Browsing by Author "Siribaddana, S."

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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 Following an unpublished clinical study claiming efficacy, Dammika Bandara Syrup© gained wide media publicity and political patronage.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.
Body weight status and implications on kidney health of the pediatric communities in the dry climatic zone in Sri Lanka: A cross-sectional study
(Faculty of Graduate Studies, University of Kelaniya Sri Lanka, 2022) Gunasekara, T. D. K. S. C.; Silva, P. M. C. S. D.; Chandana, E. P. S.; Jayasinghe, S.; Herath, C.; Siribaddana, S.; Jayasundara, N.
Unhealthy bodyweight is associated with multiple clinical complications that serve as potential risk factors for kidney diseases. However, pediatric renal outcomes associated with the bodyweight status are not properly understood in many communities. Hence, the aim of this study was to assess potential associations of bodyweight status with renal health of selected pediatric communities in the dry climatic zone of Sri Lanka. This cross-sectional study was conducted with school students of both genders 13-16 years of age (N=326) in selected education divisions in dry zone regions where chronic kidney disease of uncertain etiology (CKDu) is not evident. Mid-stream early morning urine samples of the students were assessed for creatinine and albumin using an automated clinical chemistry analyzer. Quantitative assessment of urinary kidney injury molecule (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) was based on enzyme-linked immunosorbent assay (ELISA). Age and gender-specific World Health Organization guidelines (LMS-based body mass index (BMI) percentiles), adopted by the family Health Bureau of the Ministry of Health, Sri Lanka, were used to assign the students into four BMI strata: underweight, normal, overweight, and obese. Urinary KIM-1, NGAL, and albumin creatinine ratio (ACR) were used as the criteria to interpret renal function. The median levels of biomarkers, NGAL, ACR and particularly KIM-1 which is a more sensitive indicator of renal injury, showed no significant difference across the four BMI strata in both girls and boys. Also, the median levels of the three biomarkers showed no significant difference between the girls and boys within the same age stratum. Furthermore, BMI did not significantly correlate with urinary KIM-1, NGAL, and ACR in the three age strata, while very weak correlation of age was observed with BMI. Our findings did not produce plausibly strong evidence to establish a potential link between bodyweight status and altered renal function in the studied dry-zone pediatric communities. However, longitudinal studies with increased sample size and broader age range are warranted to make more accurate interpretations on potential associations of longstanding unhealthy bodyweight with pediatric renal health in Sri Lanka.
Features of Covid-19 patients detected during community screening: A study from a rural hospital in Sri Lanka.
(The Sri Lanka Medical Association., 2020) Senanayake, A.P.; Indrakantha, D.; Sumathipala, S.; Wanigasuriya, K.; Kularathne, S.; Lekamwasam, S.; Jayasinghe, S.; de Silva, H.J.; Siribaddana, S.
ABSTRACT: We studied the clinical course and virus shedding of all patients referred to Welikanda Hospital, in one month. There were 53 positives for Covid-19 by PCR. 24 (45%) were male, with an age range of 11-94 years. Of these, 41 (77%) were asymptomatic, 9 had cough, 4 had sore throat and six had fever. Pulse, blood pressure, respiratory rate and capillary oxygen were normal in all. A proportion of them had poor prognostic factors: asthma (n=4), hypertension (n=11), age above 60 years (n=9), and diabetes (n=11). Lymphopenia was seen in 20 and elevated CRP in 14. Viral shedding continued beyond 14 days in several persons and continued in symptomatic patients for a significantly longer time than asymptomatic patients. Covid-19 was an asymptomatic or mild illness in this group of people. Several of them continued to be RT-PCR positive even after 14 days. Such cases are an important source of community spread.
Human intestinal nematode infections in Sri Lanka: A scoping review
(Public Library of Science, 2024-12) Jayakody, N. K.; Silva, A.; Wickramasinghe, S.; De Silva, N.; Siribaddana, S.; Weerakoon, K. S.
BACKGROUND Sri Lanka, an island located in South Asia, once experienced a notable prevalence of human intestinal nematode infections (HINIs). With the implementation of control programs, infection prevalence was reduced. Detailed information on prevalence, distribution and temporal trends of HINIs is limited. This review aims to explore Sri Lanka's HINI distribution, trends, diagnostics, control and challenges.METHODOLOGY We reviewed published information on HINIs in Sri Lanka in electronic databases, local journals and grey literature from inception to September 2022. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-Scr), a systematic strategy was used for searching, screening, reviewing and data extraction. The screening was initiated with a review of titles and abstracts using specific keywords, followed by a full-text screening based on predefined eligibility criteria. A total of 105 studies were included in the review, with 28 selected for pooled prevalence analysis.PRINCIPAL FINDINGS The first nationwide survey in 1924 reported a hookworm infection prevalence of 93.1%. By 2017, soil-transmitted helminth (STH) infection prevalence across the island was 0.97% (ascariasis-0.45%, trichuriasis-0.25%, and hookworm infection-0.29%), and the enterobiasis prevalence between 2003 and 2017 ranged from 0% to 42.5%. Strongyloidiasis had been understudied, with a prevalence of 0.1% to 2%. Over the past two decades, the islandwide pooled HINI prevalence was 13.3%. Within specific demographics, it was 6.96% in the general community, 33.4% in plantation sector, and 11.6% in slum communities. During the colonial period, hookworm infection was the commonest HINI, but ascariasis is now more prevalent. The prevailing data relied solely on microscopy, often utilising single stool smears. Mass deworming programs were widely pursued in the first half of the 20th century, initially targeting antenatal women and schoolchildren, and now focusing on specific community groups. National surveys continue monitoring the three main STH infections.CONCLUSIONS The significant reduction in STH prevalence in the country over the past ten decades highlights the effectiveness of public health interventions, particularly mass deworming programs. Despite the success, STH prevalence disparities persist in vulnerable populations like plantation and slum communities, where hygiene and living conditions continue to pose challenges. Reliance on single stool smear microscopy highlights the need for more sensitive diagnostics to better assess infections. Fluctuating enterobiasis prevalence and limited strongyloidiasis data underscore the importance of continued surveillance and targeted interventions for sustained control and eventual elimination. Sri Lanka's experiences and control measures offer valuable insights for low-income countries in South Asia and beyond, particularly in managing HINIs with limited resources.
Hydroxychloroquine for post-exposure prophylaxis of COVID-19 among naval personnel in Sri Lanka: study protocol for a randomized, controlled trial
(BioMed Central, 2020) Niriella, M.A.; Ediriweera, D.S.; de Silva, A.P.; Premaratna, R.; Balasooriya, P.; Duminda, K.D.; Malavige, N.G.; Wanigasuriya, K.; Lekamwasam, S.; Kularathne, S.A.; Siribaddana, S.; de Silva, H.J.; Jayasinghe, S.
BACKGROUND: The first case of a coronavirus 2019 (COVID-19) infection in a Sri Lankan was reported on March 11, 2020. The situation in Sri Lanka changed with the rapid increase of personnel contracting COVID-19 in a naval base camp that housed more than 4000 people. This provided a unique opportunity to study the effectiveness of hydroxychloroquine (HCQ) for post-exposure prophylaxis (PEP), while taking stringent, non-pharmacologic, public health measures to prevent spread. Our aim is to study the effectiveness and safety of HCQ for PEP among naval personnel with exposure to COVID-19-positive patients. METHODS/DESIGN: This is a placebo-controlled, randomized, clinical trial carried out in the naval base camp and quarantine centers of the Sri Lanka Navy, Ministry of Defense, Sri Lanka. Navy personnel who are exposed to a patient with confirmed COVID-19 infection but test negative for the virus on reverse real-time polymerase chain reaction (rRT-PCR) at recruitment will be randomized, 200 to each arm, to receive HCQ or placebo and monitored for the development of symptoms or rRT-PCR positivity for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus for 14 days. DISCUSSION: This trial will provide high-quality evidence of the effectiveness and safety of HCQ as PEP for COVID-19. The study design is unique due to the circumstances of the outbreak in a confined area among otherwise healthy adults, at a relatively early stage of its spread. TRIAL REGISTRATION: Sri Lanka Clinical Trials Registry (SLCTR) SLCTR/2020/011. Registered on 04 May 2020. KEYWORDS: COVID-19; HCQ; Hydroxychloroquine; Post-exposure; Prophylaxis; Randomized controlled trial; SARS-CoV-2; Sri Lanka.
