Molecular xenomonitoring for the assessment of lymphatic filariasis transmission in Jaffna and Trincomalee districts in Sri Lanka

Background: Lymphatic filariasis also known as elephantiasis is a neglected tropical disease causes by filarial parasites are transmitted to humans through infected female mosquito bite. The disease was formerly endemic in Sri Lanka and has been declared eliminated as a public health problem in 2016. However, LF transmission was not studied in detail in Jaffna and Trincomalee districts due to the long political unrest. The present study, LF transmission in mosquito was assessed by Molecular Xenomonitoring. Methods: A prior investigation was carried out to detect anti-filarial IgG4 in urine with ELISA and circulating filarial antigen in capillary blood with Filariasis strip tests. Subjects become positive in both testes were included their house location for mosquito collection to conduct MX. Surrounding residents were selected as target for mosquito collection with CDC gravid trap. Collected mosquitoes were dried and sorted in 827 pools (?20 mosquitoes/pool). DNA was extracted and purified from all the pools and examined by Polymerase Chain Reaction to detect filarial DNA. Results: Total, 16,631 female C. quinquefasciatus mosquitoes were collected by CDC gravid traps and tested with PCR. All pools from Jaffna and Trincomalee districts were negative for W. bancrofti infection. But, four pools (0.67%) from Trincomalee district were positive for B. malayi infection which indicated possible resurgence of brugian filariasis. Conclusions: The result suggested no evidence of infection of bancroftian filarisis. However, identification of B. malayi filarial DNA in post elimination phase is concerning and warrant further investigation.

Resurgence of measles virus infection in an eliminated country, Sri Lanka

@#Objective: To describe the situation of measles in Sri Lanka from May to November, 2023 and to define the role of virology laboratory towards case confirmation and epidemiological and genetic characterization of the outbreak. Methods: This retrospective study analyzed all samples tested for measles from 1st of May to 30th of November, 2023 at National Measles Rubella Laboratory, Sri Lanka. According to the World Health Organization (WHO) algorithm, serum and oropharyngeal/ nasopharyngeal swabs were tested with WHO recommended kits for anti-measles IgM and measles virus specific RNA, respectively. Selected RNA positive samples were sequenced at reference laboratory, India. Analysis of sequencing data and construction of phylogenetic tree were carried out at National Measles Rubella Laboratory. Data was analyzed using descriptive statistics. Results: Of the total 1 132 serum samples and 497 oropharyngeal/ nasopharyngeal swabs from 1 326 patients, 657 (49.5%) patients were confirmed as measles by anti-measles IgM, measles virus specific RNA or both. Males (55.6%, n=365) and the age group from >20 to ≤30 years (33.0%, n=217) predominated positive patients. All provinces reported measles positive cases. All samples sequenced (100%, n=42) were genotype D8 with 95.2% (n=40) bearing Victoria.Australia origin. Conclusions: We described resurgence of measles in an eliminated country, confirming the genotype to be D8, one of the two genotypes currently circulating globally. Further, the study strongly convinced the importance of a strengthened virological surveillance system in an eliminated country, despite its eliminated status.

Evaluation of in vitro anti-acne activity of methanolic extracts of Cyperus rotundus and Nymphaea nouchali

Background: The objective of this study was to evaluate in vitro anti-acne activity against Staphylococcus aureus (S. aureus), Staphylococcus epidermidis (S. epidermidis), and Escherichia coli (E. coli) using the agar well diffusion method. Methods: Air-dried and ground, matured rhizomes of Cyperus rotundus (CR), petals and pollen of Nymphaea nouchali (NN) were macerated in methanol. The resultant extracts were concentrated using a rotary evaporator. The anti-bacterial activity was performed against Staphylococcus aureus (ATCC 25923), Staphylococcus epidermidis (ATCC12228), and Escherichia coli (ATCC 25922) using the agar well diffusion method, and gentamicin was used as a positive control. The whole experiment was done in triplicates. Results: The data obtained from dose-response curves, methanolic extracts of Cyperus rotundus rhizomes against staphylococcus aureus (IC50=819.2 µg/ml), Nymphaea nouchali pollens against Staphylococcus epidermidis (IC50=787.7 µg/ml) and combination against Escherichia coli (IC50=813.6 µg/ml) were exhibited the highest potency. A strong positive statistically significant correlation was exhibited between the zone of inhibition and the concentrations of all plant extracts. The p value was less than 0.05 (p<0.05) and all the R2 values were around 1. Conclusions: The maximum anti-bacterial potency against gentamicin equivalent was observed in S. aureus, S. epidermidis, and E. coli at the concentration of 15625 µg/ml in combination. The present study might bring progress in the treatment of acne using herbs and in developing herbal formulations for safe and effective management of the disease.

