(90)s of erythromycin were >32 mg/liter among isolates from Korea, Vietnam, China, Taiwan, Singapore, Malaysia, and Hong Kong. Isolates from Hong Kong showed the highest rate of ciprofloxacin resistance (11.8%), followed by isolates from Sri Lanka (9.5%), the Philippines (9.1%), and Korea (6.5%). Multilocus sequence typing showed that the spread of the Taiwan(19F) clone and the Spain(23F) clone could be one of the major reasons for the rapid increases in antimicrobial resistance among S. pneumoniae isolates in Asia. Data from the multinational surveillance study clearly documented distinctive increases in the prevalence rates and the levels of antimicrobial resistance among S. pneumoniae isolates in many Asian countries, which are among the highest in the world published to date.
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Affiliation(s)
- Jae-Hoon Song
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Asian-Pacific Research Foundation for Infectious Diseases, 50 Il-won dong, Kangnam-ku, Seoul 135-710, Korea.
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Song JH, Jung SI, Ki HK, Shin MH, Ko KS, Son JS, Chang HH, Kim SW, Lee H, Kim YS, Oh WS, Peck KR, Chongthaleong A, Lalitha MK, Perera J, Yee TT, Jamal F, Kamarulzaman A, Carlos CC, So T. Clinical Outcomes of Pneumococcal Pneumonia Caused by Antibiotic-Resistant Strains in Asian Countries: A Study by the Asian Network for Surveillance of Resistant Pathogens. Clin Infect Dis 2004; 38:1570-8. [PMID: 15156445 DOI: 10.1086/420821] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2003] [Accepted: 01/28/2004] [Indexed: 11/03/2022] Open
Abstract
To evaluate the clinical outcomes of pneumococcal pneumonia caused by antibiotic-resistant strains in Asian countries, we performed a prospective observational study of 233 cases of adult pneumococcal pneumonia in 9 Asian countries from January 2000 to June 2001. Among 233 isolates, 128 (55%) were not susceptible to penicillin (25.3% were intermediately susceptible, and 29.6% were resistant). Clinical severity of pneumococcal pneumonia was not significantly different between antibiotic-resistant and antibiotic-susceptible groups. Mortality rates among patients with pneumococcal pneumonia caused by penicillin-, cephalosporin-, or macrolide-resistant strains were not higher than those with antibiotic-susceptible pneumococcal pneumonia. Bacteremia and mechanical ventilation were significant risk factors for death, but any kind of antibiotic resistance was not associated with increased mortality due to pneumococcal pneumonia. Outcome of pneumococcal pneumonia was not significantly affected by drug resistance, and current antimicrobial regimens are mostly effective in the treatment of pneumococcal pneumonia, despite the widespread emergence of in vitro resistance.
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Affiliation(s)
- Jae-Hoon Song
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Abstract
OBJECTIVES To determine the morbidity and mortality patterns of varicella and risk factors affecting its outcome, and the facilities available at the Infectious Diseases Hospital (IDH), Sri Lanka. METHODS A retrospective study on all patients admitted with varicella-zoster virus (VZV) infection to the IDH from August 2000 to July 2001. Data were collected from the hospital records. RESULTS Among the 1690 patients admitted during the study period, 1090 (64.9%) were due to VZV infection. Nine hundred and eighty nine (90.7%) had varicella and 101 (9.3%) herpes zoster. Common complications were secondary bacterial infection (62.1%), neurological complications (3.4%), pneumonia (9.1%) and carditis (1.01%). They were significantly commoner in patients with coexisting diseases. Hospital stay was significantly shorter in patients who received early aciclovir, which was not available on a regular basis. Forty one patients died and mortality was highest in the elderly. The commonest cause of death was pneumonia. CONCLUSIONS Varicella related complications are high in patients with coexisting diseases. Mortality rates are higher than reported elsewhere. Health care facilities available at IDH are quite inadequate, and should be improved.
