The mechanical failure of locally manufactured prosthetic feet from the Jaffna Jaipur Centre for Disability Rehabilitation (JJCDR), Sri Lanka

BACKGROUND

The International Organization for Standardization (ISO) 10328 standards are used to verify the safety of lower limb prosthetic devices. However, the ISO 10328 tests are performed in sterile laboratory settings and do not account for environmental or sociocultural factors associated with prosthetic use. Most locally manufactured prosthetic feet from low-income and middle-income countries, which are safely used for years, do not meet these standards. In this study, we investigate the modes of wear patterns of naturally worn prosthetic feet from Sri Lanka.

OBJECTIVE

To characterize wear patterns of locally manufactured prosthetic feet from low-income and middle-income countries.

METHODS

Sixty-six replaced prosthetic feet from the Jaffna Jaipur Center of Disability and Rehabilitation were analyzed. Delamination between the keel and rest of the foot could not be detected with ultrasound. Sole wear pattern was quantified by photographing soles and dividing them into 200 rectangles and scoring the rectangle's wear from 1 to 9 (no to extreme wear). Homologous scores were averaged to create a contour map of prosthetic foot wear.

RESULTS

The highest levels of wear occurred at the heel, end of the keel, and the perimeter of the prosthetic foot. All regions of the prosthetic feet had significantly different wear scores ( p < 0.005).

CONCLUSIONS

Locally manufactured solid ankle cushion heel feet display high levels of wear in localized areas of the sole of prosthetic feet, which can limit their life span. High levels of wear occur at the end of the keel, which would not be detectable in the ISO 10328 tests.

Healthy lifestyle practices: Evidence from clinic attending mothers in the northern province, Sri Lanka

Healthy lifestyles are known to reduce noncommunicable disease-related mortalities and morbidities. Public health initiatives should encourage healthier lifestyles to prevent the risk of noncommunicable diseases. This study aimed to determine healthy lifestyle practices and their associated factors among clinic-attending mothers (mothers attending antenatal clinics, postnatal clinics, well-baby clinics, family planning clinics, well-women clinics, and polyclinics) in the Chavakachcheri Medical Officer of Health (MOH) area. We conducted a clinic-based cross-sectional study in 19 centers covering 28 Public Health Midwives (PHM) areas. Healthy lifestyle practices, such as regular exercise, consumption of recommended servings of fruits and vegetables, measuring their own BMI, and average salt consumption, were poor. In the multivariate analysis, we found only three factors that had higher odds of affecting healthy lifestyle practices that were statistically significant: attributes of higher level of perceptions about healthy lifestyle practices (AOR = 4.36, 1.32-14.39), participating in Mothers' Support Groups (AOR = 7.97, 2.17-29.27) and BMI value of < 23 kg/m2 (AOR = 4.47, 1.35-14.73). Effective targeted healthy lifestyle-related educational programs instead of regular training during clinic visits and promoting participation in peer groups at the community level may benefit clinic-attending mothers.

A short report on a preliminary interventional study to evaluate play-mediated interaction skills in caregivers of children with autism spectrum disorder from Sri Lanka

LAY ABSTRACT

Most children with autism spectrum disorder live in low- and middle-income countries. Most of them do not have access to timely and culturally acceptable interventions. Research from high-income countries and low- and middle-income countries, such as Sri Lanka, show that parent-mediated intervention programmes improve functional outcomes, highlighting the importance of parents as partners. We undertook a preliminary study to evaluate how play-based parent coaching will enhance the parent interaction skills to promote social-emotional, cognitive and language skills in children with autism spectrum disorder aged 2-4 years. We evaluated how parents acquire interaction skills to engage with children using a caregiver skills assessment checklist adapted from freely accessible resources. Before and after training, all parent-child dyads participated in a 10-min video-recorded play session with a set of toys of their choice. Over the course of 2 weeks, all parents spent 2 h/day playing and interacting with the child to harness the desired skills. The results showed that the parental training had a positive effect on all 30 caregivers in gaining skills, with a significant improvement in all three domains with the highest impact on skills for social-emotional development. Overall, parents reported high levels of satisfaction on the training. The significant improvement in parent interaction skills was promising. However, further studies to look at the sustainability of the skills and the impact on children's overall development need to be looked into using larger and more generalised studies.

Fiscal policies and regulations for healthy diets in Sri Lanka: an analysis of the political economy of taxation and traffic light labelling for sugar-sweetened beverages

BACKGROUND

Unhealthy dietary patterns significantly contribute to rising non-communicable diseases (NCDs) in Sri Lanka. The government has implemented policy measures to promote healthy dietary patterns, including the traffic light labelling (TLL) system for sugar-sweetened beverages (SSBs) in 2016 and taxation on SSBs in 2017.

OBJECTIVES

To analyse how ideas, institutions, and power dynamics influence the formulation and implementation of these two interventions, and to identify strategies for public health actors to advocate for more effective food environment policies in Sri Lanka.

