Traditional Sri Lankan Medicine Intervention In The Management Of Knee Osteoarthritis (janu Sandigatavata): Case Series

Background: Osteoarthritis (OA) of the knee is a degenerative disease, which significantly restricts the functions of the joint. Janu Sandigatavata (JS) is considered to be the close equivalent in traditional medicine to OA in modern medicine. The aim of this case series was to report the effectiveness of Traditional Sri Lankan Medicine (TSM)on JS patients attend to National Ayurveda Teaching Hospital. Method: Reported cases (n=10) were at the age range of 45years to70 years and both female (n=8) and male (n=2) patients were diagnosed as having JSof the knee joints. Radiology (X?ray) reported by a radiologist confirmed that they were in Kellgren?Lawrence grade III or less. TSM treatments were given as regimens up to 86days.At the end point, external treatment of oleation and herbal immune enhancing drugs were further continued over 8weeks. Visual analogue scale for pain, knee scores in Knee Society clinical Rating System (KSS) and Ayurveda clinical assessment criteria were used to evaluate the effects of treatment. Results: Reductions of visual analogue scale for pain was observed between baseline and the 86 days endpoint. Clinical assessment criteria and the KSS scores of pain, movement and stability were also improved up to good level and function score were improved up to excellent level. During the follow?up period, joint symptoms and signs and the knee scores were remaining unchanged. Conclusions: Study explored that substantial decrease in clinical parameters of OA in knee and improved patients’ quality of life by the intervention of the TSM.

Laparoscopically Assisted Pancreaticoduodenectomy First Sri Lankan Experience

Pancreaticoduodenectomy (PD) is the curative surgical option for periampullary tumors. Minimally invasive pancreaticoduodenectomy (MIPD) is gaining popularity as the open PD has considerable morbidity and mortality. MIPD was first described in 1994 by Gagner and Pomp. Since then the literature is flourishing with case reports and systematic reviews and are rapidly increasing in recent past. The first Sri Lankan report of laparoscopic pancreatico-duodenectomy with all anastomosis done by mini-laparotomy is in 2015. The patient presented in this report underwent pancreaticoduodenectomy and the hepatico-jejunostomy laparoscopically followed by mini-laparotomy for the other two anastomoses.

Supraorbital notch/foramen in Sri Lankan skulls: morphometry and surgical relevance / Escotadura/foramen supraorbitario en cráneos de Sri Lanka: morfometría y relevancia quirúrgica

Evidence supports the ethnic and sex variation in the form and position of the supraorbital foramen. Therefore, detailed knowledge of the population specific data on biometric features of the supraorbital foramen will facilitate diagnostic, local anesthetic and surgical manipulations in the maxillo-facial region. The goal of this study was to elucidate the morphological features and precise anatomical position of the supraorbital foramen with reference to surrounding surgically encountered anatomical landmarks in an adult Sri Lankan population. A total of one hundred and eight adult dry skulls of known sex were assessed to determine the number, shape, orientation, vertical and transverse diameters of the supraorbital foramen, transverse distance from the supraorbital foramen to the nasal midline and the zygomatico-maxillary suture and the vertical distance from the supraorbital foramen to the supraorbital rim and infraorbital foramen. The position of the supraorbital foramen was determined in relation to the infraorbital foramen. Data were evaluated between sides and sex. The supraorbital notch (64.81%) was found more frequently than the supraorbital foramen (35.19%). Of the skulls investigated, 55.56% displayed bilateral supraorbital notches, whereas 20.37% had bilateral supraorbital foramina and 24.07% had a notch on one side and a foramen on the contralateral side. The incidence of multiple supraorbital foramina was 6.48%. Sex variations were observed in the relative position of supraorbital notch/foramen from nasal midline (male: 26.12±3.89; female: 24.40±2.76), temporal crest of the frontal bone (male: 32.74±3.94; female: 30.87±4.18) and infraorbital foramen (male: 44.86±3.35; female: 43.26±3.63). The modal position for the infraorbital foramen was lateral to the lateral margin of the supraorbital notch/foramen (68.52%) and supraorbital and infraorbital foramina were lying in the same sagittal plane only in 24.07% of the skulls. The results of this study highlight the racial and sex differences and emphasize the need for meticulous preoperative evaluation of the supraorbital foramen to define the optimal locations in patients who are candidates for maxillo-facial surgeries and regional block anesthesia.