Phosphate fertilizer is a main source of arsenic in areas affected with chronic kidney disease of unknown etiology in Sri Lanka
(SpringerPlus, 2015) Jayasumana, C.; Fonseka, S.; Fernando, A.; Jayalath, K.; Amarasinghe, M.; Gunatilake, S.; Siribaddana, S.; Paranagama, P.A.
Chronic Kidney Disease of unknown etiology (CKDu) has escalated into an epidemic in North Central Province (NCP) and adjacent farming areas in the dry zone of Sri Lanka. Studies have shown that this special type of CKD is a toxic nephropathy and arsenic may play a causative role along with a number of other heavy metals. We investigated the hypothesis that chemical fertilizers and pesticide could be a source of arsenic. 226 samples of Fertilizers and 273 samples of pesticides were collected and analyzed using atomic absorption spectrometry and inductively coupled plasma mass spectrometry for arsenic and other heavy metals in two university laboratories. Almost all the agrochemicals available to the farmers in the study area are contaminated with arsenic. The highest amount was in triple super phosphate (TSP) with a mean value of 31 mg/kg. Also TSP is a rich source of other nephrotoxic metals including Cr, Co, Ni, Pb and V. Annually more than 0.1 million tons of TSP is imported to Sri Lanka containing approximately 2100 kg of arsenic. The next highest concentration was seen in the rock phosphate obtained from an open pit mine in NCP (8.56 mg/kg). Organic fertilizer contained very low amounts of arsenic. Arsenic contamination in pesticides varied from 0.18 mg/kg to 2.53 mg/kg although arsenic containing pesticides are banned in Sri Lanka. Glyphosate the most widely used pesticide in Sri Lanka contains average of 1.9 mg/kg arsenic. Findings suggest that agrochemicals especially phosphate fertilizers are a major source of inorganic arsenic in CKDu endemic areas. Organic fertilizer available in Sri Lanka is comparatively very low in arsenic and hence the farmers in CKDu endemic areas in Sri Lanka should be encouraged to minimize the use of imported chemical fertilizer and use organic fertilizers instead.
Presence of arsenic in Sri Lankan rice
(Springer, 2015) Jayasumana, C.; Paranagama, P.A.; Fonseka, S.; Amarasinghe, M.; Gunatilake, S.; Siribaddana, S.
Background: Arsenic and heavy metals are implicated in causation of CKDu among farmers in dry zone of Sri Lanka. Rice has been identified as a major source of arsenic in research carried out in other countries. We analyzed 120 samples of new improved varieties (NIVs) and 50 samples of traditional varieties (TV) of rice for total arsenic content. Findings: Rice cultivated in Sri Lanka is contaminated with arsenic. Agrochemical dependent NIVs contain considerable amount (20.6 -540.4 μg/Kg) of arsenic. There is no difference between the arsenic content in NIV rice samples from areas where there is high or low prevalence of CKDu. TVs that are cultivated without using agrochemicals contain significantly less arsenic (11.6 - 64.2 μg/Kg). However, it is evident that the TVs also contain toxic metals if they are grown with fertilizers and pesticides. Conclusion: A high proportion of arsenic in rice exists in the inorganic form. Sri Lanka is a nation with high per capita consumption of rice. Codex Alimentarius recommends the maximum allowable limit for inorganic arsenic in rice as 200 μg/kg. Assuming that 70% of the total arsenic content exists in the inorganic form, this corresponds to a level of about 286 μg/kg of total arsenic. As such, 11.6% of the samples of NIVs exceeded this maximum recommended level in polished rice. Inorganic arsenic is a non-threshold carcinogen. Research should be focused on developing rice varieties that do not retain arsenic within the rice grain.
Qualitative research
(Sri Lanka Medical Association, 2003) Sumathipala, A.; Siribaddana, S.; de Silva, N*.
No Abstract Available