The Medical Dance 2016 SAITM?

REGISTERED AT THE DEPARTMENT OF POST QD / 14 / NEWS / 2017 December 2016, VOLUME 09, ISSUE 12

THE OFFICIAL NEWSLETTER OF THE SRI LANKA MEDICAL ASSOCIATION

Why this fuss over The Medical Dance 2016 SAITM?

Ethics Review Committee of the SLMA Receives Global Accreditation

Doctors vs. Lawyers – Annual Cricket Encounter 2016

MERRY CHRISTMAS & HAPPY NEW YEAR 2017

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Further information available on request from: GlaxoWellcome Ceylon Ltd. 121, Galle Road, Kaldemulla, Moratuwa, Sri Lanka. Tel:2636 341 Fax:2622 574 SLMA President Dr. Iyanthi Abeyewickreme CONTENTS MBBS (Ceylon), Diploma in Venereology (London), MSc, MD (Colombo), FCVSL, Hon. Senior Fellow PGIM Consultant Venereologist President's Message 02

Editorial Committee Why This Fuss Over SAITM? 02-04 2016 Monthly Clinical Meeting of The Editor-In-Chief: 04

Dr. Hasini Banneheke SLMA in November & December

Committee: Ethics Review Committee of The

Dr. Sarath Gamini De Silva SLMA Obtains SIDCER Recognition From 06 Dr. Kalyani Guruge FERCAP Dr. Ruvaiz Haniffa Dr. Amaya Ellawala Notice-Free Copies of Ceylon Medical 06 Journal

Official Newsletter of Doctors vs. Lawyers – The Sri Lanka Medical Association 08 Annual Cricket Encounter 2016 No. 6, Wijerama Mawatha, Colombo 7. Tel: +94 112 693324 Joint Regional Meetings in 08-10 E mail: [email protected] November & December

Cover Story... The Medical Dance 2016 12-13

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Publishing and printing assistance by: This Source (Pvt.) Ltd, Suncity Towers, Mezzanine Floor, 18 St. Anthony's Mawatha, Colombo 03. Tel: +94 117 600 500 Ext 3521 Email: [email protected] 1 PRESIDENT’S MESSAGE

his is my last message to the This year, continuous professional best. SLMA newsletter as the Presi- development (CPD) activities were The SLMA has grown in stature over dent. I believe that we present- conducted, not only for medical pro- the years and is now recognized and edT the membership with content that fessionals in the public sector but also well respected by all health-related were important and up to date and I for those in the private sector. CPD stakeholders. We also continued to hope that you have enjoyed read- activities were extended to medical engage with the Ministry of Health ing the newsletters of 2016. The last faculties and this year we also includ- and were successful in getting an en- Council Meeting was held on 2nd De- ed the Sir John Kotalawala Defence hanced financial allocation from the cember and arrangements have been University in these activites. The pin- ministry. This year the SLMA has been made to hand over the responsibili- nacle academic event was the 129th able to extend and further strengthen ties to the new Council before the end Anniversary International Medical our international partnerships by sign- of the year. Only the Annual General Congress held in July which was con- ing an MOU with the Chinese Medi- Meeting remains to be held on the 23rd cluded very successfully. While it was cal Association and by taking over of December. encouraging to note the large num- the presidency of the Commonwealth bers of outstation doctors attending First and foremost, I wish to extend Medical Association for the next three the CPD activities, the limited partici- my most sincere gratitude to all the years. pation of Council Members in regional Members of the Executive Committee, meetings was disappointing. The renovations and refurbishments Members of the Council, Members carried out at Wijerama House during of the Expert Committees and the The Medical dance was held on 9th 2016 has given it a more attractive Members of the Working Groups who December and the opinion of many and user-friendly atmosphere. served the SLMA with dedication in who attended the Dance was that carrying out their duties. I have been it had been one of the best Medical It has been an honour and a privi- very fortunate to have had young, dy- Dances held so far. I wish to thank all lege for me to serve the SLMA as its namic and super efficient colleagues the members of the Dance Committee, 119th President. I fervently hope that I in the Executive Committee whose especially Dr.Christo Fernando and have justified the trust that was placed enthusiasm for work was infectious. Dr.Pramilla Senanayake, who looked in me by the membership. It has in- The Expert Committees and the Work- into every aspect of the dance with deed been a memorable year and I ing Groups form the backbone of the meticulous attention to detail. Many have truly enjoyed my tenure as the SLMA and their commitment to the members of the committee played a head of this august institution. tasks undertaken was commendable. part in securing sponsorships for the Finally I wish each and ev- They were ably supported by the Ad- event and advertisements for the sou- ery one of you the Compliments ministrative Staff of the SLMA. Many venir. of the Season, a Joyous Christ- other SLMA members too helped in The Induction of the new President, mas and a Happy New Year! numerous ways to carry out the activi- Prof. Chandrika Wijeratne, has been ties of the Association and I am ever planned for 21st of January next year. I Dr. Iyanthi Abeyewickreme so grateful for their support. wish her and the new Council the very President-SLMA WHY THIS FUSS OVER SAITM?

Prof A H Sheriff Deen, tion of crises, economic hardships and same newspaper that I have been Guest of Honour – unemployment, an erosion of politi- asked on several occasions whether Foundation sessions of the cal centre and a growing resentment I was for or against Private Medical SLMA against the elites. He had a penchant Colleges and I had replied that I was ne of the objectives of the for long rambling speeches, present- neither for or against these but that I SLMA is to play an advocacy ing himself in messianic terms, prom- was against unregulated “commercial” role in medical affairs of the ising to lead his country to a new era medical colleges which were akin to country.O It was only 2 weeks ago that of greatness” – Donald Trump? Boris mere tutories. Johnson? Rodrigo Duterte? No, it is I saw these news items in the news- Of late I have been approached by a about Adolf Hitler! paper and I thought it is time to air my few businessmen who have asked me view on private medical colleges with “Why this fuss over SAITM?” • “Doctor, will you help me set up a Pri- the hope that the SLMA will take on asks a reader. The answer is the vate Medical College? You name your the task of advising the Government price and we will pay you.” on this contentious issue. In the article same – because of the hidden on Trump the correspondent had this dangers. And the conversation on each occa- to say “he emerged amid a constella- Many years ago I wrote to this very sion has gone like this- Contd. on page 03

