Use of a rapid diagnostic test to detect cutaneous leishmaniasis in Sri Lanka

Objectives: This study was initiated to determine the sensitivity and specificity of a commercially available rapid diagnostic test (RDT) to detect leishmania antigen in cutaneous leishmaniasis(CL) skin lesions among Sri Lankan patients compared to PCR and Slit skin smear(SSS).Methods: Patients clinically suggestive of CL lesions were subjected to parasitological investigations. The clinical history was collected by the researcher. Samples were collected by a qualified trained medical officer from the suspected CL lesions at the dermatology clinic in the Hambantota hospital and from the patients coming to the Department of Parasitology, Faculty of Medical Sciences, University of Sri Jayewardenepura. RDT was done at the Hambantota hospital and samples were brought to the Department of Parasitology, to perform SSS, PCR and cultures.Results: Fifty samples have been collected thus far and PCR was performed only in 48 samples. Out of the 50 samples only 9 were positive by RDT and 32 by SSS and PCR. The 9 samples that were positive for RDT were positive by SSS and 7 positive by PCR. Of the 41 samples that were negative by RDT, 16 were negative by PCR as well as SSS.Conclusions: From the data collected it can concluded that RDT is not the best method to diagnose CL skin lesions in patients in Sri Lanka. Also it confirms that the best method to diagnose leishmaniasis is PCR

Climate change and agricultural adaptation in Sri Lanka: a review

Climate change is inevitable and will continue into the next century. Since the agricultural sector in Sri Lanka is one of the most vulnerable to climate change, a thorough understanding of climate transition is critical for formulating effective adaptation strategies. This paper provides an overview of the status of climate change and adaptation in the agricultural sector in Sri Lanka. The review clearly indicates that climate change is taking place in Sri Lanka in terms of rainfall variability and an increase in climate extremes and warming. A number of planned and reactive adaptation responses stemming from policy and farm-level decisions are reported. These adaptation efforts were fragmented and lacked a coherent connection to the national development policies and strategies. Research efforts are needed to develop and identify adaptation approaches and practices that are feasible for smallholder farmers, particularly in the dry zone where paddy and other food crops are predominately cultivated. To achieve the envisaged growth in the agricultural sector, rigorous efforts are necessary to mainstream climate change adaptation into national development policies and ensure that they are implemented at national, regional and local levels

Traditional and new composite endpoints in heart failure clinical trials: facilitating comprehensive efficacy assessments and improving trial efficiency

Composite endpoints are commonly used as the primary measure of efficacy in heart failure clinical trials to assess the overall treatment effect and to increase the efficiency of trials. Clinical trials still must enrol large numbers of patients to accrue a sufficient number of outcome events and have adequate power to draw conclusions about the efficacy and safety of new treatments for heart failure. Additionally, the societal and health system perspectives on heart failure have raised interest in ascertaining the effects of therapy on outcomes such as repeat hospitalization and the patient's burden of disease. Thus, novel methods for using composite endpoints in clinical trials (e.g. clinical status composite endpoints, recurrent event analyses) are being applied in current and planned trials. Endpoints that measure functional status or reflect the patient experience are important but used cautiously because heart failure treatments may improve function yet have adverse effects on mortality. This paper discusses the use of traditional and new composite endpoints, identifies qualities of robust composites, and outlines opportunities for future research

Evolving management and improving outcomes of pregnancy-associated spontaneous coronary artery dissection (P-SCAD): a systematic review.

Background: Pregnancy-associated spontaneous coronary artery dissection (P-SCAD) is defined as SCAD occurring during pregnancy or within 3 months post-partum. Earlier systematic reviews have suggested a high maternal and foetal mortality rate. We undertook a structured systematic review of P-SCAD demographics, management and maternal and foetal outcomes. Methods: Case study identification was conducted according to PRISMA guidelines, with screening of all published P-SCAD cases not meeting pre-defined exclusion criteria. Of two hundred and seventy-three publications screened, one hundred and thirty-eight cases met inclusion criteria. Cases were allocated to one of three time periods; 1960-85 (twenty cases) reflecting early management of P-SCAD, 1986-2005 (forty-two cases) reflecting recent management, and 2006-16 (seventy-six cases), reflecting contemporary management. Results: The only significant demographic change in women experiencing P-SCAD over the last 50 years was an increasing proportion of primigravidas (p = 0.02). Management and outcomes, however, have altered significantly. Emergent angiography (p < 0.0001), reduced thrombolysis (p = 0.006) and increasingly conservative or percutaneous management (p < 0.0001) are associated with dramatic reductions in maternal mortality (85% in earliest reports to 4% in the last decade, p < 0.0001) and foetal mortality (50% in earliest reports to 0.0% in the last decade, p = 0.023). Conclusion: This systematic review of temporal changes in presentation, management and outcomes of P-SCAD represents the widest range of variables analysed in the largest cohort of P-SCAD patients to date. In the setting of earlier coronary angiography and increasingly conservative management, maternal and foetal survival rates continue to improve

Surface modification of silica with a hydrophilic polymer and its influence on reinforcement of natural rubber latex

Surface modification of silica particles by means of macromolecules is a novel technology and surface modified particles are used in diverse applications; amongst them reinforcement of polymer materials is distinguished. However, reinforcement of natural rubber latex (NRL) is still in research stage. In the present study precipitated silica (Ultrasil VN3) is modified with a hydrophilic polymer of which the hydrophilic groups interact with surface bound hydroxyl groups of silica and then the modified silica is used to reinforce NRL. The hydrophilic polymer was synthesized in the laboratory by solution polymerisation technique. Viscosity average molecular weight of the polymer was determined by using Ubbelohde viscometer.  Surface modification of precipitated silica particles was carried out with the synthesised polymer separately in two mediums; aqueous and non aqueous. FTIR spectroscopy of the treated silica was performed to confirm the surface modification. Aqueous dispersions of unmodified/modified silica were prepared prior to compounding and the colloidal stability of the dispersions was observed at different pH levels. The dispersions at neutral pH were incorporated in different loadings namely 5, 10, 15 and 20 phr, to un-compounded and compounded NRL and thin latex films from them were produced by casting. The distribution of silica particles in rubber matrix was examined through microstructural studies and contribution of surface modification towards enhancement of mechanical properties was investigated by measuring tensile and tear properties of unmodified (UM) and modified filler added NRL cast films.Optimum stability of the aqueous dispersions of modified silica was conveyed at pH close to seven.  Uniform distribution of modified silica particles within rubber matrix was seen in films cast from modified silica incorporated NRL whereas a settled layer of filler was seen in UM filler added films. Influence of surface modification upon the reinforcement of NRL was confirmed by comparing the values of tensile and tear strengths of UM and modified filler added vulcanized films. Tear strength of all the films first increased, passed a maximum and then decreased with the increase of filler loadings. The maximum values of both modified filler added films were nearly 50% higher than that of UM filler in the range of 5-10 phr of filler loadings. The tensile strength of modified filler added films also showed a maximum at 5 phr of filler addition whilst that of UM filler added films was slightly increased with the concentration of filler.  However, the modified filler added films showed nearly 35% increase at 5 phr compared that with the highest value of UM filler added films at 20 phr. It is suggested that uniform distribution of filler particles and the improvement in mechanical properties envisage the better compatibility of modified silica particles with NRL via interfacial interactions and enhanced reinforcement

Reinforcement of natural rubber latex film using silica filler modified with a commercially available co-polymer solution

Reinforcement of natural rubber (NR) latex films is one of the most difficult tasks in latex industry. Among the others, the best reinforcing filler is silica that steers for improvement of mechanical properties such as tear and tensile strengths of rubber matrix. However, surface of the silica particle is surrounded by hydrophilic silanol groups which are less compatible with natural rubber molecules. Hence, silica is not easy to be used as reinforcing filler for NR latex films without any surface modification. A study of modification of silica surface was successfully done by using an acrylic polymer synthesized in the laboratory. However, synthesis of polymers in this regard is not economically sound for latex industry. Therefore, a commercially available sodium salt of acrylic co-polymer solution is consumed for the modification of surface of silica particles. Modification is accomplished by the establishment of hydrogen bonds between silanol groups of silica and hydrophilic groups of co-polymer and that is confirmed by FTIR spectroscopy. Stability of modified filler dispersion is optimum at neutral pH and particle size reduction of modified filler particles is compatible with the size of rubber particles. The improved physical properties of modified filler added NR latex films are confirmed by testing tear strength, tensile strength and elongation at break. The preferred level of flexibility through interactions formed between modified filler and rubber matrix is shown by reduced glass transition temperature of modified filler added NR films that tested using differential scanning calorimeter (DSC)

Effect of <i>Phyllanthus maderaspatensis</i> L. crude methanolic extract on diet induced hypercholesterolemia in Wistar albino rats (<i>Mus norvegicus albinus</i>)

Present experiment was aimed to assess the diet induced hypocholesterolemic activity of crude methanolic extracts of Phyllanthus maderaspatensis L. on Wistar rats. The crude whole plant methanolic extract was administered orally at the dosage of 2000 mg/kg body weight per day, to diet induced hypercholesterolemic Wistar albino rats for 14 days to assess the acute toxicity and hypercholesterolemic activity. Lower concentrations were used since no toxicity found during the acute toxicity experiment. Dosages of Methanolic extracts of 400mg, 800 mg and 1200 mg/ kg body weight per day were orally administered to rats for 42 days whilst total cholesterol, triglyceride, were studied. Hardly any acute toxicity signs and liver toxicity were observed with the extract of 2000 mg/kg. The same concentration indicated a reduction of total cholesterol and triglyceride during 14 days. The groups treated with three lower doses of extract exhibited dose dependent negative response with total cholesterol and triglyceride. Results indicated capability of the crude methanolic extract of P. maderaspatensis L. in total cholesterol and triglyceride in diet induced hypercholestrolemic Wistar rats