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2.
Sci Rep ; 11(1): 2062, 2021 01 21.
Artículo en Inglés | MEDLINE | ID: mdl-33479465

RESUMEN

In order to support vaccine development, and to aid convalescent plasma therapy, it would be important to understand the kinetics, timing and persistence of SARS-CoV-2 neutralizing antibodies (NAbs), and their association with clinical disease severity. Therefore, we used a surrogate viral neutralization test to evaluate their levels in patients with varying severity of illness, in those with prolonged shedding and those with mild/asymptomatic illness at various time points. Patients with severe or moderate COVID-19 illness had earlier appearance of NAbs at higher levels compared to those with mild or asymptomatic illness. Furthermore, those who had prolonged shedding of the virus, had NAbs appearing faster and at higher levels than those who cleared the virus earlier. During the first week of illness the NAb levels of those with mild illness was significantly less (p = 0.01), compared to those with moderate and severe illness. At the end of 4 weeks (28 days), although 89% had NAbs, 38/76 (50%) in those with > 90 days had a negative result for the presence of NAbs. The Ab levels significantly declined during convalescence (> 90 days since onset of illness), compared to 4 to 8 weeks since onset of illness. Our data show that high levels of NAbs during early illness associated with clinical disease severity and that these antibodies declined in 50% of individuals after 3 months since onset of illness.


Asunto(s)
Anticuerpos Neutralizantes/inmunología , /inmunología , Inmunidad Adaptativa/inmunología , Adulto , Anticuerpos Neutralizantes/análisis , Anticuerpos Antivirales/inmunología , /terapia , Convalecencia , Femenino , Humanos , Inmunización Pasiva/métodos , Masculino , Persona de Mediana Edad , Pruebas de Neutralización/métodos , Índice de Severidad de la Enfermedad , Sri Lanka/epidemiología
3.
BMC Infect Dis ; 21(1): 97, 2021 Jan 21.
Artículo en Inglés | MEDLINE | ID: mdl-33478430

RESUMEN

BACKGROUND: Inappropriate antibiotic use is linked to the spread of antimicrobial resistance worldwide, but there are limited systemic data on antibiotic utilization in low- and middle-income countries. The purpose of this study was to evaluate the prevalence and patterns of antibiotic prescription in an ambulatory care setting in Sri Lanka. METHODS: This cross-sectional survey was conducted at the Outpatient Department of a public tertiary medical center in Southern Province, Sri Lanka from February to April 2019. Among consecutive outpatients presenting for care, questionnaires were verbally administered to a systematic random sample to capture information about patient demographics, illness characteristics, and visit outcomes. Prescription data were obtained from the outpatient pharmacy's electronic prescribing system. RESULTS: Of 409 surveyed patients, 146 (35.7%) were prescribed an antibiotic. The most frequently prescribed agents were amoxicillin (41 patients, 28.1% of antibiotic recipients) and first-generation cephalosporins (38, 26.0%). Respiratory indications were the most common reason for antibiotic use, comprising 69 (47.3%) of all antibiotic prescriptions. Antibiotics were prescribed for 66.1% of patients presenting with cough and 78.8% of those presenting with rhinorrhea or nasal congestion. Among all antibiotic recipients, 6 (4.1%) underwent diagnostic studies. CONCLUSIONS: A high prevalence of antibiotic prescription was observed, in particular for treatment of respiratory conditions. These data support the need for improved antimicrobial stewardship in the Sri Lankan outpatient setting.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Antibacterianos/uso terapéutico , Prescripciones/estadística & datos numéricos , Enfermedades Respiratorias/tratamiento farmacológico , Adolescente , Adulto , Programas de Optimización del Uso de los Antimicrobianos , Niño , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Pautas de la Práctica en Medicina , Prevalencia , Enfermedades Respiratorias/diagnóstico , Enfermedades Respiratorias/epidemiología , Sri Lanka/epidemiología , Centros de Atención Terciaria , Adulto Joven
4.
Bull World Health Organ ; 98(11): 731-732, 2020 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-33177768

RESUMEN

The novel coronavirus pandemic is increasing demand for digital health in primary care delivery, highlighting the progress being made and the challenges still faced. Gary Humphreys reports.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Líneas Directas/organización & administración , Neumonía Viral/epidemiología , Telemedicina/organización & administración , Betacoronavirus , Humanos , Aplicaciones Móviles , Pandemias , Sri Lanka/epidemiología
5.
Malar J ; 19(1): 386, 2020 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-33138814