2 December 2016 SLMANEWS Contd. from page 02 Why this fuss... • “Have you got a Teaching Hospital”- ary 2009 under the provisions of Sec- environment, Medical Education unit, Answer “No”. tion 19 of the Medical Ordinance, in Accommodation and Sports, Food • “Do you have any idea of medical cur- conformity with the Committee of Vice service, Water supply, sanitation, riculum, teaching medicine?” -Answer Chancellors, Directors of the Univer- Electricity, gas, Central workshop are “No”. sity Grants Commission (UGC) of Sri spelt out. Lanka for medical schools and foreign Next is a section on student se- • “Have you got capital?” -Answer “No”. medical schools to be approved as lection, Staffing policy, staff devel- centres of medical education for Sri • “Have you got permission to start a opment and PG development. degree awarding Institution/ Medical Lankan citizens. The last section is the Accreditation School?” -Answer “No Doctor, but when Since then the WHO in November Report, It says “the report must con- SAITM gets the OK we can advertise, 2009 published “Guideline for Accredi- clude with recommendations concern- collect 5 to 10 million rupees from tation of Medical Schools in countries each applicant, start with a lecture hall ing the decision on accreditation to be of the South East Asia region “bearing and later build up the rest – just like taken by the SLMC, this decision must in mind the country specific require- our International Schools!” be conveyed to the Minister of Health, ments and the prevailing national ac- Minister of Higher Education and UGC Following the 1920s, the training of creditation practice and are non-bind- and also made public. doctors in the United States moved ing, flexible and facilitatory in nature from commercial medical schools to and are under the jurisdiction of the Now compare this with the Guide- medical colleges with research fa- medical councils.” lines put out by the Medical Council of India. There is an official Gazette cilities associated with teaching “It is proposed that with the follow- Emphasis on the scientific titled “Establishment of Medical Col- hospitals. ing standards of medical education basis of medicine stimulated major leges 1999” The first clear statement by every University, medical school or breakthroughs in our understanding of goes “No person shall establish a degree awarding institute established human biology and disease and this medical college except after obtain- under the Universities Act No. 16 on fostered progress. The triumvirate of ing prior approval from the Central 1978 shall be periodically undertaken medical school, research faculty, and Government submitting a scheme: by the SLMC in accordance with Part teaching hospital spawned the mod- 111 A of the Medical Ordinance. Single plot of land 25 acres in ern academic medical centers with the extent following objectives: The process starts in the following sequence: Application for Accredi- Essentiality Certificate: No objec- • Educate and train tomorrow's doctors and tation, Scrutiny of Documents, Self tion of State/ territory of administra- medical scientists Evaluation, Site Visit, Approval of Cur- tion, availability of adequate clinical • Discover new medical knowledge and riculum/ substantial changes. material as per Council regulations, conduct research to find tomorrow's University consent, Person manages This is followed by a set of guide- cures (almost a hundred and fifty years a Hospital not less than 300 beds with lines on Standards, Educational pro- later, how many of our medical faculties facilities for expansion, that the per- gramme, Instructional methods, As- have this in their Mission statements?) son has not admitted students to sessments. The next section is on the proposed medical college, Bank • Develop innovative ways to prevent, diag- Clinical Teaching facilities. It spells guarantees in favour of the Medical nose, and treat disease out minimum number of beds and oc- Council of India, opening of Medical cupancy, the specialties, professorial • Provide the most up to date medical care Colleges in hired or rented build- Units, Clinicians Operating Theatres, ings shall not be permitted, Market We too should move forwards not radiology facilities, Laboratory facili- survey and environmental analysis, backwards. ties, and rehabilitation. The next sec- Educational programme with method tion is Finances and resources with The first step in establishing a of recruitment, administration, Depart- a sum of money deposited by pri- medical school is to get permis- ment wise and year wise curriculum vate medical schools as a guarantee sion from the Ministry of Higher of students, Functional programme against eventualities! Education and the SLMC. There is a – department wise and service wise, document issued from the SLMC titled Physical facilities like lecture rooms, Equipment programme, Manpower “Guidelines and specifications and Auditorium and examination hall, Tu- programme, Building programme, criteria for accreditation of Medical torial rooms, AV Unit, Laboratories Planning and layout, Revenue and schools in Sri Lanka and courses of and museums, Library, Information expenditure assumptions, Application study provided by them” dated 2011. technology, Clinical Skills and English with 3.5 lakhs to the Medical Council These were first published in Febru- competency laboratories, Research of India. Contd. on page 04

SLMANEWS December 2016 3 Contd. from page 03 Why this fuss... This is followed by a review process by the MCI on desirability and feasibil- ity, Report by MCI, Grant of permission with a time based programme. (www. mcindia.org/for-colleges/Estl-of-new- Med-Coll-Regulations-1999.pdf) You may now see the process set up of a stepwise transparent process starting with a plot of land and resources, to obtaining national/ state/ territorial permission/teaching hospi- appointment of Professors and schools are a necessary evil / inevitable tal/ departments, infrastructure facili- Lecturers, then building a Teach- phenomenon ties, curriculum/criteria for recruitment ing hospital and finally applying for of staff, admission of students and that • Re write the guidelines using the MCI permission from the Medical Coun- at each stage the MCI is involved in format cil. Maybe some will see now the assessing adequacy before final per- answer to the question “Why this • Close all loopholes which could enable mission is given. Compare this with corrupt practices fuss over SAITM?” the business entrepreneurs who • Lobby with the Government for Gazette are waiting to make a quick buck I hope the SLMC will get involved. notification by commencing at the reverse end • Sub committee to study the problem by recruiting the students, collect- • Ensure punitive action in case of non- • Lobby with the Government for a policy ing the money, starting preclinical conformity on Private Medical Schools courses in hired halls, stepwise Thank you. hiring of staff as required, ad hoc • Accept the fact that private medical MONTHLY CLINICAL MEETING OF THE SLMA IN NOVEMBER & DECEMBER Dr.Kushlani Jayatilleke, December 2016 was held on 20th of Assistant Secretary- December from 12 noon to 1.30pm SLMA at the SLMA Auditorium in collabora- November Meeting tion with the Heart Association of Sri Lanka. The topic was “Acute Coronary The monthly clinical meeting of the Syndrome”. The resource persons SLMA for November 2016 was held were Dr. W. S. Santharaj, Consultant on 15th of November from 12 noon to Cardiologist, National Hospital of Sri 1.30pm at the SLMA auditorium in col- Lanka and Dr.Eranga Colombage, laboration with the Sri Lanka College Senior Registrar, National Hospital of of Psychiatrists. The topic was “The Sri Lanka. The meeting was chaired short and long term management by Dr. M.R. Haniffa, Vice President, of alcohol dependence and harmful SLMA and Dr. Kushlani Jayatilleke, use”. The resource persons were Prof Assistant Secretary, SLMA. Raveen Hanwella, Professor in Psy- chiatry, Faculty of Medicine, Colombo and Dr. Suhashini Ratnatunga, Senior Registrar in Psychiatry, University Psychiatry Unit, National Hospital of Sri Lanka. The meeting was chaired by Dr Dennis Aloysius, a past president of the SLMA. December Meeting The monthly clinical meeting for