Morphological Variations of Lumbrical Muscles of Hand in Sri Lankan Cadavers

Introduction: Lumbricals are the small, worm-like, intrinsic muscles responsible for performing the precision pinch movements of the hand. These are quite unique in their position owing to movable proximal and distal tendon attachments. Purpose of the study: The aim of the study was to identify anomalies of lumbrical muscle present in the Sri Lankan people. Materials and Methods: A sample of 39 formalin preserved cadaveric human hands were subjected to the gross morphological study. Results: It was encountered that 59% of the lumbricals were normal in proximal and distal attachments whereas the rest of the lumbicals (41%) indicated the morphological variations. Among the hands, unipennate third lumbrical was seen in 7.7% (Left-15.7%: Right 0%) and unipennate fourth lumbrical was seen in 5.1% (Left10.5%: Right 0%). The bipennate second lumbrical was seen in 5.1% (Left 5.3%: Right 5.1%). The 10.3% of split insertion was encountered in third lumbricals (Left 10.5%: Right 10%) as well as in fourth lumbricals (Left 5.3%: Right 15%). The third lumbrical insertion on the medial side of the middle finger was seen in 2.5% (Left 5.3%: Right 0%). Conclusion: The left hand is having more lumbrical variations than the right hand of the subjected human cadavers. The most common variation site is the insertion site. The variants are numerous in third and fourth lumbricals. The most common type of variation is the split insertion.

Abandoned boats contribute to spread of Aedes and Culex vector mosquitoes in coastal belt, Galle District, Southern Sri Lanka

Background & objectives: Although, the number of considerable cases of dengue and lymphatic filariasis have been reported from Galle District, Sri Lanka in the past several years, contribution of abandoned boats to spread vector mosquitoes of Aedes and Culex in the coast is not well studied. Our aim was to assess the positive composition of different types of abandoned boats by larval vector mosquitoes to investigate their occurrence and habitat preference, and the monsoonal and co-existence variation of Aedes mosquitoes. Methods: The 4th instar larvae of Aedes and Culex species from three different abandoned boat types in nine subsampling sites at three municipal areas in Galle District were collected during 2017–2019. In total, 15 sampling rounds were conducted in each site for three years duration as five sample rounds per year. Larval collections and identifications were carried out using standard techniques and identification keys according to WHO guidelines. The occurrence of mosquito larvae was analysed by boat type, locations within area and year. Further, the average infestation variation of Aedes mosquitoes were compared with monsoonal and co-existence changers. Results: Out of the total abandoned boats, majority (51%) were engine boats and, 32.7%, 16.35% were troller boats and canoe boats, respectively. Troller boats were highly infested boat type for vector mosquitoes. Aedes albopictus was the dominant vector in abandoned boats other than recorded Ae. aegypti and Culex quinquefasciatus. Culex quinquefasciatus showed comparatively low infestation percentages. The average infestation of Ae. albopictus showed a consistent pattern with monsoon variation. A competitive rapid invasion of Aedes aegypti was observed with the suppressing Ae. albopictus in abandoned boats after 2018. Interpretation & conclusion: Abandoned boats contribute noteworthy to spread of Aedes and Culex vector mosquitoes in coastal belt, Galle District. These study findings would be helpful for researchers and health authorities to design appropriate vector control measures and to mitigate future dengue and filariasis outbreaks

Molecular characterization of BK virus detected in renal transplant patients in Sri Lanka: a preliminary study

Background & objectives: BK virus (BKV) is a polyomavirus and cause of a common infection after renal transplantation which could be preceded to BKV-associated nephropathy. It has four main subtypes (I–IV). BKV subtypes II and III are rare, whereas subtype I shows a ubiquitous distribution. The objective of the present study was to investigate the prevailing BKV subtypes and subgroups in renal transplant patients in Sri Lanka. Methods: The presence of BKV in urine was tested through virus load quantification by real-time PCR from 227 renal transplant patients who were suspected to have BKV infection. Of these patients only 41 were found to be BKV infected (>103copies/ml) and those were subjected to conventional PCR amplification of VP1 gene followed by BKV genotyping via phylogenetic analysis based on DNA sequencing data. Results: Persistent BK viral loads varied from 1×103 to 3×108 copies/ml. Of the 41 patient samples, 25 gave positive results for PCR amplification of subtyping region of VP1 gene of BKV. BKV genotyping resulted in detecting subtype I in 18 (72%) and subtype II in seven (28%) patients. BKV subgroups of Ia, Ib-1 and Ib-11, and Ic were identified with frequencies of 6/18 (33.3%), 6/18 (33.3%), 5/18 (27.8%), and 1/18 (5.6%), respectively. Interpretation & conclusions: Findings from this preliminary study showed a high occurrence of subtype I, while the presence of subtype II, which is rare and less prevalent, was a novel finding for this Asian region. This emphasizes the need for further molecular and serological studies to determine the prevalence of different BKV subtypes in Sri Lanka

