This blog is allocated for news and reecollections about the 1960 Colombo Medical Faculty Entrants. If you are in the batch please send your articles re the batch to the following email address ;- 1960batch@gmail.com. Please click on 'OLDER POSTS' at the end of each web-page. Please type your search queries in the box provided and press 'search'.
Thursday, June 27, 2019
Monday, June 24, 2019
The cause of death of King Rajasinghe of Sithawake, Ceylon in 1593
Analysis of the reported symptoms that preceded the death of KingRajasinghe of Sithawake (1593 AD)
Abstract
A copy of an ola leaf manuscript, the original of which was written around the late 1590s, was published recently. It describes the sequence of events leading to the death of the warrior King Rajasinghe of the Sithawake Kingdom (1521-1593). A study of the contents of this letter is presented. The dressing applied to a wound on the foot of the King is described in that letter. It is likely that this dressing would have been an ideal medium to produce the highly potent tetanus exotoxin. The toxin would have diffused into the open wound and produced the sequence of symptoms and signs mentioned in the letter. An analysis of the symptoms and signs noted during the King's last illness as described in the letter is presented. Laryngospasm, and tonic and clonic spasms are easily identified. In addition, a group of symptoms attributed in the 1960s to sympathetic over-activity in tetanus are also recognisable. The conclusion is drawn that the King died of tetanus. The intriguing possibility of the wilful use of a lethal dressing on an open wound as a biological contact poison is left open for discussion.
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Saturday, June 22, 2019
Coconut oil, WADL Amarasiri, AS Dissanayake,
Title
page
Title : Coconut fats - a perspective
Authors : 1. Dr. W. A. D. L. Amarasiri 1
2.
Dr. A. S. Dissanayake 2
Author for correspondence
:
Dr. W. A. D. L. Amarasiri
Lecturer
Department
of Physiology
Faculty
of Medicine
University of Kelaniya
P.O. Box 6, Thalagolla Road,
Ragama.
Tel: 0777 449 866, 0112 958219 ext 28
All reprint requests could be
directed to the above address.
Number of words in manuscript : 2026
Abstract
In many
areas of Sri Lanka
the coconut tree and its products have been an integral part of rural life and
it come to be called the “Tree of Life”.
Coconut
fats (CF) account for 80% of the fat intake among Sri Lankans. Around 92% of
coconut fats are saturated fats. This has lead to the belief that coconut fats
are ‘bad for health’ particularly in relation to ischaemic heart disease. Yet,
most of the saturated fats in coconut are medium chain fatty acids whose
properties and metabolism are different to those of animal origin. The relationship between coconut fats and
health has been the subject of much debate and misinformation.
The main
fatty acid in CF is lauric acid (LA).
The only other naturally occurring fat with high LA content is human
breast milk. This begs the question whether CFs
do have beneficial effects.
There is
the need to clarify issues relating to intake of coconut fats and health more
particularly for populations that still depend on coconut fats for much of
their fat intake. This paper describes the metabolism of coconut fats and its
potential benefits, and attempts to highlight its benefits in order to remove
certain misconceptions regarding its use. …
…Coconut trees were known to have
existed as far back as 161 BC and the existence of coconut plantations was first
recorded in the 2nd Century AD. Coconut kernel and kernel products
such as coconut milk and coconut oil (CO) are eaten mainly for the exquisite
taste that the fats in coconut convey to food.
Fats make up less than 25% of the
total energy expenditure among Sri Lankans. Studies done more than 20-30 years
back have shown that coconut fats constitutes about 80% or more of the total
fat intake of Sri Lankans [1].
Over 95% of coconut oil is fat
while the fat content of scraped coconut is around 34% and that of coconut milk
around 20%. It is also true that around 92% of the coconut fat is saturated fat
[2]. However, the saturated fats in
coconut and palm-kernel oil also called “tropical oils” differ from saturated
fats in animal fats. Over 50% of the fats in coconut are medium chain
triglycerides that are formed from fatty acids of chain length 8:0 to 14:0. It
is primarily the 14:0 fatty acids that are thought to be atherogenic. When digested in the small intestine, these
yield saturated medium chain free fatty acids and monoglycerides. Lauric acid
and monolaurin constitute around 50% of CF derived lipid. However unlike long chain fatty acids, these
medium chain free fatty acids and monoglycerides are absorbed intact from the
small intestine and do not undergo degradation and re-esterification processes.
They are directly utilized in the
body to produce energy and are therefore widely used in infant formulas,
nutritional drinks for athletes and in intravenous lipid infusions. Animal and
human studies have shown that the fast rate of oxidation of medium chain free
fatty acids leads to greater energy expenditure. Animal studies have also
demonstrated that this greater energy expenditure results in less body weight
gain and decreased size of fat depots after several months of consumption.
Furthermore, both animal and human trials suggest a greater satiating effect of
medium-chain triglycerides compared with long-chain triglycerides [3]. In fact, administration of medium-chain
triglycerides in the form of coconut oil along with a saturated fat diet
increased oxidation of long-chain fatty acids in the body [4].
Current understanding based on the
effect of dietary lipid manipulation upon immune system function indicates that
fatty acids are involved in the modulation of the immune response through
different and complex pathways. The problem with many animal studies is that
they use hydrogenated coconut oil. One study where non hydrogenated coconut oil
was used showed that lipopolysaccharide-stimulated TNF-alpha production by
macrophages decreased with increasing unsaturated fatty acid content of the
diet [24]. There are anecdotal claims to the effect that using coconut oil
improves the action of anti-HIV drugs. Many other unsubstantiated claims on the
benefits of coconut products such as its anti-oxidant effects etc, are gaining
popularity among health food enthusiasts.
Clearly more work both of an
epidemiological and experimental nature need to be done to establish whether
coconut fats are indeed associated with the atherogenesis, ischaemic heart
disease and cerebro-vascular disease. Population studies should attempt to
remove the possible effect of other confounding variables such as increased
consumption of animal fats along with coconut, smoking, alcohol more particularly
illicit brews that could contribute to the increasing incidence of ischaemic
heart disease and cerebro-vascular disease in Sri Lanka. In the absence of
convincing evidence both epidemiological and experimental against the continued
use of coconut fats in relation to atherosclerosis and ischaemic heart disease,
one has to ask whether the recommendation of the Asian Heart Assoication issued
in 1996, “An intake of 400 g/day
fruit, vegetables and legumes, mustard or soybean oil (25 g/day) instead of
hydrogenated fat, coconut oil or butter in conjunction with moderate physical
activity (1255 kJ/day), cessation of tobacco consumption and moderation of alcohol
intake may be an effective package of remedies for prevention of coronary
artery disease in Asians” is valid in toto[25]. Should we be encouraging the
use of mustard, soybean, corn or sunflower oils all of which will need to be
imported or emphasize the need for eliminating smoking, excessive use of
alcohol, animal fats and other life-style changes instead?
Honorary Fellowship of the Royal College of Psychiatrists.
|
The College
|
Dr Pearl D. J. Hettiaratchy
(Introduced by Professor Susan Benbow)
Dr Pearl Hettiaratchy is a distinguished clinician,
doctor, psychiatrist
and old age psychiatrist, who has contributed to the
National Health Service (NHS) over a period of more than 30
years. She qualified in Sri Lanka, one of three family members
who took up medicine: her brother was a physician and her
sister Port Health Officer in Colombo.
She
came to the United Kingdom in 1968 for a clinical attachment at
St James Hospital, Portsmouth, where she later commenced her
first consultant appointment in 1975 after completing her training.
Here, together with a nurse manager colleague, she pioneered
the development of old age psychiatry services, setting up the
first travelling day hospital for older people in the UK.
She
has enthused colleagues of all disciplines, and educated people
from many backgrounds to reflect on and improve their practice.
For 5 years from 1983 to 1987, she single-handedly ran the
Region’s Day Release Courses in the Psychiatry of Old Age, and
educated 400-500 key professionals, who are now leading old age
psychiatry services regionally and nationally. She moved to
Winchester in 1984, where she continued to teach and develop
services.
Pearl
has worked for the Royal College of Psychiatrists on committees concerning
later life, nursing, ethnic issues and unethical practices, and
has also served as Vice President. She has been an important
role model for younger people coming into the specialty. She
was featured as one of five psychiatrists giving their views on
why psychiatry is a rewarding career to choose, in the
College’s career information pack produced in 1990, and again
in 1994. What she wrote here is typical of Pearl’s approach to
her work:
‘the field of psychiatry
fascinates me. It takes time, patience and diligence to unravel
the workings of the human mind and one can never fully
understand its intricacies. Every patient I see, even after 23
years’experience is still a diagnostic puzzle and a therapeutic
challenge. So there can never be any burnout or boredom.’
And
further:
‘At the core of
psychiatry is the ability to empathise, understand and give
something of yourself to the patient within thetherapeuticrelationship....’
Pearl
has been determined and devoted to her work: her humanity and
compassion are shown by her willingness to take unpopular stances
when in the interests of her patients. Her advice wasoverruled during a ward
closure in 1994 and eight elderly patients died shortly after
moving from long-term hospital care into private nursing homes,
against medical advice. The ensuing scandalled to guidance on long-term care,
an ombudsman’s enquiry and a Select Committee hearing. Pearl
was quoted in the press as saying:
‘the care team becomes
the family of the patient. They are faces in their failing
memories.’
She
has worked tirelessly on behalf of older people in need of
long-term care, unafraid of making her views known.
Pearl
was elected to the General Medical Council (GMC)in 1994, and
reelected in 1999. Her election was a great event in Sri Lanka,
as she was the first Sri Lankan to serve on the GMC. Her
reelection was reported in Island International on July 21
1999: the report noted that Pearl had participated in the discussions
the GMC had with Sri Lanka’s Minister of Health in 1998 on
holding the Professional and Linguistic Assessments Board test
(part 1) in Sri Lanka. This was a landmark achievement and she
has continued to work to support the development of services in
Sri Lanka. With the GMC she has served on the Racial Equality
Group, the Steering Group for Performance, the Professional Conduct
Committee, the Standards Committee, and the Working Group on
withholding and withdrawing life-prolonging treatment. She
became Medical Screener for Conduct and Performance in 1997 and
regularly investigates complaints against doctors.
She
retired from clinical practice on 4 February 2002, after 34
years’ continuous service in the NHS, but later that year on 23
October, her work was recognised and honoured when she was
invested OBE by Her Majesty the Queen at Buckingham Palace for
services to old age psychiatry.
Pearl
continues to be active in voluntary work, medico-legal work and
medical politics. She is actively involved in national and
local fora in influencing policy and decision making in the
NHS, and her advice is respected on a range of subjects including
the ethics of heath care, the support of doctors in difficulty
and issues in multi-ethnic populations. Following the inquiry
into the death of Stephen Lawrence, she has become involved in
work with the Chief Medical Officer on racism in medicine, and
is about to become an official role model for ethnic minority
doctors. For many of us, she has been an unofficial role model
for a number of years. One of the pleasures of her retirement
is to be able to spend more time with her family, especially her
six grandchildren.
Pearl
is a valued, loved and respected psychiatrist and old age
psychiatrist. I am delighted to present her for the Honorary Fellowship
of the Royal College of Psychiatrists.
Thursday, June 20, 2019
Reminiscences of the 1960 entrants batch reunions
Please click on each underlined web-link below with your speakers on :-
Medical
entrants 1960, Kynsey road, Colombo, Sri Lanka.
25th
year after passing out reunion – Kandy
Geris
dancing couple
Geri –
One armed fiddler
Funeral
of Sarath Kapuwaththe
Habarana
reunion
Lodge
dinner at Habarana
Get
together - Negombo
Memorable
poems
of our schooldays
of our schooldays
Soft
launch of a book
CoMSAA - Mini get together of the batch
Jayadewi - Interview
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