Effect of Hydrothermal Treatment on Macro/Micro Nutrients Extraction from Chicken Manure for Liquid Organic Fertilizer Production.

In order to study the influence of the hydrothermal treatment technology (HTT) on macro/micro nutrients extraction from two types of chicken manure (broiler chicken manure (BCM) and laying hen chicken manure (LCM)), hydrothermal treatment followed by the solid/liquid separation of the HTT product was performed with a fixed feedstock to water mass ratio (1:3), 30 min reaction time and three different reaction temperatures (160ºC, 180ºC, 200ºC). More than 50% of N can be extracted from solid to liquid after HTT for both BCM and LCM. Moreover, the organic N content was more than 80% in all liquid samples and it was increasing with the increase of HTT temperature. According to all the results, 180ºC is the optimum temperature for both types of chicken manure and the pH value of the liquid extracted at the optimum temperature was close to 7 for both types of chicken manure. The heavy metal contents in the liquid obtained from BCM and LCM were not detected. It was observed that macro nutrients and micro-nutrients were dissolved in the liquid after HTT.

Oral Assessments in Postgraduate Exit Examinations in Forensic Medicine: a Point of View from Sri Lanka.

Postgraduate education, training and assessment in Forensic Medicine in Sri Lanka are managed by the Postgraduate Institute of Medicine (PGIM), University of Colombo. There are several components in the postgraduate examinations; theory, clinical case presentation, a full autopsy and presentation, Objective Structured Practical Examination (OSPE), Histopathology component and a viva voce examination where a pass grade is compulsory in each component. This includes the 20 minute viva voce examination as well. The viva voce can be used to test intellectual processes such as decision making and justification of opinions; abilities paramount to an effective expert medial witness. However, it has been dropped by many Examination Boards due to several shortcomings. Poor inter examiner reliability is one example that has been quoted as a serious drawback. Certain measures can be taken to increase the validity and reliability of the viva voce, some of which have been introduced in Sri Lanka by the Board of Study in Forensic Medicine, PGIM. Improvements to the viva voce should be an ongoing process. This paper will 1) discuss the value of the viva voce in postgraduate examinations in Forensic Medicine, 2) study its pass/fail reliability as a compulsory component, 3) examine how its shortcomings could be overcome, 4) examine the evolution of the viva voce in postgraduate examinations in Forensic Medicine in Sri Lanka and 5) make recommendations for the future.

Seroprevalence of rubella antibodies among pregnant females in Sri Lanka.

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.

Strategies for immunisation against rubella: evidence from a study in the Kalutara District.

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.

Primary drug resistant tuberculosis in the Central Chest Clinic, Colombo.

OBJECTIVE: To determine the drug sensitivity of Mycobacterium tuberculosis strains isolated from pretreatment (primary) cases of pulmonary tuberculosis. DESIGN: A descriptive study. SETTING: The Central Chest Clinic, Colombo. PATIENTS: 103 patients with pulmonary tuberculosis who have not taken anti-tuberculosis drugs previously. MEASUREMENTS: Antibiotic sensitivity pattern of M tuberculosis isolates for isoniazid (INAH), ethambutol (EMB), rifampicin (RMP) and streptomycin (SM) tested in drug incorporated Lowenstein Jenson (LJ) medium using resistance ratio method. RESULTS: 15.5% isolates of M tuberculosis were resistant to at least one drug. Resistance to a single drug was found to be most prevalent (69%) among the resistant isolates and among these INAH resistance was most prevalent followed by streptomycin. None of the isolates were resistant to all four drugs. Resistance rates to individual drugs were INAH 9.7%. SM 6.7% EMB 2.9% and RMP 2.9%. CONCLUSIONS: Since the introduction of RMP and EMB in the treatment regimens from mid-1970s the incidence of tuberculosis and rate of primary drug resistance to anti-tuberculosis drugs has not changed significantly (p > 0.05) when compared with the results of studies conducted previously (2, 3). However, it is recommended that regular surveillance of drug sensitivity pattern should be maintained to determine alternate drug regimes and to detect the spread of resistant strains in the community.

The pattern of tissue damage in occupational trauma.

OBJECTIVE: To study the pattern of tissue damage in occupational hand injuries. SETTING: Trauma and Orthopaedic Unit of the General Hospital, Colombo. PATIENTS: 190 patients with occupational hand injuries submitted to surgery by me were studied prospectively. The incidence of compound and simple fractures and dislocations, digital amputations, tendon injuries and skin loss were studied. The individual bones and tendons affected, the level of digital amputations and the involvement of individual fingers were recorded. RESULTS: Compound fractures accounted for 42.1% of injuries and in 56.4% the distal phalanx was involved. Finger tendons were affected in 66.6%. The highest incidence of compound fractures (30.6%), amputations (41.1%) and skin and subcutaneous tissue loss (28.5%) was seen in the index finger. CONCLUSIONS: 1. Compound fractures and digital amputations were the main injuries. 2. Distal phalanx is more frequently affected in compound fractures. 3. Among the amputations loss of finger tip is the commonest. 4. Flexor tendons were more injured than the extensor tendons. 5. Index finger is the most frequently injured digit.

Anatomy of the origin of the deep femoral artery.

OBJECTIVE: To study the variability in the level of origin of the deep femoral artery in relation to the different patterns of origin of the femoral circumflex arteries. DESIGN: 124 femoral triangles obtained from cadavers were dissected. The origins of the circumflex femoral arteries were classified into two groups. In group A medial and lateral circumflex arteries arose from the deep femoral artery. In group B either one or both femoral circumflex arteries arose from the common femoral artery. The distance of origin of the deep femoral artery from the mid point of the inguinal ligament was measured in both groups and compared. SETTING: Department of Anatomy, Faculty of Medicine, Colombo. RESULTS: A statistically significant difference was noted in the two groups regarding the level of origin of the deep femoral artery. CONCLUSION: There is a distal migration of the level of origin of the deep femoral artery when either one or both circumflex femoral arteries arose from the common femoral artery.

PCR based detection of Mycobacterium tuberculosis: effect of sample preparation.

Tests based on the polymerase chain reaction (PCR) for the detection of the Mycobacterium tuberculosis complex in clinical samples have a lower sensitivity when compared to culture. This has been attributed to the presence of inhibitors to Taq polymerase and/or suboptimal DNA extraction procedures. We tested different methods of processing smear negative culture positive sputum (n = 52) using different detergents, including nonidet P-40 (NP-40), sodium dodecyl sulphate (SDS), tween 20, triton X 100 and N-lauryl sarcosine. The detergents were used in combination with lysozyme and proteinase K enzymes. NP-40 was significantly better than SDS, tween 20 and N lauryl sarcosine (p < 0.05). When NP-40 was used as the detergent, 42 out of 52 specimens gave positive results with the standard amplification protocol which amplifies a 245 bp sequence of the insertion element IS 986. The 10 specimens that were negative were further diluted ten fold and/or eluted in sephadex G-50 columns before standard DNA amplification. A further 8 specimens then became positive. Elution in sephadex G-50 was better than ten fold dilution in processing of samples. The two negative samples had very low colony counts (n < 5). The study demonstrates that the sensitivity of the PCR is dependent on the sample preparation technique and the amount of target sequence available for amplification.

Econazole and clotrimazole in the treatment of vaginal candidiasis: a double blind comparative study.

OBJECTIVES: To compare the efficacy of treatment with econazole and clotrimazole in patients with vaginal candidiasis. DESIGN: A double blind study. Patients with vaginal candidiasis were randomly treated with vaginal depot preparations of econazole and clotrimazole. Efficacy after treatment by reduction of symptoms, a gynaecological examination and microbiological analysis of vaginal fluid. Adverse reactions were noted. SETTING: University gynaecological clinic at the de Soysa Hospital for Women, Colombo. PATIENTS: 102 patients microbiologically confirmed as having vaginal candidiasis. RESULTS: Two weeks after econazole treatment 19% still complained of a discharge and 7.5% had pruritus. The respective values for clotrimazole were 18% and 12%. The finding on gynaecological examination generally supported the reduction of symptoms. Microbiological assessment showed that 90.5% in the econazole group and 96% in the clotrimazole group became culture negative at two weeks after treatment. Adverse effects were similar in incidence and number for both treatment groups. Econazole was less acceptable to patients than clotrimazole. CONCLUSIONS: Econazole and clotrimazole are of equal efficacy for treatment of vaginal candidiasis. Econazole was less acceptable to patients.

Microbiological patterns in vaginitis.

