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Biomedical subjects

R Premaratna

Publications and source records attributed to R Premaratna.

8 recordsLinked to original sources
PubMed2006

Modified Dermatology Life Quality Index as a measure of quality of life in patients with filarial lymphoedema.

The quality of life (QoL) and correlates of the QoL of lymphoedema patients attending filariasis clinics and a hospital outpatient department were studied using a Life Quality Index (LQI) in a region endemic for Bancroftian filariasis in Sri Lanka. The index was derived by modifying a previously validated Dermatology Life Quality Index (DLQI) to focus on the oedematous limb rather than the skin. The index was scored from 0 (normal) to 30 (severely affects QoL). Lymphoedema was graded using criteria recommended by the WHO. Another semi-structured questionnaire was used to assess the patient's socioeconomic status, frequency of acute adenolymphangitis attacks (ADLA) and measures practiced for morbidity control. Ninety-one patients (62 females, 29 males; mean age 50.4 years) were studied. A single lower limb, both lower limbs or a single upper limb were affected in 78 (85.7%), 10 (11.0%) and 3 (3.3%) patients, respectively. The severity of lymphoedema ranged from stage 1 (mild) to stage 6 (severe). The mean LQI was 8.2 (SD 5.2, range 0-20). The modified DLQI scores showed a significant positive correlation with severity of lymphoedema and a negative correlation with age (R=0.59 and R=-0.1, respectively). The frequency of ADLAs correlated with an increased modified DLQI score. Local pain, embarrassment and limitations of physical activities were the most distressing aspects of lymphoedema. Disease severity and early onset lymphoedema were found to be significantly associated with poorer QoL in filarial lymphoedema.

Activities of Daily Living↗
PubMed2005

Acute hearing loss due to scrub typhus: a forgotten complication of a reemerging disease.

We describe 6 patients with scrub typhus who presented with acute hearing loss, a forgotten complication of this reemerging disease. They were admitted with fever of 10-14 days' duration and had clinical evidence of deafness and pneumonitis. Five patients had eschars, which prompted the diagnosis of typhus fever and led to early institution of treatment. Deafness has been described as a clue to the diagnosis of scrub typhus; awareness of this symptom facilitated early diagnosis in 4 of 5 patients who recovered. Acute hearing loss or hearing impairment in a febrile patient should arouse strong suspicion of scrub typhus.

Acute Disease↗
PubMed2002

Red blood cell antioxidant levels in Wuchereria bancrofti infection.

The elimination of microfilariae of Wuchereria bancrofti is probably mediated by free radicals. Red cell catalase (C), glutathione peroxidase (GPX), and superoxide dismutase (SOD) activity levels were measured as an indirect method of assessing blood oxidant status in 29 asymptomatic microfilaraemics, 29 "endemic normals", and 29 controls living in a non-endemic area. Changes in the activity of these enzymes were also compared over a one month period in 22 asymptomatic microfilaraemics randomised to receive either single dose or 14 day treatment with diethyl carbamazine citrate (DEC). Red cell GPX activity levels were significantly higher in "endemic normals" when compared to mf positive cases and non-endemic controls. An early and significant increase in GPX activity (on days 3, 7 and 14 compared to pretreatment levels, p<0.01) was observed after DEC in both treatment groups. Increases in the activity of catalase and SOD became significant only on days 14 and 30 respectively. The percentage reduction in microfilaraemia correlated significantly with the percentage increase in GPX activity levels (R(2)=0.58, p=0.6 x 10(-5)). Our results may suggest a role for GPX related oxidant species in the elimination of microfilariae.

Adolescent↗
PubMed2001

Parasuicide by self-injection of an organophosphate insecticide.

Parasuicide by ingestion of organophosphate (OP) insecticides is common in Sri Lanka, but the use of the parateral route to self administer the poison is extremely rare. We report a patient who deliberately injected herself intramuscularly with an OP compound with suicidal intent. The clinical manifestations of OP poisoning were unpredictable and posed a therapeutic problem.

Adult↗
PubMed1998

The recto-anal inhibitory reflex: abnormal response in diabetics suggests an intrinsic neuroenteropathy.

As electrical stimulation of the rectum has been shown to result in reflex internal sphincter inhibition mediated by intrinsic nerves, we aimed to evaluate the integrity of these nerves in the rectum of diabetic patients. Anal canal pressure, recto-anal inhibitory reflex (RAIR) and continence were evaluated in 30 diabetic patients (male:female 13:17, median age 57 years, range 37-70) and these data were compared with similar data obtained from 22 age- and sex-matched healthy controls (male:female 9:13, median age 51 years, range 19-65 years). Median duration of diabetes was 8 years (range 3-30). Twelve (40%) of the 30 diabetics had impaired continence for gas (n = 12) and liquid faeces (n = 3). None of the controls had incontinence. Median maximum resting anal canal pressure (MRP) was: patients 30 mmHg (range 20-75 mmHg) versus controls 40 mmHg (range 20-105 mmHg, P = 0.61). Median maximum squeeze pressure (MSP) was 65 mmHg (range 30-150 mmHg) in patients versus 84mmHg (range 35-230 mm Hg) in controls (P = 0.59). Median threshold rectal mucosal electrosensation (RMES-T) was 27mA (5-40 mA) in patients versus 13 mA (5-28 mA) in controls (P = 0.03). Maximum tolerable rectal mucosal electrosensation was 40 mA (20-60) in patients versus 20 mA (10-30), in controls (P = 0.042, all comparisons using the Wilcoxon rank test). Recto-anal inhibitory reflex was present in eight, abnormal in five (one incontinent) and absent in 17 (11 incontinent) diabetics, while it was present in 18 and abnormal in four controls (test of proportion, P = 0.031). Blood glucose in diabetics on the day of the procedure was 98 mg/dL (70-165 mg/dL). Rectal mucosal electrosensitivity and RAIR were impaired in significantly more patients with diabetes than controls, implying impairment of intrinsic neuronal function. The recto-anal inhibitory reflex was either impaired or absent in all diabetic patients with incontinence.

Adult↗
PubMedDate not supplied

Evaluation of the ICT whole-blood antigen card test to detect infection due to Wuchereria bancrofti in Sri Lanka.

The sensitivity, specificity and cost effectiveness of an immunochromatographic card test (ICT, AMRAD) for the diagnosis of bancroftian filariasis were estimated against 2 standard parasitological techniques: thick blood film (TBF) and Nuclepore membrane filtration (NMF). Individuals were selected from endemic localities in the Western Province (n = 213) and from the non-endemic Central Province (n = 29) of Sri Lanka. Blood was collected between 21:00 and midnight. Sixty microlitre of non-heparinized blood, and 1 mL and 100 microL of heparinized blood were used in TBF, NMF and ICT, respectively. NMF was positive in 31.5% (67/213) of the endemic group, with a mean microfilaria (mf) count of 343/mL (range 8-1782, SD 422). All 67 were positive by ICT (sensitivity 100%), but only 63 by TBF (sensitivity 94%). Among the endemic population there were 12 who were mf negative but antigen positive by ICT. There were, however, no false positives among the non-endemic controls, indicating the possibility that the ICT may in fact be more sensitive and 100% specific. Thus, ICT filariasis test appears to be more effective (both sensitive and specific) than TBF or NMF in diagnosing infection in lymphatic filariasis. The direct unit recurrent costs of the 2 survey tools, TBF and ICT, were US$ 0.30 (Rs. 27/=) and US$ 2.75 (Rs. 248/=), respectively. The high cost of the ICT may be offset by other factors that are difficult to cost.

Adolescent↗