CNN News

Zachary Reyna, a 12-year-old Florida boy stricken with a brain-eating parasite, has died. Zachary's family told CNN, believe that the boy who they described as an active seventh grader was infected while knee boarding with friends in a water-filled ditch by his house on August 3. Officials warn of brain-eating amoeba, after he was hospitalized, the boy underwent brain surgery, and doctors diagnosed him with primary amoebic meningoencephalitis.

The first symptoms of primary amoebic meningoencephalitis appear one to seven days after infection, including headache, fever, nausea, vomiting and a stiff neck, according to the Centers for Disease Control and Prevention. "Later symptoms include confusion, lack of attention to people and surroundings, loss of balance, seizures and hallucinations," the agency website says. "After the start of symptoms, the disease progresses rapidly and usually cause death within one to 12 days."

Florida issues warning about rare, brain-eating amoeba

Naegleria fowleri - Brain-Eating Amoeba

Ravi Kumudesh / Sri Lanka Society for Medical Laboratory Science

Naegleria fowleri, popularly known as the "brain-eating amoeba", is a free-living excavates form of protist typically found in warm bodies of fresh water, such as ponds, lakes, rivers, and hot springs. It is also found in soil, near warm-water discharges of industrial plants, and unchlorinated or poorly chlorinated swimming pools in an amoeboid or temporary flagellate stage. 

There is no evidence of this organism living in salt water. It is an amoeba belonging to the groups Percolozoa or Heterolobosea. N. fowleri can invade and attack the human nervous system. Although this occurs rarely, such an infection nearly always results in the death of the victim. The case fatality rate is estimated at 98%.

Signs and Symptoms

Onset symptoms of infection start about five days (range is from one to seven days) after exposure. The initial symptoms include, but are not limited to, changes in taste and smell, headache, fever, nausea, vomiting, and stiff neck. Secondary symptoms include confusion, hallucinations, lack of attention, ataxia, and seizures. After the start of symptoms, the disease progresses rapidly over three to seven days, with death occurring from seven to fourteen days after exposure.

Causes

In humans, N. fowleri can invade the central nervous system via the nose. The penetration initially results in significant necrosis of and hemorrhaging in the olfactory bulbs. From there, the amoeba climbs along nerve fibers through the floor of the cranium via the cribriform plate and into the brain. The organism begins to consume cells of the brain piecemeal by means of a unique sucking apparatus extended from its cell surface. It then becomes pathogenic, causing primary amoebic meningoencephalitis (PAM). PAM is a syndrome affecting the central nervous system. PAM usually occurs in healthy children or young adults with no prior history of immune compromise who have recently been exposed to bodies of fresh water.

Amphotericin B is effective against N. fowleri in vitro, but the prognosis remains bleak for those who contract PAM, and survival remains less than 1%. On the basis of the in vitro evidence alone, the CDC currently recommends treatment with amphotericin B for primary amoebic meningoencephalitis, but no evidence supports this treatment affecting outcome. Treatment combining miconazole, sulfadiazine, and tetracycline has shown limited success only when administered early in the course of an infection.

While miltefosine had therapeutic effects during an in vivo study in mice, chlorpromazine showed to be the most effective substance the authors concluded: "Chlorpromazine had the best therapeutic activity against N. fowleri in vitro and in vivo. Therefore, it may be a more useful therapeutic agent for the treatment of PAM than amphotericin B.

Untimely diagnoses remain a very significant impediment to the successful treatment of infection, as most cases have only been discovered post mortem. Infection killed 121 people in the United States from 1937 through 2007.

Life cycle

Biotic phases:

Naegleria fowleri occurs in three forms:

   cyst,

   flagellate,

   trophozoite

Cyst stage

Trophozoites encyst due to unfavorable conditions. Factors that induce cyst formation can include food deprivation, crowding, desiccation, accumulation of waste products, and cold temperatures. N. fowleri has been found to encyst at temperatures below 10 °C/50F.