OBJECTIVES: To determine the incidence and microbial aetiology of vaginitis, and the usefulness of Gram staining of vaginal fluid in detecting the aetiology of vaginitis in Sri Lankan women. DESIGN: Prospective study with microbiological investigation of high vaginal specimens from symptomatic and healthy groups of women. SETTING: A gynaecological clinic of the De Soysa Hospital for Women, and a family planning clinic of the Family Health Bureau, Colombo. PATIENTS: 114 untreated patients with symptoms suggestive of vaginitis and 109 healthy controls. RESULTS: Candida species were isolated from 36% patients and 9% of controls. Gardnerella vaginalis was recovered from 8.8% of patients and 7.3% of controls. The bacterial vaginitis group consisted of several distinct subgroups, viz Gardnerella vaginalis vaginitis, anaerobic vaginitis, non-anaerobic vaginitis and polymicrobial vaginitis. The incidence of trichomoniasis was lower (4.4%) compared to other studies. Other bacteria (anaerobes, enterococci, coliforms, Group B Streptococci) were isolated in significantly higher numbers in the symptomatic group compared to the control group. Microscopy showed that the majority (73%) of the Candida vaginitis patients retained the normal Lactobacillus morphotype. In bacterial vaginitis Lactobacillus morphotype was replaced by other bacterial morphotypes. CONCLUSIONS: In our study 36% had candidiasis, 4.4% had trichomoniasis and 47% had bacterial vaginitis. In 12% there was no detectable pathogen. Microscopy of vaginal fluid is useful in determining the aetiology of vaginitis.

Patent vitello-intestinal duct: an unusual presentation.

The case history of a child passing a roundworm through the umbilicus is presented. The diagnosis and management of a patent vitello-intestinal duct is discussed.

Fungal skin infections in a paediatric dermatology clinic.

A diagnosis of fungal infection was established in 8.6% of patients who attended the dermatology clinic at the Lady Ridgeway Hospital, Colombo over a one year period. Only 4.3% were confirmed in the laboratory. The agreement between clinical and laboratory diagnosis was 96.6% for patients with typical clinical features, but only 26.4% for patients who did not have the classical appearance. Both direct microscopy and culture are required to determine the causative agent, although the majority (92%) of patients could be diagnosed on microscopy alone. Microsporum gypseum was the commonest fungus isolated from children.

Effects of transcutaneous needle stimulation on the immune response in rabbits.

Studies in the field of neuroimmunomodulation have shown that endorphins such as methionine-encephalin may have an immunomodulatory role. This study was undertaken to test whether transcutaneous needle stimulation, which is known to release such peptides from the central neurones, has an effect on immune response in rabbits. Twelve healthy rabbits, in three similar subgroups, were exposed to pathogenic Escherichia coli and their immune response was studied under different experimental conditions. Our results show that needle stimulation causes a reversal of stress induced suppression of antibody production. Further studies are necessary to evaluate any therapeutic uses these observations may have in humans.

Methicillin resistant Staphylococcus aureus.

Out of 308 isolates of Staphylococcus aureus isolated from specimens processed at the Department of Microbiology, Faculty of Medicine, Colombo 66 (21.5%) were resistant to methicillin. A significantly higher proportion of methicillin resistant Staphylococcus aureus (MRSA) were isolated from special care units, namely the Premature Baby Unit (PBU) and the Plastic Surgery Unit (PSU) when compared with other general medical and surgical units. Most of these strains were also resistant to many other antibiotics. The patients with MRSA infections had a longer mean hospital stay when compared to patients with methicillin sensitive Staphylococcus aureus (MSSA) infections. MRSA strains are as virulent as MSSA strains and these infections are mainly nosocomial.

Cryptosporidiosis--oocyst shedding and infection in household contacts.

The incidence of cryptosporidiosis in children with acute diarrhoea when compared with age-matched controls was 6.1% in a paediatric unit. Studies were made on eight immunocompetent children with cryptosporidiosis to determine the period of oocyst shedding after cessation of diarrhoea. The majority (75%) shed oocysts for less than ten days after cessation of diarrhoea. There was considerable variation among patients, some eliminating oocysts more quickly than others. This was not related to the severity or duration of diarrhoea. The sucrose floatation technique was found to be more sensitive than direct smear for detecting small numbers of oocysts present at the end of the shedding period. Studies on household contacts showed infection in 43%, which suggests a subclinical infection or a transient carrier state, and confirms the occurrence of person to person transmission.