Diagnosis, Treatment, and Outcomes of Presumed Ocular Tuberculosis Patients Attending Central Chest Clinic, Colombo

Aims: Main objective of this study was to describe the diagnosis, treatment, outcomes, and associated factors of presumed ocular tuberculosis patients attending Central Chest Clinic, Colombo. Study Design, Place and Duration: A cross sectional descriptive study was conducted among all ocular tuberculosis patients referred to Central Chest Clinic, Colombo for treatment from 1st of January 2016 to 31st June 2018.Methodology: Pretested content validated secondary data extraction form was used. Socio-demographic and work-related characteristics were analysed using frequency distributions. Association between socio-demographic characteristics and factors associated with diagnosis, treatment and outcomes were analysed using Fisher-extract test. Results: Among study respondents, 52.6% showed abnormal ESR finding (>20mm), 17.8% displayed Chest X-ray abnormalities and 89.5% reported positive Tuberculin skin test (>14mm in diameter). Uveitis was the most common diagnosis (87.9%). Among Uveitis patients, 36.5% presented with posterior uveitis. Out of all ocular TB patients who have completed the treatment, 77.6% reported improvement of vision following the anti-TB treatment regimen. Duration of the treatment with anti-TB drugs was similar across all types of ocular diseases among Ocular TB patients (p=0.590).Conclusions: Large number of patients received treatment for 6 months with majority reported as improved vision on completion of treatment. Further prospective studies using primary data need to be conducted to have greater insight of the ocular tuberculosis in Sri Lanka.

Genetic diversity of Leishmania donovani isolates from cutaneous lesions of military personnel in the Mullaitivu and Kilinochchi districts of the Northern Province, Sri Lanka

Objective: To compare the DNA sequences of Leishmania (L.)donovani isolated from individuals in two districts of the Northern Province with other parts of Sri Lanka and neighboring countries. Methods: Samples were collected from military personnel at the Army Hospital, Narahenpita, Sri Lanka from November 2018 to March 2020. A portion of the samples was fixed, stained with Giemsa and observed under the light microscope. The genomic The DNA was extracted from the remaining portion of the samples using DNEasy blood tissue kit (Qiagen, Germany) and amplified using Leishmania genus-specific primers for molecular diagnosis initially. DNA was amplified using L. donovani species-specific primers by PCR and the amplified product was sequenced for comparison of nucleotide sequences. Results: Out of 76 suspected patients, at least one biological sample of 45 (59.2%) was positive for L. amastigotes upon microscopy. Overall, 33 (43.4%) were positive in Leishmania genus-specific PCR, but only 23 (30.3%) were positive in L. donovani specific PCR. The dendrogram indicates that the current sequences clustered together with those from Nepal and Gampaha districts (Western Province), Sri Lanka, while the Indian and Eastern African sequences clustered separately. Conclusions: The genetic diversity was low among the isolates, indicating a single and possibly a local point of origin. However, the similarity of Sri Lankan and Nepal strains indicate a possibility of a shared point of origin, which needs more extensive evidence to confirm.

Public knowledge, practices and perceptions on typhus fevers in Southern Sri Lanka

Objective: To assess public knowledge, practices and perceptions on typhus fevers in Sri Lanka. Methods: A descriptive study was done in four selected typhus-prone areas in Southern Sri Lanka. A mixed-method was employed using face-to-face interviews and questionnaire-based surveys among confirmed cases of typhus and at-risk populations, respectively. Frequencies, percentages, and means were used to characterize socio-demography and evaluate disease awareness. Results: The lay terms for typhus fevers reported in the studied region were 'peacock fever', 'tick fever' and 'bird fever'. A total of 499 subjects participated [mean±SD, (45±16) years] in the questionnaire-based survey, and 13.6% (n=68) reported past experience of typhus fever, 1.2% (n=6) identified the disease as 'typhus' while 58.7% (n=293) and 11.8% (n=59) knew it as 'peacock fever' and 'tick fever', respectively. The etiological agent was unknown to 95.2% (n=475), but 53.5% ((n=267) were aware that it was vector-borne. Fever (57.3%, n=286), eschar (35.7%, n=178), headache (22.0%, n=267) and myalgia (19.2%, n=96) were identified as key symptoms. Past disease experience was significantly associated with higher awareness of the main disease symptoms (fever: χ 2 =15.713, P<0.001; headache: χ 2 =19.447, P<0.001; lymphadenopathy: Fisher's exact test, P=0.023; eschar: χ 2 =12.049, P<0.001). None knew of any disease prevention methods. Participants with a past history of typhus fever had sought treatment at state hospitals (55.9%, 38/68) and private sector hospitals (5.9%, 4/68). Conclusions: Public awareness on preventive practices for typhus fevers was rare among the participants though vector-borne aspect was known to many. Clinical disease awareness was deficient among those without past experience of typhus fever. Community sensitization on vector avoidance strategies is highly recommended.

