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Sri Lanka's antivenom leap forward

By making its own antivenom, Sri Lanka could boost its technology capacity and become a model exporter for others.

[NEWS] Colombo, Sri Lanka - In 2006, a Russell's viper sank one fang into Sanath Weeraratne's left hand.

Weeraratne immediately started to bleed profusely as the anticoagulant properties in the venom took effect. He knew what could come next: more bleeding from the rectum and the gums and blood-stained vomit.

The blood could seep into the brain and affect other organs, and this could be fatal. Fortunately for Weeraratne, the two people he was with were experts themselves. They identified the snake that had bitten him, applied first aid, and rushed him to a nearby hospital where he was successfully treated.

The accident was a turning point in his life.

It led him to his job as a caretaker at Sri Lanka's first national serpentarium, home to some 185 venomous snakes. Common kraits, cobras, Russell's vipers, saw-scaled vipers and hump-nosed pit vipers lie coiled in their containers - with water bowls, foliage and coconut shells.

The small three-man team at the serpentarium keeps odd hours because some of these snakes, such as the kraits, are most active at night.

Weeraratne and his team must see to the serpents' health and extract their venom, which is collected and sent to a lab in Costa Rica. It is there that the first polyspecific freeze-dried antivenom to offer protection specifically against Sri Lankan snakes is being produced.

The serpentarium was set up and is operated by the United States-based Animal Venom Research International (AVRI). Its executive director, however, is the Sri Lankan-born Roy Malleappah, a herpetological field operations specialist. It has taken him and his team years of dedicated work to make the Sri Lankan antivenom a reality.

Sri Lanka boasts 92 different species of snakes, but most deaths are attributed to only three - the highly venomous cobras, Russell's vipers and kraits.

A medical breakthrough

The antivenom was developed in close collaboration with the Instituto Clodomiro Picado (ICP) in Costa Rica, while the University of Peradeniya - partly funded by the National Research Council of Sri Lanka - is responsible for the clinical trials, which are now ongoing.

The antivenom ICP and AVRI have produced is polyspecific - covering multiple species including, for the first time, Sri Lanka's hump-nosed pit viper. It is the most common cause of snakebite envenoming in Sri Lanka and is known to cause serious systemic toxicity and death.

Sri Lanka has one of the highest snakebite rates in the world, yet statistics are hard to come by as many cases go unreported. The island boasts 92 different species of snakes, but most deaths are attributed (PDF) to just three - the highly venomous  cobra, Russell's viper and krait.

The national serpentarium itself is located in Dambulla in central Sri Lanka. Locals here know well what damage a snakebite can do. There is always a rash of incidents in March, when farmers go into the fields to harvest paddy and find snakes hiding amid the green stalks.

Weeraratne himself remembers a trip to a village in this area. "Every single house I visited told me that they had lost someone to a snakebite: from fathers to a 17-year-old who was sitting for her A-Level exams. The stories are enough to bring tears to your eyes."

Even among those who survived, there were some who would struggle with chronic kidney disease for the rest of their lives.

An island-wide community survey in 2016 extrapolated that, over a 12-month period, there were more than 80,000 bites, 30,000 envenomings and 400 deaths from snakebites.

Today, the antivenom used in Sri Lankan hospitals is imported - typically from India, where many of the same species exist.

"However, the reaction to the antivenom has become part of the problem," says Sarath Kotagama, a conservationist and emeritus professor of environmental science at the University of Colombo.

He explains that what is not always understood is how much variation there is between Indian and Sri Lankan snakes, even though they may belong, in theory, to the same species.

"The toxicity and composition of the venom is affected by the snakes' diet and other regional variations," says Kotagama, adding that "the Hypnale hypnale group [the hump-nosed pit vipers] are very specific to this country, and so you need a specific antivenom for them".

When a person is brought into a hospital with a bite from a hump-nose pit viper, doctors are at a loss.