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Affiliation(s)
- U Welgama
- Infectious Diseases Hospital, Sri Lanka
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Oh WS, Suh JY, Song JH, Ko KS, Jung SI, Peck KR, Lee NY, Yang Y, Chongthaleong A, Chiu CH, Kamarulzaman A, Parasakthi N, Lalitha MK, Perera J, Yee TT, Kumarasinghe G, Carlos CC. Fluoroquinolone Resistance in Clinical Isolates ofStreptococcus pneumoniaefrom Asian Countries: ANSORP Study. Microb Drug Resist 2004; 10:37-42. [PMID: 15140392 DOI: 10.1089/107662904323047781] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Seventeen clinical isolates of Streptococcus pneumoniae showing reduced susceptibility to ciprofloxacin (MIC >/= 4 micro g/ml) collected from eight different Asian countries were analyzed by antimicrobial susceptibility, serotyping, pulsed-field gel electrophoresis (PFGE), and DNA sequencing of the quinolone resistance-determining regions (QRDRs) in gyrA, gyrB, parC, and parE. All isolates but one showed more than one amino acid alteration in QRDRs of four responsible genes. Ile460 --> Val in parE was the most common mutation. Data suggest that Lys137 --> Asn in parC may be a primary step in the development of high-level and multiple FQ resistance. An additional mutation of Ser81 --> Phe in gyrA resulted in high-level resistance to ciprofloxacin, levofloxacin, and gatifloxacin, whereas Ser79 --> Phe in parC may exert an important role in the development of moxifloxacin resistance. Two novel amino acid changes in gyrB, Ala390 --> Val and Asn423 --> Thr, were found. Data from PFGE suggest an introduction and local spread of multiple resistant Spain(23F)-1 clone in Hong Kong, but isolates from other Asian countries were not related to this clone.
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Affiliation(s)
- Won Sup Oh
- Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
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Song JH, Chang HH, Suh JY, Ko KS, Jung SI, Oh WS, Peck KR, Lee NY, Yang Y, Chongthaleong A, Aswapokee N, Chiu CH, Lalitha MK, Perera J, Yee TT, Kumararasinghe G, Jamal F, Kamarulazaman A, Parasakthi N, Van PH, So T, Ng TK. Macrolide resistance and genotypic characterization of Streptococcus pneumoniae in Asian countries: a study of the Asian Network for Surveillance of Resistant Pathogens (ANSORP). J Antimicrob Chemother 2004; 53:457-63. [PMID: 14963068 DOI: 10.1093/jac/dkh118] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To characterize mechanisms of macrolide resistance among Streptococcus pneumoniae from 10 Asian countries during 1998-2001. METHODS Phenotypic and genotypic characterization of the isolates and their resistance mechanisms. RESULTS Of 555 isolates studied, 216 (38.9%) were susceptible, 10 (1.8%) were intermediate and 329 (59.3%) were resistant to erythromycin. Vietnam had the highest prevalence of erythromycin resistance (88.3%), followed by Taiwan (87.2%), Korea (85.1%), Hong Kong (76.5%) and China (75.6%). Ribosomal methylation encoded by erm(B) was the most common mechanism of erythromycin resistance in China, Taiwan, Sri Lanka and Korea. In Hong Kong, Singapore, Thailand and Malaysia, efflux encoded by mef(A) was the more common in erythromycin-resistant isolates. In most Asian countries except Hong Kong, Malaysia and Singapore, erm(B) was found in >50% of pneumococcal isolates either alone or in combination with mef(A). The level of erythromycin resistance among pneumococcal isolates in most Asian countries except Thailand and India was very high with MIC(90)s of >128 mg/L. Molecular epidemiological studies suggest the horizontal transfer of the erm(B) gene and clonal dissemination of resistant strains in the Asian region. CONCLUSION Data confirm that macrolide resistance in pneumococci is a serious problem in many Asian countries.
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Affiliation(s)
- Jae-Hoon Song
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Il-won dong, Kangnam-ku, Seoul 135-710, Korea.
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Corea E, de Silva T, Perera J. Methicillin-resistant Staphylococcus aureus: prevalence, incidence and risk factors associated with colonization in Sri Lanka. J Hosp Infect 2004; 55:145-8. [PMID: 14529641 DOI: 10.1016/s0195-6701(03)00256-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We studied the prevalence of and risk factors for nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) on admission and the incidence and risk factors for nosocomial acquisition of MRSA in a 60 bed, male surgical unit in the National Hospital of Sri Lanka (NHSL). Nasal swab cultures were obtained from 271 patients admitted for routine surgery within 36 h of admission and repeated every other day until discharge. Clinical and epidemiological risk factors for colonization were compared between patients with MRSA at the time of admission or colonized after admission, and patients who were not colonized. MRSA was isolated from 35 patients (12.9%) with 20 (7.4%) colonized on admission and 15 (6%) acquiring MRSA after admission. Hospitalization within the previous year, antibiotic use within the previous two months, and transfer from another ward within the NHSL were associated with colonization with MRSA on admission. Risk factors for nosocomial acquisition of MRSA were the prophylactic and empiric use of antibiotics. The duration of antibiotic use and the duration of stay in hospital were significantly longer in patients who acquired MRSA. MRSA surveillance and control programmes in this unit would be more cost-effective if targeted at patients with these risk factors.