Antimicrobial susceptibility and serotypes of Neisseria meningitidis and Streptococcus pneumoniae in Sri Lanka: Experience from the National Reference Laboratory

Objective: To determine the antimicrobial susceptibility and serotypes of Neisseria (N.) meningitidis and Streptococcus (S.) pneumoniae in Sri Lankan patients. Methods: We retrospectively analyzed 11 blood culture specimens from suspected patients with invasive meningococcal disease and 26 S. pneumoniae clinical isolates. We tested 6 antimicrobials against N. meningitidis and 12 antimicrobials against S. pneumoniae. Meningococcal serogroup was determined by realtime PCR and Quellung serotyping was used for pneumococcal analysis. Results: N. meningitidis serogroup B was the most common in this study. Intermediate-susceptibility to penicillin was seen in 75.0% (6/8) of strains. Susceptibility to ciprofloxacin, levofloxacin and cotrimoxazole was 62.5% (5/8), 62.5% (5/8) and 87.5% (7/8), respectively. Excellent susceptibility was seen in cefotaxime and meropenem. In S. pneumoniae, the most common serotype was 19F in both invasive and non-invasive pneumococcal diseases. The majority of strains showed multidrug resistance. Penicillin non-susceptibility in non-meningeal strains were 13.6% and all meningeal strains were penicillin resistant. Erythromycin was highly resistant in both groups. Amoxicillin showed excellent susceptibility in non-invasive pneumococcal diseases strains. Linezolid, levofloxacin and vancomycin showed 100.0% susceptibility in all pneumococcal isolates. Conclusions: Implementation of vaccines should be considered, especially for children and high-risk populations. This may contribute to reducing pneumococcal and meningococcal invasive disease burden and help prevent emergence of antimicrobial resistant strains.

Estimation of sex from the osteometric measurements of the femur in a contemporary Sri Lankan population / Estimación del sexo a partir de las medidas osteométricas del fémur en una población contemporánea de Sri Lanka

SUMMARY: Sex estimation from human skeletal remains is of vital importance in the buildup of a biological profile of an individual in medico-legal and bioarchaeological studies. The present study is focused on the estimation of sex from osteometric measurements of the complete femur and its fragmentary parts, and the development of a web based application related to this. Fifteen osteometric measurements were taken from 78 dry cadaveric femurs from the Faculty of Medicine, University of Kelaniya. Using R software, linear discriminant analysis and logistic regression methods were applied to build classification models with the help of the application of a stepwise procedure, to identify the best combination of measurements to estimate the sex of the femur. A cross-validation method was applied to estimate the predictive accuracy of each model. Since the linear discriminant analysis model gave more predictive accuracy than the regression model, we suggest using linear discriminant analysis to estimate the sex using osteometric measurements of the femur. From the whole femur measurements, a formula to determine sex was developed with highest total accuracy of 83 % using four parameters; epicondylar breadth, anteroposterior mid-shaft diameter, bi-trochanter length, and maximum shaft diameter. Similarly, measurements of transverse head diameter and bi-trochanter length with a total accuracy of 76 % for the proximal part of the femur, measurements of anteroposterior mid-shaft diameter with a total accuracy of 77 % for the mid-shaft, and measurements of epicondylar breadth and maximum length of the lateral condyle with a total accuracy of 70 % for the distal part of the femur were identified as significant discriminants to determine sex, and formulae were written accordingly. Average accuracy ranged from 83 % to 70 %, with male accuracy slightly higher than that of females. A web application to estimate the sex of femur using these formulae was developed and this will be of great importance for forensic medicine and bio-archaeological research in Sri Lanka.

RESUMEN: La estimación del sexo a partir de restos óseos humanos en los estudios médico-legales y bioarqueológicos es de vital importancia en la construcción de un perfil biológico de un individuo. El objetivo de este estudio fue la estimación del sexo a partir de medidas osteométricas del fémur completo y sus partes fragmentarias, y el desarrollo de una aplicación web relacionada con esto. Se tomaron quince medidas osteométricas de 78 fémures cadavéricos secos de la Facultad de Medicina de la Universidad de Kelaniya. Utilizando el software R, se aplicaron métodos de análisis discriminante lineal y regresión logística para construir modelos de clasificación con la aplicación de un procedimiento por pasos, para identificar la mejor combinación de medidas y estimar el sexo a partir del fémur. Se aplicó un método de validación cruzada para estimar la precisión predictiva de cada modelo. Dado que el modelo de análisis discriminante lineal proporcionó una mayor precisión predictiva que el modelo de regresión, sugerimos su utilización para estimar el sexo mediante mediciones osteométricas del fémur. A partir de las mediciones del fémur completo, se desarrolló una fórmula para determinar el sexo con la mayor precisión total del 83 % utilizando cuatro parámetros; anchura del epicóndilo, diámetro anteroposterior del tercio medio de la diáfisis, longitud bitrocánter y diámetro máximo de la diáfisis. De manera similar, utilizamos las mediciones del diámetro transversal de la cabeza del fémur y la longitud del bitrocánter con una precisión del 76 % para la parte proximal del hueso, las mediciones del diámetro anteroposterior del tercio medio de la diáfisis se obtuvo con una precisión del 77 %. El ancho del epicóndilo y la longitud máxima del cóndilo lateral con una precisión del 70 % para la parte distal del fémur se identificaron como discriminantes significativos para determinar el sexo y se escribieron fórmulas. La precisión promedio osciló entre el 83 % y el 70 %, siendo la precisión en los hombres ligeramente superior al de las mujeres. Se desarrolló una aplicación web para estimar el sexo del fémur utilizando estas fórmulas y creemos será importante para la medicina forense y la investigación bioarqueológica en Sri Lanka.

Human skeletal remains analysis rom pallemalala shell midden in Southern Sri Lanka / Análisis de restos óseos humanos del vertedero de conchas de pallemalala en el sur de Sri Lanka

SUMMARY: Sri Lanka, an island off the tip of the Southeast of the Indian subcontinent processes the earliest skeletal evidence of anatomically modern Homo sapiens (37,000 B.P.) and the best human skeletal record sequence in the South Asian region. Adding another to the list, the skeletal remains, which belong to Mesolithic culture were found at Pallemalala shell midden in Southern Sri Lanka during scientific archaeological exploration by Postgraduate Institute of Archaeology, University of Kelaniya. Sri Lanka. The aim of the study was to determine the minimum number of human individuals, age, sex, and pathological conditions related to the ancient Pallemalala commiunity. For the primary analysis, 426 bone fragments were available. Out of those, 233 bones were identified as human bones which represent 7 minimum number of individuals. The rest of the collection comprises some animal bones and shell species. The community was predominated by the female population. The identified age categories were around 20 years, between 35-45 years, and over 45 years. The encountered pathological lesions were bone thickening, alveolar resorption, dental abscesses, dental caries, antemorterm tooth loss, calculus deposits and brown colour stains on teeth. Regarding the dietary pattern, it was evident that their diet may have consisted of coarse foodstuffs with an extremely basic dietary chemistry.

RESUMEN: Sri Lanka es una isla en la punta del sureste del subcontinente indio que procesa la evidencia esquelética más antigua del Homo sapiens anatómicamente moderno (37.000 AP) y la mejor secuencia de registros esqueléticos humanos en la región del sur de Asia. Agregando otro elemento a la lista, los restos óseos, que pertenecen a la cultura mesolítica, se encontraron en el vertedero de conchas de Pallemalala en el sur de Sri Lanka durante la exploración arqueológica científica realizada por el Instituto de Postgrado de Arqueología de la Universidad de Kelaniya, Sri Lanka. El objetivo del estudio fue determinar el número mínimo de individuos humanos, edad, sexo y condiciones patológicas relacionadas con la antigua comunidad Pallemalala. Para el análisis se dispuso de 426 fragmentos óseos. De esos, 233 huesos fueron identificados como huesos humanos que representan un número mínimo de 7 individuos. El resto de la colección se componía de algunos huesos de animales y especies de conchas. La comunidad estaba dominada por la población femenina. Las categorías de edad identificadas fueron alrededor de 20 años, entre 35-45 años y mayores de 45 años. Las lesiones patológicas encontradas fueron engrosamiento óseo, reabsorción alveolar, abscesos dentales, caries dental, pérdida de dientes antemortem, depósitos de cálculo y manchas de color marrón en los dientes. En cuanto al patrón dietético, era evidente que su dieta pudo haber consistido en alimentos toscos con una química dietética extremadamente básica.

The in vivo glycaemic response of different rice varieties in Sri Lanka

@#Introduction: Diabetes poses a heavy economic burden in Sri Lanka. High glycaemic index (GI) diets are known to promote a higher risk of diabetes. This study was aimed to determine the GI values of nine improved and three traditional rice varieties of Sri Lanka including Bg406, H.H.Z.36, Ld368, Bw367, Bg94-1, At405, At362, Bg300, Bg352, Sudu heenati, Madathawalu, and Pachchaperumal. Furthermore, comparisons of GI values between improved and traditional varieties, as well as the effect of subject gender and colour of pericarp on GI were described. Methods: Fourteen healthy subjects consisting of seven males and seven females were fed with a reference food and cooked rice varieties containing 50 g available carbohydrate; GI were calculated. Results: The GI of 12 rice varieties varied from 40-69. All traditional varieties including Sudu heenati, Madathawalu and Pachchaperumal were in the low GI category presenting GI values of 51, 54, and 41, respectively. Rice with red pericarp obtained significantly lower GI compared to those with white pericarp. Yet, GI values obtained in males were significantly higher than females. Conclusion: The result of this study suggested that all traditional varieties and improved rice H.H.Z 36, Ld368, and Bg406 could have beneficial effects on lowering the glycaemic response in healthy subjects. Glycaemic index can be predicted from the colour of the rice grain. Gender should be considered in the determination of GI.

A study of lipid profile and glycemic status in patients with chronic kidney disease of unknown etiology in Sri Lanka

Background: Dyslipidemia and impaired glucose tolerance are common complications of chronic kidney disease (CKD) and are responsible for increased cardiovascular risk. Studies on lipid profile and glycemic status in CKD of unknown origin (CKDu) are scarce. The objective of this study was to evaluate the lipid profile and glycemic status of the patients with CKDu and to aid in preventing morbidity and mortality.Methods: The descriptive, cross sectional study was conducted in a rural CKDu endemic area, Girandurukotte.  Data was collected from February 2018 to June 2019. For the diagnosis of CKDu, history and clinical features with supportive biochemical, renal biopsy and radiological evidence were taken as criteria. Blood samples were taken for serum creatinine, lipid profile and HbA1C. Already diagnosed patients with diabetes mellitus and dyslipidemia were excluded.Results: A total of 168 patients within the age range of 32-66 years (mean 50.3±7.7) were participated. There were 106 males (63%) 46.4% were farmers. Majority of the patients (65.5%) had normal body mass index (BMI) (mean 22.9 kg/m2, normal range 18.5-23.5%) followed by overweight (23.5-30 kg/m2) in 55 (32.7%) patients. The prevalence of dyslipidemia in CKDu was found to be 55.9%.  Majority of the abnormality was seen in the HDL group with 68 (40.5%) patients having low HDL cholesterol (mean 44.7 mg/dl, SD=12.3).  There was a significant rise in the serum triglyceride concentration (>150 mg/dl) in 53 (31.5%) (mean 152.4 mg/dl, SD=73.5) and total cholesterol (>200 mg/dl) in 30 (18%) patients (mean 182 mg/dl, SD=36.9). LDL cholesterol abnormality (>130 mg/dl) was seen in only 9 patients (mean 88.7 7658mg/dl, SD=25.4). From the total, 144 (85.7%) patients had abnormal HbA1C levels; 27 (16.1%) patients had HbA1C levels between 5.7% and 6.4% (pre-diabetes), and 117 (69.6%) patients had HbA1C level more than 6.5% (diabetes mellitus). There was no statistically significant association between HbA1C levels and BMI (p=0.29) or HbA1C and lipid abnormalities (p=0.32)Conclusions: The high prevalence of dyslipidemia, pre-diabetes and diabetes mellitus in patients with CKDu may accelerate the progression of chronic kidney disease and increase the risk of cardiovascular disease. Early detection, initiation of appropriate medication and early referral to the expertise will ameliorate morbidity and mortality.

A simple screening tool to identify women with previously undiagnosed prediabetes and diabetes mellitus in the community

Background:In the current context of rising prevalence of non-communicable diseases, simple low-cost screening tools are essential for identifying individuals who have glucose dysregulationat its early stages. Therefore, we developed and validated a screening tool for dysglycemia (defined as HbA1c≥5.7%) with the potential to identify undiagnosed prediabetes and as well as diabetes mellitus.Methods:A sample of 2800 women representative ofColombo Municipal Council area was screened using fasting blood glucose for dysglycemia. All (n=272) newly diagnosed dysglycemics and a further 345 normoglycemics were recruited following confirmation of glycemic status by HbA1c, to enable ROC analysis. Apretested questionnaire and the International physical activity questionnaire validated for Sri Lanka were used to generate variables for the risk score.Results:A risk score for dysglycemia with a sensitivity of 87% and specificity of 87% and AUC of 0.941 was developed with two common symptoms of dysglycaemia, history of recent increase in frequency of passing urine and recent reduction in vision, one common food related practice, inability to resist sugary food and one indicator of sedentary behavior, TV viewing time and a single anthropometric measurement, waist circumference.Conclusions: A tool to identify prediabetesis currently unavailable and this new tool fills this gap. Further, the tool is designed to include women with previously undiagnosed diabetes mellitus. Inclusion of lifestyle parameters having a known association with dysglycemia increased the strength of the tool. Early identification will ensure targeting of interventions at the point of maximum effect.

Cardiac Manifestations of Thevetia peruviana Poisoning: A Descriptive Study from Northern Sri Lanka

Background: Poisoning with Thevetia peruviana (yellow oleander) is commonly observed in Northern and Eastern provinces of Sri Lanka causing significant morbidity and mortality. It contains cardiac glycosides which are toxic to cardiac muscle that results in cardiovascular dysrhythmias. Objective: To determine the pattern of cardiac dysrhythmias and outcome of yellow oleander poisoning at a tertiary care center of Northern Sri Lanka. Methods: A descriptive, cross sectional, prospective study was carried among patients with yellow oleander poisoning admitted to Teaching hospital, Jaffna, Sri Lanka over a period of two years. Twelve lead standard electrocardiography and 2‑lead ECG monitoring were performed in all patients during the hospital stay at the cardiology unit. Data were entered in Microsoft Excel sheet and was analyzed using SPSS [version 21] analytical package. Results were presented as counts, percentages and mean ± SD for continuous variables. Results: 23 out of 44 patients were females. Mean age of the patients was 24.84 [SD ± 0.43] years. Most of the patients were symptomatic and presented with gastro intestinal symptoms like vomiting, abdominal pain and diarrhea. Bradycardia was the most commonly observed cardiac rhythm abnormality within the first 24 hrs of ingestion of yellow oleander seeds. Sinus bradycardia [75%] was the commonest cause for bradycardia. All patients were treated with multiple doses of activated charcoal irrespective of the time of presentation. Patients with bradyarrhythmias were treated with intravenous boluses of atropine and 12 of them needed temporary pacing. Conclusion: Most of the victims of Yellow oleander poisoning were young adults. The cardiac toxicity developed within 24 hours of ingestion of the seeds. The risk of toxicity has not related to the number of seeds consumed. Most patients have nonspecific symptoms. AV conduction abnormalities are common. Activated charcoal is useful in most cases.

Manifestations and outcomes of leptospirosis during local outbreaks in high endemic districts of Sri Lanka: A retrospective multi-center study

Objective: To determine the clinical presentations and disease outcomes of suspected and confirmed cases of leptospirosis from 3 high endemic districts of Sri Lanka, during outbreaks reported between 2013 and 2017. Methods: The retrospective multi-center study was carried out during 2013-2017 in 5 selected hospitals representing 3 high endemic districts in Sri Lanka. Clinically suspected leptospirosis patients were recruited according to the Communicable Disease Epidemiology Profile Sri Lanka, WHO. Leptospirosis was confirmed by either single microscopic agglutination test titre 1: 400 or by positive polymerase chain reaction (PCR) test result. Results: Out of 372 clinically suspected cases, 29.00% were confirmed as leptospirosis cases by either microscopic agglutination test (50.00%) or positive polymerase chain reaction (52.77%) and 12.90% were presumptively identified as leptospirosis. Clinical symptoms (headache, vomiting, jaundice and dyspnoea) and variations in haematological parameters (haemoglobin, platelet count) and biochemical parameters (serum creatinine, serum urea, serum bilirubin and C-reactive protein) were associated with confirmed leptospirosis (P<0.05). Acute kidney injury, meningitis, myocarditis, pulmonary haemorrhage and acute liver failure was seen among 21.30%, 12.04%, 6.48%, 6.48%, 5.56%, respectively with 4.63% fatality among the leptospirosis confirmed patients. The sensitivity, specificity, positive predictive value and negative predictive value of the case definition of Ministry of Health, Sri Lanka were 96.29%, 9.09%, 31.13%and 85.71%, respectively, when benchmarked against either positive polymerase chain reaction or microscopic agglutination test as the gold standard. Conclusions: Acute kidney injury is the predominant complication observed among the leptospirosis confirmed patients. However, pulmonary haemorrhage is predominantly associated with mortality. The case definition of Ministry of Health, Sri Lanka is found to have higher sensitivity and enabled the screening of all probable cases of leptospirosis.

Melioidosis: A hidden tropical disease in Sri Lanka

Melioidosis, caused by the soil saprophyte Burkholderia pseudomallei, is found in tropical countries. Infection is acquired from soil and water by inoculation through the skin and mucous membranes, inhalation into the respiratory tract and ingestion of untreated water. Clinical manifestations range from acute fulminant septicaemia to chronic localized infection characterised by abscess formation. Isolation of Burkholderia pseudomallei from patient specimens confirms the diagnosis. Although exposure is widespread in rural, agricultural communities, clinical disease is less common as it usually requires compromised immunity, commonly diabetes. Case fatality is high in the absence of effective antibiotic treatment which comprises an acute phase of intravenous antibiotics and a long eradication phase of oral antibiotics. Prevention and control is difficult as the bacterium is widespread in the soil and water of endemic countries and exposure is common in rural, agricultural populations. Sri Lanka was not considered a country with endemic melioidosis in the past. National surveillance was instituted in 2006. Around 450 culture positive cases and more than 1 000 antibody positive cases were recorded to date. Males predominated. The age range was wide. All provinces were affected with the majority living in rural areas. Case load increased during the two monsoons. There was representation of all population groups including farmers, drivers, housewives, school children, professionals, businesspersons, white collar and blue collar workers. Diabetes was the predominant risk. Clinical presentations included community acquired sepsis and pneumonia, superficial and deep abscesses, septic arthritis, neurological melioidosis and endocarditis. Mortality was more than 20%. Melioidosis is endemic in Sri Lanka with a wide geographic and demographic distribution. There is a need to extend surveillance to under-resourced parts of the country.

Manifestations and outcomes of leptospirosis during local outbreaks in high endemic districts of Sri Lanka: A retrospective multi-center study

Objective: To determine the clinical presentations and disease outcomes of suspected and confirmed cases of leptospirosis from 3 high endemic districts of Sri Lanka, during outbreaks reported between 2013 and 2017. Methods: The retrospective multi-center study was carried out during 2013-2017 in 5 selected hospitals representing 3 high endemic districts in Sri Lanka. Clinically suspected leptospirosis patients were recruited according to the Communicable Disease Epidemiology Profile Sri Lanka, WHO. Leptospirosis was confirmed by either single microscopic agglutination test titre 1: 400 or by positive polymerase chain reaction (PCR) test result. Results: Out of 372 clinically suspected cases, 29.00% were confirmed as leptospirosis cases by either microscopic agglutination test (50.00%) or positive polymerase chain reaction (52.77%) and 12.90% were presumptively identified as leptospirosis. Clinical symptoms (headache, vomiting, jaundice and dyspnoea) and variations in haematological parameters (haemoglobin, platelet count) and biochemical parameters (serum creatinine, serum urea, serum bilirubin and C-reactive protein) were associated with confirmed leptospirosis (P<0.05). Acute kidney injury, meningitis, myocarditis, pulmonary haemorrhage and acute liver failure was seen among 21.30%, 12.04%, 6.48%, 6.48%, 5.56%, respectively with 4.63% fatality among the leptospirosis confirmed patients. The sensitivity, specificity, positive predictive value and negative predictive value of the case definition of Ministry of Health, Sri Lanka were 96.29%, 9.09%, 31.13%and 85.71%, respectively, when benchmarked against either positive polymerase chain reaction or microscopic agglutination test as the gold standard. Conclusions: Acute kidney injury is the predominant complication observed among the leptospirosis confirmed patients. However, pulmonary haemorrhage is predominantly associated with mortality. The case definition of Ministry of Health, Sri Lanka is found to have higher sensitivity and enabled the screening of all probable cases of leptospirosis.

Study on the approach of promoting service trade of traditional Chinese medicine into Sri Lanka / 国际中医中药杂志

Sri Lanka and China enjoy profound traditional friendship and active bilateral friendly cooperation. With the deepening of bilateral FTA negotiations, service trade of traditional Chinese enters into Sri Lanka is also promising. Though the current policy and law exists insufficiency, leveraging the FTA negotiations, TCM-Center binding Confucius Institute, providing TCM features and developing tour routes of medical tourism can help to push service trade of traditional Chinese medicine into Sri Lanka. The development of overseas Chinese medicine health services is not only benefit to the local, but also contribute to the new pattern of Chinese economic reformation.