METHODS

This study drew on Kingdon's theory of agenda-setting and Campbell's institutionalist approach to develop the theoretical framework. We examined the political economy at the policy development and implementation stages, adopting a deductive framework approach for data collection and analysis. Data were collected from documents and key informants.

RESULTS

NCDs and nutrition are recognised and framed as important policy issues in health-sector policy documents, and the SSB tax and TLL system are seen as means of improving diets and health. Sri Lanka's commitment to addressing NCDs and nutrition-related issues is evident through these policies. The Ministry of Health led policy development, and key stakeholders were involved. However, there are opportunities to learn and strengthen policy in Sri Lanka and elsewhere. Limited involvement and commitment of some stakeholders in developing national policies, industry interferences, and other gaps resulted in weaker policy design. Gender considerations were also given minimal attention in policy formulation and implementation.

CONCLUSIONS

To enhance the effectiveness of the policies and regulations to promote healthy diets in Sri Lanka, comprehensive policy coverage, multistakeholder involvement and commitment to national policies, balanced power dynamics, technical feasibility, government commitment backed with high-level political support, awareness, and knowledge creation, managing industry interferences, integrating gender considerations are crucial factors.

Genetic diversity and phylogeography of Phlebotomus argentipes (Diptera: Psychodidae, Phlebotominae), using COI and ND4 mitochondrial gene sequences

BACKGROUND

Phlebotomus argentipes complex is the primary vector for cutaneous leishmaniasis, a burgeoning health concern in contemporary Sri Lanka, where effective vector control is important for proper disease management. Understanding the genetic diversity of the P. argentipes population in Sri Lanka is vital before implementing a successful vector control program. Various studies have indicated that genetic divergence, caused by genetic drift or selection, can significantly influence the vector capacity of arthropod species. To devise innovative control strategies for P. argentipes, exploring genetic diversity and phylogeography can offer valuable insights into vector competence, key genetic trait transfer, and impact on disease epidemiology. The primary objective is to analyze the genetic diversity and phylogeography of the P. argentipes complex in Sri Lanka, based on two mitochondrial genomic regions in modern representatives of P. argentipes populations.

METHODOLOGY

A total of 159 P. argentipes specimens were collected from five endemic areas of cutaneous leishmaniasis and identified morphologically. Two mitochondrial regions (Cytochrome c oxidase subunit I (COI) and NADH dehydrogenase subunit 4 (ND4) were amplified using the total DNA and subsequently sequenced. Partial sequences of those mitochondrial genes were utilized to analyze genetic diversity indices and to explore phylogenetic and phylogeographic relationships.

PRINCIPAL FINDINGS

Among five sampling locations, the highest genetic diversity for COI and ND4 was observed in Hambantota (Hd-0.749, π-0.00417) and Medirigiriya (Hd-0.977, π-0.01055), respectively. Phylogeographic analyses conducted using COI sequences and GenBank retrieved sequences demonstrated a significant divergence of P. argentipes haplotypes found in Sri Lanka. Results revealed that they have evolved from the Indian ancestral haplotype due to historical- geographical connections of the Indian subcontinent with Sri Lanka.

CONCLUSIONS

Utilizing high-mutation-rate mitochondrial genes, such as ND4, can enhance the accuracy of genetic variability analysis in P. argentipes populations in Sri Lanka. The phylogeographical analysis of COI gene markers in this study provides insights into the historical geographical relationship between India and P. argentipes in Sri Lanka. Both COI and ND4 genes exhibited consistent genetic homogeneity in P. argentipes in Sri Lanka, suggesting minimal impact on gene flow. This homogeneity also implies the potential for horizontal gene transfer across populations, facilitating the transmission of genes associated with traits like insecticide resistance. This dynamic undermines disease control efforts reliant on vector control strategies.

Effect of Temperature Humidity Index (THI) on resting pattern of dairy cows in different regions of Sri Lanka

The ability to spend time resting is extremely important for dairy cattle welfare. Through this study, lying behaviour of dairy cows in to Up-Country (UP), Mid-Country (MC), Coconut-Triangle (CT) and Western-Province (WP) of Sri Lanka was studied to get an insight into their resting pattern. Resting pattern was assessed in 170 Holstein-Friesian/ Jersey crossed, tie-stalled lactating cows (UP = 49, MC = 49, CT = 48 and WP = 24) using electronic data loggers. Appropriate resting behaviours were attained in UP and MC regions, with longer lying time (11.7, 11.3 h/day) and lying bout durations (78.0, 84.9 min) respectively, where lower THI ranges were observed compared to other regions. WP and CT resulted with lower lying times (9.00, 9.26 h/day) and lying bout durations (48.3, 64.3 min) respectively with higher THI. There is a slight variation of the environmental temperature of each region with the time period of experiment. Cows in all regions prefer to lie on their left side (UP-6.1, MC-6.1, CT-4.4, WP-4.7 h/d) and with significant differences (P<0.05) between MC-WP, MC-CT, UP-CT and UP-WP. A negative significant (P<0.05) correlation was observed between THI and lying behaviours. There were significant effects of time (hour) and time × region interaction (P<0.05) on the lying down pattern. More lying down was observed in late night and early morning with a peak rest around the hours of 21:00-05:00. Overall, according to the results of the current study, the existing environmental conditions of four regions affected the resting pattern of dairy cows and, identification of possible mechanisms to modify the environment to enhance cow comfort is vital.

