Evaluation of the diagnostic performance of a commercial molecular assay for the screening of suspected monkeypox cases in Sri Lanka.

Background: The main objective of the present study was to compare the diagnostic performance of the commercial LightMix Modular Monkeypox Virus (MPXV) qPCR (TIB Molbiol, Germany) assay with the in-house nonvariola orthopox/monkeypox generic real-time PCR assay (ICMR-NIV, Pune) for the screening of (MPXV) cases at Medical Research Institute (MRI) in Sri Lanka. Furthermore, clinical and sociodemographic data of suspected /confirmed cases received at MRI for the MPXV screening were also analyzed. Methods: The diagnostic performance of the commercial LightMix Modular MPXV qPCR assay with the in-house nonvariola orthopox/monkeypox generic real-time PCR assay for the screening of suspected MXPV cases was evaluated using standard methods with minor modifications. Socio-demographic and clinical profiles of suspected and confirmed MPXV cases were also analyzed. Results: The commercial LightMix Modular MPXV assay was able to detect MPXV with 100% sensitivity and specificity with non-variola orthopox/monkeypox generic rtPCR assay. During the period of study, from the total of 25 samples tested, only 2 were MPXV-positive (males). The most common symptoms of suspected MPXV cases were lesions or rashes (92%). Conclusions: With the continually increasing number of cases, access to MPXV testing should be made more widely available. The commercial LightMix Modular MPXV (TIB Molbiol) qPCR assay offers comparable performance to the non-variola orthopox/monkeypox generic real time PCR assay for MPXV detection during the present outbreak.

Validation of psoriasis disability index (PDI) questionnaire Sinhala version.

INTRODUCTION/OBJECTIVES: Psoriasis is a chronic inflammatory dermatosis with significant physical and psychological impact leading to negative influence on the quality of life among patients with psoriasis. Other than the disease characteristics many external factors could operate in South Asian context. Lack of a reliable disease-specific instrument prevents objective estimation and monitoring of disability in patients with psoriasis and hence we aim to validate assess the psychometric properties of the Sinhala version of PDI. METHODS: A cross-sectional study conducted at dermatology clinic at a tertiary care National Hospital in Sri Lanka. Patients with psoriasis and on therapy at least 4 weeks prior to enrollment, aged more than 18 years, were included while those with already diagnosed psoriatic arthritis and/or nail psoriasis alone without any skin involvement and generalized pustular psoriasis de novo were excluded. All patients were examined by dermatologist to obtain disease characteristics. The reliability was assessed by internal consistency using Cronbach's α and item-total correlation. Convergent validity was measured with the known groups. RESULTS: Of 199 patients studied, the PDI Sinhala version showed Cronbach's α of 0.86 (all 15 items) and ranged from 0.57 to 0.77 for subscales. PDI score and Dermatology Life Quality Index (DLQI) showed good correlation of coefficient 0.76 (p < 0.01). Positive associations were noted with extent and severity of psoriasis when using sample medians (p < 0.05). The dimensionality of the PDI was determined using exploratory factor analysis and four factors were structured. CONCLUSION: The PDI Sinhala version is proved to be valid and reliable tool to assess the burden of psoriasis among Sinhala conversant patients in Sri Lanka.

Acceptability of home fortification with multiple micro-nutrients among Sri Lankan children.

Micronutrient deficiencies are mostly hidden; clinically less visible compared to macronutrient deficiencies. Food fortification with multiple micronutrients (MMN) is provided for children between 6-23 months, daily for two months at three-time points. We assessed the acceptance and adherence of this nutritional intervention in an urban community setting in Sri Lanka. This cross-sectional study enrolled caregivers of children aged 7 to 23 months with a cluster sampling method. Caregivers ' acceptance of taste and smell, health gains, ease of use, and need perception (Cronbach's reliability: 0.801) were assessed. Also, anemia knowledge (Cronbach's reliability: 0.642), MMN knowledge, and reported adherence (number of sachets consumed per month) were evaluated through a self-administered questionnaire. Adequate adherence was defined as the use of ≥80% sachets. The univariate and multivariate statistical analysis examined the association of acceptability, adherence, and anemia knowledge with independent variables (socio-demographic, household characteristics, and knowledge). The survey included 153 respondents. The Median (range) age of children was 12 months (7-23). The mean (SD) acceptability score was 66.82% (9.78%). Acceptance of sensory qualities (smell/taste) had a lower score than perceived health benefit. Most consumed MMN adequately (72.5%). The mean (SD) anemia knowledge score was 62.20% (25.79%). In multivariate analysis, child's age (OR: -0.360, 95% CI:-0.510,-0.211) and father's education (OR: 2.148, 95% CI: 0.439, 3.857) were independently associated with acceptability. Child's age (OR: -0.108, 95% CI:0.818, 0.985), anemia knowledge (OR:0.016, 95% CI: 1.003, 1.031) and acceptability (OR:0.236, 95% CI:1.140, 1.406) were significant determinants of adherence. Anemia knowledge was significantly associated with the mother's education and household income when adjusted. In conclusion, unpleasant smell/taste and daily schedule were reported as barriers to MMN use. Yet, perception and trust regarding health benefits were encouraging. Reported adherence was somewhat high. Improving acceptability and anemia knowledge could enhance adherence further in this population.

Prevalence and Quantitative Analysis of Antibiotic Resistance Genes (ARGs) in Surface and Groundwater in Meandering Part of the Kelani River Basin in Sri Lanka.

Nearly 80% of the population in the Colombo district fulfill their major requirement from the Kelani river. Recent studies are interoperating: most groundwater and surface water in Sri Lanka are contaminated with waterborne pathogens and antibiotics. In the present study, nine antibiotic resistance genes (ARGs) were screened which were belonging to two common groups of antibiotic: penicillin - OPR D, bla TEM , bla OXA , amp a, and amp b - and tetracycline - tet A, tet M, tet B, and tet S. The results of the study reveled that the surface and groundwater of the entire lower part of the Kelani river basin were contaminated with TC and FC (98%). None of the penicillin and tetracycline group antibiotics were detected either surface or groundwater samples except the Kelani river mouth (amoxicillin (AMX) at 0.003 ± 0.001 µg/ml). The results showed that 5 to 15% of surface water samples were positive for penicillin resistance genes (bla TEM , bla OXA , OPR D, amp a, amp b) where ~ 10% of groundwater samples were positive against tetracycline resistance genes (tet A, tet M, tet S, tet B). Among the penicillin resistance genes, the bla TEM (700.576 × 102 copy/ml) was recorded as the highest concentration where the highest tet A gene (439.875 × 102 copy/ml) was detected among the tetracycline resistance genes. Therefore, water quality management and regular monitoring are essential to maintain the quality of drinking water in the meandering part of the Kelani river basin to safeguard river water consumers.

Validation of Sinhala version of Psoriasis Epidemiology Screening Tool.

INTRODUCTION/OBJECTIVES: Psoriatic arthritis (PsA) occurs in one-third of patients with psoriasis and mostly remains undetected leading to debilitating deforming arthritis, eventually. The Psoriasis Epidemiology Screening Tool (PEST) is a quick and valid tool, widely used to detect PsA in clinical practice, and it has been validated to many languages. In this study, we intended to validate a Sinhala version of the PEST and assess its psychometric properties. METHODS: The Sinhala version of the questionnaire was tested on 199 patients with psoriasis attending the dermatology clinic at a tertiary care National Hospital in Sri Lanka. Patients who were detected to have PsA previously (n = 5) and those with other rheumatologic conditions (n = 12) were excluded. All patients were examined by a dermatologist, and demographic and disease characteristics were obtained. All patients were assessed by two rheumatologists who were blinded to the answers provided in the questionnaire. The diagnosis of PsA was made based on the CASPAR criteria. RESULTS: We observed the total PEST score of 3 or more to be the best cutoff value to screen for PsA. This cutoff value showed the highest Youden index (sensitivity = 0.89, specificity = 0.95). In the ROC analysis, the area under the curve of the PEST_sv was 0.95 (SE 0.02, p < 0.001). PEST_sv total score showed a significant correlation with body surface area involved but not with Dermatology Life Quality Index or Psoriasis area and severity index score. CONCLUSION: The Sinhala version of PEST demonstrated satisfactory performance as a screening tool for PsA. Key Points • Psoriatic arthritis (PsA) is the most debilitating complication of psoriasis and lack of quick, valid screening tool is a limiting factor for early identification in Sri Lankan context. • Sinhala version of the Psoriasis Epidemiology Screening Tool (PEST_sv) was tested on 199 patients with psoriasis and examined for the diagnosis of PsA according to Classification of Psoriatic Arthritis (CASPAR) criteria. • PEST_sv score of 3 or more was observed to be the best cutoff value to screen for PsA with sensitivity and specificity of 0.89 and 0.95 respectively. • PEST_sv demonstrated satisfactory performance as a screening tool for PsA.

An Atypical Clinical Manifestation of a Hump-Nosed Pit Viper Envenomation.

Envenomations by hump-nosed pit vipers (HNVs) are frequent in Sri Lanka and in South India. Until recently, HNV was considered a moderately venomous snake. Here, we report a case of a previously healthy female developing all the known serious complications, plus some previously unreported complications following a HNV envenomation. She had muscarinic symptoms like profuse sweating and salivation within a couple of minutes and a seizure several minutes after envenomation. Her acute kidney injury (AKI) was swift onset and progressed to end-stage renal failure at three months. She had mild parotid swelling, crepitations in her lungs, and edema of the bitten leg. She had evidence of microangiopathic hemolytic anemia and hemolytic uremic syndrome as well. She developed local tissue necrosis, a non-ST-elevation myocardial infarction (non-STEMI), and anterior ischemic optic neuropathy (AION) following the envenomation. We believe the best explanation for her swift onset complication is intravascular injection of venom. We believe ischemia due to thrombotic microangiopathy has contributed to local tissue necrosis. Those ischemia and kidney failure have contributed to non-STEMI and AION. We illustrate the issue of the sluggish progress made by medicine in understanding the complications of envenomation by using HNV as an example.

Ethnic differences in lung functions of children in the Colombo District, Sri Lanka

Background: Reference values of lung functions vary with age, height, ethnicity and sex of the reference population. Global Function Initiative 2012 compared reference equations for Sri Lankan children with those of South Indian and South East Asian equations. Sri Lanka has a multi-ethnic society comprising of Sinhalese, Tamils, Moors and other ethnic minorities. Applicability of existing Sri Lankan equations to children from different ethnic groups in the country has not been adequately verified. Our aim was to investigate the effect of ethnicity on spirometry parameters in school aged children. Methods: We enrolled healthy boys and girls between 9-15 years of age from 6 schools in Colombo District using stratified cluster sampling. A pretested self-administered questionnaire collected details on demography, respiratory health and other chronic illnesses. Anthropometric measurements (standing height and weight) were collected. Spirometry was performed with a flow sensing spirometer that complies with American Thoracic Society/European Respiratory Society (ATS/ERS) standards adopted for children. Highest FVC and FEV1 values were obtained from 2 repeatable tests. Results: Spirograms of 849 students were analysed. Majority (n=496) were Sinhalese. There were 240 Tamils and 113 Moors. Multiple regression found that height, age and sex were significantly associated with lung functions (p<0.05). Ethnicity was not significantly associated with parameters measured in spirometry when the regression was performed controlling for height and age. Conclusions: The same spirometry reference equations could could be used for children of all ethnic groups in Sri Lanka aged 9-15 years.

Effect of body mass index on pulmonary function in children

Introduction: The relationship between obesity or overweight and pulmonary functions has not been investigated in Sri Lankan children previously. Therefore, we aimed to study the effects of obesity/overweight on dynamic lung functions in healthy school children in Sri Lanka. Results: Of 275 children 55 (20%) were 'obese/ overweight'. BMI has no significant relationship to any of the pulmonary function parameters. However, in contrast to what is expected, mean values of FVC, FEV1 and FEF 25-75% were lower in 'normal weight' group (Table 2). Conclusions: No significant difference was detected in spirometry parameters between obese/overweight and normal weight school children in our study.

Cytotoxic amides from the octocoral Telesto riisei.

Two new acyl derivatives of beta-phenylethylamine, N-(2-phenylethyl)-9- oxohexadecacarboxamide (1) and N-(2-phenylethyl)-9-hydroxyhexadecacarboxamide (2), and two new tetrahydroxysterols, cholestane-3 beta, 5 alpha,6 beta-26-tetrol 27-acetate (3) and cholestane-3 beta, 5 alpha, 6 beta-26-tetrol (4), have been isolated from the coelenterate Telesto riisei collected in Chuuk, Federated States of Micronesia. Structures were determined from spectroscopic data. All new compounds were mildly toxic to murine leukemia cells (P-388) in culture.

Post-coital contraceptive agents from extracts of Sri Lankan alcyonacean soft corals--I.

Dichloromethane-methanol (1:1) extracts of ten species of alcyonacean soft corals were screened for post-coital interceptive effects on female rats, using oral administration, from day 1 to day 7 of pregnancy. Significant suppression of fertility was observed in the animals treated with the crude extracts of Sarcophyton ehrenbergi (250 mg/kg/day, P less than 0.05; 500 mg/kg/day, P less than 0.001), Sinularia crispa (500 mg/kg/day, P less than 0.05; 1000 mg/kg/day, P less than 0.001), Sinularia abrupta (1000 mg/kg/day, P less than 0.001), Sinularia spp--III (500 mg/kg/day, P less than 0.05). This antifertility effect appears to be due to interruption of embryonic events during implantation and/or pre-implantation periods.

A new spermatostatic glycoside from the soft coral Sinularia crispa.

The steroid glycoside 1 has been isolated from the Sri Lankan soft coral Sinularia crispa. The structure has been determined by spectroscopic (1H and 13C nmr) techniques. Glycoside 1 showed spermatostatic activity on rat cauda epididymal spermatozoa.