La evidencia señala que existe dimorfismo étnico y sexual en la forma y posición del foramen supraorbitario. Por lo tanto, el conocimiento detallado de los datos específicos de una población sobre las características biométricas del foramen supraorbitario facilitará el diagnóstico, anestesia local y procedimientos quirúrgicos en la región maxilofacial. El objetivo fue determinar las características morfológicas y posición anatómica exacta del foramen supraorbitario con referencia a los referencias anatómicas circundantes encontradas quirúrgicamente en una población adulta de Sri Lanka. Ciento ocho cráneos adultos secos de sexo conocido se evaluaron para determinar el número, forma, orientación, diámetros vertical y transversal del foramen supraorbitario, distancia transversal desde el foramen supraorbitario a la línea mediana nasal y sutura cigomático-maxilar y distancia vertical desde el foramen supraorbitario hasta el margen supraorbitario y foramen infraorbitario. La posición del foramen supraorbitario se determinó en relación al foramen infraorbitario. Los datos fueron evaluados según lado y sexo. La incisura supraorbitaria (64,81%) se encontró con mayor frecuencia que el foramen supraorbitario (35,19%). El 55,56% de las incisuras supraorbitarias y 20,37% de los forámenes supraorbitarios fueron bilaterales; mientras que el 24,07% de las incisuras fueron unilaterales con un foramen en el lado contralateral. La incidencia de los forámenes supraorbitarios múltiples fue del 6,48%. Se observaron variaciones sexuales en la posición relativa de la incisura/foramen supraorbitario respecto a la línea mediana nasal (hombres= 26,12±3,89; mujeres: 24,40±2,76), cresta temporal del hueso frontal (hombres= 32,74±3,94; mujeres: 30,87±4,18) y foramen infraorbitario (hombres= 44,86±3,35; mujeres= 43,26±3,63). La posición modal para el foramen infraorbitario fue lateral al margen lateral de la incisura/foramen supraorbitario (68,52 %), y los forámenes supraorbitario e infraorbitario se ubicaron en el mismo plano sagital sólo en el 24,07% de los cráneos. Los resultados muestran las diferencias raciales y sexuales y enfatizan la necesidad de una evaluación preoperatoria minuciosa del foramen supraorbitario para definir su posición en pacientes que son candidatos a cirugías maxilofaciales y bloqueo anestésico regional.

In vitro anti-hyaluronidase activity of Sri Lankan low grown orthodox orange pekoe grade black tea (Camellia sinensis L.)

To access the anti-hyaluronidase activity of Sri Lankan low grown orthodox orange pekoe (OP) grade black tea with a view to develop an anti-aging skin formulation. Methods: Five concentrations (0.125, 0.250, 0.500, 1.000 and 2.000 mg/mL) of black tea brew (BTB) were made using a freeze dried sample of Sri Lankan low grown orthodox OP grade black tea which was prepared according to international organization for standardization specification. Epigallocatechin gallate (EGCG) was used as the reference agent (concentrations tested: 0.012, 0.025, 0.050, 0.100 and 0.200 mg/mL). Anti-hyaluronidase activity of BTB and EGCG in vitro were ascertained spectrometrically using hyaluronic acid (from rooster comb) and bovine testicular hyaluronidase. Results: The results revealed that BTB had moderate [IC50=(1.09±0.12) mg/mL] and dose dependent (r2=0.94) anti-hyaluronidase activity. EGCG also exhibited dose dependent (r2=0.93, P<0.05) anti-hyaluronidase activity which was superior [IC50=(0.09±0.00) mg/mL] to BTB. Conclusions: Sri Lankan low grown orthodox OP grade black tea has promising anti-hyaluronidase activity in vitro and has the potential to be used as an anti-aging cosmaceutical. In addition, it may prove useful as a beverage in the management of allergy, some joint diseases and envenomation.

