Browsing by Author "Wanigasuriya, K."

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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 Following an unpublished clinical study claiming efficacy, Dammika Bandara Syrup© gained wide media publicity and political patronage.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.
Burnout among Intern Medical Officers in selected Teaching Hospitals: a cross-sectional descriptive study
(Sri Lanka Medical Association, 2016) de Silva, S.T.; Dahanayaka, N.; Ralapanawa, U.; Nishad, A.A.N.; Silva, F.H.D.S.; Shyamali, N.L.A.; Wanigasuriya, K.
INTRODUCTION: Burnout is characterized by emotional exhaustion, depersonalization and reduced personal accomplishment, occurring due to chronic emotional and interpersonal stressors. Burnout is well recognized among medical doctors. Identifying and, where possible, treating burnout is critical, as it has a major impact on the quality of life of doctors, patient safety and health outcomes. OBJECTIVES: Research on burnout in the medical community of Sri Lanka is scarce. Our objective was to determine the prevalence and risk factors for burnout among intern medical officers (IMOs), who are likely to be at high risk. METHOD: Consenting IMOs in Medical, Surgical, Paediatrics and Obstetric and Gynaecology Units of Teaching Hospitals in Colombo South, Colombo North, Peradeniya, Kandy and Karapitiya were administered three standard, validated, self-administered questionnaires on burnout. RESULTS: 124 IMOs participated; 79(62.9%) were females. Mean age was 27.4 years. Oldenburg Burnout Inventory: 75/124(60.5%) suffered from disengagement, and 77/124(62%) from exhaustion. Abbreviated Maslach Inventory: 47/124(38%) suffered from emotional exhaustion, 20/124(16.1%) from depersonalization, and 6/124(5%) from poor personal accomplishment. Work and lifestyle-related causes (ie heavy and monotonous work-load, lack of control over work-load, chaotic work environment, inadequate rest and sleep, lack of help, and absence of a supportive relationship) were significantly associated with higher burnout scores. CONCLUSIONS: Burnout appears to affect approximately 1 in 3 IMOs in our sample. Most work and lifestyle related risk factors for burnout are modifiable. Further studies are needed to identify causes of burnout among IMOs. A system to detect and treat burnout, particularly among IMOs, is an urgent
Detection of cylindrospermopsin and microcystin-LR in well water of CKDu prevalent Medirigiriya, Sri Lanka
(Research Symposium on Pure and Applied Sciences, 2018 Faculty of Science, University of Kelaniya, Sri Lanka, 2018) Abeysiri, H.A.S.N.; Wanigasuriya, K.; Manage, P.M.
Cyanobacterial blooms in aquatic systems have increased over recent decades. Many of the blooms are highly toxic, causing a serious hazard to human and animal health. The commonest cyanotoxins are hepatotoxins such as microcystin-LR (MC-LR) and cylindrospermopsin (CYN). Cyanotoxin has been proposed as one of the causative agents for CKDu in Sri Lanka and recent studies have revealed the contamination of drinking dug wells by toxin-producing cyanobacteria in the North Central, Uva and Eastern provinces. Thus, the present study was carried out to determine the contamination of CYN and MC-LR in randomly selected CKDu patients’ household well water. The study was carried out for both dry and wet seasons and water samples were collected from 42 wells in Medirigiriya and 21 wells from Hambanthota as a control area. Water temperature, pH, conductivity, Dissolved Oxygen (DO) were measured at the site itself using standard methods. N-NO3-, N-NO2-, N-NH3, total phosphorous and total hardness were measured by standard spectrophotometric and titrimetric methods. CYN and MC-LR quantification were done using ELISA detection kits (Beacon) (minimum detection limit 0.1 ppb). Identification and enumeration of cyanobacteria were carried out under a light microscope (×400). The results of the study revealed that all the tested general water quality parameters were within the Sri Lanka standards given for potable water. Mean cell densities of Microcystis sp. were varying during dry season from 60 ± 0.03 cells/mL to 307 ± 0.08 cells/mL and from 48 ± 0.07 cells/mL to 127 ± 0.73 cells/mL during wet season where MC-LR ranged from 0.02 to 6.73 µg/L and from 0.01 to 5.34 µg/L during dry and wet seasons respectively. Mean cell densities of Cylindrospermopsis sp. during dry and wet season ranged between 20 ± 0.02 cells/mL to 82 ± 0.29 cells/mL and 14 ± 0.19 cells/mL to 76 ± 0.78 cells/mL respectively, whereas the mean concentrations of CYN during dry and wet season was between 0.38 ± 0.01 µg/L to 1.45 ± 0.08 µg/L and 0.27 ± 0.04 µg/L to 1.25 ± 0.08 µg/L. Cyanotoxins and cyanobacteria were not recorded from well water collected from Hambanthota. Principal Component Analysis was done for cyanotoxin concentration, water quality parameters and a number of CKDu patients in the study area and shows a positive relationship between cyanotoxin in wells and CKDu patients who consume water from the wells (p<0.05).
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.
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.
Microcystin -LR contamination status of Nile tilapia (Oreochromis niloticus) and biomarker response
(4th International Research Symposium on Pure and Applied Sciences, Faculty of Science, University of Kelaniya, Sri Lanka, 2019) Abeysiri, H. A. S. N.; Wanigasuriya, K.; Manage, P.M.
Microcystin-LR (MC-LR) is a cyanotoxin derived from some cyanobacteria. Nile tilapia (Oreochromis niloticus) is the most popular freshwater fish among people in Sri Lanka. MC-LR accumulation in tilapia from thirteen reservoirs; Nallachchiya Wewa, Galkulama Wewa, Anakattiya Wewa, Padaviya Wewa, Nachchaduwa Wewa and Kalawewa in Anuradhapura District and from four reservoirs; Parakrama Samudraya, Halmilla Wewa, Kaudulla Wewa and Ambagas Wewa in Polonnaruwa District Muwapatigewela Wewa in Ampara District and Ulhitiya Wewa and Rathkinda Wewa in Badulla District was determined to evaluate the risk posed by the MC-LR contamination in fish on human health. Sample collection, transportation and analysis were followed according to the standard protocols and MC-LR was quantified by High Performance Liquid Chromatography. Fish skin, flesh and head were analyzed for MC-LR and Tolerable Daily Intake (TDI) values were calculated according to the WHO guidelines. MC-LR levels of fish in different reservoirs were compared with WHO standard of TDI (0.04 μg/kg/day). MC-LR level of fish skin (717.14 ± 0.82 μg/kg), flesh (105.11±0.08 μg/kg) and head (553.24±0.12 μg/kg) collected from Padaviya Wewa were recorded the highest mean concentrations of MC-LR. The mean concentrations of MC-LR in the skin and head of fish were significantly higher than that of flesh (p<0.05). The Average Daily Intake of MC-LR in the skin and head of all fish exceeded the provisional TDI set by WHO. Thus, the results of the present study revealed that consumption of head and skin of fish has a potential risk on accumulation of MC-LR in human body. Cyanobacterial toxins have been shown to affect aquatic organisms such as fish, resulting in oxidative stress. Among the antioxidant enzymes, glutathione peroxidase (GPx) plays an important role in the detoxification of MCs. Fish tissues such as head, flesh and skin were obtained for “GPx” gene expression analysis and results showed availability of detoxifying enzymes in fish skin and head collected from Parakrama Samudraya, Padaviya Wewa, Nallachchiya Wewa and Galkulama Wewa. MC-LR contamination in Galkulama Wewa showed a negative result. Therefore, previous exposure of fish for MC-LR shows indicator of the expression of gene of any detoxifying enzyme. Therefore, the results support the use of GPx in fish as a biomarker to assess the contamination by MC-LR
Novel urinary biomarkers and their association with urinary heavy metals in chronic kidney disease of unknown aetiology in Sri Lanka: a pilot study
(Sri Lanka Medical Association, 2017) Wanigasuriya, K.; Jayawardena, I.; Amarasiriwardena, C.; Wickremasinghe, R.
INTRODUCTION: Chronic kidney disease of unknown etiology (CKDu) has emerged as a significant public health problem in Sri Lanka. The role of environmental exposure to cadmium and arsenic in the aetiology of CKDu is still unclear. Identification of a panel of novel urinary biomarkers would be invaluable in the study of toxin mediated damage postulated to be the aetiology of CKDu. OBJECTIVES: The aims of this study were to evaluate the profile of novel urinary biomarkers in CKDu patients and identify any association with environmental exposure to heavy metals. METHODS: Thirty seven randomly selected CKDu patients attending a renal clinic in the North Central Province and two control groups namely a farmer group (n=39) and a non-farmer group (n=40) from a non-endemic area were included in this comparative cross sectional study. Urine samples were analyzed for heavy metals and five urinary biomarkers. RESULTS: CKDu patients had significantly elevated urinary levels of fibrinogen (198.2 ng/mg creatinine p<0.001), clusterin (3479 ng/mg creatinine p<0.001), cystatin-C (5124.8 ng/mg creatinine p<0.001) and β2-microglobulin (9913.4 ng/mg creatinine p<0.001) compared to the control groups. Fibrinogen and β2-microglobulin were the best to discriminate CKDu patients from normal individuals with the receiver operator areas under the curve being 0.867 and 0.853, respectively. Urinary fibrinogen and KIM-1 levels correlated positively with urinary arsenic levels. KIM-1 levels correlated positively with urinary mercury and lead levels but no correlation was seen with urinary cadmium levels. CONCLUSIONS: Fibrinogen and β2-microglobulin have the potential of being a screening tool for detection of CKDu and may aid the early diagnosis of toxin mediated tubular injury in CKDu. Their usefulness need to be further validated in a larger epidemiological study of patients with early stages.
Physicians’ response to the COVID-19 pandemic: A view from Sri Lanka
(Ceylon College of Physicians, 2021) Wanigasuriya, K.; Dassanayake, S.; de Silva, S.; Jayasinghe, S.
No abstract available