4 December 2016 SLMANEWS

ETHICS REVIEW COMMITTEE OF THE SLMA OBTAINS SIDCER RECOGNITION FROM FERCAP

he Ethics Review Committee of ors of the FERCAP in June 2016 in all SIDCER criteria and was cleared the Sri Lanka Medical Associa- collaboration with the Forum for Eth- for recognition in September 2016. tion became the 5th Ethics Re- ics Review Committees in Sri Lanka The SLMA ERC is chaired by Pro- Tview Committee (ERC) in Sri Lanka to (FERCSL) and was coordinated by fessor Anoja Fernando and its mem- obtain Strategic Initiative for Develop- Prof. Vajira Dissanayake, Board Mem- bers are ing Capacity in Ethical Review (SID- ber of FERCAP. CER) recognition from Forum for Ethi- Dr Malik Fernando - Alternate Chair A 3 day rigorous assessment of the cal Review Committees in Asia and ERC was performed under the follow- Prof. Chandanie Wanigatunge - the Western Pacific (FERCAP). ERC ing criteria laid down by the Strategic Secretary of the SLMA thus becomes the only Initiative for Developing Capacity in National level ERC of a Professional Prof. Shalini Sri Ranganathan Ethical Review (SIDCER) programme. Association to obtain international rec- Dr .Carukshi Arambepola ognition. 1. Structure and Composition Dr. Sumal Nandasena The recognition plaque was received 2. Adherence to specific policies Dr. Jayanie Weeratna by Professor Anoja Fernando (Chair- 3. Completeness of the Review Process person) and Professor Chandanie Dr. Mayuri Thammitiyagodage 4. After Review process Wanigatunge (Secretary) on behalf Dr. Kamal Weerapperuma of the SLMA ERC at the recognition 5. Documentation and Archiving ceremony held during the 16th Annual Prof. Amala de Silva The survey included perusal of all Conference of FERCAP on 23rd No- documents of the ERC, interviewing Dr.Naazima Kamardeen vember 2016 in Bangkok, Thailand. its committee members and office staff Mr. Sujeewa Rajapakse The SLMA ERC was surveyed by a and observation of a full board meet- team of international and local survey- ing. The ERC SLMA successfully met Ms. Chitra Ranasinghe

NOTICE Free copies of Ceylon Medical Journal Excess copies of several past issues of the Ceylon Medical Journal are available at the CMJ office to be distributed free. Those who are interested please inquire from Ms. Saumya of CMJ office (Tel: 0112680212).

6 December 2016 SLMANEWS

DOCTORS VS. LAWYERS – ANNUAL CRICKET ENCOUNTER 2016

he annual cricket encounter between the SLMA Doctors and the Lawyers of the Bar Association Tof Sri Lanka (BASL) was held 13th of December 2016 at the BRC grounds and, the Doctors’ team won the match. Power your vehicle The Hon Secretary of the BASL, Mr. Amal Randeniya joined the President of the SLMA, Dr. Iyanthi Abeyewick- with a Panasonic battery reme to award the winner’s trophy to the captain of the Doctors’ team. Prof. Indika Karunthilake awarded the medals to the members of the winning team.

JOINT REGIONAL MEETINGS IN NOVEMBER & DECEMBER

Dr.Sumithra Tissera, Assistant secretary- SLMA

SLMA – Ruhunu Clincial Society Joint Regional Meeting he Sixth SLMA joint Region- al clinical meeting was held at Sanaya Hotel, Matara, on 16Tth of November 2016 with the at- tendance of around 100 participants. The welcome address was delivered Factory- tted in most Japanese by Dr. Shantha Kumara, President motor vehicles and SUVs, Ruhunu Clinical Society. Dr.Iyanthi in Healthcare”, Dr. Prasad Katulanda, OTT Abeyewickreme, President of SLMA The Post lunch session included Panasonic batteries now come Senior Lecturer Department of Medi- was the Chief Guest and Dr. P.M.G. a guest lecture by Dr. Janatha Li- cine, University of Colombo on “Man- with a warranty of up to 5 years. Punchihewa, Consultant Paediatrician yanage, Consultant Paediatric Sur- agement of Thyroid Disorders for the geon, Teaching Hospital, Karapitiya was the Guest of Honor. HOLMES POLLARD & S T Generalist”, Dr. PadminiKolombage, on “Management of Genitourinary Sole distributor : Rs.13,490/- upwards The Pre-lunch session had five Senior Consultant Radiologist, Teach- Problems in Children”, a Symposium guest lectures by Dr. Hemantha Per- ing Hospital, Karapitiya, on “An Over- on Cardiology with an eminent Panel era, Consultant Gynecologist, Sri Jay- view of Imaging in Muscular Skeletal of Consultant Cardiologists Dr. Dumin- douglas & sons (pvt) ltd. awardenapura Hospital on “Size at System & Small Parts” and Dr. T. Sa- da Samarasinghe, LRH, Colombo, on 290/25, Sri Sangaraja Mawatha, Colombo 10. Birth – Pathway to NCD”, Dr. Sarath beshan, Consultant OMF Surgeon, “Structural Heart Disease What can Hotlines: 011 5 608 430, 0773 354 354 Samarage, Senior Fellow Institute of General Hospital Chilaw on “Surgical we do?”, Web: www.dsl-autoparts.com Health Policy on “Shared Leadership Art & Facial Beauty”. Contd. on page 10 https://www.facebook.com/PanasonicbatteriesSL 8 December 2016 SLMANEWS Power your vehicle with a Panasonic battery

Factory- tted in most Japanese motor vehicles and SUVs,

Panasonic batteries now come OTT with a warranty of up to 5 years. HOLMES POLLARD & S T Sole distributor : Rs.13,490/- upwards douglas & sons (pvt) ltd. 290/25, Sri Sangaraja Mawatha, Colombo 10. Hotlines: 011 5 608 430, 0773 354 354 Web: www.dsl-autoparts.com

https://www.facebook.com/PanasonicbatteriesSL Contd. from page 08 Joint Regional Meetings ... Dr. Tiran Pereira, North Colombo Teaching Hospital, on “Pearls in the Heart Failure Management”, and Dr. Susith Amarasinghe, Consultant Electro physiologist, Teaching Hos- pital, Karapitiya, on “Sudden Cardiac Death and Risk Assessment”. There was also three free paper sessions where doctors from Hospitals around presented their research. Dr. Murali Vallupathran, Consultant Community Physician, Member SLMA, was the Judge of for these sessions.

SLMA – Awissawella Clini- SLMA – Wathupitiwala cal Society Joint Meeting Base Hospital Clinical So- The seventh SLMA’s joint Continu- ciety Joint Meeting ing Medical Education Programme The eighth joint clinical meeting (CME) was held at the Board of Invest- of the SLMA was held jointly with ment (BOI) auditorium, Seetawaka on Wathupitiwala Base Hospital Clini- 18th of November 2016 with an atten- cal Society at Hotel Sanol, Nittam- dance of over 150 participants. The buwa on the 19th of November 2016 programme commenced with a joint with over 125 participants. The pro- welcome address by Dr. Lucian Jaya- gramme commenced with a joint wel- suriya Past President of the SLMA, come address by Dr.Malik Fernando, and Dr.Priyantha Jayalath, President, Past President of the SLMA, and Dr. Avissawella Clinical Society. Champa S. D. Jayamanne, President Lectures during the first session Clinical Society, Wathupitiwala Base was delivered by Dr. Hasini Banne- Hospital followed by a brief address heke, Secretary, Expert Committee on by the regional director of Health ser- Communicable Diseases on “Recent vices (RDHS) Gampaha Dr. Nalin Ari- Global Epidemics and Outbreaks of yaratne and Medical Superintendent, Emerging and Re-emerging Infections Wathupitiwala Base Hospital Dr. Sisir- and their relevance to Sri Lanka”, Dr. aWijesundara. Randula Ranawaka, Consultant Pae- The three guest lectures in the first diatric Nephrologist, LRH, on “UTI in session were given by Dr. Panduka Children” and Dr. Uditha Bulugahap- Karunanayake on “Antibiotic Resis- itiya, Consultant Endocrinologist, on tance”, Prof. MudithaVidanapathirana “Obesity”. The first session concluded on “Euthanasia” and Dr. Anuradha with an informative Quiz. Dassanayake on “Role of physician The second session which com- on management of cirrhosis”. menced after tea also had four guest The session after tea also had three lectures delivered by Dr. Saman guest lectures delivered by Dr. E. G. Hewamanna, Consultant Onco-Hae- D. S. Rajindrajith on “Abdominal Pain matologist on “Treatment of Blood in Paediatrics Practice”, Dr. D. T. Gu- Cancer”, Dr.Wasanatha Kapuwatta, nasena on “Photography as a Hobby” Consultant Cardiologist on “Evalua- and Dr. Nissanka Jayawardhana on tion of Chest Pain”, Dr. Kaushal Ka- “Current Surgical Management of runarathna, Consultant Orthopedic Breast Carcinoma, Is it feasible in a Surgeon on “Osteomyelitis and an in- peripheral surgical unit?”. teresting insight in to Sri Lankan Tea” was provided by Dr. Phillip Veerasing- The Annual Sessions concluded ham, Consultant General Surgeon. with a delicious lunch, music, dancing and fellowship.

10 December 2016 SLMANEWS

Cover Story... THE MEDICAL DANCE 2016

Dr. B.J.C. Perera dressed Lady (Eastern & Western) and Baila Competition. & The dance concluded around 3.30

am and it was of such calibre that the Dr. Christo Fernando, guests were very reluctant to finally Joint Social Secretaries- leave the floor. The considered opin- SLMA ion of many who attended the Dance he Medical Dance was held on was that it had been the best ever 9th December 2016 at the Oak Medical Dance held so far. Room, The Cinnamon Grand This magnificent event was made Tfrom 8.00 pm onwards. All appropriate possible through the exceptional ef- arrangements, logistics and the finer forts of all members of the Dance details were worked out by a very ca- Committee, especially Dr. Christo pable Dance Committee of the SLMA. Fernando and Dr. Pramilla Senanay- There were around 400 guests ake, who looked into every aspect of who had a really wonderful time at an the dance with meticulous attention evening of superlative music comple- to detail. Some of the logistical ar- mented and adorned by an outstand- rangements and other details were ingly opulent sit-down dinner. Music capably attended to by Dr. Manisha was provided by two of the acclaimed Abeyewickreme and Dr. Parakrama leaders amongst the bands of Sri Lan- Dharmaratne. Many members of the ka, “Misty” and “Flame”. The compère committee played a part in securing for the show was the inimitable Faizal sponsorships for the event and adver- Bongso, a connoisseur amongst them tisements for the souvenir. all. Very many grand prizes were also The Social Secretaries also appre- awarded to the winners of a plethora of ciatively acknowledge the valuable draws and contests during the event. organisational contributions made by The evening began with prelimi- the Administrative Manager of SLMA, nary cocktails from 8 to 8.45 pm. This Ms. Chathurani Ilayperuma, and the helped to facilitate camaraderie and Administrative Team of the SLMA. bonhomie amongst the participants. The dance proper started at 9.00 pm to the scintillating music provided by “Flame”. They set the tempo for the rest of the evening and the other band “Misty” joined in with an equally dazzling repertoire of their own. The bands took turns at short intervals to provide excellent and continuous fare for the participants of the dance and this led to the dancers enjoying an alluring night to remember. The fabulous and plush five-course for- mal dinner, augmented by coffee and chocolates, was served from around 10.00 pm. During the dinner, Season- al Christmas Carols were presented by Drs.Selvi and Lalith Perera, who were joined on stage by some of the doctors, with the bands and the audi- ence joining in. There were more than 50 prizes on offer including 4 Air Tick- ets for the Entrance, Table and Raffle Draws. There were also prizes for the first five Couples on the floor, the best Contd. on page 13

12 December 2016 SLMANEWS Contd. from page 12 The Medical Dance...

SLMANEWS December 2016 13 IMPORTANCE OF FIRST TRIMESTER SCAN (11-14 WEEKS) IN MANAGEMENT OF TWIN PREGNANCY

Dr.Tiran Dias MBBS, MD, MRCOG, MD (Res), Diploma in Fetal Medicine Senior Lecturer in Obstet- rics and Gynecology Faculty of Medicine University of Kelaniya [email protected] 0094-773051142

Introduction Twin pregnancies are at increased risk of complications than singletons. Monochorionic (MC) twins account for 20% of all spontaneous twin pregnancies, but yet carry five time higher peri- natal morbidities and mortalities than dichorionic (DC) twins. This is due to Pregnancy dating ative orientation of the fetuses to each the presence of placental vascular other (Figure 2) should be defined as Routine dating of pregnancy from anastomoses allowing twin twin trans- either lateral (left/right) or vertical (top/ first trimester (11-14 weeks) crown- fusion syndrome (TTTS) and severe bottom). rump length (CRL) is superior to the birthweight discordances. Moreover, use of menstrual dates. The main con- most of the complications in mono- cern in twin pregnancy dating is that chorionic twins are early onset (before which twin's measurement should be 20 weeks) and if not treated majority considered for dating. Larger twin's of them will die before 25 weeks. Frist CRL is more practical for gestational trimester scanning between 11 and 14 age assessment because of patho- weeks enables accurate pregnancy logical largeness in early pregnancy dating, determination of chorionicity, is highly unlikely whereas smallness labelling and possible risk prediction is possible with very early onset fetal in Monochorionic twin pregnancies. growth restriction. After 14 weeks as Figure 2: Diagrammatic representation of Determination of chorionicity for singletons, head circumference of twin orientation relative to the longitudinal the larger twin can be reliably used for axis of the uterus. The twins may have a top/ Chorionicity can be accurately deter- bottom (T/B) (vertical) (a) or right/left (R/L) mined during first trimester ultrasonog- twin pregnancy dating up to 25 weeks. (lateral) (b) orientation. raphy. Monochorionic twin pregnancy Twin pregnancy orientation can be diagnosed in the presence of A reproducible method of antenatal the T-sign and dichorionic with the Aneuploidy screening in twin labeling is important in twins for con- Lambda-sign or when two separate pla- pregnancy sistent accurate identification of them cental masses are present (Figure 1). Risk of chromosomal aneuploidy in in subsequent examinations. The rel- each fetus is determined by the zy- gocity. In dizygotic twins the maternal age-related risk for each fetus is the same as in singleton pregnancies. As majority of dichorionic twins are dizygotic the chance that at least one fetus is affected by a chromosomal defect is twice as high as in singleton pregnancies. Since all the Monochorionic twins are monozygotic their risk for a chromosomal abnormality affecting both fetuses is the same as in single-

'T' sign in monochorionic twin Lambda sign in dichorionic twin ton pregnancies (Table 1). Figure 1: Twin pregnancy chorionicity determination at first trimester scan Contd. on page 14

14 December 2016 SLMANEWS Contd. from page 14 Antimicrobial Resistance... Risk assessment for chromosomal 8–10% of monochorionic pregnan- Mar;119(4):417-21. abnormalities in twin pregnancies can cies. First trimester CRL discrepancy 2. Dias T, Ladd S, Mahsud-Dornan S, be effectively done by combined test at 11–14 weeks in monochorionic twin (a combination of maternal age, fetal pregnancies is predictive for the sub- Bhide A, Papageorghiou AT, Thila- nuchal translucency (NT) thickness, sequent development of sFGR, but ganathan B. Systematic labeling FHR and maternal serum free beta- not TTTS. First-trimester NT discrep- of twin pregnancies on ultrasound. hCG and PAPP-A) or by non-invasive ancy in monochorionic twins does not Ultrasound Obstet Gynecol. 2011 prenatal testing (NIPT). Amniocente- effectively predict the later develop- sis in twins is effective in providing a ment of either TTTS or sFGR. Aug;38(2):130-3. reliable karyotype for both fetuses and 3. Dias T, Mahsud-Dornan S, Thilaga- the procedure related fetal loss rate is Screening for early fetal nathan B, Papageorghiou A, Bhide about 2%. In the case of chorionic vil- structural anomalies lous sampling, the procedure-related First trimester scan can also be used A. First-trimester ultrasound dat- fetal loss rate is also about 2%, but in in screening fetal structural anomalies ing of twin pregnancy: are single- about 1% of cases there may be a di- in twin pregnancies. It is important ton charts reliable? BJOG. 2010 that the operator needs to be familiar agnostic error, either due to sampling Jul;117(8):979-84. the same placenta twice or cross-con- with the sonograpic appearance of tamination fetal structures in first trimester when 4. Dias T, Arcangeli T, Bhide A, Mahsud- evaluating fetal anatomy. Transverse Table 1. Risk of trisomy 21 at 12 weeks Dornan S, Papageorghiou A, Thila- ganathan B. Second-trimester assessment of gestational age in twins: validation of singleton biometry charts. Ultrasound Obstet Gynecol. 2011 Jan;37(1):34-7.

5. Dias T, Arcangeli T, Bhide A, Napoli- tano R, Mahsud-Dornan S, Thilaga- nathan B. First-trimester ultrasound determination of chorionicity in twin pregnancy. Ultrasound Obstet Gyne- col. 2011 Nov;38(5):530-2

6. Dias T, Bhide A, Thilaganathan B. Early pregnancy growth and pregnancy outcome in twin pregnancies. Ceylon Med J. 2010 Sep;55(3):80-4.

Prediction of monochorionic twin sweep across the fetal body from the complications crown to rump enables to visualize Monochorionic twin pregnancies most fetal structures. in the early second trimester can be References: complicated with TTTS due to an im- balance in the blood flow between the 1. Memmo A, Dias T, Mahsud-Dornan twins sharing the placenta or selective S, Papageorghiou AT, Bhide A, fetal growth restriction (sFGR), which Thilaganathan B. Prediction of se- is a consequence of abnormal placental sharing. TTTS occurs in approxi- lective fetal growth restriction and mately 10–15% and the estimated twin-to-twin transfusion syndrome prevalence of sFGR is approximately in monochorionic twins. BJOG. 2012