Trophozoite stage

The trophozoites are characterized by a nucleus and a surrounding halo. They travel by pseudopodia, temporary round processes which fill with granular cytoplasm. The pseudopodia form at different points along the cell, thus allowing the trophozoite to change directions. In their free-living state, trophozoites feed on bacteria. In tissues, they phagocytize red blood cells and white blood cells and destroy tissue.

Flagellate stage

This biflagellate form occurs when trophozites are exposed to a change in ionic concentration, such as placement in distilled water. The transformation of trophozoites to flagellate form occurs within a few minutes.

Diagnosis

N. fowleri can be grown in several kinds of liquid axenic media or on non-nutrient agar plates coated with bacteria. Escherichia coli can be used to overlay the non-nutrient agar plate and a drop of cerebrospinal fluid sediment is added to it. Plates are then incubated at 37°C and checked daily for clearing of the agar in thin tracks, which indicate the trophozoites have fed on the bacteria. Detection in water is performed by centrifuging a water sample with E. coli added, then applying the pellet to a non-nutrient agar plate. After several days, the plate is microscopically inspected and Naegleria cysts are identified by their morphology. Final confirmation of the species' identity can be performed by various molecular or biochemical methods.[13] Confirmation of Naegleria presence can be done by a so-called flagellation test, where the organism is exposed to a hypotonic environment . Naegleria, in contrast to other amoebae, differentiates within two hours into the flagellate state. Pathogenicity can be further confirmed by exposure to high temperature (42 °C): Naegleria fowleri is able to grow at this temperature, but the nonpathogenic Naegleria gruberi is not.

Sri Lanka Society for

Medical Laboratory Science

kumudeshr@gmail.com / 0094773077717

Mark of our respect to Mr. H. Weerawarna

Mark of our respect  

"My special attention was on the workshop 'Chronic kidney diseases - getting it right. The reason for selecting this topic was the present undiagnosed epidemic of Chronic Kidney disease prevailing in North Central Province of Sri Lanka of which the root cause has yet to be established. I also appreciate one of the ideas given during this session "Laboratories as the best vehicle for implementing a national program for the early detection of CKD" and to serve laboratories as the "hub" for information flow. While attending this work shop I conceived the idea of validating the e- GFR equation for Sri Lankan population".


Mr. Hemachandra Weerawarna
IFCC - eNewsletter 2013 January - February

Waived Tests and Glucose Tolerance Test

Waived Tests

http://slsmls.org/

Waived tests are the laboratory procedures that are the simplest to perform but provide important diagnostic information. They can be performed accurately by non laboratory health care workers with minimum training. These procedures have traditionally been performed in physicians’ offices and clinical laboratories for years, but have since found their way into such settings as long-term care facilities, at bedside in acute care settings, ambulatory settings, insurance companies, and home health care. Waived tests have become a valuable component of the competency menu in multi skilling for the non laboratory health care provider, as the industry and its members prepare for the evolution of health care roles in the 21st century. These procedures are regulated by a variety of health care agencies.

Moderately complex tests require more highly trained personnel, a procedure manual, instrument calibration, specific quality control procedures, proficiency testing, and extensive documentation and record keeping.

Glucose Tolerance Test

Glucose is the sugar the body uses for energy. Patients with untreated diabetes have high blood glucose levels. Glucose tolerance tests are one of the tools used to diagnose diabetes. Determine how quickly it is cleared from the blood. The test is usually used to test for diabetes, insulin resistance, and sometimes reactive hypoglycemia and acromegaly, or rarer disorders of carbohydrate metabolism.

With type 2 diabetes, the illness and symptoms tend to develop gradually (over weeks or months). This is because in type 2 diabetes you still make insulin (unlike type 1 diabetes). However, you develop diabetes because: you do not make enough insulin for your body's needs, or the cells in your body do not use insulin properly. This is called 'insulin resistance'. The cells in your body become resistant to normal levels of insulin. This means that you need more insulin than you normally make to keep the blood glucose level down; or a combination of the above two reasons.