RESUMEN

The COVID-19 pandemic has had a considerable impact on other health programmes in countries, including on malaria, and is currently under much discussion. As many countries are accelerating efforts to eliminate malaria or to prevent the re-establishment of malaria from recently eliminated countries, the COVID-19 pandemic has the potential to cause major interruptions to ongoing anti-malaria operations and risk jeopardizing the gains that have been made so far. Sri Lanka, having eliminated malaria in 2012, was certified by the World Health Organization as a malaria-free country in 2016 and now implements a rigorous programme to prevent its re-establishment owing to the high receptivity and vulnerability of the country to malaria. Sri Lanka has also dealt with the COVID-19 epidemic quite successfully limiting the cumulative number of infections and deaths through co-ordinated efforts between the health sector and other relevant sectors, namely the military, the Police Department, Departments of Airport and Aviation and Foreign Affairs, all of which have been deployed for the COVID-19 epidemic under the umbrella of a Presidential Task Force. The relevance of imported infections and the need for a multi-sectoral response are features common to both the control of the COVID-19 epidemic and the Prevention of Re-establishment (POR) programme for malaria. Sri Lanka's malaria POR programme has, therefore, creatively integrated its activities with those of the COVID-19 control programme. Through highly coordinated operations the return to the country of Sri Lankan nationals stranded overseas by the COVID-19 pandemic, many from malaria endemic countries, are being monitored for malaria as well as COVID-19 in an integrated case surveillance system under quarantine conditions, to the success of both programmes. Twenty-three imported malaria cases were detected from February to October through 2773 microscopic blood examinations performed for malaria in quarantine centres, this number being not much different to the incidence of imported malaria during the same period last year. This experience highlights the importance of integrated case surveillance and the need for a highly coordinated multi-sectoral approach in dealing with emerging new infections. It also suggests that synergies between the COVID-19 epidemic control programme and other health programmes may be found and developed to the advantage of both.


Asunto(s)
Enfermedades Transmisibles Emergentes/prevención & control , Enfermedades Transmisibles Importadas/prevención & control , Infecciones por Coronavirus/complicaciones , Malaria/prevención & control , Pandemias , Neumonía Viral/complicaciones , Enfermedades Transmisibles Emergentes/complicaciones , Enfermedades Transmisibles Emergentes/epidemiología , Enfermedades Transmisibles Importadas/complicaciones , Enfermedades Transmisibles Importadas/epidemiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Humanos , Malaria/complicaciones , Malaria/epidemiología , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Cuarentena , Sri Lanka/epidemiología , Viaje , Enfermedad Relacionada con los Viajes
6.
PLoS One ; 15(10): e0238609, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33112881

RESUMEN

INTRODUCTION: Although immune responses to the Japanese Encephalitis virus (JEV), and the dengue viruses (DENV) have a potential to modulate the immune responses to each other, this has been poorly investigated. Therefore, we developed an ELISA to identify JEV specific, DENV non cross-reactive antibody responses by identifying JEV specific, highly conserved regions of the virus and proceeded to investigate if the presence of JEV specific antibodies associate with dengue disease severity. METHODOLOGY AND RESULTS: 22 JEV specific peptides were identified from highly conserved regions of the virus and the immunogenicity and specificity of these peptides were assessed in individuals who were non-immune to JEV and DENV (JEV-DENV-, N = 30), those who were only immune to the JEV and not DENV (JEV+DENV-, N = 30), those who were only immune to DENV(JEV-DENV+, N = 30) and in those who were immune to both viruses (JEV+DENV+, N = 30). 7/22 peptides were found to be highly immunogenic and specific and these 7 peptides were used as a pool to further evaluate JEV-specific responses. All 30/30 JEV+DENV- and 30/30 JEV+DENV+ individuals, and only 3/30 (10%) JEV-DENV+ individuals responded to this pool. We further evaluated this pool of 7 peptides in patients following primary and secondary dengue infection during the convalescent period and found that the JEV-specific peptides, were unlikely to cross react with DENV IgG antibodies. We further compared this in-house ELISA developed with the peptide pool with an existing commercial JEV IgG assay to identify JEV-specific IgG following vaccination, and our in-house ELISA was found to be more sensitive. We then proceeded to investigate if the presence of JEV-specific antibodies were associated with dengue disease severity, and we found that those who had past severe dengue (n = 175) were significantly more likely (p<0.0001) to have JEV-specific antibodies than those with past non-severe dengue (n = 175) (OR 5.3, 95% CI 3.3 to 8.3). CONCLUSIONS: As our data show that this assay is highly sensitive and specific for detection of JEV-specific antibody responses, it would be an important tool to determine how JEV seropositivity modulate dengue immunity and disease severity when undertaking dengue vaccine trials.


