Browsing by Author "Senarathna, L."

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Determination of color characteristics, fatty acid composition and heavy metal in purified shark liver oil.
(Faculty of Science, University of Kelaniya Sri Lanka, 2023) Jayakody, J. A. K. S.; Edirisinghe, E. M. R. K. B.; Senevirathne, S. A.; Senarathna, L.
Shark liver oil (SLO) is a promising source of fatty acids (FAs) particularly of Omega-3 polyunsaturated FAs including, Eicosapentaenoic acid (EPA- cis-5, 8, 11, 14, 17- eicosapentaenoic acid) and Docosahexaenoic acid (DHA- cis-4, 7, 10, 13, 16, 19- docosahexaenoic acid). SLO as a dietary supplement is one of the best options to overcome healthrelated problems that arise due to imbalance and insufficient levels of omega-3 FAs. The objectives of this research were to extract and purify omega-3 rich oils from shark livers by traditional method and determine color characteristics, fatty acid composition (FAC), and heavy metals (As, Cd, Pb, and Hg) during purification. SLO was extracted using the conventional heat extraction method. Purification of crude SLO (CSLO) was done using a semi-refining which included, degumming, neutralization, and bleaching to produce purified SLO (PSLO). The color of the SLO was determined using a Chromameter and FAC was determined by Gas Chromatography - Mass Spectrometry. The heavy metals in SLO were determined using Inductively Coupled Plasma-Mass Spectrophotometry after microwave digestion. Both chroma value and hue angle were enhanced during purification, ranging from 15.15 to 35.18 and from 25.17 to 87.68, after each step of purification respectively. Moreover, the total color difference was significantly increased (p < 0.05) in every step of purification, with values of 17.02, 30.78, and 39.17, respectively. During purification, the contents of saturated FAs and monounsaturated FAs significantly increased (p < 0.05) from 117.63 to 141.53 mg g-1 and from 78.91 to 117.53 mg g-1 , respectively w hile, polyunsaturated FAs levels significantly decreased (p < 0.05) from 141.95 mg g-1 in CSLO to 131.09 mg g-1 in PSLO, respectively. The omega-3 fatty acids significantly decreased (p < 0.05) from 96.35 to 83.83 mg g-1 and the EPA+DHA level significantly decreased (p < 0.05) from 85.58 to 72.35 mg g-1 in PSLO compared to CSLO. The As levels decreased during purification from 8.749, 0.348, and 0.006 mg kg-1 , respectively. As was not detected (ND) in PSLO. Cd was ND in any SLO. Pb was recorded only in CSLO with a level of 0.225 mg kg-1 . Hg levels of CSLO and PSLO were found to be 0.292 and 0.135 mgkg-1 , respectively. SLO purification enhanced color characteristics with lowering of heavy metal contents. Moreover, it can be concluded that the purified SLO is a promising rich source of omega-3, enabling the potential for the development of omega-3 dietary supplements.
Multidose activated charcoal in acute oleander poisoning - a longitudinal observational study
(Sri Lanka Medical Association, 2009) Jayamanne, S.P.; Senarathna, L.; Dawson, A.H.
BACK GROUND: Deliberate self-poisoning with yellow oleander seeds is associated with severe cardiac toxicity and a mortality rate of about 5%- 10%. Specialised treatment is expensive and not widely available. Multiple-dose activated charcoal (MDAC) binds cardiac glycosides in the gut lumen and promotes their elimination. There have been conflicting results on whether activated charcoal benefits patients with yellow oleander poisoning. METHODOLOGY: Patients who were admitted to Polonnaruwa General Hospital before September 2007 received single dose charcoal if they presented within two hours of poisoning. Patients who were admitted after September 2007 received MDAC (50 g 6 hourly for 48 hours). In this study, the clinical features and development of serious cardio toxic effects (2nd and 3rd degree heart block) following yellow oleander poisoning was assessed in patients who were admitted during a period of eight months prior to September 2007 and eight months afterwards. RESULTS: There were 254 patients before starting MDAC and 237 patients after starting MDAC. They were of comparable age and sex distribution. Proportion of patients who were transferred with 2nd and 3rd degree heart block for cardiac pacing in the pre MDAC group was 51 (20.1%) 95% CI (15.5%-25.5%). In the post MDAC group it was 30 (12.7%) 95% CI (8.9%-17.3%), the odds ratio was 0.58 (95% CI 0.35-0.94) for this relationship. There was no difference in deaths. Interpretation: The administration of multi dose charcoal in yellow oleander poisoning was associated with a 40% reduction in cardiac toxicity and the need to transfer for pacing.
