Ayurvedic and traditional medical practitioners of Sri Lanka use the decoction of the immature inflorescence of Cocos nucifera L. (IC) variety aurantiaca for the treatment of menorrhagia. The progestogenic effect of the ethyl acetate soluble proanthocyanidins (EASPA) of the IC in female rats at a dose of 3.5 mg/kg body weight has been reported. Acute and subacute toxicity studies of EASPA of the IC carried out using female Wistar rats according to Organization for Economic Co-operation and Development (OECD) guidelines 423 and 407, respectively, are reported herein. In the acute toxicity study, a single dose of EASPA (2000 mg/kg body weight) was orally administered to rats, which were monitored for 14 days. In the subacute toxicity study, rats were orally administered with EASPA daily for 28 days at doses of 1.75, 3.5, 7, and 14 mg/kg body weight. No rat in either the acute or subacute toxicity study exhibited mortality or clinical signs of toxicity. Further, these rats did not show any significant change in their mean body weight, food, and water intake, haematological and biochemical parameters as well as in the results of their histopathological examinations compared to those of control group rats. According to results of the acute toxicity, the LD50 of EASPA is estimated to be greater than 2000 mg/kg body weight. Considering the results of the subacute toxicity study, the oral administration of EASPA daily for 28 days was well tolerated up to the dose, 14 mg/kg by rats. These results will be useful in the development of a novel therapeutic agent from EASPA of the IC for the treatment of menorrhagia, which incapacitates a considerable proportion of women worldwide.

Cutaneous leishmaniasis (CL) is caused byLeishmania donovani in Sri Lanka. Pentavalent antimonials (e.g. sodium stibogluconate; SSG) remain first line drugs for CL with no new effective treatments emerging. We studied whole blood and lesion transcriptomes from Sri Lankan CL patients at presentation and during SSG treatment. From lesions but not whole blood, we identified differential expression of immune-related genes, including immune checkpoint molecules, after onset of treatment. Using spatial profiling and RNA-FISH, we confirmed reduced expression of PD-L1 and IDO1 proteins on treatment in lesions of a second validation cohort and further demonstrated significantly higher expression of these checkpoint molecules on parasite-infected compared to non-infected lesional CD68 + monocytes / macrophages. Crucially, early reduction in PD-L1 but not IDO1 expression was predictive of rate of clinical cure (HR = 4.88) and occurred in parallel with reduction in parasite load. Our data support a model whereby the initial anti-leishmanial activity of antimonial drugs alleviates checkpoint inhibition on T cells, facilitating immune-drug synergism and clinical cure. Our findings demonstrate that PD-L1 expression can be used as a predictor of rapidity of clinical response to SSG treatment in Sri Lanka and support further evaluation of PD-L1 as a host directed therapeutic in leishmaniasis.

INTRODUCTION: Diabetic retinopathy is a chronic, progressive and potentially sight threatening disease and the most commonly diagnosed complication of diabetes. Its incidence increases with prolonged duration of diabetes and accounts for a significant amount of morbidities that are directly related to diabetes as it is one of the leading causes of visual handicap. This study was conducted to assess the knowledge of diabetic retinopathy among diagnosed diabetic patients, attending clinics at the Colombo South Teaching Hospital (CSTH). OBJECTIVES: (1) To assess the knowledge of diabetic retinopathy among diabetic patients at CSTH. (2) To assess the association between the duration of diabetes and the knowledge on diabetic retinopathy. (3) To assess the association between the education level and the knowledge on diabetic retinopathy. (4) To assess the association between the socio-economic background and the knowledge on diabetic retinopathy. METHODOLOGY: The data collection was carried out over a period of 12 weeks, during which an interviewer administered questionnaire was distributed among 200 respondents attending clinics at CSTH. Systematic random sampling was used as the sampling technique and data was analyzed using SPSS version 15.0. Descriptive data was presented as numbers and percentages and the difference between the categories was decided with the chi square test. RESULTS: Analysis of data revealed that 31% (62) of the study population had a good knowledge of diabetic retinopathy while 69.0% had poor knowledge, implying that a significant proportion of patients have a poor knowledge on diabetic retinopathy (DR). A significant association between the level of knowledge and the duration of the disease (< 5 years or = > 5 years), was identified in the present study. Level of education and level of income had a significant association with knowledge. Educational level of the spouse too was a significant factor (P < 0.05) under the category of family support. Sources of information had a significant association with the level of knowledge. CONCLUSION: The knowledge of diabetic retinopathy (DR) in the study population was found to be poor. A statistically significant association between knowledge of diabetic retinopathy and the following variables, which included the duration of diabetes, socio-economic background, family support and the sources of information was identified.

ObjectiveThe study aimed to compare the usefulness of two staining methods for imprint cytology for diagnosis of Helicobacter pylori infection. Gastric biopsy specimens (from dyspeptic patients attending routine upper gastrointestinal endoscopy) were placed on glass slides to obtain imprints. The imprints were stained with Toluidine blue and Giemsa stains separately and observed under ×400 magnification using a light microscope. Imprinted biopsies were sectioned and stained with H & E stain and Giemsa stain for histological analysis. Diagnosis of H. pylori infection in both imprint and histological sections were confirmed by a consultant pathologist. The sensitivity, specificity, positive predictive value and negative predictive value of each stain were calculated and benchmarked against histological diagnosis.ResultsOf the 55 dyspeptic patients enrolled in the study, 5 were positive for H. pylori by Toluidine blue stain and 4 by Giemsa stain. The sensitivity of Toluidine blue stain (57.1%) was higher than Giemsa stain (42.9%) while the specificity of both stains was equal (97.9%). Giemsa stain gave a better discrimination for identification of H. pylori bacteria among the mucosal background. Imprint cytology is a rapid, simple and cost effective diagnosis method that can supplement histological diagnosis.Electronic supplementary materialThe online version of this article (10.1186/s13104-018-3592-2) contains supplementary material, which is available to authorized users.

Fine needle aspiration cytology technique (FNAC) is a very popular first line investigation for disorders of the thyroid gland. It is a rapid and cost effective technique that can be easily performed in any category of patients. This technique provides useful information for the clinician to plan out the strategy for management of patients.It is critical therefore that the cytopathologist communicate thyroid FNA interpretations to the referring physician in terms that are unambiguous and clinically useful.The currently used classification for thyroid FNAC includes the following categories. Lesions are classified as "Thy 01" when the cellular yield is inadequate. This is often encountered following the aspiration of highly vascular nodules and cystic lesions. One of the main advantages of this cost effective technique is that it can be easily repeated within a short time.When there is unequivocal evidence of a benign condition such as colloid goiter, thyroiditis and hyperplastic nodule the lesion will be classified as "Thy 02". "Thy 03/follicular proliferation" category of the above classification includes a significant number of pathological entities with different clinical outcomes. Conditions that qualify to be included within the "Thy 03" category are hyperplastic nodules with highly cellular smears, florid thyroiditis, neoplastic lesions such as follicular adenoma/carcinoma, hurthle cell tumours (hurthle cell adenoma/carcinoma) and certain types of papillary carcinoma, such as follicular variant of papillary carcinoma when the cytological findings are equivocal. Hence the spectrum of diseases within the "Thy 03" group is comparatively wide.As such, from clinician's point of view a cytological diagnosis of "Thy 03" in the current classification provides little information to plan out the management. Some of the pathological conditions within "Thy 03" do not require surgery and can be managed effectively by medical intervention. Conditions that require surgery need a further qualification as to the precise nature of the lesion. A significant number of "Thy 03" lesions end up with lobectomies as this category does not separate neoplastic from non-neoplastic lesions and benign from malignant conditions. Hence a cytological diagnosis of "Thy 03/follicular proliferation" fails to provide clinically useful information in most of the cases with regard to the management of the patient.Thyroid lesions that have some but not all the features of malignancy are included in "Thy 04" category. The "Thy 05" category includes lesions having unequivocal cytological features of malignancy.Time has arrived to change to a better classification that provides useful information to the clinician enabling him to decide the treatment option. By this means the number of unnecessary thyroid surgery for patients with thyroid disorders can be effectively reduced.The Bethesda system for reporting thyroid cytology (BSRTC) consists of six diagnostic categories. It provides the definitions and morphologic criteria for the different categorie...