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Affiliation(s)
- E Corea
- Department of Microbiology, Faculty of Medicine, University of Colombo, P.O. Box 275, Kynsey Road, Colombo 8, Sri Lanka.
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Palihawadana P, Wickremasinghe AR, Perera J. Seroprevalence of rubella antibodies among pregnant females in Sri Lanka. Southeast Asian J Trop Med Public Health 2003; 34:398-404. [PMID: 12971571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
The purpose of this study was to determine the seroprevalence of rubella antibodies among pregnant females in the Kalutara District of Sri Lanka, and to identify factors associated with susceptibility to rubella infection among pregnant females. A cross-sectional clinic-based study was conducted among 620 pregnant women attending antenatal clinics and residing in the district for more than one month. Data on the pregnant females and the socio-economic characteristics of the families were obtained using an interviewer-administered structured questionnaire. Three milliliters of blood was obtained to measure rubella-specific IgG antibody levels by ELISA (enzyme linked immunosorbent assay) tests. Overall, 76% of pregnant females were seropositive for rubella antibodies. Seropositivity in pregnant females increased with age. Susceptibility to rubella was significantly associated with rubella immunization status. Given the high susceptibility rate to rubella infection among pregnant females, it is imperative that any vaccination strategy in the short-term should focus on reducing the number of susceptible women of child-bearing age.
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Affiliation(s)
- P Palihawadana
- Epidemiological Unit, Department of Health Services, De Saram Place, Colombo, Sri Lanka
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Abstract
OBJECTIVE To simulate different immunisation programs against rubella and estimate the proportion of the population susceptible to rubella infection of each. METHODS The impact of 3 immunisation schedules on the susceptibility of women of childbearing age and the community to rubella infection was simulated using a probabilistic approach. The first schedule involved selective immunisation of 12-year old girls, the second immunisation of all children at 3 years of age for different immunisation coverages, and the third comprised a combination of the first two. The proportion of different segments of the population currently susceptible to rubella was obtained from a field study conducted in the Kalutara District in 1999. RESULTS An immunisation program of 12-year old girls will reduce the susceptibility to rubella in 5 years in only the 15 to 19 year age group. In 10 years, the susceptibility in both the 15 to 19 and 20 to 24 year age groups will be reduced. Immunisation only of children at 3 years will take 20 years for a reduction in the susceptibility to rubella infection in the 15 to 19 year and the 20 to 24 year age groups, and the proportion of the population susceptible to rubella can be reduced to less than 10% in 20 years if 90% coverage is attained. If a combination of the two strategies i.e. selective immunisation of girls at 12 years for 10 years and immunisation of all children at 3 years is adopted, the proportion of the community susceptible to rubella will be less than 14% in 10 years. CONCLUSIONS The combination of immunising girls at 12 years of age for 10 years and all children at 3 years of age against rubella is recommended for Sri Lanka to reduce the risk of congenital rubella syndrome in the short term and the proportion susceptible to rubella in the community in the long term.
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Affiliation(s)
- P Palihawadana
- Epidemiological Unit, Department of Health Services, De Saram Place, Colombo 10
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Abstract
OBJECTIVE Previous studies have shown that 5% to 15% of healthy people do not show a protective antibody response following hepatitis B vaccination. The study was done to determine the protective efficacy of vaccination in healthy young adults 1 to 4 years after the three dose vaccination series and to study the effect of a booster dose on non-responders and hypo-responders. DESIGN Prospective intervention study. SETTING From January to June 2000, Faculty of Medicine, University of Colombo. STUDY GROUP 258 volunteers from five batches of medical students vaccinated with three doses of the recombinant vaccine at 0, 1 and 6 months. RESULTS 9.5% were non-responders. Duration of vaccination, sex and body mass index were not significantly associated with anti-HBs levels. 28.6% had potential risk factors for acquiring HBV infection. 86.3% of non-responders developed protective anti-HBs titres after a booster dose. The persistent non-responders did not have a chronic illness or past HBV infection. CONCLUSIONS A substantial number do not seroconvert after hepatitis B vaccination. Testing of blood for anti-HBs one month after vaccination is recommended to recognise non-responders as a booster dose will be beneficial in the majority of them.