In vitro anti-hyaluronidase activity of Sri Lankan low grown orthodox orange pekoe grade black tea (Camellia sinensis L.)

Objective: To access the anti-hyaluronidase activity of Sri Lankan low grown orthodox orange pekoe (OP) grade black tea with a view to develop an anti-aging skin formulation. Methods: Five concentrations (0.125, 0.250, 0.500, 1.000 and 2.000 mg/mL) of black tea brew (BTB) were made using a freeze dried sample of Sri Lankan low grown orthodox OP grade black tea which was prepared according to international organization for standardization specification. Epigallocatechin gallate (EGCG) was used as the reference agent (concentrations tested: 0.012, 0.025, 0.050, 0.100 and 0.200 mg/mL). Anti-hyaluronidase activity of BTB and EGCG in vitro were ascertained spectrometrically using hyaluronic acid (from rooster comb) and bovine testicular hyaluronidase. Results: The results revealed that BTB had moderate [IC

Genetic variants in the cytochrome P450 2D6 gene in the Sri Lankan population.

INTRODUCTION: Cytochrome P450 2D6 (CYP2D6) enzymes are involved in the metabolism of a large number of commonly prescribed drugs such as antidepressants and cardiovascular drugs. The CYP2D6 *3, *4 and *14 variants associated with the loss of enzyme function; CYP2D6 *10 and *17 variants with reduced enzyme function; and CYP2D6 *2 variant with no effect on enzyme function. Establishing the frequency of these variant alleles in Sri Lankan population would be useful for optimizing pharmacotherapy with CYP2D6‑substrate drugs. OBJECTIVE: The objective of this study was to determine the prevalence of CYP2D6 *2, *3, *4, *10, *14 and *17 variants in the main ethnic groups in the Sri Lankan population. MATERIALS AND METHODS: A total of 90 deoxyribonucleic acid (DNA) samples (30 each from Sinhalese, Tamils and Moors) were selected from a DNA resource at the Human Genetic Unit, Faculty of Medicine, University of Colombo. This collection had been made for population genetic studies from a random population based volunteers. Genotyping was performed using published polymerase chain reaction/ restriction fragment length polymorphism methods. RESULTS: The prevalence of the CYP2D6 variants in Sinhalese, Sri Lankan Tamils and Moors respectively were CYP2D6 *2: 37%, 41.6% and 37.9%; CYP2D6 *3: 60.3%, 45% and 30%; CYP2D6 *4: 21.6%, 6.6% and 8.3%; CYP2D6 *10: 40%, 35% and 44%. CYP2D6 *14 and *17 variants were not identified. CONCLUSION: CYP2D6 *3, *4 and *10 variants, which are associated with reduced or loss of CYP2D6 enzyme function were found in our population in significant frequencies. CYP2D6*4, which is reported to be a Caucasian variant was also found in all three ethnic groups.

On the variations of the muscle flexor digitorum brevis: anatomical insight / Variaciones del músculo flexor corto de los dedos: experiencias de anatomía

Flexor digitorum brevis, an intrinsic muscle of the sole of the foot, is stated as one of the muscles that shows frequent anatomical variations. Its most commonly reported anomaly is the absence of tendon to the little toe. From a clinical standpoint of view, flexor digitorum brevis musculocutanous flap is used in the reconstruction of the heel pad and flexor digitorum brevis tendon transfer is employed in the correction of flexible claw and hammer toe deformities. Despite its significance little is known regarding the variations of this muscle in Sri Lankans. Hence, the goal of this study was to elucidate the incidence and morphological features of this muscle in an adult Sri Lankan population. A total of one hundred and thirty five apparently healthy human feet were dissected and studied for the morphological features of the flexor digitorum brevis muscle. The incidence of the absent fourth tendon of the flexor digitorum brevis in the present study was found to be 71.85 percent. In all cases, when absent, it was missing bilaterally. The results of the present study further highlight the anatomical variations of the flexor digitorum brevis muscle. A sound knowledge about the anatomical variations of flexor digitorum brevis will facilitate the outcome of surgical as well as diagnostic imaging techniques of the foot. Furthermore, understanding muscle architecture of the foot may assist in the design of prosthesis and analysis of foot function.