Asunto(s)
Anticuerpos Antivirales/sangre , Virus de la Encefalitis Japonesa (Especie)/inmunología , Ensayo de Inmunoadsorción Enzimática/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Secuencia de Aminoácidos , Especificidad de Anticuerpos , Niño , Secuencia Conservada , Reacciones Cruzadas , Dengue/inmunología , Dengue/virología , Virus del Dengue/clasificación , Virus del Dengue/genética , Virus del Dengue/inmunología , Virus de la Encefalitis Japonesa (Especie)/genética , Encefalitis Japonesa/epidemiología , Encefalitis Japonesa/inmunología , Encefalitis Japonesa/virología , Ensayo de Inmunoadsorción Enzimática/estadística & datos numéricos , Femenino , Voluntarios Sanos , Humanos , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos/genética , Fragmentos de Péptidos/inmunología , Sensibilidad y Especificidad , Estudios Seroepidemiológicos , Serogrupo , Sri Lanka/epidemiología , Vacunación , Proteínas Virales/genética , Proteínas Virales/inmunología , Adulto Joven
7.
PLoS One ; 15(10): e0239576, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33113548

RESUMEN

In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the differences in the level of income and expenditure between chronically-ill people and non-chronic population. Data were gathered from a national level survey conducted namely, the Household Income and Expenditure Survey (HIES) by the Department of Census and Statistics (DCS) of Sri Lanka. These data were statistically analysed with one-way and two-way ANOVA, to identify the factors that cause the differences among different groups. For the first time, this study makes an attempt using survey data, to examine the differences in the level of income and expenditure among chronically-ill people in Sri Lanka. Accordingly, the study discovered that married females who do not engage in any type of economic activity (being unemployed due to the disability associated with the respective chronic illness), in the age category of 40-65, having an educational level of tertiary education or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. If workforce population is compelled to lose jobs, it can lead to income insecurity and impair their quality of lives. Under above findings, it is reasonable to assume that most health care expenses are out of pocket. Furthermore, the study infers that chronic illnesses have a statistically proven significant differences towards the income and expenditure level. This has caused due to the interaction of demographic and socio-economic characteristics associated with chronic illnesses. Considering private-public sector partnerships that enable affordable access to health care services for all as well as implementation of commercial insurance and community-based mutual services that help ease burden to the public, are vital when formulating effective policies and strategies related to the healthcare sector. Sri Lanka is making strong efforts to support its healthcare sector and public, which was affected by the coronavirus (COVID-19) in early 2020. Therefore, findings of this paper will be useful to gain insights on the differences of chronic illnesses towards the income and expenditure of chronically-ill patients in Sri Lanka.


Asunto(s)
Betacoronavirus , Enfermedad Crónica/epidemiología , Infecciones por Coronavirus/epidemiología , Gastos en Salud/estadística & datos numéricos , Renta/estadística & datos numéricos , Pandemias , Neumonía Viral/epidemiología , Adolescente , Adulto , Anciano , Análisis de Varianza , Niño , Preescolar , Enfermedad Crónica/economía , Comorbilidad , Infecciones por Coronavirus/economía , Países en Desarrollo/economía , Personas con Discapacidad/estadística & datos numéricos , Grupos Étnicos/estadística & datos numéricos , Composición Familiar , Femenino , Alimentos/economía , Humanos , Lactante , Recién Nacido , Masculino , Indigencia Médica/estadística & datos numéricos , Persona de Mediana Edad , Pandemias/economía , Neumonía Viral/economía , Pobreza , Factores Socioeconómicos , Sri Lanka/epidemiología , Encuestas y Cuestionarios , Adulto Joven
8.
Virol J ; 17(1): 144, 2020 10 07.
Artículo en Inglés | MEDLINE | ID: mdl-33028382

RESUMEN

BACKGROUND: The basic reproduction number (R0) is the number of cases directly caused by an infected individual throughout his infectious period. R0 is used to determine the ability of a disease to spread within a given population. The reproduction number (R) represents the transmissibility of a disease. OBJECTIVES: We aimed to calculate the R0 of Coronavirus disease-2019 (COVID-19) in Sri Lanka and to describe the variation of R, with its implications to the prevention and control of the disease. METHODS: Data was obtained from daily situation reports of the Epidemiology Unit, Sri Lanka and a compartmental model was used to calculate the R0 using estimated model parameters. This value was corroborated by using two more methods, the exponential growth rate method and maximum likelihood method to obtain a better estimate for R0. The variation of R was illustrated using a Bayesian statistical inference-based method. RESULTS: The R0 calculated by the first model was 1.02 [confidence interval (CI) of 0.75-1.29] with a root mean squared error of 7.72. The exponential growth rate method and the maximum likelihood estimation method yielded an R0 of 0.93 (CI of 0.77-1.10) and a R0 of 1.23 (CI of 0.94-1.57) respectively. The variation of R ranged from 0.69 to 2.20. CONCLUSION: The estimated R0 for COVID-19 in Sri Lanka, calculated by three different methods, falls between 0.93 and 1.23, and the transmissibility R has reduced, indicating that measures implemented have achieved a good control of disease.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Número Básico de Reproducción , Teorema de Bayes , Betacoronavirus/aislamiento & purificación , Humanos , Pandemias , Sri Lanka/epidemiología
9.
Comput Math Methods Med ; 2020: 4045064, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33101453

RESUMEN

The ongoing COVID-19 outbreak that originated in the city of Wuhan, China, has caused a significant damage to the world population and the global economy. It has claimed more than 0.8 million lives worldwide, and more than 27 million people have been infected as of 07th September 2020. In Sri Lanka, the first case of COVID-19 was reported late January 2020 which was a Chinese national and the first local case was identified in the second week of March. Since then, the government of Sri Lanka introduced various sequential measures to improve social distancing such as closure of schools and education institutes, introducing work from home model to reduce the public gathering, introducing travel bans to international arrivals, and more drastically, imposed island wide curfew expecting to minimize the burden of the disease to the Sri Lankan health system and the entire community. Currently, there are 3123 cases with 12 fatalities and also, it was reported that 2925 patients have recovered and are discharged from hospitals, according to the Ministry of Health, Sri Lanka. In this study, we use the SEIR conceptual model and its modified version by decomposing infected patients into two classes: patients who show mild symptoms and patients who tend to face severe respiratory problems and are required to be treated in intensive care units. We numerically simulate the models for about a five-month period reflecting the early stage of the epidemic in the country, considering three critical parameters of COVID-19 transmission mainly in the Sri Lankan context: efficacy of control measures, rate of overseas imported cases, and time to introduce social distancing measures by the respective authorities.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Biología Computacional , Simulación por Computador , Infecciones por Coronavirus/transmisión , Humanos , Conceptos Matemáticos , Modelos Biológicos , Pandemias/estadística & datos numéricos , Neumonía Viral/transmisión , Sri Lanka/epidemiología , Factores de Tiempo
10.
Comput Math Methods Med ; 2020: 6397063, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33101454

RESUMEN

The COVID-19 pandemic has resulted in increasing number of infections and deaths every day. Lack of specialized treatments for the disease demands preventive measures based on statistical/mathematical models. The analysis of epidemiological curve fitting, on number of daily infections across affected countries, provides useful insights on the characteristics of the epidemic. A variety of phenomenological models are available to capture the dynamics of disease spread and growth. The number of daily new infections and cumulative number of infections in COVID-19 over four selected countries, namely, Sri Lanka, Italy, the United States, and Hebei province of China, from the first day of appearance of cases to 2nd July 2020 were used in the study. Gompertz, logistic, Weibull, and exponential growth curves were fitted on the cumulative number of infections across countries. AIC, BIC, RMSE, and R 2 were used to determine the best fitting curve for each country. Results revealed that the most appropriate growth curves for Sri Lanka, Italy, the United States, and China (Hebei) are the logistic, Gompertz, Weibull, and Gompertz curves, respectively. Country-wise, overall growth rate, final epidemic size, and short-term forecasts were evaluated using the selected model. Daily log incidences in each country were regressed before and after the identified peak time of the respective outbreak of epidemic. Hence, doubling time/halving time together with daily growth rates and predictions was estimated. Findings and relevant interpretations demonstrate that the outbreak seems to be extinct in Hebei, China, whereas further transmissions are possible in the United States. In Italy and Sri Lanka, current outbreaks transmit in a decreasing rate.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Modelos Estadísticos , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , China/epidemiología , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/estadística & datos numéricos , Biología Computacional , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Epidemias/prevención & control , Epidemias/estadística & datos numéricos , Predicción , Humanos , Incidencia , Italia/epidemiología , Modelos Logísticos , Conceptos Matemáticos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Sri Lanka/epidemiología , Factores de Tiempo , Estados Unidos/epidemiología
11.
BMC Infect Dis ; 20(1): 649, 2020 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-32883213

RESUMEN

BACKGROUND: More than 80,000 dengue cases including 215 deaths were reported nationally in less than 7 months between 2016 and 2017, a fourfold increase in the number of reported cases compared to the average number over 2010-2016. The region of Negombo, located in the Western province, experienced the greatest number of dengue cases in the country and is the focus area of our study, where we aim to capture the spatial-temporal dynamics of dengue transmission. METHODS: We present a statistical modeling framework to evaluate the spatial-temporal dynamics of the 2016-2017 dengue outbreak in the Negombo region of Sri Lanka as a function of human mobility, land-use, and climate patterns. The analysis was conducted at a 1 km × 1 km spatial resolution and a weekly temporal resolution. RESULTS: Our results indicate human mobility to be a stronger indicator for local outbreak clusters than land-use or climate variables. The minimum daily temperature was identified as the most influential climate variable on dengue cases in the region; while among the set of land-use patterns considered, urban areas were found to be most prone to dengue outbreak, followed by areas with stagnant water and then coastal areas. The results are shown to be robust across spatial resolutions. CONCLUSIONS: Our study highlights the potential value of using travel data to target vector control within a region. In addition to illustrating the relative relationship between various potential risk factors for dengue outbreaks, the results of our study can be used to inform where and when new cases of dengue are likely to occur within a region, and thus help more effectively and innovatively, plan for disease surveillance and vector control.


Asunto(s)
Dengue/epidemiología , Clima , Brotes de Enfermedades , Humanos , Modelos Estadísticos , Factores de Riesgo , Sri Lanka/epidemiología , Temperatura , Viaje
12.
Toxicon ; 187: 105-110, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32891665

RESUMEN

Reporting of snakebite is poor in areas where they are most common. Comparatively, bites by snakes of high medical importance are likely to be documented than snakes of lesser medical importance. This study aims to describe the demographic, epidemiological and, clinical data of patients who were presented during a 49-month study period to a tertiary care center in rural Sri Lanka following authenticated bites by snakes of lesser medical importance. Of the total of 2362 confirmed snakebite patients during the study period, 517 (22%) presented with the offending snake specimen. Of them, 76 (15%) were identified as snakes of lesser medical importance and were included in this study. There were 41 (54%) females. The median ages of females and males were 35 and 43 years respectively. Most patients (86%) were bitten indoors or at home gardens. More than half of them were bitten between 1800 and 0000 h. Most bites (54%) had occurred to the ankle or below. The patients were bitten by 12 species of colubrids, one pythonid (Python molurus), and one viperid (Trimeresurus trigonocephalus). The snake species that caused the most-number of bites was the Trinket snake (Coelognathus helena) (n = 15). Three species of wolf-snakes, Lycodon aulicus, L. anamallensis, and L. striatus were responsible for 12, 11, and 5 bites respectively. Most of the patients (55%) presented to the local hospital and subsequently transferred to the study hospital for further management. None of the patients developed systemic envenoming and five developed mild local pain and swelling. Fifty-six (74%) patients were discharged on the following day, while 18 (24%) were discharged on the third day. There is a need to educate medical personnel working the peripheral hospital on how to identify medically lesser important snakes to avoid unnecessary transfers.


Asunto(s)
Mordeduras de Serpientes/epidemiología , Adulto , Animales , Antivenenos , Estudios de Cohortes , Colubridae , Edema , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor , Venenos de Serpiente , Serpientes , Sri Lanka/epidemiología , Trimeresurus , Adulto Joven
13.
PLoS One ; 15(8): e0238340, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32853295

RESUMEN

BACKGROUND: Sri Lanka diagnosed its first local case of COVID-19 on 11 March 2020. The government acted swiftly to contain transmission, with extensive public health measures. At the end of 30 days, Sri Lanka had 197 cases, 54 recovered and 7 deaths; a staged relaxing of the lockdown is now underway. This paper proposes a theoretical basis for estimating the limits within which transmission should be constrained in order to ensure that the case load remains within the capacity of Sri Lanka's health system. METHODS: We used the Susceptible, Infected, Recovered (SIR) model to explore the number of new infections and estimate ICU bed requirement at different levels of R0 values after lifting lockdown restrictions. We developed a web-based application that enables visualization of cases and ICU bed requirements with time, with adjustable parameters that include: population at risk; number of identified and recovered cases; percentage identified; infectious period; R0 or doubling time; percentage critically ill; available ICU beds; duration of ICU stay; and uncertainty of projection. RESULTS: The three-day moving average of the caseload suggested two waves of transmission from Day 0 to 17 (R0 = 3.32, 95% CI 1.85-5.41) and from Day 18-30 (R = 1.25, 95%CI: 0.93-1.63). We estimate that if there are 156 active cases with 91 recovered at the time of lifting lockdown restrictions, and R increases to 1.5 (doubling time 19 days), under the standard parameters for Sri Lanka, the ICU bed capacity of 300 is likely to be saturated by about 100 days, signaled by 18 new infections (95% CI 15-22) on Day 14 after lifting lockdown restrictions. CONCLUSION: Our model suggests that to ensure that the case load remains within the available capacity of the health system after lifting lockdown restrictions, transmission should not exceed R = 1.5. This model and the web-based application may be useful in other low and middle income countries which have similar constraints on health resources.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Toma de Decisiones , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Betacoronavirus , Control de Enfermedades Transmisibles/métodos , Humanos , Internet , Modelos Teóricos , Salud Pública , Programas Informáticos , Sri Lanka/epidemiología
14.
PLoS Negl Trop Dis ; 14(8): e0008573, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32841248