Multiple-dose activated charcoal in acute self-poisoning: a randomised controlled trial
(Lancet Publishing Group, 2008) Eddleston, M.; Juszczak, E.; Buckley, N.A.; Senarathna, L.; Mohamed, F.; Dissanayake, W.; Hittarage, A.; Azher, S.; Jeganathan, K.; Jayamanne, S.; Sheriff, M.R.; Warrell, D.A.; Ox-Col Poisoning Study collaborators
BACKGROUND: The case-fatality for intentional self-poisoning in the rural developing world is 10-50-fold higher than that in industrialised countries, mostly because of the use of highly toxic pesticides and plants. We therefore aimed to assess whether routine treatment with multiple-dose activated charcoal, to interrupt enterovascular or enterohepatic circulations, offers benefit compared with no charcoal in such an environment. METHODS: We did an open-label, parallel group, randomised, controlled trial of six 50 g doses of activated charcoal at 4-h intervals versus no charcoal versus one 50 g dose of activated charcoal in three Sri Lankan hospitals. 4632 patients were randomised to receive no charcoal (n=1554), one dose of charcoal (n=1545), or six doses of charcoal (n=1533); outcomes were available for 4629 patients. 2338 (51%) individuals had ingested pesticides, whereas 1647 (36%) had ingested yellow oleander (Thevetia peruviana) seeds. Mortality was the primary outcome measure. Analysis was by intention to treat. The trial is registered with controlled-trials.com as ISRCTN02920054. FINDINGS: Mortality did not differ between the groups. 97 (6.3%) of 1531 participants in the multiple-dosegroup died, compared with 105 (6.8%) of 1554 in the no charcoal group (adjusted odds ratio 0.96, 95% CI 0.70-1.33). No differences were noted for patients who took particular poisons, were severely ill on admission, or who presented early. INTERPRETATION: We cannot recommend the routine use of multiple-dose activated charcoal in rural Asia Pacific; although further studies of early charcoal administration might be useful, effective affordable treatments are urgently needed. Comment in : Is this the epitaph for multiple-dose activated charcoal? [Lancet. 2008]
Pralidoxime in acute organophosphorus insecticide poisoning--a randomised controlled trial
(Public Library of Science, 2009) Eddleston, M.; Eyer, P.; Worek, F.; Juszczak, E.; Alder, N.; Mohamed, F.; Senarathna, L.; Hittarage, A.; Azher, S.; Jeganathan, K.; Jayamanne, S.; von Meyer, L.; Dawson, A.H.; Sheriff, M.H.; Buckley, N.A.