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Affiliation(s)
- Jennifer Perera
- Department of Microbiology, Faculty of Medicine, University of Colombo
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Lee NY, Song JH, Kim S, Peck KR, Ahn KM, Lee SI, Yang Y, Li J, Chongthaleong A, Tiengrim S, Aswapokee N, Lin TY, Wu JL, Chiu CH, Lalitha MK, Thomas K, Cherian T, Perera J, Yee TT, Jamal F, Warsa UC, Van PH, Carlos CC, Shibl AM, Jacobs MR, Appelbaum PC. Carriage of antibiotic-resistant pneumococci among Asian children: a multinational surveillance by the Asian Network for Surveillance of Resistant Pathogens (ANSORP). Clin Infect Dis 2001; 32:1463-9. [PMID: 11317248 DOI: 10.1086/320165] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2000] [Revised: 10/12/2000] [Indexed: 11/04/2022] Open
Abstract
To investigate the nasal carriage of antibiotic-resistant pneumococci by children, anterior nasal swabs were done for 4963 children <5 years old in 11 countries in Asia and the Middle East. In total, 1105 pneumococci isolates (carriage rate, 22.3%) were collected, 35.8% of which were found to be nonsusceptible to penicillin. Prevalence of penicillin nonsusceptibility was highest in Taiwan (91.3%), followed by Korea (85.8%), Sri Lanka (76.5%), and Vietnam (70.4%). Penicillin resistance was related to residence in urban areas, enrollment in day care, and a history of otitis media. The most common serogroups were 6 (21.5%), 23 (16.5%), and 19 (15.7%). The most common clone, as assessed by pulsed-field gel electrophoresis, was identical to the Spanish 23F clone and to strains of invasive isolates from adult patients. Data in this study documented the high rate of penicillin or multidrug resistance among isolates of pneumococci carried nasally in children in Asia and the Middle East and showed that this is due to the spread of a few predominant clones in the region.
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Affiliation(s)
- N Y Lee
- Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
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Abstract
The whole nucleotide sequence of pT3.2I, the smallest plasmid of the acidophilic bacterium Thiobacillus T3.2, has been determined. pT3.2I is 15,390 bp long with a 53.7% GC content. Different regions can be defined in it: one 2569-bp putative insertion sequence similar to other insertion sequences of some Agrobacterium Ti plasmids; and a longer sequence, which occurs in two almost identical copies, differing only in a 1-bp deletion (6406 and 6405 bp). Several open reading frames and some smaller sequences were found in this duplicated region: ORFA and ORFG, encoding a putative polyol dehydrogenase and a putative RepA replication protein, respectively, an 83-bp sequence which could code for an antisense RNA, and a 36-bp region highly homologous to ori sequences of ColE2- and ColE3-related plasmids. Another putative gene, ORFH, is only present in the longer copy of this region (it is deleted in the short copy) and might encode a 90-amino-acid polypeptide which could act as a second replication protein, RepB. Based on sequence comparisons, pT3. 2I can be related to plasmids in the pColE2-CA42 incB incompatibility group.
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Affiliation(s)
- T Aparicio
- Department of Biochemistry and Molecular Biology, Complutense University of Madrid, Madrid, 28040, Spain
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Perera J. A preliminary study on neonatal septicaemia in a tertiary referral hospital paediatric unit. Ceylon Med J 1999; 44:145-6. [PMID: 10676005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Affiliation(s)
- J Perera
- Asturias Centre, University of Balearic Islands, Spain.
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Perera J, Arachchi DM. The optimum relative centrifugal force and centrifugation time for improved sensitivity of smear and culture for detection of Mycobacterium tuberculosis from sputum. Trans R Soc Trop Med Hyg 1999; 93:405-9. [PMID: 10674089 DOI: 10.1016/s0035-9203(99)90135-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Direct microscopy is the only available method for diagnosis of tuberculosis in most centres in developing countries. Methods to improve the sensitivity of direct smear are an urgent requirement. Sputum specimens artificially seeded with known concentrations of Mycobacterium tuberculosis were liquefied and decontaminated with sodium hydroxide-sodium citrate-N-actyl-L-cysteine solutions. They were subjected to different centrifugation forces and centrifugation times after which the centrifuged deposits were examined by smear and culture. Statistical analysis of results was carried out using EpiInfo version 6.0. The optimum relative centrifugal force (RCF) and centrifugation time combination was 4000 g for 15 min. The sensitivity of detection at an RCF of 4000 g for 15 min was 5000 organisms/mL and 500 organisms/mL for smear and culture, respectively. When results of 163 clinical samples were analyzed after centrifugation at 4000 g for 15 min sensitivity of the direct smear improved from 63% to 92% (P < 0.05) and negative predictive value from 30.5% to 45% (P < 0.05) when culture was considered the 'gold standard'. With the concentrated smear there was a reduction in specificity from 82% to 60% (P > 0.05). As most laboratories are equipped with a simple centrifuge, smear sensitivity can be improved with this simple modification. The other advantage is that the same centrifuged deposit can be cultured, in contrast to when sodium hypochlorite is used for liquefaction.
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Affiliation(s)
- J Perera
- Department of Microbiology, Faculty of Medicine, Colombo, Sri Lanka
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