RESUMEN

BACKGROUND: Leptospirosis has gained much attention in Sri Lanka since its large outbreak in 2008. However, most of the cases were clinically diagnosed and information on Leptospira genotypes and serotypes currently prevailing in the country is lacking. METHODOLOGY/PRINCIPAL FINDINGS: We retrospectively analyzed 24 Leptospira strains from human patients as well as isolated and characterized three Leptospira strains from black rats using the microscopic agglutination test with antisera for 19 serovars and multilocus sequence typing. The isolates were identified as Leptospira borgpetersenii sequence types (STs) 143 and 144; L. interrogans STs 30, 34, 43, 44, 74, 75, 80, 308, 313, 314, 316, and 317; and L. kirschneri ST318. Six of the 15 STs were identified for the first time in this study. Five serogroups such as Autumnalis, Grippotyphosa, Hebdomadis, Javanica, and Pyrogenes were detected among the isolates. Contrary to previous studies, various genotypes including novel STs were isolated during an outbreak in Southern Province. L. borgpetersenii serogroup Javanica ST143 was isolated both from a human and black rat. CONCLUSIONS/SIGNIFICANCE: This study revealed that genetically diverse Leptospira strains currently circulate in Sri Lanka: some genotypes have been circulating and others have emerged recently, which may explain the recent surge of leptospirosis patients with varying clinical manifestations and frequent outbreaks of leptospirosis. Black rats were identified as the source of infection for humans, but reservoir animals for other genotypes remain unknown.


Asunto(s)
Genotipo , Leptospira/clasificación , Leptospira/genética , Leptospira/aislamiento & purificación , Leptospirosis/microbiología , Tipificación de Secuencias Multilocus/métodos , Adolescente , Adulto , Anciano , Pruebas de Aglutinación , Animales , Niño , ADN Bacteriano/análisis , Reservorios de Enfermedades , Femenino , Humanos , Leptospirosis/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Secuencia de ADN , Serogrupo , Serotipificación , Sri Lanka/epidemiología , Adulto Joven
15.
Am Surg ; 86(6): 591-595, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32683969

RESUMEN

An informal workgroup of 9 hepatopancreaticobiliary (HPB) surgeons from 6 different countries on 4 continents shifted the focus of their quarterly tumor board discussions to their responses to the current COVID-19 pandemic. Just as they had discussing HPB cases, they share their experiences and ideas in dealing with the outbreak that faced their hospitals and communities. Their efforts to improve care proved that professionalism in surgery, like the global pandemic, has no boundaries.


Asunto(s)
Infecciones por Coronavirus/terapia , Pandemias , Rol del Médico , Neumonía Viral/terapia , Cirujanos , Australia/epidemiología , Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Cuidados Críticos , Procedimientos Quirúrgicos Electivos , Inglaterra/epidemiología , Gastroenterología , Humanos , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Mianmar/epidemiología , Nepal/epidemiología , Equipo de Protección Personal , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Aislamiento Social , Sri Lanka/epidemiología , Texas/epidemiología
16.
J Pregnancy ; 2020: 4926702, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32685213