BACKGROUND: Poisoning with organophosphorus (OP) insecticides is a major global public health problem, causing an estimated 200,000 deaths each year. Although the World Health Organization recommends use of pralidoxime, this antidote's effectiveness remains unclear. We aimed to determine whether the addition of pralidoxime chloride to atropine and supportive care offers benefit. METHODS AND FINDINGS: We performed a double-blind randomised placebo-controlled trial of pralidoxime chloride (2 g loading dose over 20 min, followed by a constant infusion of 0.5 g/h for up to 7 d) versus saline in patients with organophosphorus insecticide self-poisoning. Mortality was the primary outcome; secondary outcomes included intubation, duration of intubation, and time to death. We measured baseline markers of exposure and pharmacodynamic markers of response to aid interpretation of clinical outcomes. Two hundred thirty-five patients were randomised to receivepralidoxime (121) or saline placebo (114). Pralidoxime produced substantial and moderate red cell acetylcholinesterase reactivation in patients poisoned by diethyl and dimethyl compounds, respectively. Mortality was nonsignificantly higher in patients receiving pralidoxime: 30/121 (24.8%) receiving pralidoxime died, compared with 18/114 (15.8%) receiving placebo (adjusted hazard ratio [HR] 1.69, 95% confidence interval [CI] 0.88-3.26, p = 0.12). Incorporating the baseline amount of acetylcholinesterase already aged and plasma OP concentration into the analysis increased the HR for patients receiving pralidoxime compared to placebo, further decreasing the likelihood that pralidoxime is beneficial. The need for intubation was similar in both groups (pralidoxime 26/121 [21.5%], placebo 24/114 [21.1%], adjusted HR 1.27 [95% CI 0.71-2.29]). To reduce confounding due to ingestion of different insecticides, we further analysed patients with confirmed chlorpyrifos or dimethoate poisoning alone, finding no evidence of benefit. CONCLUSIONS: Despite clear reactivation of red cell acetylcholinesterase in diethyl organophosphorus pesticide poisoned patients, we found no evidence that this regimen improves survival or reduces need for intubation in patients with organophosphorus insecticide poisoning. The reason for this failure to benefit patients was not apparent. Further studies of different dose regimens or different oximes are required.
Study protocol: a randomised controlled trial of multiple and single dose activated charcoal for acute self-poisoning
(London : BioMed Central, 2007) Eddleston, M.; Juszczak, E.; Buckley, N.A.; Senarathna, L.; Mohammed, F.; Allen, S.; Dissanayake, W.; Hittarage, A.; Azher, S.; Jeganathan, K.; Jayamanne, S.; Sheriff, M.H.; Warrell, D.A.; Ox-Col Poisoning Study collaborators
BACKGROUND: The case fatality for intentional self-poisoning in rural Asia is 10-30 times higher than in the West, mostly due to the use of highly toxic poisons. Activated charcoal is a widely available intervention that may - if given early - bind to poisons in the stomach and prevent their absorption. Current guidelines recommend giving a single dose of charcoal (SDAC) if patients arrive within an hour of ingestion. Multiple doses (MDAC) may increase poison elimination at a later time by interrupting any enterohepatic or enterovascular circulations. The effectiveness of SDAC or MDAC is unknown. Since most patients present to hospital after one hour, we considered MDAC to have a higher likelihood of clinical benefit and set up a study to compare MDAC with no charcoal. A third arm of SDAC was added to help determine whether any benefit noted from MDAC resulted from the first dose or all doses. METHODS/DESIGN: We set up a randomised controlled trial assessing the effectiveness of superactivated charcoal in unselected adult self-poisoning patients admitted to the adult medical wards of three Sri Lankan secondary hospitals. Patients were randomised to standard treatment or standard treatment plus either a single 50 g dose of superactivated charcoal dissolved in 300 ml of water or six doses every four hours. All patients with a history of poison ingestion were approached concerning the study and written informed consent taken from each patient, or their relative (for unconscious patients or those <16 yrs), recruited to the study. The exclusion criteria were: age under 14 yrs; prior treatment with activated charcoalduring this poisoning episode; pregnancy; ingestion of a corrosive or hydrocarbon; requirement for oral medication; inability of the medical staff to intubate the patient with a Glasgow Coma Score <13; presentation >72 hrs post-ingestion, and previous recruitment. The primary outcome was in-hospital mortality; secondary outcomes included the occurrence of serious complications (need for intubation, time requiring assisted ventilation, fits, cardiac dysrhythmias). Analysis will be on an intention-to-treat basis; the effects of reported time to treatment after poisoning and status on admission will also be assessed. DISCUSSION: This trial will provide important information on the effectiveness of both single and multiple dose activated charcoal in the forms of poisoning commonly seen in rural Asia. If charcoal is found to be effective, it should be possible to make it widely available across rural Asia in an affordable formulation. TRIAL REGISTRATION: Current Controlled Trials ISRCTN02920054.