Factors affecting job performance of Sri Lankan IT professionals working from home

This study investigated the influence of the physical work environment, work life balance, work flexibility, and effective communication on the job performance of IT professionals in Sri Lanka's IT industry who work from home (WFH). A standard questionnaire was used to collect data from 293 IT specialists in 50 different IT organizations in Sri Lanka, and a stepwise probit model was employed for data analysis. According to the findings, both the physical work environment and work life balance had a significantly positive effect on job performance. A one-unit increase in the physical work environment and work life balance increased the likelihood of high job performance by 0.21% and 0.19%, respectively. In contrast, work flexibility had a negative effect on job performance, with an increase of one unit resulting in a 0.18% decrease in the likelihood of high job performance. The positive impact of effective communication on job performance was less significant. The study emphasises the significance of providing a conducive work environment and promoting work life balance to enhance the job performance of IT professionals in Sri Lanka's IT industry who WFH.

Plasmodium ovale infection in Sri Lanka: distant exposure and incidental detection of hyperparasitemia: a case report

BACKGROUND

Plasmodium ovale malaria, which was previously endemic to tropical Africa and the Southwest Pacific islands is now being reported from parts of Asia. In Sri Lanka, the indigenous transmission of malaria has not been documented since October 2012. Since then, there have been several imported cases of malaria, including P. ovale, which have been detected sporadically. The reporting case of P. ovale was imported and detected incidentally in 2021, with several atypical presentations.

CASE PRESENTATION

A 40-year-old Sri Lankan medical doctor developed continuous fever with chills, rigors, and dysuria a day following removal of a large lipoma at the root of the neck under general anaesthesia. When the fever has been responding to antibiotics, on the 4th postoperative day a mild thrombocytopenia on complete blood count was detected. A blood smear which was done on the 5th postoperative day incidentally found a malaria parasite and confirmed as Plasmodium ovale with a density of 6535 parasites/microliter on the same day. He never had malaria in the past, but he had worked in South Sudan 1 year ago and visited India six months ago. On the 6th postoperative day, he was treated with chloroquine, and hyperparasitemia reduced rapidly by the next day. As the fever recurred with clinical deterioration, he was treated with different antibiotics. During the course of the illness, he did not develop pallor, or icterus except for a palpable soft spleen. The parasite count was zero on the 9th postoperative day and his fever subsided on the next day. Further, he was treated with primaquine to prevent future relapse and transmission.

CONCLUSION

A long incubation period, incidental detection of P ovale in a blood smear, and hyperparasitaemia are the atypical presentations of this case. Postoperative bacterial infection and stress may have reactivated the dormant malaria (hyponozoites) in this patient with an unusual picture. Coinfection of malaria with bacterial sepsis is a challenge in the management of the patient. As the Anopheles mosquito vector exists in Sri Lanka, the risk of indigenous transmission is high from such imported cases of P. ovale.

Polyphyly of the Dinurinae Looss, 1907 (Digenea: Hemiuridae) and resurrection of the Mecoderinae Skrjabin & Guschanskaja, 1954 based on novel collection of Tubulovesicula laticaudi Parukhin, 1969 from marine elapid snakes in Sri Lanka

With one exception, the only known hemiurid trematodes that do not use teleost fishes as definitive hosts instead occur in marine elapid snakes. These comprise six species across four genera and three subfamilies, and so presumably indicate at least three independent invasions of marine snakes from teleost fishes. Here, one of these taxa, Tubulovesicula laticaudi Parukhin, 1969 (= T. orientalis Chattopadhyaya, 1970 n. syn.) is reported from Sri Lanka, collected from Shaw's sea snake Hydrophis curtus (Shaw) (Elapidae: Hydrophiinae: Hydrophinii), the annulated sea snake H. cyanocinctus Daudin and the yellow sea snake H. spiralis (Shaw) off Nayaru in the Bay of Bengal, and from H. spiralis in Portugal Bay, Gulf of Mannar. Novel molecular data, for COI mtDNA and ITS2 and 28S rDNA, are the first for a species of Tubulovesicula Yamaguti, 1934. Nominally, Tubulovesicula belongs in the Dinurinae Looss, 1907, but in phylogenetic analyses based on 28S rDNA, our sequences for T. laticaudi resolved relatively distant from that for representatives of Dinurus Looss, 1907, the type-genus, rendering the subfamily polyphyletic. Tubulovesicula laticaudi resolved closest to data for the type-species of the Plerurinae Gibson & Bray, 1979, but that subfamily is also polyphyletic. These findings lead us to re-evaluate an alternative classification considered by Gibson & Bray (1979). We propose restricting the Dinurinae for forms with a permanent sinus-organ (Dinurus, Ectenurus Looss, 1907; Erilepturus Woolcock, 1935; Paradinurus Vigueras, 1958; Qadriana Bilqees, 1971) and resurrect the Mecoderinae Skrjabin & Guschanskaja, 1954 for forms with a temporary sinus-organ (Mecoderus Manter, 1940, Allostomachicola Yamaguti, 1958, Stomachicola Yamaguti, 1934 and Tubulovesicula).