"The bite from this snake is not covered by the antivenom we have, even though it is one of the most common bites," says Dr Indika Gawarammana, the lead investigator for the AVRI/ICP antivenom clinical trials at the University of Peradeniya's teaching hospital.

He explains that symptomatic treatment, such as surgical incisions and pain relief medications, is all that is on offer.

There is another reason doctors sometimes hesitate to treat snakebite victims with the current antivenom, he says.

"The imported antivenom creates adverse effects in a big proportion of those patients who receive it," Gawarammana tells Al Jazeera, citing a range of symptoms from relatively mild skin reactions, such as itching, to life-threatening anaphylactic reactions.

Sri Lanka's excellent network of hospitals means that most people are within 30 minutes to an hour of getting help, but the side-effects of the antivenom can mean doctors will insist that patients be transferred to bigger, more distant hospitals where severe reactions can be managed. The delay is increased if a patient is not certain what species of snake bit them.

"This allows complications to set in," says Gawarammana.

Currently, 2,500 vials of the new antivenom have been produced as part of a test batch. First freeze-dried, the antivenom can be stored at room temperature. Malleappah notes that ICP's technology has produced a particularly pure, concentrated and effective version of the antivenom. This is why treatment can begin with only two vials instead of the 10 vials that are currently routine with imported antivenom.

The clinical trials are still ongoing, but Gawarammana says the patients have so far responded very well to the new antivenom.

The allergic reactions have been negligible, necessitating fewer days in the hospital.

"In Sri Lanka, we haven't really calculated the cost to the government of treating the allergic reactions to the old antivenom," he says, noting that, typically, patients would spend days, and sometimes weeks, at home recuperating, thereby adding to the economic cost.

In contrast, the new antivenom has delivered quick recoveries that allow people to return to work within days of being bitten. As part of the trial, the AVRI/ICP antivenom will also be sent to an Australian laboratory to have its efficacy tested.

Maintaining a balance

It is Malleappah's hope that Sri Lanka will be able to begin producing its own antivenom very soon. He is currently arranging for more than 100 horses to be imported to help produce the antivenom in a new Sri Lankan facility. These will be injected with a small amount of snake venom and will generate antibodies that can then be extracted and used to create an antivenom.

Malleappah says this is typically not a lucrative business and so very few pharmaceutical giants are willing to invest money into research and development or manufacturing the product. He believes that if Sri Lanka were to start producing its own antivenom, it would be a boost to the island's technology capacity, and serve as a model that could be exported to other countries in the region.

Gawarammana agrees. "We should have our own manufacturing capabilities. There are lots of issues in this country where the same approach can be used to produce antidotes, for example, for plant poisons. It's important Sri Lanka has the technology."

While people are the focus of these efforts, for the AVRI team, saving snakes is a crucial goal as well.

"I am really sad to see the indiscriminate killing of snakes in this country. It has a huge, catastrophic effect on the ecological balance," Malleappah says.

As another unapologetic conservationist, Kotagama, too, is interested in seeing the antivenom developed.

"Today, every snake is a deadly snake," he says. "If people were confident that they could be treated, that they would not die from this bite, then we would definitely see fewer snakes being killed out of hand."

Source: aljazeera.com

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plastic surgery erie pa

zvacsenie pier The very long and interesting past of cosmetic surgery may be traced to the ancient times. Physicians or healthcare providers in older India started off making use of skin area grafts to reconstruct man epidermis spots within the 8th century BC. An ancient Indian native operating specialist branded Susrutha made the first captured nose area structure. He utilized a percentage or some skin area with a forehead. During that time, nose area amputations ended up punishable by older Native indian regulations. Several century in the future, the Romans carried out straightforward approaches like replacing broken ear. In Europe, Dr Heinrich von Pfolspeundt done an easy cosmetic surgery by getting rid of skin coming from the arm’s rear and sutured it set up. Nevertheless, the process and research of synthetic surgey advanced and have become frequent only during the 19th and 20th ages. It absolutely was mainly because from the aged situations, too much risk was associated with plastic-type surgeries. In the states, Doctor John Peter Mettauer was the very first Us plastic surgeon. The 1st cosmetic surgery operations he done was obviously a cleft palate procedure where dates back to 1827. He created his personal equipment and process products. The father of modern aesthetic surgery is Sir Harold Gillies. He could create several ways of contemporary plastic cosmetic surgery. Sir Gillies aimed at people who struggled face traumas in the course of Planet Combat I. Understanding plastic cosmetic surgery The phrase cosmetic surgery is actually a common term discussing manual or important cure or process done for aesthetic or practical good reasons or functions. The phrase ‘plastic’ from synthetic surgey originates from a Greek historic term ‘plastikos’ meaning to structure or even to mold.