SLMANEWS December 2016 15 DR.S.C. PAUL MEMORIAL ORATION OF THE SLMA 2016

Emerging risk factors for proceeded to Presidency College, sionalism and accountability. I am severe dengue infection Madras and qualified with M.B.B.Ch. addressing a fitting issue as we are He left for London in early 1900 and currently experiencing a dengue epi- By Dr. Chandima K. Jeewandara, entered the King’s College as a post demic in Sri Lanka . Senior Lecturer, graduate student and qualified with Centre for Dengue Research, At present, dengue is the most im- M.R.C.S and L.R.C.P. In 1901 he be- University of Sri Jayewardenepura portant arthropod-borne viral infec- came a fellow of the Royal College of tion of humans in Sri Lanka. Dengue ood Afternoon. Thank you Surgeons of England. infections are caused by four closely Madam for your kind introduc- On his return to the country, Dr. Paul related viruses named DEN-1, DEN- tion. G was appointed lecturer in Anatomy 2, DEN-3, and DEN-4 which are President of the SLMA Dr. Iyan- at the Ceylon Medical College and transmitted to humans, principally thi Abeyewickreme, members of the he was also appointed first acting by infected Aedes aegypti, mosqui- council, respected past presidents, surgeon to the hospital. He obtained toes. The amino acid sequence of the distinguished invitees, respected M.D. Madras during that same year. 4 serotypes is 65-70% similar. Infec- teachers, colleagues, and friends, I As a surgical luminary in the country tion with one serotype confers lifelong would like to thank the president and he contributed immensely to the field immunity against that particular sero- the council of SLMA for selecting me by way of many publications and in- type. Subsequent infection with other to deliver the prestigious SC Paul troduction of new techniques in an serotypes may cause severe disease. Oration at the129th Anniversary Inter- era where surgical gloves and masks Dengue poses a substantial clinical national Medical Congress of the Sri were still unused and X-rays were still problem, infecting millions of people Lanka Medical Association. in its infancy. He has the reputation per year and approximately half the of a dexterous, resolute surgeon who My interest over the past few years world’s population is estimated to be was also a brilliantly skilled obstetri- was on dengue viral infections. In at risk. It carries a significant mortality cian. 2011 December, when I joined the and morbidity. As there is no specific faculty of Medical Sciences, I had the Dr.Paul married Dora Elenor. They treatment for dengue, although vac- opportunity to meet Prof. Neelika Ma- had seven sons and three daughters. cines have been licensed, the devel- lavige who is one of the pioneers in opment of an effective vaccine for all In 1912, Dr. Paul was inducted Pres- dengue research in Sri Lanka. I had the serotypes concerned will be an ident of the Ceylon Branch of the Brit- an excellent opportunity to read for my important measure for controlling this ish Medical Association (now the Sri PhD in defining protective immunity to disease. Lanka Medical Association). Through- dengue viral infections at University of out his lifetime he held many distin- Dengue poses a significant disease Sri Jayewardenepura and University guished positions in the field, such as burden throughout the world. It is of Oxford. the President of the surgical section of spread mainly in the tropical and sub- One of the objectives of the study the association in 1937, and the acting tropical regions of the world. Despite was to identify risk factors of severe director of the bacteriological institute. its relatively small size it carries a pro- dengue infections, which I will be dis- Dr. Paul joined the Ceylon Medical portionately bigger burden of disease. cussing over the next 45 minutes , I Corps, a voluntary organization found- Sri Lanka is experiencing dengue feel greatly privileged to deliver this ed in 1881, as a second lieutenant and since 1962 and the infection became oration in honour of Dr S C Paul. rose up its ranks to take command of endemic since 1989. the Corps as Lieutenant Colonel from To those of you who did not know We are experiencing an increased 1923 to 1927. him I would like to describe him, as a number of cases from the year 2000 surgical giant, a man of the highest He was a man of diverse interests onward. For the last five years it had academic calibre, an excellent tech- and associations. He was the Chair- peaked and follows a biannual epi- nical and safe surgeon and very human of the Colonial Motors Ltd., the demic pattern associated with mon- mane person who looked after all his Chairman of the Planters’ Association, soon rains. Mortality has reduced patients with utmost dedication and the Founder Chairman of the Board of dramatically over the years thanks to care. the Ceylon Insurance Company and a the meticulous fluid management in Samuel Chelliah Paul was born on member of the Ceylon Banking Com- inward patients. Even though the case the 28th of February 1872 in Uduvil, mission. fatality ratio (CFR) has reduced to 0.4 % the morbidity has increased dra- Jaffna. He received his education at Ladies and gentleman, This paper, matically over the last decade. the Central College, Jaffna and then I am presenting as a tribute to a man Wesley College, Colombo. He then who taught us the value of profes- Contd. on page 18 077 395 1513 /

16 December 2016 SLMANEWS 077 395 1513 / Contd. from page 16 Dr.S.C. Paul Memorial... Although dengue has a wide spec- development of more severe clinical gue specific antibodies along with trum of manifestations ranging from disease. As non-communicable dis- other tests were done and they were asymptomatic infections to more se- eases are also on the rise, especially informed about their dengue antibody vere forms like DHF/ DSS, majority in South Asia, it would be important to results. Details regarding their clini- of the infections are asymptomatic. determine the relationship between cal features were also recorded in a We do not know what exactly causes co-morbidities and possible risks of separate data form. In addition anoth- severe disease. On the other hand severe dengue. er sample was obtained to detect the majority of the people who gets in- serotype specific peptide response on These are a few of the unanswered fected develops a protective immune day 21. At the time of recruitment of questions. In short we need to know response which we are yet to define. individuals, if they were found to have what gives protection and what causes The pathophysiology of dengue viral no dengue specific IgG antibodies or severe disease. infections and factors that result in se- ELISpot responses, 5ml of blood was vere clinical disease is poorly under- • Are they the antibodies ? If so what is the antibody obtained at yearly intervals to find out stood. However various factors have titer? How do we measure them? if they become asymptomatically in- been proposed to contribute to the • Are they the T cells T cells? If so what is the role of fected. occurrence of severe disease. Den- cross reactive T cells and the role of polyfunctional By following up of this cohort I have gue infection has a characteristic criti- T cells ? tried to answer these research ques- cal phase. It is described as a capil- tions lary leakage syndrome where most of In that background we carried out the complications of severe dengue this research to specifically answer • Have you had dengue? those questions. including death due to shock occur. • If so which serotypes? Unfortunately the imunopathogenic a) In the first part I will explain the following. • How many times? mechanisms of this capillary leakage b) Co-morbid factors contributing to severe disease, syndrome were not well understood • What are your antibody responses to dengue? until now. The fundamental features c) Age stratified seroprevalence of dengue infections, • What are your antibody responses to other flavivirus- of severe infection include increased d) How the immune response to Japanese encephalitis es? capillary permeability with lack of tis- modulates clinical presentation and immune response • How are your T cell responses to dengue and other sue inflammation. Interestingly, those to the dengue virus and who recover from dengue have a flavi viruses ? e) The differences in the functionality of dengue virus rapid and complete recovery usually • What factors associated with severe dengue infection within 48 hours. (DENV) specific memory T cell responses in individuals with past severe and subclinical dengue infection. I used different techniques in as- Many epidemiological risk factors The study named ‘Dengue Watch’ sessing the immune response in this that are associated with severe den- study; gue infections have been identified. included 1689 healthy individuals at- Although secondary dengue infection tending the Family Practice Center, 1. Ex vivo ELISpot assay- ELISPOT assay is a widely is currently a well known risk factor for which is a primary health care facility used method for monitoring immune responses. The development of severe dengue, more of the University of Sri Jayewarde- assay is a highly sensitive method for the ex vivo quan- recent studies have also focused on nepura, recruited following informed tification of cytokine after stimulation with an appro- other risk factors and have shown that written consent. Following recruitment priate stimulus in vitro. they were invited to give 15ml -25ml pre-existing antibodies to the Japa- 2. Enzyme-linked immunosorbent assay (ELISA), is a of blood. All individuals were tested for nese encephalitis virus was associ- biochemical technique used mainly in immunology to the presence of dengue virus specific ated with a greater risk of developing detect the presence of an antibody a symptomatic dengue infection. In antibodies (seropositivity) and anti At this point I would like to give you addition, the time interval between two Japanese encephalitis (JE) specific an overview of the demography, dengue infections is a determinant of antibodies. Once the individuals were severity of the infection. The incidence recruited in the study, they were asked Basically we had two groups, adults of dengue infection in a particular year to report if they experience a febrile, and children which have similar char- and preceding years also appears to flu like illness (dengue like illness) dur- acteristics. influence the incidence of symptom- ing the study period (3 years). In such Only 8 % a severe illness. Majority atic dengue. Apart from epidemio- instances, a second sample of blood were unaware that they were sero- logical risk factors, many existing co- was obtained for dengue NS1 /PCR positive for dengue which means they morbid factors such as the presence and if positive, another blood sample have had asymptomatic dengue. of diabetes, asthma, hypertension and was taken on day 6-10 of illness (10ml obesity have been implicated in the from adults, 5ml from children). Den- Contd. on page 19

18 December 2016 SLMANEWS Contd. from page 18 Dr.S.C. Paul Memorial... determined the as- severe dengue. We also found that sociation between female children were more likely to the optic density develop severe dengue compared values for DENV to male children. and JEV in those Data on T cell responses and its role with severe dengue in causing severe disease are as fol- and those who had lows. We looked at three main cyto- asymptomatic den- toxic cytokines i.e. IFN gamma, TNF gue. We did not find alpha and granzyme b. We investi- any association in gated whether the quantity of these either group. cytokines produced in exposure to In order to inves- dengue peptides were different with Asignificant positive correlation tigate if JEV vaccination was likely to the severity of the illness, that is the was observed for dengue antibody be associated with JEV seropositivity depth of the T cell response. There seropositivity and age in children in children, we looked to see whether was no difference in quantity of IfN (Spearman’s R = 0.84, p = 0.002) and children who received the JEV were gamma, granzyme B and TNF alpha in adults (Spearman’s R = 0.96, p = more likely to be seropositive for JEV, produced in those who were hospital- 0.004). even many years following vaccina- ized due to dengue compared to non severe illness. Jeewandara C, Adikari TN, Gomes L, Fernando S, Fernando RH, et al. (2015) Functionality of Dengue Virus Specific Memory T Cell Responses in Individuals Who Were Hospital- ized or Who Had Mild or Subclinical Dengue Infection. PLoS Negl Trop Dis 9(4): e0003673. doi:10.1371/journal. pntd.0003673 Jeewandara C, Gomes L, Paranavitane SA, Tantirimudalige M, Panapitiya SS, et al. (2015) http://journals.plos.org/plosntds/ Change in Dengue and Japanese Encephalitis Seroprevalence Rates in Sri Lanka. PLoS ONE 10(12): e0144799. doi:10.1371/journal.pone.0144799 article?id=info:doi/10.1371/journal. http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0144799 pntd.0003673 However the number of the individ- We observed a significant rise in the tion. As expected we found that there uals who were hospitalized produced age stratified seroprevalence rates was a statistically significant asso- significantly higher IFN gamma or in children over a period of 12 years. ciation (p = 0.04) between the pres- TNF alpha or in combination, On the These data support the higher inci- ence of JEV specific antibodies and other hand in people who has asymp- dence of dengue transmission in the JEV vaccination. However, only 143 tomatic illness, the profile of cytokines community over the last twelve years. (25.3%) of those who received the JEV skewed towards granzyme b. JEV seropositivity did not have posi- vaccine were seropositive, whereas tive correlation with age. We found 297 (52.6%) were seronegative and Therefore, it appears that although that both adults (p<0.001) and chil- 125 (22.1%) showed an equivocal the depth of production of cytotoxicic dren (p = 0.03) who were hospitalized response. On the other hand we saw cytokines was not different in those due to dengue were more likely to be that the seroconversion rate for killed who were hospitalized and in those seropositive for JEV antibodies. vaccine was effective compared to the with mild/sub clinical dengue infec- ones who received the live vaccine. tion, there was a significant difference Flavivirus antibodies are known to Obesity, asthma, allergic rhinitis and a of the breadth of the T cell response. be highly cross-reactive in nature and waist circumference of >80cm in wom- During the study period we performed are known to give false positive re- en was significantly associated with cultured ELISpot assays to deter- sponses in antibody detection assays. increased risk of hospitalization. We mine past infecting serotype. For the The higher JEV seropositivity in adults cultured ELISpot we used serotype who had severe dengue, could pos- found that in children, as in adults, the presence of bronchial asthma, specific, highly conserved regions of sibly be due to higher cross-reactive dengue viruses which were patented DENV antibody titres (and therefore allergic rhinitis and obesity was associated with the occurrence of by Prof. Malavige. JEV antibody titres). Therefore, we Contd. on page 20

SLMANEWS December 2016 19 Contd. from page 19 Dr.S.C. Paul Memorial...... Cultured ELISpot assays were car- increased vascular permeability. We icine, university of Oxford, we were ried out in all those who developed went on to test this hypothesis in an able to design a maro to analyze the DHF in primary as well as secondary in-vitro model using endothelial cells. Zo 1 expression. Here you see with dengue and the responses were com- Before describing the experiments, PAF on exposure to the endothelial pared with the base line responses. I would like to draw your attention to cells the Zo1 expression diminished Accordingly 7 previously seronegative the molecular arrangement of endo- on a dose dependant manner and we individuals and 5 individuals who had thelial junction molecules. There are were able to demonstrate that the ef- only responded to one dengue sero- two types of Junctions namely tight fect of PAF could be reversed partially type by this assay developed DHF. and adherens. Of them tight junctions with equal or higher concentration of Following the episode of DHF, sero- play a major role in maintaining of the its antagonist. negative individuals showed new re- integrity. Of this ZO 1 is sponses to one serotype and people our main molecule of who has secondary dengue respond- interest .So we decided ed to an additional dengue serotype. to plan our experiments We found that this was a useful tool in to identify the effect of identifying the past infecting serotype PAF on ZO 1. which could be used in future vaccine Human umbilical vein studies. endothelial cells (HU- As expected, we found that multiple VEC) obtained and infections are more frequent as indi- grown in tissue culture flasks accord- viduals aged. In addition, individuals ing to standard protocols. They were who had severe dengue were more cultured until a monolayer resembling likely to be infected with multiple den- human endothelium was developed. gue serotypes when compared to Then they were sub cultured in cham- those who had a sub clinical dengue ber slides for experiments and imag- infection. Although infection with mul- ing. In experiments we used dengue tiple dengue serotypes increased with serum, control serum, in the presence age, dengue specific IFNγ responses or absence of PAF r antagonist as well did not increase significantly with age. as PAF alone with varying concentra- Effect of PAF and PAFR blocker All four dengue serotypes are known tions to assess the expression of ZO I on expression of ZO-1 to cause severe clinical disease .We by confocal imaging and the endothe- A: ZO-1 expression in HUVECs was investigated if the type of infecting lial permeability by TEER measure- evaluated with different concentra- dengue serotype determined the se- ments. tions of PAF. ZO-1 expression was verity of dengue infection. However, Here are some images for you compared in untreated HUVECs, with we could not find any association. HUVECs incubated with 100ng/ Quite a lot of mediators have been ml PAF; 200ng/ml PAF and implicated in association with severe 500ng/ml PAF. dengue infection. We were also in- B: The differences in ZO-1 terested in certain lipid mediators. expression were evaluated in One of these was the platelet ac- HUVECs treated with differ- tivating factor. We saw that the PAF ent concentrations of PAF. The levels were significantly higher in HUEVECs were pretreated with a severe dengue. The highest level PAFR blocker for one hour prior was observed with the onset of criti- to been treated with different con- cal phase. Why did we choose PAF? centrations of PAF. C: ZO-1 ex- As I mentioned before, we are unclear The red linear arrangement of mol- pression was evaluated in HUVECs what causes vascular leakage in se- ecules resembles the tight junctions. that were treated with media alone vere dengue. However PAF has been From these experiments, we showed (untreated) compared to HUVECs implicated in anaphylaxis and shock. that on exposure to dengue serum, treated with 500ng/ml PAFR blocker We also wanted to see certain lipid the junctional architecture is disrupted. alone; treated with dengue patient se- mediators like PAF and its role in se- This is the quantification of the ZO 1 rum (DS) and pre-treated with a PAFR vere dengue infection. So we hypoth- expression. Thanks to Dominic of the blocker (PAFRA) prior to treatment esized a link between PAF level and Weatherall institute of molecular med- with dengue patient serum (DS). the endothelial dysfunction leading to Contd. on page 21

20 December 2016 SLMANEWS Contd. from page 20 Dr.S.C. Paul Memorial... Jeewandara C, Gomes L, Wickra- ma and allergic rhinitis were significantly higher in tude to all the funding agencies, masinghe N, Gutowska-Owsiak D, those who had severe dengue infection. USJP, CDR, NSF, WIMM and also Waithe D, et al. (2015) Platelet Acti- • The majority of individuals were naturally infected the Association of Commonwealth vating Factor Contributes to Vascu- with the DENV, had DENV-NS3 specific T cell re- Universities for granting me a Com- lar Leak in Acute Dengue Infection. sponses, which produce multiple cytokines. monwealth Scholarship to pursue my PLoS Negl Trop Dis 9(2): e0003459. postgraduate studies in a prestigious doi:10.1371/journal.pntd.0003459 • However, DENV-NS3 specific T cells of those who had university and to the University of Ox- a past mild/sub clinical dengue infection were more ford for granting me the studentship http://journals.plos.org/plosntds/ likely to produce only granzyme B, whereas, T cells and providing excellent facilities to article?id=info:doi/10.1371/journal. of those with past hospitalized dengue infection were carry out my research work. I would pntd.0003459 more likely to be double positive for IFNγ and TNFα. like to acknowledge the contribu- A similar pattern was seen with den- • We have also investigated the usefulness of a novel T tion made by the following members gue serum also where we showed cell based assay, which can be used to determine the of the team leading to this oration. I that the ZO expression significantly past infecting DENV serotype. wish to thank Thiruni Adikari, Laksiri reduced on exposure to dengue se- Gomez, Dr. Samitha Fernando, Dr. • PAF levels were significantly higher in more severe rum which could be partially reversed Randika Fernando and Dr. Shiran Pa- forms of dengue and were associated with a reduced with PAFRA. This is with the effect of ranavithane for being so supportive expression of tight junction proteins and reduced cell dengue serum on endothelial cells. with such enthusiasm and also my layer integrity that is likely to result in an increased It should be emphasized here again colleagues Achala Kamaladasa, Mari- paracellular leak. that pre incubating PAF receptor an- yam Salimi, Danuta Gutowska-Owsiak tagonist could significantly reverse • Use of PAFR blockers significantly reduced these ef- and Anthony Cheung. Further I would the effect of dengue serum on endo- fects. like to acknowledge the head and staff thelial tight junctions. It is very clear This has implications for the future of the departments of Family Medicine that there is a significant reduction in management of patients such as use and Microbiology and Center for den- ZO 1 which is a marker of permeabil- of PAFR blocker in acute dengue in- gue research for all the logistic help ity in the presence of PAF or dengue fection. We are happy to note that they provided. I wish to mention Dr. N serum which could be reversed using from these findings we have proceed- L A Karunathne- former Vice Chancel- its antagonist. We confirmed our find- ed to a clinical trial in the Infectious lor of the University, Prof. Mohan de ing using transendothelial resistance Diseases Hospital, which is currently Silva, former Dean of the Faculty of measurements. Basically we checked in progress and reached the final stag- Medical Sciences, Prof. Sampath Am- the electrical resistance across the es to reduce complications in dengue arathunga, the current Vice Chancel- endothelial membrane in different test infection. lor and Prof. Surangi Yasawardena, conditions using electrodes. If there is the Dean of the Faculty of Medical less resistance it indicates widening of So ladies and gentleman, this work Sciences with extreme gratitude. the gap junctions. Our findings were is impossible without the outstanding I am grateful to the Head of the de- similar and we showed that resistance guidance and the contribution from partment and my fellow lecturers for across the membrane is reduced with many. I wish to express my sincere being understanding and giving me dengue serum and could be reversed gratitude to my supervisors. I am the time I needed by sharing the du- with its antagonist. deeply indebted to my supervisor Prof. Neelika Malavige for her elemental ties and responsibilities among them. Then I further tried to use a drug role in my PhD. It is a great honour I would like to acknowledge our blood which is licensed for human use and being her first PhD student. I was priv- donors too, who voluntarily donated actually in use for other conditions but ileged to be supervised by one of the their blood to help this research a suc- not in dengue, to see the effect us- leading dengue experts in the world. cess. I am grateful to my mother, who ing similar experimental methods de- This extremely costly research would has been a pillar of strength, to my scribed above. The findings were ex- not be a reality without her outstand- late father who has been my constant citingly similar. We confirmed that PAF ing assistance. I am extremely grate- source of inspiration, to my wife Sub- receptor antagonism is able to reduce ful to Prof. Graham Ogg, my external hani who has given unstinted support the permeability effect PAF. supervisor who kindly agreed to have throughout my academic and person- I would like to sum up this presenta- me in Oxford as a student. It was a al life and my son Lisara for all their tion with the following conclusions. rare privilege to learn from a world love and patience and finally ladies renowned authority in a world class and gentlemen to all of you for your • In Sri Lanka, dengue seroprevalence rates have risen presence to grace this occasion. significantly over the last 12 years. laboratory. Thank you • In both adults and children, obesity, presence of asth- I wish to express my sincere grati-

SLMANEWS December 2016 21 A NOTE OF THANK YOU FROM THE OUTGOING EDITOR-IN-CHIEF

Dr.Hasini Bannheke in various ways, publisher for timely Editor-In-Chief – printing and most importantly the SLMA Newsletter SLMA membership for being with us. would like to thank and express my I wish the new editorial committee heartfelt gratitude to all members all the very best. Merry Christmas and of the Editorial Board for providing a Happy New Year to all! Icontinuous support, authors of articles for high quality materials and member of the council including honorable President and secretary for their feed- back, SLMA office staff for assisting

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22 December 2016 SLMANEWS

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