Knowledge and practice of infection control during radiology procedures among radiography undergraduates in Sri Lanka

INTRODUCTION

Sufficient knowledge and adherence to infection control measures are essential for healthcare workers to effectively combat healthcare-associated infections (HCAIs). Radiography undergraduates should stay updated and proficient in their infection control practice. This study aimed to assess knowledge and practice of infection control measures during radiological procedures among radiography undergraduates in Sri Lanka.

METHOD

A web-based, descriptive, self-administered, cross-sectional study was conducted. The questionnaire collected data on demographic, knowledge and practice related to infection control measures from radiography undergraduates.

RESULTS

A total of 167 radiography undergraduates returned the completed questionnaire. The majority (88%) have never participated in infection control programs. The mean knowledge and practice scores were 58% and 41.1%, indicating moderate and poor levels, respectively. A significant difference was observed in the overall knowledge of infection control when considering the academic year (p = 0.001) and the duration of clinical exposure (p = 0.01). There was no significant difference between practice and gender, age, ethnicity, academic year and duration of clinical exposure (p > 0.05).

CONCLUSIONS

The results of this study indicate that knowledge of nosocomial infection was moderate and practice was inadequate among most of the radiography students surveyed. This highlights the need to reassess the educational components of radiography programs to incorporate practical and comprehensive teaching, learning and monitoring of infection control measures.

Knowledge and attitudes on attention deficit hyperactivity disorder (ADHD) among school teachers in Anuradhapura district, Sri Lanka: a descriptive cross-sectional study

OBJECTIVE

This study aimed to assess the knowledge and attitude of school teachers from a rural district in a developing country towards children with attention deficit hyperactivity disorder (ADHD).

DESIGN

A population-based descriptive cross-sectional study was conducted using probability proportionate to size cluster sampling.

SETTING

This study was conducted in 21 government schools in Anuradhapura district, Sri Lanka.

PARTICIPANTS

The study sample consisted of 458 teachers with a mean age of 41 completed years ranging from 24 to 59 years.

MAIN OUTCOME MEASUREMENTS

We assessed knowledge, attitudes and sources of information on ADHD using the self-administered, validated Knowledge of Attention Deficit Disorder Scale (KADD), Teacher Attitudes Towards Inclusion Scale (TAIS) and the Perceived and Actual Sources of Information questionnaires.

RESULTS

The median KADD score was 11 (IQR 8-14) and 45.5% (n=208) of participants lacked sufficient knowledge. Percentages of the correct answers, misconceptions and 'don't know' responses were 28.2%, 24.5% and 45.5%, respectively. The majority of teachers believed that the children with ADHD generally experience more problems in novel situations than in familiar situations (63.5%), a diagnosis of ADHD by itself makes a child eligible for placement in special education (61.1%), and children with ADHD do not often have difficulties organising tasks and activities (61.1%). Some participants (12%) stated that punishment would improve the outcome of the children with ADHD. The attitudes were positive with TAIS 1 and 2 median scores of 46 (IQR 36-58) and 49 (IQR 40-59). The majority of participants relied on informal knowledge gained through their personal experience in the classroom on ADHD (n=337, 76%). The majority of teachers (n=300, 67.7%) preferred to be educated through seminars.

CONCLUSIONS

School teachers possess a positive attitude. However, they have poor knowledge and significant misconceptions regarding ADHD which may affect the identification and management.

Delay in diagnosis to treatment and impact on survival of gastric adenocarcinoma in a low income setting without screening facility

The treatment modality of gastric adenocarcinoma (GCA) depends on the stage of the disease at the clinical presentation. Long delays are probably an unfavorable factor for the patient's prognosis. A prospective longitudinal, study involving 145 consecutive GCA was conducted at the National Hospital of Sri Lanka (NHSL). The overall delay (in weeks) was recorded for each patient and divided into four periods-patient, endoscopy, pathology and treatment. The median and Interquartile Range (IQR) duration of delays were calculated and differences were explored with chi square test and Mann Whitney U test Survival analysis was done with Kaplan Meier technique and Cox regression. The median duration of delays for patient, endoscopy, histology reporting delay, other histology delay (specimen transfer delay and report receipt delay) and treatment were 18 (IQR 14-27), 2 (IQR 2-3), 3 (IQR 2-3), 2 (IQR 1-2) and 6 (IQR 4-8) weeks respectively. Delayed patient presentation to hospital was associated with significant adverse median survival 16 (IQR 11.5-22.5) weeks versus 20 (IQR 16-27.5) weeks, p = 0.004. Delay in initiating treatment was associated with significantly lower median survival 04 (IQR 4-6) weeks versus 06 (IQR 4-8) weeks, p = 0.003. Over 60% of both proximal and distal GCA presented at an advanced radiological stage (stage III/IV). The Kaplan Meier analysis showed that the higher hazard function was associated with a higher tumour stage and undergoing chemotherapy. Age of the patient and the treatment modality were significant predictors of the survival. Patient delay and delay in initiation of definitive treatment are the most important factors that adversely affect the outcomes of GCA. Public health interventions aiming to shorten the patient delay time with proper referral for specialist care would play an important role. Also, it is important to minimize these preventable delays and there should be time limits in producing the histopathology report and to establish online portals of hospital and laboratory information systems for easy access of histology reports in future.

Quality of measuring devices enclosed with paediatric oral liquid dosage forms of medicines registered in Sri Lanka

INTRODUCTION

Oral liquid dosage forms remain popular in several middle income countries. The accuracy of liquid dosage form dosing depends on the accuracy and availability of measuring devices. Lack of quality oral liquid measuring devices will lead to medication errors. Hence there is an urgent need to describe the quality of manufacturer supplied measuring devices enclosed with paediatric oral liquid dosage forms currently registered in Sri Lanka.

METHODOLOGY

Standards for measuring devices were developed after a detailed literature search. Multidisciplinary panel rated each standard for the necessity criteria on a 9 point Likert scale. Standards with overall panel median score of ≥ 7 with agreement were selected. A cross-sectional study was done. All the measuring devices, labels and instructions enclosed with the registered products were assessed against the standards developed. Three volumes of liquid antibacterials were measured using the enclosed measuring device. Accuracy of the volumes was measured.

RESULTS

Of the total products (n = 202) only 126 were packed with a dosing device. Around quarter of the oral liquid dosage forms (n = 36) did not have a measuring device. More than half of the measuring devices aligned with all the standards developed. Out of 44 oral liquid paediatric antimicrobials measuring cups (n = 25, 56.8%, 95% CI: 41%-72%) were enclosed more and less error was seen with measuring cups.

CONCLUSION

The quality of oral liquid measuring devices were not satisfactory. Quality could be further improved if the regulatory body request the manufactures/importers to adhere to the standards developed. Correct volumes were not measured using the measuring devices provided with the liquid antimicrobial agents.

Impact of debt, reserves, and political stability on Sri Lanka's financial crisis

This study attempts to explore the impact of external debt ($Debt), foreign reserves ($Reserves), and political stability & absence of violence/terrorism (PS&AVT) on the current financial crisis in Sri Lanka. Using data from 1996 to 2022 obtained from the World Bank (WB) and the Central Bank of Sri Lanka (CBSL), a regression analysis is conducted, with a composite variable named "CRISIS," which accounts for interest rate, inflation, currency devaluation adjusted to GDP growth, as the dependent variable. The findings indicate that, collectively, these predictors significantly contribute to explaining the variance in the financial crisis, although their impact is relatively minor. While the direct influence of PS&AVT on the financial crisis is not statistically significant, it indirectly affects the crisis through its considerable impact on debt and reserves. Granger causality tests showed predictive value for $Debt and $Reserve in relation to CRISIS, but the reverse relationship was not significant. Regression analysis using the error term and scatter plots supports the absence of endogeneity issues in the model. These findings suggest that while external debt and foreign reserves are more directly related to financial crises, political stability and the absence of violence/terrorism can influence the crisis indirectly through their effects on debt accumulation and reserve levels. This study represents a pioneering effort in investigating the impact of external debt, foreign reserves, and political stability on the financial crises in Sri Lanka. By utilizing a comprehensive dataset and applying a regression analysis, it sheds light on the complex interactions between these variables and their influence on the country's financial stability.

Establishment of institutional diagnostic reference level for coronary angiography procedures in Sri Lanka

Amongst many interventional procedures performed in a cardiac catheterisation laboratory, the coronary angiography (CAG) is the most frequently performed cardiac interventional procedure. A diagnostic reference level (DRL) is an effective tool to optimise the radiation exposure to patients and staff whilst maintaining the adequate diagnostic image quality. The aim of the study was to establish institutional DRLs for the CAG procedures performed at a selected private hospital in Colombo, Sri Lanka. A total of 325 CAG procedures were selected for this study from two C-arm machines. The institutional DRLs of cumulative dose length product (DAP) and fluoroscopic time for the CAG procedure were calculated. The established institutional DRL for accumulated DAP and fluoroscopic time are 10 610 mGycm2 and 2.31 min, respectively. As this study conducted at only one institute we recommend to develop national DRLs for mostly performing interventional procedures in Sri Lanka by considering all influencing factors to optimise the patient dose.

Banning highly hazardous pesticides saves the lives of young people, particularly females, in low- and middle-income countries

Pesticide self-poisoning is a public health problem mostly affecting low- and middle-income countries. In Sri Lanka, India and China suicide rates have reduced among young people, particularly females, following highly hazardous pesticides (HHP) bans. This success story requires attention to encourage more research on differential effects of HHP bans.

RB1 screening of retinoblastoma patients in Sri Lanka using targeted next generation sequencing (NGS) and gene ratio analysis copy enumeration PCR (GRACE-PCR)

BACKGROUND

Retinoblastoma (RB) a tumour affecting those under 5 years, has a prevalence of 1 in 20,000, with around twenty new diagnoses per year in Sri Lanka. Unilateral and bilateral RB presents around 24 and 15 months respectively. Approximately 10% are familial. Systematic genetic testing for germline pathogenic variants of RB1, the only gene associated with an inherited risk of RB, is unavailable in Sri Lanka. Genetic testing optimizes management of affected children and at-risk siblings. This study aimed to develop accessible genetic testing to identify children with a germline pathogenic variant of RB1 in Sri Lanka.

METHODS

Targeted next generation sequencing (NGS) for detecting pathogenic sequence variants and Gene Ratio Analysis Copy Enumeration PCR (GRACE-PCR) for detecting RB1 copy number variations (CNVs) were performed for 49 consecutive RB patients treated between 2016 and 2020 at the designated RB care unit, Lady Ridgway hospital, Colombo. Patients (bilateral RB (n = 18; 37%), unilateral n = 31) were recruited following ethical clearance and informed consent.

RESULTS

There were 26 (53%) females. Mean age at diagnosis was 18 months. Thirty-five patients (71%) had undergone enucleation. Germline pathogenic variants of RB1 identified in 22/49 (45%) patients including 18 (37%; 12 bilateral and 6 unilateral) detected by targeted NGS (2 missense, 7 stop gained, 1 splice donor, 8 frameshift variants). Six were previously undescribed, likely pathogenic frameshift variants. Four bilateral RB patients had GRACE-PCR detected CNVs including one whole RB1, two intragenic deletions (exon 12/13; exon 11 and 23) and a partial duplication of exon 27. The only familial case (affected mother and child) shared the duplication. Only 2 of 4 CNVs and 10 of 18 pathogenic variants were confirmed by whole exome sequencing and Sanger sequencing respectively, due to funding limitations.

CONCLUSIONS

The study identified pathogenic or likely pathogenic germline RB1 sequence variants and copy number variants in 16/18 (89%) bilateral and 6/31(19%) unilateral cases, which is comparable to worldwide data (10-15% unilateral, 80-85% bilateral). Targeted NGS combined with GRACE-PCR significantly reduce the cost of RB1 testing in Sri Lanka, and may widen access for genetic diagnosis of RB patients in other low and middle income countries.

Caregiver strain among patients of palliative care in Sri Lanka: validation of modified caregiver strain index - Sinhala version

BACKGROUND

Care givers of Palliated patients are at risk of adverse physical, psychosocial and emotional sequelae in varied nature. Efficient and valid assessment tools facilitate early detection to take corrective measures. The Modified Caregiver Strain Index (MCSI), composed of domains associated with caregiver strain is a simple and brief tool that can be used in both clinical and field settings. This study aimed to adapt and validate this in order to cater effective palliative care services in Sri Lanka.

METHODS

After cross-cultural adaptation, 200 primary caregivers in 3 teaching hospitals were recruited. The internal consistency, item-total correlations, of the 13-item S-MCSI were performed. The criterion validity was assessed by Pearson correlation between the total scores of S-MCSI, the Karnofky Performance Scale and the Barthel index. Construct validity was determined by the principal component analysis keeping the Varimax with Keiser normalization as the rotation method. The Kaiser-Meyer-Olkin test (KMO) and Bartlett's test of sphericity statistics were also performed to determine the adequacy of the sample and correlations between items, respectively. The number of factors was determined by the Scree plot, percentage of variance explained by each component and number of Eigen values over 01 (Kaiser-Guttman rule).

RESULTS

The total MCSI score ranged 0 to 26. The overall Cronbach's alpha of the 13-item questionnaire was 0.80 while item-total corrections ranged 0.34 to 0.62, exception of one item (0.11). Inverse correlations were demonstrated in total scores of MCSI and Karnofky Performance Scale (r =- 0.32, p < 0.001) and Barthel index (r =-0.34, P < 0.001). A Kaiser-Meyer-Olkin value of 0.79 (p < 0.001) for Bartlett's test indicated adequate sampling and nonlinearity of factors. The Scree plot showed a three-factor structure explaining 57% of the variation. Items regarding personal wellbeing of caregiver loaded together while the effects on the family loaded separately. Adjustment of personal concerns and family issues along with time alteration grouped as the third factor.

CONCLUSIONS

The study showed that the Sinhala version of MCSI has adequate psychometric properties and reliability to be used as a validated tool to estimate the caregiver burden within a short time period for any health care workers.

Anti-protein glycation and free-radical scavenging properties of Sri Lankan antidiabetic medicinal plant Salacia reticulata l. (Kothala Himbutu)

BACKGROUND

Decoctions of the root and stem of the medicinal plant Salacia reticulata is an indigenous remedy for diabetics and its complications in Sri Lanka. In diabetics, the formation of advanced glycation end products (AGEs) leads to many pathologies. Nevertheless, the anti-protein-glycation property of this plant is poorly documented. This study reports the anti-protein-glycation and radical scavenging potential of various plant parts of S. reticulata.

METHODS

Hot water extracts (2g dried powder/50 ml) of root, stem, leaf, twigs, and fruits at various concentrations (15.6 to 500.0 µg/ml) were subjected to anti-glycation and glycation reversing assays in vitro. 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay was used for free radical scavenging property.

RESULTS

Various plant parts of S. reticulata showed anti-protein-glycation and free-radical scavenging activities. IC50 for the anti-glycation activity of root, stem, leaf, twigs, and fruit extracts were 11.92 ± 1.14, 35.18 ± 2.79, 113.3 ± 1.91, 149.59 ± 1.06, and 1120.37 ± 229.48 µg/ml respectively. IC50 of Rutin was 21.88 ± 2.82 µg/ml. EC50 of the root, stem, twigs, and leaf extracts for glycation reversing was 102.09 ± 6.23, 116.99 ± 5.82, 154.45 ± 5.79, and 278.78 ± 14.19 µg/ml respectively. The EC50 values for the radical scavenging activity of leaf, stem, and roots were 26.4±4.7, 9.0±1.2, and 9.1±1.3 respectively. Root had significantly (p<0.05) high activity for all the parameters tested.

CONCLUSION

Salacia reticulata possess anti-glycation, glycation-reversing, and free radical scavenging activities. Other than root and stem, the leaves and twigs too may be a useful source for anti-diabetic bioactive molecules.

Effect of LHCGR and FSHR gene polymorphisms on fertility traits and milk yield of cross-bred dairy cows in Sri Lanka

Single nucleotide polymorphism (SNP) analysis of fertility genes will be useful in improving the genetic potential of dairy cows. A population of 142 cross-bred dairy cows was screened for SNPs in bovine luteinizing hormone choriogonadotropin receptor (LHCGR) and bovine follicle stimulating hormone receptor (FSHR) genes. The effect of reported SNPs on selected fertility traits (average calving interval, average number of services per conception and age at first calving) and milk yield was determined. Altogether six SNPs were detected in animals screened under the present study. Among them, four SNPs (rs41256848, rs41256850, rs465790244, and rs45463781) were located in the exon 11 region of the LHCGR gene and two SNPs (rs43676359 and G-278-A (GU253337) were located in the five upstream region of the FSHR gene. Minor alleles identified for SNPs in the FSHR gene in the studied small population of cows differed from those reported in other research. In this study, only rs45463781 SNP at exon 11 of the LHCGR gene significantly affected the average milk yield in cross-bred cows. The nucleotide change from "G" to "A" negatively affected the average milk yield. Further investigations are needed to confirm the reported association with a larger sample size.

Selection of priority emerging contaminants in surface waters of India, Pakistan, Bangladesh, and Sri Lanka

The challenge of emerging contaminants (ECs) in global surface water bodies and particularly in low- and middle-income countries such as India, Pakistan, Bangladesh, and Sri Lanka, is evident from the literature. The complexity arises from the high costs involved in EC analysis and the extensive list of ECs, which complicates the selection of essential compounds for scientific and regulatory investigations. Consequently, monitoring programs often include ECs that may have minimal significance within a region and do not pose known or suspected ecological or human health risks. This study aims to address this issue by employing a multi-risk assessment approach to identify priority ECs in the surface waters of the aforementioned countries. Through an analysis of occurrence levels and frequency data gathered from published literature, an optimized risk quotient (RQ) was derived. The findings reveal a priority list of 38 compounds that exhibit potential environmental risks and merit consideration in future water quality monitoring programs. Furthermore, the majority of antibiotics in India (12 out of 17) and Pakistan (7 out of 17) exhibit a risk quotient for antimicrobial resistance selection (RQAMR) greater than 1, highlighting the need for devising effective strategies to mitigate the escalation of antibiotic resistance in the environment.

Potential health risk assessment of selected metal concentrations of Indian backwater oyster, (Crassostrea madrasensis) in Sri Lanka

The study was conducted to assess the health risks of selected metals in cultured and wild Crassostrea madrasensis in Sri Lanka over 13 months. Metal concentrations varied monthly, and Zn and Cu concentrations significantly varied between cultured and wild oysters. The mean metal concentrations (mg kg-1) were accumulated in order of Zn (1220.60) > Mg (496.97) > Fe (356.30) > Cu (114.95) > Pb (23.20) > Cd (6.15) > As (3.09) > Hg (0.12). The metal concentrations were well below the standard guidelines given by international standards except for Pb, Cd, As and Zn. The weekly intakes of Hg, Cu, Fe, and Zn from C.madrasensis were below the Provisional Tolerable Weekly Intake while Cd exceeded the established limit. The calculated non-carcinogenic and carcinogenic risk indices for Hg, As, Pb and Zn were within safe levels and the values for Cd exceeded the limit revealing carcinogenic results with long-term consumption. Hence, creating proper awareness and a suitable depuration system ensures human health and supports export-oriented markets.