Above-normal blood glucose levels can be used to diagnose type 2 diabetes or high blood glucose during pregnancy (gestational diabetes). Insulin levels may also be measured. (Insulin is the hormone produced by the pancreas that moves glucose from the blood into cells.)

The oral glucose tolerance test is used to screen pregnant women for gestational diabetes between 24 and 28 weeks of pregnancy. It may also be used when the disease is suspected, even though the fasting blood glucose level is normal.

Interpretation

Normal blood values for a 75-gram oral glucose tolerance test used to check for type 2 diabetes in those who are not pregnant:

Fasting: 60 -100 mg/dL

1 hour: less than 200 mg/dL

2 hours: less than 140 mg/dL

Higher-than-normal levels of glucose may mean you have prediabetes, diabetes, or gestational diabetes. Between 140 - 200 mg/dL is called impaired glucose tolerance. Your doctor may call this "prediabetes." It means you are at increased risk for developing diabetes. A glucose level of 200 mg/dL or higher is a sign of diabetes. However, high glucose levels may be related to another medical problem (for example, Cushing syndrome).

Procedure

Ÿ  The test takes up to 3 hours.

Ÿ  Eat normally for several days before the test.

Ÿ  Do not eat or drink anything for at least 8 hours before the test. You cannot eat during the test. In preparation for the oral glucose tolerance test, the person should eat and drink as they normally would. The morning of the test, the person should not smoke or consume caffeine.

Ÿ  Ask your health care provider if any of the medicines you take can affect the test results.

Ÿ  Before the test begins, a sample of blood will be taken.

Ÿ  You will then be asked to drink a liquid containing a certain amount of glucose (usually 75 grams). 1.75 grams of glucose per kilogram of body weight, to a maximum dose of 75g. Dose should be drunk within 5 minutes. Your blood will be taken again every 30 to 60 minutes after you drink the solution.

Ÿ  If renal glycosuria (sugar excreted in the urine despite normal levels in the blood) is suspected, urine samples may also be collected for testing along with the fasting and 2 hour blood tests.

Factors that may affect the test results

Ÿ  Acute stress (for example, from surgery or an infection)

Ÿ  Vigorous exercise

Ÿ  Several drugs may cause glucose intolerance, including:

Ÿ  Atypical antipsychotic medications, including aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone

Ÿ  Beta-blockers (for example, propranolol)

Ÿ  Birth control pills

Ÿ  Corticosteroids (for example, prednisone)

Ÿ  Dextrose

Ÿ  Epinephrine

Ÿ  Estrogens

Ÿ  Glucagon

Ÿ  Isoniazid

Ÿ  Lithium

Ÿ  Phenothiazines

Ÿ  Phenytoin

Ÿ  Salicylates (including aspirin)

Ÿ  Thiazide diuretics (for example, hydrochlorothiazide)

Ÿ  Triamterene

Ÿ  Tricyclic antidepressants

Ÿ  Medicines that could affect the blood glucose. 

ඇදුරු කාලෝ - අපට සදා විරුවෙකි !

           http://slsmls.org/

කාලෝ ෆොන්සේකා යනු විචිත්‍ර වූත්, බහුවිධ පැතිකඩවලින් සැදුම් ලද්දා වූත් අපූරු චරිතයකි. ඔහු වෛද්‍යවරයකු හැටියට පරම්පරා දෙක තුනක ලාංකික වෛද්‍යවරුන්ගේ ගුරුවරයෙකි. කලා රසිකයකු හා ගීත රචකයකු හැටියට ඔහුගේ සෞන්දර්යාත්මක දායකත්වය හේතුවෙන්, ඔහු විද්‍යාව හෙවත් යතාර්ථවාදී කලාව දන්නා විරළ කළා කරුවන් අතරට එක්වෙනවා. වාමාංශික දේශපාලන චින්තනයක් මත පදනම් වී ඔහු සමාජ සාධාරණත්වය හා ප්‍රතිපත්ති ගරුක දේශපාලන සම්ප්‍රදායක් සඳහා ක්‍රියාකාරී භූමිකාවක් රඟ පෑවා.

කාලෝ ෆොන්සේකා යන නාමය මුල් වරට කරලියට පැමිණියේ 1970 දශකයේදීය. ගිනි පෑගීමේ වෛද්‍ය විද්‍යාත්මක සැබෑ තත්ත්වය ගවේෂණාත්මකව හෙළි කරමින්, ඒ සඳහා කිසිදු ගුප්ත බලවේගයක පිහිට අවශ්‍ය නැති බව ප්‍රායෝගිකව පෙන්වීම නිසා ඒ වන විට කාලෝ ලක් සමාජයේ ප්‍රකට හා ආන්දෝලනාත්මක චරිතයක් වීය. හැම දෙයක් ගැන ම විචාරශීලීව සීතීමේ හා විවෘතව විවාද කිරීමේ සමාජ සංගායනාවක පෙරගමන්කරුවකු වශයෙන්, අවිද්‍යාව රජයන රටක-විද්‍යාව කෙරෙහි විශ්වාස තබන අප, එතුමන්ව ගුරු තැන්හි තබමු.

අන්ධ භක්තිය හෝ විශ්වාස වෙනුවට ඉන්ද්‍රිය ගෝචර ප්‍රත්‍යක්ෂ හා තර්කානුකූල පදනමක් මත ඕනෑ ම දෙයක් විමර්ශනය කරන මහාචාර්ය කාලෝ ෆොන්සේකාගේ සෘජු දර්ෂණය, බොහෝ ලාංකිකයන්ගේ “දුපත් මනසට” කුණාටුවක් වූයේය. බටහිර වෛද්‍ය විද්‍යාවේ මහාචාර්යවරයකු දක්වා ඉහළට ගිය ඔහු, ඔහුගේ කුලයේ එකාධිකාරයේ පහස ලැබීම වෙනුවට ඊට එරෙහිව අරගල කළා. පරිපුරක වෛද්‍ය සේවයේ අධ්‍යාපන තත්වය නංවාලීම උදෙසා “වෙද” කුලයේ සිට අරගල කල ඔහු අපට සැබෑ විරුවෙක්‌....

ඔහුගේ ඉක්මන් සුවය අප සැමගේ පැතුමයි !

Get you know about "DCD" ???

Get you know about “DCD”

Recent issues with adulteration of food using nitrogen rich compounds to make the protein content of food appear higher than the actual value highlighted the need for both food manufacturers and regulatory agencies to utilize fast and accurate analytical techniques to proactively ensure product safety.

Dicyandiamide

Dicyandiamide, or DCD, is a chemical compound used by farmers to reduce the negative effects of greenhouse gas emission and nitrate leaching into waterways.  It has also been reportedly used by some to promote the growth of pastures where cows graze. Furthermore, dicyandiamide is a nitrogen-rich compound that is classified with compounds such as melamine as a potential economic food adulterant to enhance the apparent protein content of the food product.

“DCD” History in Sri Lanka

In 2007, melamine and cyanuric acid in wheat gluten added to pet food caused renal failure and sickened and killed large numbers of cats and dogs. In 2008, Chinese authorities discovered the adulteration of milk and infant formula with melamine by several Chinese producers. There were hundreds of thousands of victims and six confirmed deaths in China, as well as product recalls in many countries.

In response to the melamine contamination a large number of analytical methods were developed for the detection of melamine and its analogues, including several published by the United States Food and Drug Administration (FDA) that also targeted cyanuric acid.

However, the Kjeldahl method, the traditional standard technique for measuring protein content by indirectly measuring the nitrogen content in food, remains the most widespread methodology. As long as protein content in food is not determined directly, economic adulteration with nitrogen rich compounds will continue to be a serious concern Sample Preparation

Sample Preparation (Experimental)

1. Simple liquid extraction of food samples was performed using the following procedure
2.  Add 10 mL of acetonitrile containing 2% formic acid to 1 g of a homogenized sample.
3. Mix thoroughly and sonicate for 10 minutes.
4. Centrifuge for 10 minutes.
5. Transfer an aliquot of 50 μL of the extract into and autosampler vial and dilute with 950 μL acetonitrile resulting in a total dilution factor of 200.
6. Further dilution of the extract might be necessary if the sample is heavily contaminated.

Method

The target compounds were separated using a normal phase gradient on a Hydrophilic Interaction Chromatography (HILIC) column. LC separation was achieved using the Eksigent ekspert ultraLC 100 system with a Phenomenex LUNA HILIC 3u (100 x 2 mm) column with a mobile phase of acetonitrile and water containing 0.1% formic acid and 10 mM ammonium formate at a flow rate of 0.2 mL/min (Table 1). A sample volume of 10 μL was injected (Fanny F.U., André S./2012).

Results and Discussion

First, the limit of detection (LOD) and reproducibility were evaluated using injections of dicyandiamide standards and spiked matrix samples.

Source

LC-MS/MS Analysis of Emerging Food Contaminants

Fanny Fu¹ and André Schreiber²

¹AB SCIEX Taipei (Taiwan), ²AB SCIEX Concord, Ontario (Canada)

Sri Lanka Society for

Medical Laboratory Science

kumudeshr@gmail.com / 0094773077717

Facts on Botulinum Contamination and whey protein is risky

Facts on Botulinum Contamination and

 why whey protein is risky ???

By, Sri Lanka Society for Medical Laboratory Science

kumudeshr@gmail.com / 0094773077717

"C. botulinum is a Gram-positive bacterium, which cannot tolerate any more than trace amounts of oxygen. The bacterium produces spores which are very hard to kill and thus help the bacterium survive adverse conditions. C. botulinum is a worry because it can cause botulism, a rare but sometimes fatal illness.

"Botulism is caused by the ability of C. botulinum to produce several neurotoxins which prevent acetylcholine from being released from the motor nerve endings causing flaccid paralysis and symptoms of blurred vision, drooping eyelids, nausea, vomiting, diarrhea and/or constipation and cramps. In severe cases it leads to paralysis of the breathing muscles and causes respiratory failure.

Biotulism

Most people know that botulism is dangerous, but many are confused about whether it's an infection or a case of poisoning. In fact, it can be both. Clostridium botulinum is a worldwide bacterium that inhabits rivers, soil, and the guts of mammals, fish, and shellfish. It's not an organism that normally makes its living by attacking humans. We most often encounter C. botulinum by accident.

C. botulinum secretes a neurotoxin (nerve poison) that can weaken or paralyze muscles and can even cause death. This is botulin toxin, one of the most dangerous substances known. Botulism is the condition of having been poisoned with C. botulinum toxin.

Causes of Botulism

Botulism is rare, but there are still cases every year. There are three ways to get botulism:

Food borne

Botulism occurs when food contaminated with the toxin is eaten. The bacteria are dead or gone by the time you eat the food, but the toxin remains. Most food borne botulism is attributed to home-canned foods, but outbreaks occasionally occur in commercially-prepared foods.

Infant botulism

Infants botulism occurs when infants under 12 months of age eat bacterial spores rather than the toxins. Spores of C. botulinum then grow in the infant's intestines, where they produce toxins. Honey can contain spores of C. botulinum and is associated with infant botulism and should not be given to children under one year old. Infant botulism is rare.

Wound botulism

Wound botulism occurs when live bacteria infect an open cut and the toxin is carried through the body by the blood.

Sri Lanka Society for Medical Laboratory Science

http://slsmls.org/

Society for Medical Laboratory Science, Sri Lanka:

Society for Medical Laboratory Science, Sri Lanka: