Critical appraisal of journal club

By  Dr. Nadisha Badanasinghe

This activity is organized by the BOS in Medical Microbiology for trainees undergoing MD in Medical Microbiology. This is a compulsory activity for all MD trainees to present at least one journal article during their training period. The first meeting was held in September 2014. The First Coordinators were Dr. Dhammika Widanagama and   Dr. Dushyanthi Athukorala . Current coordinators are Prof. Neluka Fernando and Dr. Nadisha Badanasinghe

This activity is conducted on second Friday every other month .Two trainees present two articles on every session.

This activity is supervised and resourced by a Consultant Community Physician. The appointed resource person for this activity by BOS is Dr. Sharmini Prathapan (Consultant Community Physician/ Head Dept. of Community Medicine, Faculty of Medical Sciences, University of Sri Jayawardenapura)

 Objectives:

  1. To systematically appraise and assimilate scientific evidence from journal articles
  2. To critically read a journal article and draw conclusions applicable to clinical practice regarding specific clinical problems
  3. To apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness
  4. To provide a written record that forms part of the learner portfolio
  5. To facilitate learning of other trainees and Consultants
  6. To assist and guide the trainees to prepare for the FRCPath examination
  7. To improve communication skills with regard to verbalizing ideas; formulating hypotheses, and presenting solutions to problems
  8. To improve professionalism by demonstrating a commitment to educational process exhibiting enthusiasm

Workshop on Introduction of Revised Protocol for Anti- Rabies Post Exposure Therapy –

By  Dr Kanthi Nanayakkara

The Sri Lanka College of Microbiologists together with the Medical Research Institute and the Department of Public Health Veterinary Services, organized the above one day workshop on 10.06.2016 at the Aldo Castellani Auditorium, MRI. IMG_2135The participants were Medical Officers managing rabies post exposure patients from Teaching, Provincial and District General and Base hospitals of Sri Lanka covering the entire country.

One hundred and forty three Medical Officers participated at this workshop which comprised of four presentations and a session of an interactive discussion where participants clarified most of their management issues and doubts on rabies post exposure therapy. IMG_2150 The workshop was successfully concluded around 2.00pm followed by lunch.

The road way to National Action Plan for combating Antimicrobial resistance

By  -  The technical advisory group of SLCM for the development of NAP

Combating AMR was a long felt need of microbiologists. All the microbiologists were fighting with it at an individual level and collectively as the college. Several milestones of combating AMR in the recent history of SLCM include surveillance of blood culture isolates from 2009, surveillance of urine culture isolates from 2014 , strengthening the infection control  with preparation of a manual in 2005 which is currently undergoing revision, strengthening the laboratories with a lab manual in 2001 and the revision in 2011 etc. Majority of membership has contributed to research in the field of AMR which has shown the extent of resistance prevailing in the country.

During the last decade there was a developing global interest in combating AMR. In 2011 the Jaipur Declaration was signed by countries giving political commitment to the issue. After that the WHO strengthened the support to countries to have national action on AMR with the involvement of the government.  In Sri Lanka too the MoH with the support of the WHO started paying attention to the issue as agreed upon in Jaipur Declaration.

At a preliminary meeting held by the MoH which was supported by WHO in September 2015, the need to take action at national level to combat AMR was recognized. SLCM nominated following members, Dr. Jayanthi Elwitigala, Dr. Kumudu Karunaratne, Dr. Shirani Chandrasiri, Dr. Geethika Patabendige and Dr.Kushlani Jayatilleke as representatives to attend this meeting. Nomination of the members to represent college was based on involvement with different activities of the college with regard to AMR activities. At that meeting members were identified who would comprise a national multisectoral coordinating group (NMCG) for the said task.  The members in this group comprised the fields dealing with antimicrobials in human medicine, veterinary and agriculture sectors. Members for human medicine represented Ministry of Health (MoH), health education, epidemiology unit, national medicinal drug regulatory authority, professional colleges, pharmaceutical society, dental, private sector hospitals, general practitioners and pharmacologists.

Subsequent to that, again a meeting was called by the MoH with WHO in March 2016 for which the members nominated by SLCM was requested to participate. At this meeting the task of developing a draft National Action Plan (NAP) for combating Antimicrobial resistance (AMR) for the purpose to initiate discussion with NMCG was allocated to SLCM within a time limit of one month. SLCM allocated this task to the same 5 microbiologists who later identified as the technical advisory group for the purpose of development of draft national action plan. The technical advisory group developed the initial draft and submitted the draft to the MoH and the WHO within the stipulated time limit by 28.04.2016. As this draft was a comprehensive document in human medicine WHO requested to include a detailed input from the veterinary and agricultural sectors as well. Following another meeting with representatives from veterinary and agriculture sectors SLCM team was able to complete the gaps in the draft for discussion at the NMCG meeting.

This first draft was reviewed by members at the first NMCG meeting held on 27.05 2016. A decision was taken to widely circulate the second draft for comments among the necessary specialities. Currently this second draft is in circulation among all relevant stake holders including specialists of the membership of our college. The second meeting  of the NMCG is scheduled to be  held on 29.7.2016. At this meeting this draft is expected to be finalised. In addition there will be a discussion on   implementation and monitoring of the NAP as well.

Revision of manual for infection prevention and control in hospitals

By  Dr Kushlani Jayatilleke

The “Hospital Infection Control Manual” was first printed by the Sri Lanka College of Microbiologists in 2005. The college felt the need for revision of this manual and asked for volunteers to take the leadership in this task. The volunteers were appointed to the editorial board and the task of organizing the revision of the manual was allocated to them a general meeting of the college. The editorial board identified the revision needed in the structure and allocated the topics to all specialists in the college to do the draft documents. It was decided to change the title of the manual to “Manual on prevention and control of infections in hospital”. 

APPRECIATION – PROFESSOR MAHROOF ISMAIL

By   Prof. Nilanthi de Silva

On 13 June 2016, Sri Lanka lost another doyen in the field of Medical Parasitology. Prof Ismail was one of the earliest members of the Sri Lanka College of Microbiologists, serving as its 11th President, in 1987. In 2015, when the College decided to honour those who have served the College and our profession by awarding honorary Fellowships, the Council was unanimous in deciding that Prof Ismail should be among the first recipients of a Fellowship. 

Mohamed Mahroof Ismail obtained his MBBS from the University of Ceylon and his PhD in Medical Parasitology from McGill University, Canada. He also spent a post-doctoral year at the London School of Hygiene and Tropical Medicine, in the UK. After his return to Sri Lanka, he worked at the MRI for several years and became its Director in 1983. In the same year, he joined the Faculty of Medicine, University of Colombo as the Professor of Parasitology and later served as Dean of the Faculty from 1994 to 1996. Throughout his working life, Prof Ismail engaged in research, mostly on lymphatic filariasis and soil-transmitted helminths. His work was of such quality that it had significant impact on national as well as international health policies in relation to control of both groups of infections. The most significant body of work that he and his collaborators produced was to demonstrate for the first time that albendazole combined with diethylcarbamazine citrate or ivermectin has a pronounced and sustained effect of reducing microfilaraemia for over two years. This combination is currently being successfully used by the WHO and the Ministries of Health in 83 endemic countries as part of the global strategy to eliminate filariasis.

Prof Ismail also held many eminent posts, serving as a member of the University Grants Commission, as the Chairman of the Board of Management of the Post-Graduate Institute of Medicine; and as external examiner in Parasitology of the University of Malaya as well as the National University of Malaysia. He served the WHO at its Headquarters in Geneva, and in the South East Asian Regional Office in New Delhi in many different capacities:  as Chairman of the WHO Expert Committee on Soil-Transmitted Helminthiases; as a member of the WHO Expert Committee on Lymphatic Filariasis and the WHO Technical Advisory Group for Lymphatic Filariasis; as a WHO Consultant to Egypt and Bangladesh to revise their National Filariasis Control Programmes; and Chairman of the South East Asian Programme Review Group for the elimination of lymphatic filariasis from 2002 until 2006.

I am just one of many who owe an immense debt of gratitude to Prof Ismail. I learnt much of my parasitology from him, as a medical student, as a postgraduate student, and even after that. He was one of the examiners at my MD examination in 1994. I still recall very clearly, the occasion when I went to thank him after passing the exam. I was a young probationary lecturer back then, who had just started working at Ragama, in a medical faculty that was virtually in its infancy. My husband Janaka and I met Prof Ismail in the Dean’s Office in the Colombo Medical Faculty. We talked of this and that, and then I asked him if he had any suggestions for research. He immediately shared with us an idea that had occurred to him while attending a WHO meeting a few weeks previously. He said that this study could only be done in Sri Lanka because of the confluence of circumstances at that moment in time, but that it had the potential to transform international policy with regard to deworming programmes. Together with other colleagues from Ragama, we turned this idea into a study that was eventually published in one of the foremost medical journals. This little episode is only one example of the unassuming generosity and supportiveness that Prof Ismail extended to all who came into contact with him. He probably never thought twice about what he did, but for me, it was a landmark in my academic career.

Over the decades since then, we came into contact at regular intervals, especially at Parasitology oral examinations for medical students. Those times when I was his co-examiner were days that I really enjoyed, because Prof Ismail somehow turned them into learning experiences for both students and me, and his unfailing sense of humour lessened the tedium of coping with medical students who seemed to view Parasitology oral exams as an instrument of torture.

As he gradually withdrew from the professional arena, Janaka and I tried to stay in touch by visiting him at home. He was an unfailingly courteous and considerate host, and we learnt that he was an excellent cook, who also enjoyed good food. We also saw a marriage that seemed to have been made in heaven. Prof Ismail and his wife Jezima, an equally eminent figure in her own right, in the field of education, lived their life together, not only in bringing up a family, but in many other ways that sought to support the underprivileged and disadvantaged.

I have had the privilege of following in Prof Ismail’s footsteps, in that my research has been largely in the same fields. At international meetings, mention of my Sri Lankan nationality often results in enquiry after Prof Ismail. World-renowned experts speak of him with much respect and affection. One of them characterized him as a ‘gentleman and a scholar’ – a phrase which struck me as a particularly appropriate description of Prof Ismail. May he rest in peace!

Update on National Laboratory Based Surveillance of Antimicrobial Resistance – June 2016

By

Dr Kushlani  Jayatilleke

Antibiotic susceptibility patterns of bacterial isolates from midstream urine specimens which have colony count of ≥ 105 CFU/ml were analyzed centrally using WHONET software. The data entered to the WHONET software in respective hospital laboratories were sent to the consultant microbiologist nominated by the Sri Lanka College of Microbiologists for analysis via email.

The pooled data was analysed by the nominated consultant microbiologist using WHONET and 2 oral presentations were done at the 23rd and 24th Annual Scientific Sessions of Sri Lanka College of Microbiologists; “Analysis of data of urine culture isolates of 2013 sent from four laboratories of National Laboratory Based Surveillance of Sri Lanka College of Microbiologists” and “Analysis of data of urine culture isolates of 2014 sent from seven laboratories of National Laboratory Based Surveillance of Sri Lanka College of Microbiologists”.

Data of 2014 received were analysed and published in Sri Lanka Journal in Infectious Diseases as “Analysis of urine culture isolates from seven laboratories in Western province of Sri Lanka; National Laboratory Based Surveillance- conducted by the Sri Lanka College of Microbiologists -2014; SK Jayatilleke, G Patabendige, M Dassanayake, GKD Karunaratne, J Perera, RRDP Perera, WRPLI Wijesooriya, NP Sunil-Chandra, J Kottahachchi, D Athukorala, T Dissanayake;

 Sri Lankan Journal of Infectious Diseases 2016 Vol.6 (1):17-24; DOI: http://dx.doi.org/10.4038/sljid.v6i1.8105.

At present data of 2015 are being received for analysis. To date the following laboratories had sent data and this will be analysed shortly.

List of hospitals and consultants who sent the data of urine culture isolates of 2015: