Browsing by Author "Kularatne, S.A.M."

Now showing 1 - 10 of 10

Anti-venom for snake bite in Sri Lanka
(Sri Lanka Medical Association, 2002) de Silva, H.J.; Fonseka, M.M.D.; Gunatilake, S.B.; Sellahewa, K.H.; Kularatne, S.A.M.
No Abstract Available
Approach to study the efficacy and safety of new complementary and alternative medicine formulations: Lesson during COVID-19 from Sri Lanka
(Wolters Kluwer - Medknow, 2023) Pilapitiya, S.; Jayasinghe, S.; Silva, A.; Wickremasinghe, R.; Paranagama, P.; de Silva, J.; Lekamwasam, S.; Kularatne, S.A.M.; Wanigasuriya, K.; Kaluthota, S.; Sumathipala, S.; Rathnnasooriya, C.; Siribaddana, S.
COVID-19 affected Sri Lanka from early 2020, a time of considerable ignorance accompanied by wide media coverage of a devastating epidemic in Italy and Europe. Many were attracted to complementary and alternative medicine (CAM) or traditional medicine (TM) in this desperate situation. Several preparations were claimed to be effective against COVID-19 globally. Dammika Bandara Syrup© was one such preparation promoted for preventing and treating SARS-CoV-2 infection. It was based on bees' honey, pericarp and mace of Myristica fragrans (nutmeg), the seed of Foeniculum vulgare and fresh rhizome of Zingiber officinale, all believed to have anti-viral properties. Following an unpublished clinical study claiming efficacy, Dammika Bandara Syrup© gained wide media publicity and political patronage. The producer claimed of Goddess Kali revealing the formula added an anthropological, cultural, and religious complexity to the issue. The demand for the product increased rapidly as a debate raged both in public and in the parliament on utilizing such products in combating COVID-19. The Department of Ayurveda, which is statutorily responsible for regulating CAM/TM had to respond to the situation. The legislation to regulate such indigenous medicinal products was weak, and the crisis deepened as thousands converged to the production facility, defying mobility restrictions introduced to control COVID-19. This led to the Ministry of Health requesting academics to form a team and conduct a clinical trial to prove its efficacy. This paper outlines the process and issues faced during the regulatory approval for the trial in a polarized political environment. Some health professionals accused the researchers of bowing to political pressure and questioned the scientific justification for the trial. However, the team considered this as an opportunity to streamline a path for research into CAM/TM therapies in situations such as COVID-19. Several processes were identified and addressed, such as the provisional registration of CAM preparations, assessing the potential efficacy of a CAM product, confirmation of authenticity and safety, standardization and supervision of production respecting cultural identities, obtaining approval for human use, choice of comparators, and ethical issues. We believe the study has helped set standards and a benchmark for CAM and TM research in Sri Lanka.
Attitudes of Sri Lankan physicians towards end oflife decisions and care
(Sri Lanka Medical Association, 2007) Gunaratne, P.A.K.G.; Gurugama, N.P.; Kularatne, W.A.I.; Kularatne, S.A.M.; de Silva, H.J.
INTRODUCTION: Despite considerable public interest in legalizing physician-assisted suicide and euthanasia in many parts of the world, littie is known about physicians' attitudes toward these practices in Sri Lanka. OBJECTIVE: To assess attitudes of physicians towards end of life care and decision making. DESIGN, SETTING AND METHODS: Data were collected using a pre-tested self-administered questionnaire distributed among 450 physicians and aspiring physicians attending two Annual Academic Sessions. RESULTS: Sixty-six consultant physicians and 204 non-consultant doctors responded to the questionnaire (60% response rate). 262 (97%) were in agreement of palliative care and 63 (23%) of them believed in delivering the best possible care for the terminally ill. 218 (81%) indicated that they would use morphine as a mode of pain relief. But only 51 (19%) doctors said they would administer morphine knowing that it might cause death due to respiratory depression, implying their agreement to the concept of the 'doctrine of double effect'. More consultants [43 (65%)] than other doctors [80 (40%)] would give a 'do not resuscitate" order (p<0.01). Only 30 (11%) of all doctors agreed with active euthanasia or physician-assisted suicide in some instances; the majority [207 (76%)] disagreed with any form of active euthanasia (morally and ethically) for terminally ill patients, even when patients request it. CONCLUSIONS: The majority Sri Lankan physicians are in favour of palliative care for terminally ill patients. More consultants than other doctors would give a 'do not resuscitate' order. The majority would not offer any form of active euthanasia and believe it is morally and ethically incorrect.
Contribution of rickettsioses in Sri Lankan patients with fever who responded to empirical doxycycline treatment
(Oxford University Press, 2010) Premaratna, R.; Rajapakse, R.P.V.J.; Chandrasena, T.G.A.N.; Nanayakkara, D.M.; Bandara, N.K.B.K.R.G.W.; Kularatne, S.A.M.; Eremeeva, M.E.; Dasch, G.A.; de Silva, H.J.
Twenty-eight febrile Sri Lankan patients with undiagnosed fever for 7 days after hospital admission, who responded to empirical treatment with doxycycline, were retrospectively investigated using microimmunofluorescence assay to verify whether they had rickettsial infection. Eleven (39%) patients were confirmed as having spotted fever group rickettsioses and 10 (36%) as having Orientia tsutsugamushi. Seven were negative for all tests. This suggests that greater use of doxycycline appears justified for patients with undiagnosed fever in settings where rickettsial diseases are endemic or re-emerging with inadequate diagnostic facilities.
Cytotoxic effects of α-Eleostearic acid-rich fat extracted from seeds of bitter melon (Momordica charantia) on Vero 76 cells
(Faculty of Graduate Studies, University of Kelaniya, 2015) Ranasinghe, K.N.K.; Jayasooriya, A.P.; Premachandra, T.N.; Hilmi, A.J.; Kularatne, S.A.M.; Madhujith, T.; Rajapakse, R.P.V.J.
Some seed fat sources contain conjugated trienoic fatty acids in high proportions (30- 80%). Previous studies have revealed that these fatty acids possess potent anticarcinogenic properties. The bitter melon (Momordica charantia) seed fat contains a conjugated trieneoic fatty acid named α - Eleostearic acid (α – ESA; 18:3;9c,11t,13t). The reported proportion of α-ESA in the fatty acid profile ranges from 50% - 60% and it is consistent with our study giving a result of 50.56%. Thus, the current in vitro study was conducted to evaluate the cytotoxicity of α-ESA-rich fat using a continuous cell line named Vero 76. It has been previously suggested that Vero cells can be used for preliminary studies in cancer research in vitro. For the in vitro evaluation, fatty acid methyl esters (FAMEs) of bitter melon seed fat (BMO) was prepared and was incorporated into the cell line with RPMI 1640 medium (10μl FAME + 90μl RPMI medium). As a control, FAMEs of coconut fat (Cocos nucifera; CO) was incorporated (10μl FAME + 90μl RPMI medium) into growing cells. Furthermore, in the positive control, Absolute Ethanol (100 % Ethanol) was added (100μl) and in the negative control 100μl of RPMI medium was added. MTT assay was conducted after 24 hours incubation. Finally Absorbance (A) was measured at 570 nm. The results revealed that Vero cells treated with FAMEs of BMO have exhibited a significantly less cell viability (A = 0.2138) as compared with cells treated with FAMEs of CO (A = 0.8475). The viability of cells treated with FAMEs of CO was comparable with the negative control (A = 1.027). Interestingly, the viability of cells treated with FAMEs of BMO was comparable with the positive control (A = 0.2443) indicating a potent cytotoxicity on these cells. BMO exhibited a significant cytotoxic action compared with CO. As Vero cells have been recognized a suitable cell culture for preliminary cytotoxicity studies, these results pave the way for further studies on this cytotoxic conjugated fatty acid using cancer cell lines in vitro.
An Evaluation on Factors Influencing Venom Yield in Spectacled Cobra (Naja naja) in Sri Lanka
(Faculty of Graduate Studies, University of Kelaniya, 2015) Dissanayake, D.S.B.; Rajapakse, R.P.V.J.; Kularatne, S.A.M.
Snake venom contains medically important toxic proteins. Proteroglyphous snakes of the family Elapidae: Naja naja is the only recognized species of cobra in Sri Lanka and is responsible for a considerable number of envenomation and deaths due to snake bites. The dose of antivenin depends upon the amount of venom inflicted by the snake and the kinetics of venom distribution in the whole body. Although several studies have been conducted regarding this subject, the amount of venom ejecting per bite is still under investigation. The current study investigated whether the body size, sex and other morphological characteristics of N. naja have any influence on venom yield when milked manually. For milking, small-sterilized beakers that are tightly covered with parafilms layers were used. The head of each milking snake was held and venom was extracted to the prepared beakers by applying a gentle pressure to the venom glands. After that, the volume of wet venom of each snake was measured using graduated pipets and these volumes were used for statistical analysis. N. naja The average wet venom volume in 40 adult cobra (mean total length 1698 ± 161mm; mean body weight 1466 ± 287g) ranges from 200-1500μl (mean 485.15 ± 178.9μl) and 10 juvenile snakes (mean total length 632 ± 95mm and body weight 420 ± 93g) were 15-70μl. The venom yield positive correlated with the length and body weight of the snakes. Even though males hold slightly high volume of venom than females, this volume difference is not significant. In summary, we found that the venom yield is more correlated to the body size and total length than the sex and other morphological characters of snakes. Further studies are necessary to find out whether venom yield differs due to geographic variations or other related ecological factors.
Molecular characterization of rickettsial agents in ticks (Acari: Ixodidae) from Sri Lanka
(Baltimore., 2022) Dasch, G.A.; Eremeeva, M.E.; Zambrano, M.L.; Premaratna, R.; Kularatne, S.A.M.; Rajapakse, R.P.V.J.
Because the majority of spotted fever group rickettsiae are transmitted to humans by tick bites, it is important to understand which ticks might play a role in transmission of rickettsial pathogens in Sri Lanka. The purpose of our study was to conduct molecular surveillance of 847 ticks collected in different locations in central Sri Lanka to determine which were infected with Rickettsia and Anaplasmataceae. Molecular methods were used to identify the ticks and the agents detected. Most ticks (Amblyomma, Haemaphysalis, and Rhipicephalus) were collected by flagging, and lower number was collected from dogs, cattle, pigs, a pangolin, and tortoises. Five spotted fever genotypes were identified: a Rickettsia africae-like agent in Amblyomma larvae, Rhipicephalus massiliae and a related genotype identified in association with the tropical type of Rhipicephalus sanguineus from dogs and Rhipicephalus haemaphysaloides from dogs and cattle, and Candidatus R. kellyi and another novel genotype (SL94) in R. haemaphysaloides. Twenty-three ticks were positive for Anaplasmataceae, including one Anaplasma and two Ehrlichia genotypes. Because the sequence database for both ticks and rickettsial agents from Sri Lanka and southern India is not extensive, additional molecular characterization of the tick species of Sri Lanka and their rickettsial agents is required to understand their pathogenic potential more completely. However, several of the agents we identified in this survey may well be pathogenic for humans and domestic animals, and should be considered as a part of epidemiological surveillance and patient management.
Molecular Phylogeography and Clinical manifestations of Russell’s viper (Daboia russelii) in Sri Lanka
(Faculty of Graduate Studies, University of Kelaniya, 2015) Dissanayake, D.A.; Dissanayake, D.S.B.; Bandara, K.B.A.T.; Kularatne, S.A.M.; Karunathilake, D.G.K.J.K.; Rajapakse, R.P.V.J.
The Russell‘s viper, Daboia russelii has a relict distribution over large areas of Indian Sub Continent, Taiwan and the Lesser Sunda islands. Russell‘s viper is distributed with varying densities and occurrence throughout many natural and modified habitats in Sri Lanka. Bite of this species is associated with a high incidence of morbidity and mortality in Sri Lanka. There is scanty of information available about Russell‘s viper in Sri Lanka. Thus, preliminary study was carried out using clinical data obtained from the twenty eight patients admitted due to Russell‘s viper bite in General Hospitals in the Gampaha District. Further, thirty five DNA samples were collected from the tail tip of specimens of the Russell‘s viper from Gampaha, Kandy, Rathnapura, Galle, Anuradhapura and Kurunagala districts for molecular phylogeny. Then fragment of mtDNA sequencing fragments of cytochrome b genes were amplified. PCR and products were subjected. DNA sequencing for molecular analysis using raxmlGUI software. Results revealed that the clinical features following Russell‘s viper envenomation are follows; local swelling 86%, local necrosis 7%, coagulopathy 75%, neurotoxicity 32%, nephrotoxicity 14% and cardiac effects 3%. Mortality of Russell‘s viper bites are caused by complications like renal failure, neurotoxicity, respiratory failure, disseminated intravascularcoagulation, heart failure and other cardiotoxic effects. Alignment of Sequences of Cytochrome-b gene by maximum likelihood analysis revealed that two strongly supported monophyletic clades corresponding to Sri Lanka and the Indian subcontinent. However, Sri Lankan Russell‘s viper was nested within the clade of Indian Russell‘s viper group. There was genetic divergence (2%) between the Indian clades and the Sri Lankan clade. However, these haplotypes do not show any geographically significant pattern. Thus, it could be suggested that Indian and Sri Lankan Russell‘s viper are genetically closely related and origin may be India or Sri Lanka. Further studies are being carried out on morphometric, molecular taxonomic and venomous differences in different geographic location within the Sri Lanka and Asian region.
Rickettsioses in the central hills of Sri Lanka: serological evidence of increasing burden of spotted fever group
(Elsevier, 2013) Kularatne, S.A.M.; Rajapakse, R.P.; Wickramasinghe, W.M.; Nanayakkara, D.M.; Budagoda, S.S.; Weerakoon, K.G.; Edirisinghe, J.S.; Premaratna, R.
OBJECTIVES:To study the epidemiology, clinical features, and changing pattern of rickettsial infections on the western slopes of the hilly Central Province of Sri Lanka over 6 years.METHODS: All patients with rickettsial infections who presented to the Teaching Hospital, Peradeniya were studied prospectively from January 2002 to December 2007. An immunofluorescent antibody assay (IFA) was used to confirm the diagnosis. RESULTS: Of the 371 clinical cases of rickettsial infection, 122 underwent IFA to confirm the diagnosis. Species-specific IgG antibodies were positive in 105/122 (86.1%) cases: 43/105 (40.9%) to Rickettsia conorii and 6/105 (5.7%) to Orientia tsutsugamushi, with mixed antibody reactivity to more than one antigen in 56/105 (53.3%) cases, including Rickettsia typhi in 27/105 (25.7%). Among those with mixed IgG reactivity, IgM assays were used to detect pathogens responsible for acute infections. Finally, a total of 55 spotted fever group (SFG) infections, seven scrub typhus infections, and one case of murine typhus were identified. Of the 105 positive cases, 53 (50.5%) were male and 52 (49.5%) were female, and the mean age was 40 years (range 11-83 years). In the SFG patients, 13/55 (24%) had severe vasculitis with fern leaf type skin necrosis and 17/55 (31%) had arthritis. Three patients (5%) had an altered level of consciousness. A patient with scrub typhus had transient deafness. None of the 105 patients had an eschar. CONCLUSIONS: It appears that SFG rickettsioses are on the rise in the hilly Central Province of Sri Lanka, whilst murine typhus and scrub typhus are present at a lower rate. © 2013 International Society for Infectious Diseases. Published by Elsevier Inc.
Unusual pancytopenia secondary to haemophagocytosis syndrome in rickettsioses
(Oxford University Press, 2009) Premaratna, R.; Williams, H.S.A.; Chandrasena, T.G.A.N.; Rajapakse, R.P.V.J.; Kularatne, S.A.M.; de Silva, H.J.
We report two patients who presented with a long-lasting febrile illness associated with pancytopenia. Both of them had evidence of hypercellular marrow with haemophagocytosis. They were confirmed as having rickettsial infections by serology and had a rapid haematological recovery with anti-rickettsial antibiotics. We highlight the importance of considering rickettsial infections in patients with such clinical presentations, especially in areas where these infections are endemic or re-emerging. Empirical use of anti-rickettsial antibiotics in such situations could be beneficial, when facilities to diagnose rickettsial diseases are not readily available.