RESUMEN

Background: Mental illness related to pregnancy can have long-lasting consequences. Healthcare providers are often the most frequent medical contact with the potential for early detection of these. Objectives were to study the awareness regarding mental health problems during pregnancy and the postpartum period among healthcare providers. Methods: A cross-sectional study was carried out with healthcare providers including the nursing staff, midwifery staff, and medical officers working at obstetric wards in three tertiary care hospitals in Sri Lanka. A self-administered questionnaire assessed staff experience with mothers having mental problems, knowledge on mental health problems related to pregnancy, and knowledge about risk factors, common symptoms, and possible consequences on a five-point Likert scale from "Strongly Agree" to "Strongly Disagree." Results: A total of 300 staff were approached and invited to participate. Only 152 responded to the questionnaire (response rate of 50.1%). Mean (SD) age was 35.8 (9.7) years and mean (SD) years of experience was 10.1 (9.1) years. Age more than 35 years of healthcare providers is associated with statistically significant (p = 0.02) average knowledge scores on the consequences of maternal mental health problems. The symptom of "excessively worrying about baby's health" had the lowest score across all three categories with an average of 34.2%. Only 42.8% have ever heard of EPDS. Overall awareness and knowledge about risk factors, symptoms, and consequences regarding pregnancy-related maternal mental health problems are generally good among the healthcare providers studied. However, some of the few aspects are not satisfactory. Health education of pregnant women, promoting regular in-service training sessions, improvement of infrastructure, and involvement of family members from the antenatal period were discussed by the majority. Conclusion: Despite good overall awareness and knowledge, application into practice with the utilization of validated assessments is poor. This may probably explain why Sri Lanka has a high prevalence of postpartum depression suggesting urgent attention.


Asunto(s)
Concienciación , Depresión Posparto , Personal de Salud/psicología , Conocimiento , Trastornos Mentales , Complicaciones del Embarazo , Adulto , Factores de Edad , Estudios Transversales , Depresión Posparto/epidemiología , Femenino , Humanos , Masculino , Embarazo , Factores de Riesgo , Sri Lanka/epidemiología , Encuestas y Cuestionarios
17.
Sci Total Environ ; 745: 140716, 2020 Nov 25.
Artículo en Inglés | MEDLINE | ID: mdl-32731063

RESUMEN

Community-based reverse osmosis (RO) water treatment plants are employed as an interim solution for producing safe drinking water for the endemic areas of Chronic Kidney Disease of Unknown Etiology (CKDu) in the rural dry zone of Sri Lanka. It is recognized that RO-treated groundwater diminishes the progression of CKDu; thus, proper maintenance of these RO plants would be indispensable to protect public health. The present study broadly investigated the quality of groundwater in CKDu-endemic areas, and the performance, operations, and maintenance of the RO plants which purified this groundwater. The feedwater (i.e., groundwater) and treated water from 32 RO plants in Anuradhapura District, comprising 27 in the CKDu high-risk (HR) region and 5 in the low-risk (LR) region, were analyzed for major chemical and biological water quality parameters. Alkalinity, hardness, and microbiological parameters in groundwaters exceeded the maximum allowable levels (MALs) for drinking in all study areas. Additionally, TDS and magnesium exceeded the MALs, exclusively in the HR areas. Elevated occurrence of magnesium-predominant hardness and ionicity in groundwater showed significant relations with the incidence of CKDu. All RO plants achieved high removal rates (>95%) for excessive chemical constituents in groundwater, but the recovery rates were fairly low (~46%). The current disinfection practices in RO plants were insufficient to ensure the microbial safety of the product water. Low demand for product water, scarcity of groundwater, lack of technical capacity of the local communities, poor maintenance practices and unplanned brine removal were the key issues related to RO plant O&M. Unless properly handled, the lack of rules and regulations for RO water treatment in the CKDu-endemic region could lead to numerous environmental and public health issues in the future.


Asunto(s)
Agua Potable/análisis , Agua Subterránea , Insuficiencia Renal Crónica/epidemiología , Purificación del Agua , Humanos , Ósmosis , Sri Lanka/epidemiología
18.
Sci Total Environ ; 745: 140896, 2020 Nov 25.
Artículo en Inglés | MEDLINE | ID: mdl-32731068

RESUMEN

Chronic Kidney Disease of unknown aetiology (CKDu) is a major public health concern in dry climatic, agricultural regions of Sri Lanka. The chemistry of groundwater (the main source of drinking water) in the area has been studied extensively, in relation to the occurrence of CKDu. This paper investigates water quality studies published in CKDu affected areas of Sri Lanka and also presents a new data set of 27 hydrochemical and isotopic samples collected from groundwater wells in selected CKDu endemic areas in Sri Lanka. The study outcomes do not provide evidence of pollutants such as heavy metals in groundwater. However, the study identifies elevated concentrations of silica which requires further investigation. Two groups of groundwater have been identified based on the isotopic results suggesting different sources or origins. The available water quality data, including the data from this study, is not sufficient to answer questions on whether the chemistry of groundwater is related to the CKDu occurrence. However, this study identifies the importance of detailed investigation into degradation products of agrochemicals, the organic matter content and the influence of elevate silica concentration in groundwater. The study also provides research directions in the form of isotopic tracers and the frequency of sampling that is needed to capture potential pollutants in future groundwater quality studies in CKDu endemic areas in Sri Lanka.