El músculo flexor corto de los dedos, es un músculo intrínseco de la planta del pie que frecuentemente presenta variaciones anatómicas. La variación más frecuente es la ausencia de tendón destinado al dedo mínimo. Desde el punto de vista clínico se utilizan colgajos musculocutáneos del músculo flexor corto de los dedos para la reconstrucción de la región subcalcánea. Además, el tendón del músculo es usado para corregir deformidades de garra y martillo de los dedos del pie. A pesar de su importancia, es escasa la información acerca de este músculo en la población adulta de Sri Lanka.Fueron disecados 135 pies humanos aparentemente sanos analizándose sus características morfológicas. Se determinó que un 71,85 por ciento el tendón para el quinto dedo del músculo flexor corto de los dedos estaba ausente. En todos los casos, ésta se presentaba bilateralmente. El estudio señala la importancia de tener un cabal conocimiento acerca de las variaciones anatómicas del músculo flexor corto de los dedos, para facilitar tanto las técnicas quirúrgicas, como el diagnostico a través de imagenlogía del pie. Además, un buen conocimiento de la arquitectura muscular del pie puede ayudar en el diseño de prótesis y en el análisis de la función del pie.

Sexual differences in the diameter of coronary arteries in an adult Sri Lankan population / Diferencias sexuales en el diámetro de las arterias coronarias en una población adulta de Sri Lanka

Coronary artery disease is a major cause of human mortality. It is stated that females have worse outcomes than men following myocardial infarction and coronary revascularization. Sexual differences in the coronary artery diameters have also been speculated as one of the reasons for the above outcome. However, because of possible confounding effects, such as the body size and heart weight, it is unclear if there is a true sex-specific effect on coronary arterial size. The present study was undertaken to investigate the sexual differences in the diameter of coronary arteries in a group of adult Sri Lankan population. The diameters of the coronary arteries and their branches were measured at predetermined sites in a total of one hundred and two apparently healthy hearts obtained from cadavers during routine gross anatomy dissections. All measurements were taken using a digital sliding caliper capable of measuring to the nearest 0.01mm. The mean coronary arterial diameters were significantly smaller in females than in males. These differences persisted even after the diameters of coronary arteries were corrected for heart weight and body surface areas. Precise knowledge of the expected normal coronary arterial diameter at a given anatomic location is the first step towards developing a quantitative estimate of the severity of the coronary artery disease. This study provides a reference data set for adult Sri Lankans against which to compare the diameters of coronary arteries in various pathological conditions.

La enfermedad coronaria es la mayor causa de mortalidad humana. Se afirma que las mujeres tienen peores resultados que los hombres después de un infarto de miocardio y revascularización coronaria. Diferencias sexuales en los diámetros de las arterias coronarias han sido especuladas como una de las razones para los resultados anteriores. Sin embargo, debido a posibles efectos de confusión, tales como talla corporal y peso del corazón, no está claro si hay un verdadero efecto sexo-específico sobre el tamaño arterial coronario. El presente estudio se realizó para investigar las diferencias sexuales en el diámetro de las arterias coronarias en un grupo de adultos de la población de Sri Lanka. Los diámetros de las arterias coronarias y sus ramas se midieron en lugares predeterminados en un total de 102 corazones aparentemente sanos obtenidos de cadáveres durante las disecciones anatómicas de rutina. Todas las medidas fueron tomadas con un caliper digital deslizante (precisión 0,01 mm). La media del diámetro arterial coronario fue significativamente menor en mujeres que en hombres. Estas diferencias persisten aún después de que los diámetros de las arterias coronarias fueron corregidos por el peso del corazón y talla corporal. El conocimiento preciso del diámetro de la arteria coronaria normal esperado en un determinado lugar anatómico es el primer paso hacia el desarrollo de una estimación cuantitativa de la gravedad de la enfermedad de las arterias coronarias. Este estudio proporciona un conjunto de datos de referencia para adultos de Sri Lanka con el cual comparar los diámetros de las arterias coronarias en diversas condiciones patológicas.

Incidence of humeral head of biceps brachii muscle: anatomical insight / Incidencia de la cabeza humeral del músculo bíceps braquial - visión anatómica

Biceps brachii is stated as one of the muscles that shows most frequent anatomical variations. Its most commonly reported anomaly is the presence of an accessory fascicle arising from the humerus which is termed as the humeral head of biceps brachii. Evidence shows a clear racial trend in the incidence of the humeral head of biceps brachii. Therefore, detailed knowledge of this variation in different populations is important for surgical interventions of the arm, nerve compression syndromes and in unexplained pain syndromes in the arm or shoulder region. The goal of this study was to elucidate the incidence and morphological features of this muscle in an adult Sri Lankan population. Upper extremities of the total of one hundred thirty five cadavers were dissected and studied for the presence of accessory heads of the biceps brachii muscle. The proximal and distal attachments of the humeral heads as well as their cranio-caudal, antero-posterior and medio-lateral dimensions were recorded. The incidence of humeral head of biceps brachii was found to be 3.7 percent. In all cases, it was found unilaterally and only in male subjects. The humeral head originated from the antero-medial aspect of the humeral shaft and descended and merged with the other two heads to form a common tendon. The results of the present study further highlight the racial variations in the incidence of humeral head of biceps brachii among Sri Lankans. Knowledge of the occurrence of humeral head of biceps brachii may facilitate preoperative diagnosis as well as the surgical procedures of the upper limb thus avoiding iatrogenic injuries.

El músculo bíceps braquial se conoce como uno de los músculos que muestra las variaciones anatómicas más frecuentes. Su anomalía más común es la presencia de un fascículo accesorio proveniente del húmero, que se denomina cabeza humeral del músculo bíceps braquial. La evidencia muestra una clara tendencia racial en la incidencia de la cabeza humeral del músculo bíceps braquial. El conocimiento acabado de esta variación, en las diferentes poblaciones, es importante para las intervenciones quirúrgicas del brazo, en los síndromes de compresión nerviosa y en los síndromes de dolor inexplicable en la región del brazo o del hombro. El objetivo de este estudio fue determinar la incidencia y las características morfológicas de este músculo en una población adulta de Sri Lanka. Fueron estudiados los miembros superiores en 135 cadáveres, disecados para evaluar la presencia de las cabezas del músculo bíceps braquial accesorio. Fueron registrados el origen e inserción de la cabeza humeral del músculo bíceps braquial, así como su dimensión cráneo-caudal, anteroposterior y mediolateral. La incidencia de la cabeza humeral del músculo bíceps braquial se encontró en el 3,7 por ciento de los miembros estudiados. En todos los casos, su presencia era unilateral y sólo presente en hombres. La cabeza humeral se originó en la región antero-medial de la diáfisis del húmero, descendió y se fusionó con las otras dos cabezas para formar un tendón común. Los resultados de este estudio resaltan aún más las variaciones raciales en la incidencia de la cabeza humeral del músculo bíceps braquial, entre los habitantes de Sri Lanka. El conocimiento de la presencia de la cabeza humeral del músculo bíceps braquial puede facilitar el diagnóstico preoperatorio, así como los procedimientos quirúrgicos del miembro superior, evitando las lesiones iatrogénicas.

Impact of chronic urticaria on the quality of life in Australian and Sri Lankan populations

BACKGROUND: Chronic idiopathic urticaria (CIU) has a significant impact on patients' quality of life. OBJECTIVE: The purpose of this study is to assess that impact and to compare differences by culture, gender, age or duration of treatment. METHODS: We used the modified chronic urticaria quality of life questionnaire, consisting of 15 questions. Over the course of 6 months, patients attending Immunology clinics at Campbelltown Hospital and private rooms in Australia and at the faculty of Medicine, University of Kelaniya in Sri Lanka were asked to fill out the questionnaires. We have obtained the data from 125 patients (43 Australian vs. 82 Sri Lankan). There were significantly more female patients (P < 0.01). The data was analysed using SAS. RESULTS: Overall, patients were affected mostly by itch and wheals and least affected by the side effects of treatments. Sri Lankan populations were more affected by wheals and by interference on activities, mood and food choices but were less affected by tiredness due to sleep disturbances (P < 0.01). Females were more affected by sleep disturbance (P < 0.05) while those older than 40 years of age were more impacted by tiredness and by the side effects from medications (P < 0.05), though the complaints themselves were mild. Those who suffered from CIU for more than 1 year were more affected by wheal, tiredness and irritability (P ≤ 0.05). CONCLUSION: The questionnaire highlighted some differences between patients attending Australian versus Sri Lankan outpatients. Significant differences were found in one third of parameters which include mood, sleep, daily activities and food choices.

A model for the estimation of personal stature from the length of forearm / Un modelo para la estimación de la estatura personal desde la longitud del antebrazo

Prediction of stature from incomplete and decomposing skeletal remains is vital in establishing the identity of an unknown individual. It has been stated that a variety of factors such as race, gender and nutrition play an important role in determining the height of an individual. Estimation of stature from measurements of various long bones has been achieved with varying degree of accuracy. Those studies resulted in establishing different formulae for the estimation of stature for the respective populations. However, evidence shows that there is a great void in such norms for Sri Lankans. Hence, this study was designed to investigate the relationship and to propose a gender and age specific linear regression models between the ulna length and height of an individual. A total of 258 subjects with an age span of 20-23 years were included in the study. The ulna length was measured using a digital sliding caliper capable of measuring to the nearest 0.01 mm. The height of the individual was measured standing erect, in anatomical position using a standing height measuring instrument. The findings of the study indicated significant differences of the ulna length between the genders. A positive correlation between height and ulna length was observed in both sexes and it was statistically significant. Regression equations for stature estimation were formulated using the ulna lengths for both males and females. The ulna length provides an accurate and reliable means in estimating the height of an individual. The regression formulae proposed in this study will be useful for clinicians, anatomists, archeologists, anthropologists and forensic scientists when such evidence provides the investigator the only opportunity to gauge that aspect of an individual's physical description.

La predicción de la estatura a través de restos de esqueletos incompletos o en descomposición es de vital importancia para determinar la identidad de un individuo desconocido. Se ha dicho que la variedad de factores como raza, sexo y la nutrición juegan un papel importante en la determinación de la altura de un individuo. La estimación de la estatura a partir de mediciones de varios huesos largos se ha logrado con diversos grados de precisión. Los estudios han resultado en el establecimiento de fórmulas diferentes para la estimación de la estatura de las poblaciones específicas. Sin embargo, la evidencia muestra que existe un gran vacío en las normas para ciudadanos de Sri Lanka. Por lo tanto, este estudio fue diseñado para investigar la relación y proponer modelos de regresión lineal específicos en relación al sexo y la edad, entre la longitud de la ulna y la altura de un individuo. Un total de 258 sujetos con un rango de edad de 20-23 años se incluyeron en el estudio. La longitud ulnar se midió con un caliper digital deslizante, precisión de 0,01 mm. La altura del individuo se midió de pie, en posición anatómica con un instrumento de medición. Los resultados del estudio indicaron diferencias significativas de la longitud de la ulna entre los géneros. Se observó una correlación positiva entre la altura y la longitud ulnar en ambos sexos, siendo estadísticamente significativa. Las ecuaciones de regresión para la estimación de la estatura se calcularon usando las longitudes de la ulna tanto en hombres como en mujeres. La longitud de la ulna es un medio preciso y fiable en la estimación de la altura de un individuo. Las fórmulas de regresión propuestas en este estudio serán útil para los médicos, anatomistas, arqueólogos, antropólogos y científicos forenses cuando la evidencia de ese tipo permita al investigador evaluar este aspecto de la descripción física de un individuo.

Development of height-weight based equation for assessment of body composition in Sri Lankan children.

Objective. To develop a height and weight based equation to estimate total body water (TBW) in Sri Lankan children. Methods. Cross sectional descriptive study done involving 5-15 year old healthy children. Height and weight were measured. TBW was assessed using isotope dilution method (D2O) and fat free mass (FFM) calculated. Multiple regression analysis was used to develop prediction equation and validated using PRESS statistical technique. Height, weight and sex code (male=1; female=0) were used as prediction variables. Results. This study provides height and weight equation for the prediction of TBW in Sri Lankan children. To the best of our knowledge there are no published height weight prediction equations validated on South Asian populations. Conclusion. Results of this study need to be affirmed by more studies on other closely related populations by using multicomponent body composition.

Body surface area estimation: Cross validation of several prediction equations.

Background Body surface area (BSA) is used in clinical practice to prescribe medication, standardize measured parameters etc. Normogram has been the gold standard. However, there are several prediction equations in the published literature. A simple method giving an accurate estimation would help to assess BSA in day to day clinical practice efficiently. Objective To assess the accuracy of different equations for the estimation of BSA in a group of Sri Lankan children. Method Data collected in 3 different school surveys carried out between 2002 and 2005 were used. BSA estimated by 9 prediction equations described in the literature were compared with the BSA assessed by normogram. Results Two thousand three hundred and thirty eight girls and 639 boys, between the ages of 5-16 years, were assessed. The mean ages of the boys and girls were 10.3±1.47 years and 11.5±2.47 years respectively. The highest mean BSA estimation was given by Gehan & George equation (boys 1.14±0.20m2 and girls 1.2 ± 0.25m2) and lowest by Yu et al (boys 1.08±0.20m2 and girls 1.13±0.25m2). Estimates correlated highly with BSA assessed by normogram. When the estimates were compared with normogram, equation of Mattar gave the highest bias for both groups (females 0.0152m2 and males 0.0177m2). Mosteller equation gave relatively low bias (females 0.0077m2, and males 0.0072 m2). Conclusions All equations gave very good agreement between each other. Out of the equations, easiest to use in day to day clinical practice is the equation described by Mosteller. The maximum bias in estimation would lead to less than 5% error in determining drug doses which is negligible in day to day clinical practice. Mosteller equation is suitable for routine clinical use.

Morphological and molecular studies on Sri Lankan Leishmania

Cutaneous leishmaniasis (CL) is an emerging disease in Sri Lanka, more than 400 cases having been reported since 2001. However, the morphology and taxonomic status of the Sri Lankan strain of <I>Leishmania</I> is not known yet. Therefore, it is important to study the morphology and to analyze the phylogenetic position to predict the risk and expansion of the disease and thereby to develop an effective control programme. Morphology of the amastigote of the Sri Lankan isolate was checked by light microscopy and electron microscopic observation. Presence of amastigotes within macrophages was confirmed in skin biopsy samples. The promastigote had the characteristic appearance of a kinetoplastid cell in cultures. The kinetoplast minicircle DNA has been used for diagnosis of <I>Leishmania</I> for a long time and also for phylogenetic studies on trypanosomatid flagellates. The kinetoplast minicircle was amplified using PCR and subsequently sequenced from samples obtained from Sri Lankan patients with cutaneous lesions. Mitochondrial cytochrome b gene has been recently shown to be useful for identification and phylogenetic analysis of the genus <I>Leishmania</I>. The nucleotide sequence of the cytochrome b gene of Sri Lankan <I>Leishmania</I> was determined using the semi-nested PCR and 620 bp of this gene obtained. Phylogenetic analysis using these sequences unambiguously indicated that Sri Lankan isolate of <I>Leishmania</I> belongs to <I>L. donovani</I> complex. However, the Sri Lankan isolate forms a distinct lineage within the complex and probably represents a new branch.