Identification of Confusing Medicine Proprietary Names: Toward Safe Medicine Use-A Cross-Sectional Study in Sri Lanka

BACKGROUND

Look-alike sound-alike (LASA) medications have similar pronunciation (phonetic) and/or manifestation (orthographic), which could create confusion among users and challenge the safe use of medicines. The availability of foreign products in local markets aggravates the situation. This study was designed to examine the registered medicine proprietary names in Sri Lanka to discern the presence of similar medicine names in the industry.

METHODS

A cross-sectional study was conducted on the registered drug proprietary names in Sri Lanka. Using the RAND and RANK functions in Microsoft® excel® 365, a random sample of 385 proprietary names was selected. Two evaluators independently evaluated each proprietary name in the sample against the other registered proprietary names following a stepwise text filtering method. After each filter, the resulting proprietary names were manually examined for identical, similar-looking, and similar-sounding proprietary names to the name under evaluation. The observations were matched, categorized, and collated into ten groups.

RESULTS

Among the 385 names evaluated, 138 (35.84%) proprietary names had no similarity to existing other registered proprietary names. The rest of the names (n = 247, 64.15%) were found to be either identical (n = 03 pairs), look-alike (n = 91 pairs), or sound-alike (n = 80 pairs) to the registered proprietary names.

CONCLUSION

The findings revealed the presence of equal and similar proprietary names in the system. A multifactorial strategy led by the National Medicine Regulatory Authority (NMRA) is recommended to minimize the confusing names entering the system. Primarily the NMRA's call for action should include adequate industry guidance with specific guidelines, a significant pre-submission assessment process, and denying approval of LASA proprietary names.

Environmental Sterility-control Practices in Selected Retail Pharmacies in Sri Lanka: A Study in Kandy District

Maintaining the microbial quality of the environment is crucial in pharmaceutical institutions, especially community pharmacies, since they have a direct relationship with patients. The sterility of the environmental surfaces of pharmacies can be maintained by proper cleaning and disinfecting. Microbial contamination is the primary reason for product spoilage or deterioration. The present study was carried out to assess the sanitation practices of pharmacies on the maintenance of cleanliness followed by isolation and identification of microorganisms from surface and air samples of selected pharmacies. All the pharmacies followed daily sanitization practices in the pharmacy premises and surrounding environment. However, only 20% of the pharmacies cleaned their equipment daily. In total, 33 bacterial species were identified from the pharmacies. Of these, 31 were Gram-positive (29 coagulase-negative staphylococci) and 2 Streptococcus spp., while 2 were Gram-negative (Pseudomonas aeruginosa and Proteus vulgaris). The colony-forming unit count of air samples after one-hour exposure under uni-directional air flow was less than 20 except from one pharmacy which was 59. Significant statistical associations were not observed between the presence of separate extemporaneous preparation rooms, separate counseling places, type of disinfectant, spillage management, and the growth of organisms in the pharmaceutical products and complaints received for spoiled products. However, some pharmacies under investigation were confirmed to have had poor sterility-control practices since they showed the growth of fastidious organisms both Gram-negative bacilli and Gram-positive cocci of which the latter was in more abundance.

Challenges of Continuation of Exclusive Breast Feeding up to 6 Months in a Setting with High Exclusive Breast Feeding Rates Reported. Experience from Eastern Province of Sri Lanka

BACKGROUND

According to the World Breastfeeding Trends Initiative, Sri Lanka ranked as number one and only country to achieve green status. Exclusive breastfeeding (EBF) for six months is current practice with a rate of 75.5% among 0-5 months.

AIM

Identify factors contributing early cessation of breastfeeding in a single centre of Eastern province Sri Lanka.

METHODS

A descriptive cross-sectional study conducted in Sammanthurai Medical officer of Health area. Consecutive mother-infant days with the infant ageing < 6 months were included from 25 public health midwife areas using an interviewer administered questionnaire. Missing values imputed using 'missForest' algorithm.

RESULTS

The mean age of the sample was 28.4(SD ± 5.6). Of the 257 mothers recruited, 15(5.8%) were teenagers and 42(16.3%) > 35 years. 251(97.6%) had children 1-5 and 86(33.5%) were first born. 140 (54.5%) had tertiary education, 28 (10.9%).31(12.1%) were employed. EBF rates 0-6 months was 79.8% (n = 205). 239(93.0%) started breastfeeding within an hour. EBF was not associated with maternal age, birth order or income. 18 employed mothers and 186 unemployed mothers continued EBF. Regarding the factors associated with EBF, having a tertiary education (p < .001), being employed (p = .004) and having less than 3 children (p = .03) were associated with non-exclusive breastfeeding. Tertiary education was the significant predictor of non-exclusive breastfeeding in this population with an odds ratio of 4.50 (95% CI 1.331-15.215).

CONCLUSION

Employment identified as a risk factor for early cessation of EBF needs well planned further research to overcome this practical issue. Also might need revision of workplace policies, establishment of lactation areas in office premises to overcome some of these issues.