Asunto(s)
Agua Subterránea , Insuficiencia Renal Crónica/epidemiología , Humanos , Isótopos , Sri Lanka/epidemiología , Calidad del Agua
19.
PLoS Negl Trop Dis ; 14(7): e0008437, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32701971

RESUMEN

BACKGROUND: Leptospirosis is one of the most significant zoonoses across the world not only because of its impact on human and animal health but also because of the economic and social impact on agrarian communities. Leptospirosis is endemic in Sri Lanka where paddy farming activities, the use of draught animals in agriculture, and peridomestic animals in urban and rural areas play important roles in maintaining the infection cycle of pathogenic Leptospira, especially concerning animals as a potential reservoir. In this study, an environmental DNA (eDNA) metabarcoding methodology was applied in two different agro-ecological regions of Sri Lanka to understand the eco-epidemiology of leptospirosis. METHODOLOGY/PRINCIPAL FINDINGS: Irrigation water samples were collected in Kandy District (wet zone mid-country region 2) and Girandurukotte, Badulla District (intermediate zone low-country region 2); and analysed for the presence of pathogenic Leptospira, associated microbiome and the potential reservoir animals. Briefly, we generated PCR products for high-throughput sequencing of multiple amplicons through next-generation sequencing. The analysis of eDNA showed different environmental microbiomes in both regions and a higher diversity of Leptospira species circulating in Kandy than in Girandurukotte. Moreover, the number of sequence reads of pathogenic Leptospira species associated with clinical cases such as L. interrogans was higher in Kandy than in Girandurukotte. Kandy also showed more animal species associated with pathogenic bacterial species than Girandurukotte. Finally, several pathogenic bacterial species including Arcobacter cryaerophilus, responsible for abortion in animals, was shown to be associated with pathogenic Leptospira. CONCLUSIONS/SIGNIFICANCE: Leptospirosis has been considered to be endemic in wet regions, consistently, leptospiral sequences were detected strongly in Kandy. The great Leptospira species diversity in Kandy observed in this study shows that the etiological agents of leptospirosis in Sri Lanka might be underestimated. Furthermore, our eDNA metabarcoding can be used to discriminate bacterial and animal species diversity in different regions and to explore environmental microbiomes to identify other associated bacterial pathogens in the environment.


Asunto(s)
Agua Dulce/microbiología , Leptospira/aislamiento & purificación , Leptospirosis/epidemiología , Leptospirosis/microbiología , Riego Agrícola , Animales , ADN Bacteriano/genética , ADN Ambiental/genética , Humanos , Leptospira/clasificación , Leptospira/genética , Filogenia , Sri Lanka/epidemiología , Zoonosis/microbiología , Zoonosis/transmisión
20.
Chemosphere ; 257: 127186, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32516669

RESUMEN

Fluoride is an element that is widely distributed in the environment. The involvement of fluoride in pathogenesis of Chronic Kidney Disease of uncertain aetiology (CKDu) in Sri Lanka is a much-debated topic. This study aimed to investigate the fluoride concentration in drinking water in CKDu affected areas in Sri Lanka and to evaluate the possible effect of renal impairment on serum fluoride levels in CKDu patients. Drinking water (n = 60) from the common water sources from two CKDu prevalent areas and serum samples of CKDu patients (n = 311) and healthy controls (n = 276) were collected. Both environmental and biological samples were analysed for the concentration of fluoride. The fluoride concentration in over 95% of drinking water samples was below the WHO guideline of 1.5 mg/L. Serum fluoride concentrations in majority of the unaffected and early-stage CKDu patients (stages 1 and 2, eGFR >60 ml/min/1.73m2) were below the normal upper concentration of 50 µg/l and significantly higher levels were observed in patients in late stages of CKDu compared to the healthy controls. The available guidelines for drinking water are solely based on healthy populations with normal renal function. But, it is evident that once the kidney function is impaired, patients enter a vicious cycle as fluoride gradually accumulates in the body, further damaging the kidney tissue. Thus, close monitoring of serum fluoride levels in CKDu patients and establishing health-based target guidelines for fluoride in drinking water for the CKDu patients are recommended to impede the progression to end stage renal disease.


Asunto(s)
Exposición a Riesgos Ambientales/estadística & datos numéricos , Fluoruros/metabolismo , Insuficiencia Renal Crónica/epidemiología , Contaminantes Químicos del Agua/metabolismo , Femenino , Fluoruros/análisis , Tasa de Filtración Glomerular , Humanos , Masculino , Persona de Mediana Edad , Minerales/análisis , Sri Lanka/epidemiología , Incertidumbre , Agua/análisis , Contaminantes Químicos del Agua/análisis
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