There are two primary or principal parts or job areas of plastic cosmetic surgery thus far. Examples include: o Reconstructive plastic surgery. This area of cosmetic surgery concentrates on masking or undoing destructions from the face or some other additional areas of the body. This form of plastic material surgey involve closing disorders bu grafting skin with national, community or distant flaps. With the process tissue using their company parts of the body is transferred to a different component. o Beauty or plastic surgery is the most prevalent kind of plastic surgery at present. This type of cosmetic surgery is in most cases created to adjust or improve features inside the encounter or entire body which the patient locates unsightly or unflattering. Instances of these kinds of plastic surgery are breast reduction or breast implantation. Associated disciplines to cosmetic surgery In the history and the two vast regions of synthetic operations, it can still be additionally subdivided. The American Board of Plastic Cosmetic Surgery also includes the investigation or more advancement within the pursuing connected precise disciplines: o Craniofacial surgical treatment. This method of aesthetic surgery requires the cure or operation to align or revise congenital or maybe in-created physical disorders, It provides cleft lip palate, craniosynostosis as well as other defects within the deal with as a result of in given birth to triggers and real improvement. o Fingers surgical treatment is an additional control where plastic surgeons are qualified. They be given complete education in the self-discipline.

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Our equipped blue swine flu mask is made from high quality raw material, procured from extremely dependable vendors out there. The supplied swine flu mask is obtainable at really affordable charges. The Face Mask are used by the health treatment team for facial security from airborne infections. These face masks are developed with the extremely smooth substance which lets air flow in this type of manner the person doesn't experience suffocation. A rib knit 3-gap balaclava lets the wearer to guard the face from chilly air or hinder recognition. It can be conjectured that the very first masks could possibly have generally been used by primitive people to associate the wearer with some sort of unimpeachable authority, which include "the gods" or to usually lend credence to the person's declare over a presented social job. These kinds of an artist holds a respected position in tribal society because of the work that he / she produces, embodying don't just sophisticated craft tactics but additionally spiritual/social and symbolic knowledge.[27] African masks may also be used in the Mas or Masquerade in the Caribbean Carnival. Goaltender mask, a mask worn by an ice or field hockey goaltender to shield the head and face from damage By furnishing people by using a secure seal, the N95 Respirator Surgical Masks support reduce the contamination by microorganisms exhaled by Other folks. Along with dust and debris, the N95 Respirator Surgical Masks can be accustomed to assistance prevent the unfold of your flu (influen h1n1 virus). Remain wholesome with no want to prevent public areas Request Masks in different types (sacred, practical, or playful) have played a vital historical role in the development of understandings about "what it means being human", given that they allow the imaginative working experience of "what it really is like" to get remodeled into a special identification (or to affirm an existing social or spiritual identification).[22] Not all cultures have recognized the use of masks, but A lot of them have.[23] Masks in general performance Pat your face with moderate yellow mustard for a bracing facial that could soothe and encourage the skin. Attempt it on a small exam area to start with to verify it gained’t irritate. Lemon facial masks Prior to sturdy transparent materials for example polycarbonate were invented, visors to guard the face had to be opaque with compact eyeslits, and had been a form of mask, as frequently in mediaeval satisfies of armour, and (as an example) Outdated Norse grímr intended "mask or visor". Disguise Head to your posh spa and you will address by yourself (for the mere $100-$300) to an all-around body scrub. Or An Unbiased View of face mask can shell out as many as $fifty on a elaborate physique scrub. Why purchase when you can also make a homemade overall body scrub away from basic substances your self? All you may need is salt or sugar, system oil and a good, warm bath. The Iroquois manufactured impressive wood ‘Phony face’ masks, Utilized in healing ceremonies and carved from dwelling trees. These masks look in an awesome number of styles, determined by their precise purpose. Face Mask make it possible for completely all-natural respiratory through mouth and nose, incorporates a unique air cushion seal which inserts throughout the face, supplying optimum comforts, reducing useless Place by gentle inner mask and ensuring great It is usually acknowledged the masks, noise, colour and clamour are supposed to drive absent the forces of darkness and Wintertime, and open the best way to the spirits of light and the approaching of spring.[forty one]

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I love a very good lip balm 12 months-spherical, but specifically in the chilly months when my lips can chap. So think about my surprise After i realized you can make your own personal making use of beeswax, almond oil, honey and a bit of aged lipstick. Completely coat your face Using the combination, Permit dry wholly, then rinse with warm h2o. Your face will come to feel new and rejuvenated. Learn the most effective Do it yourself face masks For each and every type of skin problem. We supplying Disposable Face Mask. The offered face masks can be found with bacterial filtration effectiveness and plastic coated nose clip for convenience. Our adroit designers use substantial-quality primary content and the most recent technology to manufacture these face masks which decrease the distribute of infectious liquid droplets. Apart from this, clients can avail these face masks from us at nominal price ranges. Request With one way exhalation vent valve for respiration convenience Adjustable elastic head bands Stitched outside the house filter spot to stop leakage Among the list of problems in anthropology is getting the exact derivation of human lifestyle and early pursuits, with the creation and use with the mask only one spot of unsolved inquiry. The usage of masks dates again numerous millennia. For slightly pampering, head on the fridge and get an egg. When you have dry skin that needs moisturizing, independent the egg and beat the yolk. Oily skin requires the egg white, to which a little lemon or honey is usually included. [31] In Papua New Guinea, 6 metre-significant totem masks are placed to guard the living from spirits; While the duk-duk and tubuan masks of New Guinea are utilized to enforce social codes by intimidation. They are really conical masks, comprised of cane and leaves.[32] North America Pores and skin Care is vital to each of us and plays an important part inside our grooming course of action. Amazon India provides you a substantial selection of products that are created to satisfy your skin care requires. You could browse by our range to find the item of one's selection by utilizing beneficial research parameters for instance manufacturers, vendor, price tag, availability and normal customer testimonials. You can even get a much better knowledge of the product or service by experiencing handy user generated reviews. Right after finalizing your option, provide the products delivered to your doorstep and comprehensive the transaction by using one particular of numerous convenient payment solutions. Find the most effective pores and skin treatment merchandise online by purchasing at Amazon India. Ritual masks happen through the world, and although they tend to share quite a few traits, highly unique kinds have produced. The perform on the masks may be magical or spiritual; They might seem in rites of passage or for a make-up for just a form of theatre. Similarly masks may disguise a penitent or preside over important ceremonies; they may help mediate with spirits, or provide a protecting position towards the Culture who utilise their powers. Shigong dance masks ended up used in shamanic rituals to thank the gods, though nuo dance masks protected from terrible spirits. Wedding masks were used to pray forever luck and a long-lasting relationship, and "Swallowing Animal" masks ended up connected with shielding the home and symbolised the "swallowing" of disaster. It can be conjectured that the 1st masks could have generally been used by primitive persons to affiliate the wearer with some form of unimpeachable authority, including "the gods" or to in any other case lend credence to the person's claim on the presented social part. Then wipe 5 Tips about face mask You Can Use Today off and rinse with neat water. Your face will come to feel cleanse and smooth. Unsure which a person of those masks will operate best for your skin? This is certainly the very best face mask For each skin variety. Yogurt facial masks The continued attractiveness of sporting masks at carnival, and for children at get-togethers and for festivals including Halloween are fantastic examples. Presently these are usually mass-created plastic masks, usually affiliated with well known films, Tv set programmes, or cartoon people - They may be, on the other hand, reminders of your enduring electricity of pretence and Perform and the facility and charm of masks. Ritual masks

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This stone mask from your pre-ceramic neolithic time period dates to 7000 BC and might be the oldest mask on the planet (Musée "Bible et Terre Sainte") Masks had been accustomed to alienate and silence prisoners in Australian jails during the late nineteenth century. They ended up crafted from white fabric and coated the face, leaving only the eyes obvious. Masks are a significant A part of numerous theatre forms all through globe cultures, and their utilization in theatre has frequently made from, or proceeds to get part of aged, very advanced, stylized theatrical traditions. Present-day theatre In this economic system, why commit $30 or maybe more over a leg wax when you can do it on your own? I've a lot of friends who wax their own individual legs And that i discovered a recipe for a sugar "wax" around the Double X Web site for Ladies. The Definitive Guide to face mask shares her loved ones's recipe. Through the entire world, masks are employed for their expressive energy as a function of masked overall performance - equally ritually and in many theatre traditions. The ritual and theatrical definitions of mask usage commonly overlap and merge but nevertheless offer a useful basis for categorisation. In Females of coloration, skin could show up ashy or dull from dead pores and skin buildup. These face masks, combined with frequent exfoliation and day-to-day utilization of moisturizers should really soothe dry, chapped skin. Masks in different varieties (sacred, simple, or playful) have performed an important historical position in the event of understandings about "what this means to be human", mainly because they allow the imaginative knowledge of "what it is like" to generally be reworked into a unique id (or to affirm an current social or spiritual identification).[22] Not all cultures have recognised the usage of masks, but most of them have.[23] Masks in performance Another custom of European masks formulated, additional self-consciously, from court docket and civic situations, or entertainments managed by guilds and co-fraternities. These grew outside of the sooner revels and experienced develop into obvious via the 15th century in destinations like Rome, and Venice, where they created as entertainments to enliven cities and cities. So the Maundy Thursday carnival in St Marks Square in Venice, attended through the Doge and aristocracy also included the guilds, including a guild of maskmakers. Other Details:Mini-fiber substantial electrostatic filter, filtration efficiency of dust & powder is over ninety five%.Repel continually contamination of unsafe blood and saliva constantly. Treatment plans and Masks offered out there currently are of the very best get and will Engage in A serious function in influencing your Over-all visual appeal. Amazon India offers you a lot of the most effective skin care products that can actively impact your grooming and assist you reach the most out of your respective overall look and pores and skin tone. Store on the net at Amazon India to locate the greatest remedies and masks. Distinct variations of masks started to emerge in pre-Hispanic The united states about 1200BC, Despite the fact that there is evidence of considerably older mask forms. Welding mask to guard the welder's face and eyes within the brightness and sparks created for the duration of welding In Activity the protective mask will normally Use a secondary function to make the wearer look much more remarkable for a competitor. Robbers as well as other criminal perpetrators typically don masks as a way in concealing their faces and therefore identities from their victims and from law enforcement.

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London Rhinoplasty Surgeon

Beauty commands power is a fact well known. It could be held in a set of beautiful eyes or at the end of a sharp angular nose. It's said that the fate of the world's greatest empires London Rhinoplasty Surgeon changed when Caesar fell in love with Cleopatra's nose.

A lot of people feel that their nose is too hooked, too round or too flat to be beautiful. Not many are blessed with angular sharp noses that way of Greek gods and goddess but nowadays, an increasing number of people are resorting to surgical options like rhinoplasty to recreate the nose they always wanted.

What's Rhinoplasty? Rhinoplasty or nose surgery is just a reconstructive surgical procedure performed to either improve the aesthetic value of a person's nose and for correcting more severe medical problems like trauma, deviated septum or other congenital defects.

ENT (ear, nose and throat) is that branch of medical science which deals exclusively with disorders related to the human ear, nose and throat. Treatment involved could be either medical or surgical and at times both.

Rhinoplasty or nose surgery is completed by an ENT surgeon. History tells us that the means of reconstructive nose surgery was developed in ancient India by an Ayurvedic physician named'Sushruta '. The initial description of a nasal reconstruction can be found in his text'Sushruta Samhita '. Returning to modern times, you can find two different types of rhinoplasty that the ENT surgeon performs, open and closed rhinoplasty.

In the closed rhinoplasty approach, nose surgery is completed by making incisions in the nostrils whereas in the open procedure, one more unobtrusive incision is made over the bit of skin separating the nostrils. The ENT surgeon first separates skin and soft tissues of the nose from the underlying bone. Then reshapes the bone and the cartilage. Some ENT surgeons use a packing in the nose, followed by way of a tape on the exterior.

The incisions marks from the rhinoplasty or nose surgery are hidden in the nose, with the exception of a tiny incision that's made over the foot of the nose. Deciding to obtain a nose surgery done can be a big decision but rhinoplasty lifts not merely your nose but also your entire facial features along along with your confidence.

The ear, the nose and the throat Apparently, fifty percent of most physician office visits are by patients struggling with ear, nose or throat problems. ENTs or ear, nose and throat doctors are trained physicians who perform medical treatments mainly for ears, nose, throat, and corresponding structures of the top and neck. ENT doctors are expert in managing ailments of the Nose Job ears, nasal passage, sinuses, voice box, oral cavity, mouth and throat.

Common ear disorders include hearing disorders, ear infections and balance disorders. There's also more technical disorders just like the facial nerve or cranial nerve disorder, birth defects and cancerous growths of the outer and inner ear. The ENT Specialist is trained to address every one of these problems either with medicines or through surgery.

The primary skill of an ear, nose and throat or ENT doctor is caring for the patient's sinuses and nasal cavity. A lot of people develop problems like sinusitis and rhinitis during season change. Weather is commonly very damp in a place like London, which has months and months of constant drizzling rain. High moisture content in the air and sudden temperature changes can cause several ENT related problems. ENT doctors in London probably address maximum amount of ear, nose and throat related disorders in Europe.

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Rhinoplasty Surgery Clinic - Address to Improve the Shape of the Nose!

Of all cosmetic surgery procedures performed, perhaps, nose plastic surgery is one of the most complex surgeries. Although it is performed commonly and widely, choosing the surgeon who has experience and skills performing it is essential to achieve outstanding results. If you are not happy with the appearance of your nose then visiting rhinoplasty surgery clinic would help you explore different treatment options.

There are two different approached through which nose surgery is done. Reading further you will learn about open and close rhinoplasty surgery (www.bestrhinoplastyindia.com).

Endonasal – The closed approach

In this particular method of performing nose surgery, incisions are made inside the nostrils. Even though parallel incisions encircle almost half of the nostril lining, no incision can be seen externally. Also, visible scar can be avoided. As the left and right nostril incisions remain disconnected, repositioning the nasal skin is difficult and thus the entire surgery must be performed through narrow surgical openings with limited visibility. Access to the nasal framework needs vigorous stretching of the skin, distortion of the nasal cartilage is inevitable. No doubt that the visible scar is prevented, technical limitations and considerable challenges are associated with the procedure.

External rhinoplasty – The Open Approach

Unlike the endonasal or closed approach, the open nose surgery approach involves a small bridging incision, known as trans-columellar incision, for connecting the left and the right nostril incisions.  In the exchange of 4-5 mm visible segment, the nasal skin is folded upward and visibility of the lower nasal skeleton can be attained. Along with the direct visibility of the entire nasal framework, distortion of nasal cartilage become minimum and individualized components can be evaluated in the undisturbed and natural alignment. Hence, the hallmark of the open nose surgery (www.bestrhinoplastyindia.com) approach is vastly improved way of performing nose surgery.

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