Medical Research Institute, Colombo unique partner in making a Healthy Sri Lanka, completes 111 years of service to the nation

The Medical Research Institute [MRI] of Sri Lanka is the premier centre in the country for bio-medical and applied health research. MRI conducts research in diversified areas in the fields of Virology, Bacteriology, Parasitology, Rabies, Nutrition, Biochemistry, Histo-Pathology, Haematology, Immunology, Entomology, Molecular Biology, Pharmacology, Mycology and Animal Studies.
 
The MRI was built by Mr.J.W.C. de Soysa, in commemoration of Her Majesty Queen Victoria’s Diamond Jubilee. The ceremonial opening was conducted by the Governor of Ceylon, Sir Joseph West Ridgeway, on 31^st January 1900 and initially named as “The Soysa Bacteriological Institute”.Sir Marcus Fernando, a consultant physician of the General Hospital, Colombo was appointed in an acting capacity as the first head of the institute. Later Dr.Joseph Silva and Dr.S.C.Paul too acted as the director of the institute for a short period.
 
In 1903, Dr. Aldo Castellani, Professor of Pathology was appointed as the first Director of the MRI. Dr.Castellani had a global reputation as the discoverer of the etiology of Sleeping Sickness in 1902 in Sub- Saharan Africa. In Sri Lanka, he conducted a large number of pioneer research studies in  the fields of microbiology and parasitology. As the Director of the MRI he introduced various laboratory tests for the diagnosis of bacterial, fungal and parasitic infestations for the first time in Sri Lanka. Dr.Castellani also introduced vaccination for typhoid infections. In 1909 a vaccine unit to manufacture small pox and anti-typhoid vaccines was established.
 
This erudite scholar had to leave the colony, Ceylon, prematurely, in 1915, as he refused to change his Italian nationality during the political fiasco created by the World War I. Dr.Lucas A Nicholls, a lecturer in Bacteriology at the Ceylon Medical College was then appointed as the Director of the MRI. Under his tenure, a Pasteur Institute was commissioned in 1918.The legend says that the well known philanthropist Mr. Soysa was bitten by a rabid dog and consequently he died in relatively young age. Thereafter, his family donated a large sum of money to establish the institute. In 1936 the Pasteur institute and the Vaccination Establishment were amalgamated with the De Soysa Bacteriological Institute.
 
A two story building was commissioned in 1937 to accommodate all the departments including newly established Nutrition Division. The name of the institution was changed to its present form “Medical Research Institute” from 1^st March 1946 under the directorship of Dr. A.Nimalsuriya the first Sri Lankan to hold this august post. Next, came Dr. LBE Seneviratne as the director and during his time in 1950 the MRI was recognized as the National Reference laboratory for diagnosis of Syphilis in South – East Asia region. In the same year Smallpox was diagnosed for the first time in the island at the MRI.
 
After a very successful half century the MRI entered into a few relatively dormant years due to lack of technical facilities. But the institute was able to re-juvenate soon through the Technical Co-operation scheme of the Colombo Plan in 1956. As a result the Medical laboratory Technology school was established in 1959 with assistance of the World Health Organization. Dr. Doyne de A Seneviratne was the ‘doyen’ of the success during this re-juvenation period. Dr. K Mahadeva, Dr Mrs. Gladys Jayawardene , Dr.Nitiyananda, Dr.BAV Perera, and Dr.C.Palsuntheram held the post of Director/MRI consequently from 1960s to 1980s.
 
Next major expansion of the institute began under the directorship of Dr. Tissa Vitarana who was confirmed to the post in 1985. Initiated under the theme “Towards new Frontiers in Medical Research” an Ultra-Modern Laboratory Complex of International Standard was constructed and equipped at a cost of Rs. 700 million thanks to the generosity of the Government and the people of Japan.  Commisioning of this complex by His Excellency President Ranasinghe Premadasa on the 10^th April 1990 opened a new chapter in Bio-medical research in Sri Lanka.
 
“Together with continued Japanese Technical cooperation it should be possible for the MRI to make the qualitative and quantitative leap to a future upto international standards” Dr. Tissa Vitarana, who conquered into the territory of local politics later and became a respectful cabinet minister, the singular motive force behind the success of the entire MRI venture wrote in the ceremonial publication on the opening of the new MRI Complex.
 
MRI entered into the new millennium realizing the vision of the great pioneers in the past and played a unique vital role in the health systems in the country. The institution at present consist of 21 sections which have been grouped into seven departments covering all disciplines of laboratory medicine. Besides running the School of Medical Laboratory Technology, it also plays major role in all relevant post graduate training schemes including microbiology, haematology and histopathology.
 
In certain fields like Virology, Mycology, Pharmacology, Chemical Pathology and Immunology, the MRI alone performs the entire diagnostic function for the whole country. MRI is a major service provider for all hospitals in Sri Lanka with special and specific diagnostic laboratory tests. It also functions as a National Laboratory for Japanese encephalitis, measles, rubella and influenza and as the regional reference laboratory for poliyomyelities.
 
The Department of Virology is the only centre in the country fully equipped to carry out advanced research in Virology. It carries out specific diagnostic tests for Dengue, Encephalitis, Rabies, Measles, Influenza and many other pathogenic viruses. Surveillance of AFP, JE, Influenza & respiratory viruses, Measles, Congenital Rubella are among the major virological surveillance activities conducted by the department.
 
Dept of Rabies is the National Reference Laboratory for rabies diagnosis and research. The department provides a comprehensive service including, ante mortem & postmortem Human rabies diagnosis , Rabies diagnosis in animals, Quality assurance  of decentralized rabies diagnostic  laboratories and Specialized rabies post exposure advice clinic.
 
Dept of Vaccine Quality Control is the National Control Laboratory (NCL) for vaccines in Sri Lanka which provides Technical evaluation and quality testing of all vaccines (EPI & non EPI vaccines) for the drug regulatory authority before licensing.
 
The Department of Bacteriology has several sub-divisions that provide number of investigation services in clinical bacteriology. Anaerobic bacteriology and Leptospirosis laboratories are the reference laboratories in the country. The department conducts National External Quality Assessment programme in Bacteriology for state and private sectors. The Food and Water section carry out Microbiological Analysis of Routine Food and Water Samples, Surveillance of Water Samples , Serologic diagnosis of Streptococcal infections, Rickettsia, Brucellosis, Helicobacter pylori, Enteric fever, and SAT Antigen preparation for distribution.
 
Department of Entomology conducts research on mosquito vectors of disease is the main activity of the department. This department  also provides mosquito surveillance for dengue  haemorrhagic fever and Japanese Encephalitis. Consultancy services are also provided to the Registrar of pesticides and Sri Lanka Standard Institution on the biological efficacy of repellents. larvicides, insecticides.
 
The Department of Biochemistry of the MRI is the nerve centre for the National External Quality Assurance Scheme for 70 state sector hospital laboratories. Its functions include the provision of technical assistance, performance of routine, special, and highly specialized tests in Biochemistry, evaluation of chemicals, reagents, equipment and devices.
 
The Department of Nutrition works to improve nutritional status of individuals and populations through basic research and dissemination of nutritional advances in community based programmes, advocacy of national policies, promting and conducting of bio-medical research.
 
The Department of Mycology serves as the main service laboratory for processing and identification of patient samples from many parts of the country with regard to fungal infections. Departments of Entomology, Pharmacology, Immunology, Histopathology, Haematology, and Molecular Biology carry out numerous research projects in the respective fields annually and make unique contribution to the scientific community in addition to providing specific diagnostic services to the public.
 
Teaching and training programmes of undergraduates and post graduates in medicine, Medical Laboratory Technologists, Nurses, Public Health Inspectors, Entomological  Assistants are among the main regular activities in the annual agenda of the MRI.
 
The school of Medical Laboratory Technologists of the MRI is the main training centre for MLTs  for the Ministry of health; Armed Forces, State Universities, local government bodies, and some semi government institutions. e.g. National Transport Medical Institute
In addition following unique services are provided by the MRI:

• Reference laboratory for Immunological investigations
• National reference centre for platelet aggregation studies
• Pre-registration evaluation of pharmaceuticals

 
The Animal Centre at the MRI is the only place in Sri Lanka which breeds and maintains laboratory animal colonies according to proper breeding methods. Research institutes and universities purchase animal for diagnostic, research and reagent preparation.
 
All departments disseminate research findings by publishing a large number of scientific papers in reputed peer reviewed journals in respective fields annually.
 
Presently the MRI is operating with a  futuristic Vision focusing on Research (basic, operational and advance); surveillance programme for communicable, non communicable and emerging diseases and nutrition status in emergency settings; quality control of laboratories; monitoring and evaluation of health and nutrition interventions; Partnership, specialised laboratory tests and services; Vaccine quality assurance; Forecasting, control and prevention of outbreaks; Teaching and training (Basic, in-service and postgraduate); Providing specialist services for patient management; Supply of animals and animal blood for laboratory testing and research.
 
The heart of our Mission is to improve the health of Sri Lankans through world-class medical research so as to achieve the national health goals set by the Ministry of Health. To achieve this, we support research across the biomedical spectrum, from fundamental lab-based science to clinical trials in all major disease areas. We work closely with the Ministry of Health, and give high priority to research that is likely to make a real difference to clinical practice and the health of the population.
[Acknowledgement; Sriya Gunasekara]
 
Dr. Anil Samaranayake
Consultant Community Physician
Director
Medical Research Institute
Colombo

Ruthless Killer – New Vaccination Strategies for Human Rabies Control

Rabies is caused by a virus which is sensitive to the nervous system. Even though it causes a fatal encephalomyelitis, it is 100% preventable. Rabies disease is of two types:-furious and paralytic or dumb rabies. Though there are safe and effective vaccines available, still it is a grave public health problem in Sri Lanka. Dog is the main reservoir for transmission of rabies in the country. Medical Research Institute (MRI) is the National Reference Laboratory for rabies diagnosis and research and is kept open 24hours to offer this service.  Two tests are performed routinely by the MRI for rabies diagnosis. Namely, the screening test – report issued within 24 hours and the confirmatory test- report issued within 48hours.
 
In 2008, there were 52 human rabies deaths, in 2009 58 deaths and in 2010 49 deaths reported. In the 1980s, there were 100-150 human rabies deaths reported. Other than dogs, cats, cattle, goats, monkeys, mongoose, and pole cats are some of the animals proved positive for rabies in the MRI. House rats have not been proved to have rabies in Sri Lanka.
 
Training of medical officers, nurses and other categories of health care personnel on correct management of animal bite victims is carried out by the MRI. In addition health educational programmes are also conducted on a regular basis. Due to this work, we have been able to reduce the number of human deaths due to rabies when compared to the past decade. As you are aware, the ministry of health spends a large sum of foreign exchange to import safe and effective vaccines which are used to treat animal bite victims. In 1997, WHO recommended safe and effective economical intradermal administration of rabies vaccine was introduced by the MRI in the National Hospital. By 2010, this new schedule was introduced in most of the hospitals. Thereby, the MRI was responsible for saving more than 50% of the foreign exchange spent by the ministry, to import this life saving product.
 
Vaccine quality control
MRI is the National Control Laboratory for Vaccines in Sri Lanka. All vaccines which are imported to the country are evaluated and samples tested in the MRI, before registration by the Drug Regulatory Authority. Consultants of the MRI are members of Technical Evaluation Committees, where policy decisions regarding vaccines are made.  All vaccines batches which are used in the government sector, a lot release certificate is issued and quality tested when necessary, before they are distributed to institutions by the Medical Supplies Division (MSD) and the Epidemiological Unit.
 
In Summary, all vaccine related work- evaluation, quality assurance and research are performed only in the MRI.
Dr. Omala Wimalaratne, Consultant Virologist & Vaccinologist
Head/ Dept. of Rabies & Vaccine Quality Control
Medical Research Institute

Dengue epidemic and BTI – Hidden facts

Department of Entomology, Medical Research Institute (MRI) carries out entomological investigations to provide technical guidance to the Ministry of health for dengue vector control.
 
The entomological investigations are carried out to
 

1. Determine the major breeding sites of the dengue vector mosquitoes
2. Determine the percentage of different breeding sites in each area
3. To forecast the high larval density
4. To monitor the impact of control measures
5. To identify the vector mosquito species
6. To plan anti dengue control campaigns before the epidemics
7. To determine the appropriate control measures (source reduction, biological and chemical)

 
Department of entomology carry out dengue vector surveys in 15 high risk MOH areas in the western province covering 3000 premises per month. These premises include dwellings, schools, hospitals, institutions, bus depots, commercial establishments and also airports and sea port. During the surveys, public is educated on the breeding sites and necessary advice is given for the control of breeding sites. The information are sent to the MOOH of the relavent areas, Regional Epidemiologist, Provincial Director of Health Services,  Dengue coordination unit and relevant authorities of the airports and sea port for necessary control measures.
Department of Entomology is the only place for issuing biological efficacy reports to the Registrar of pesticides, Peradeniya, on the effectiveness of insecticides, larvicides and repellents (local or imported) against dengue vectors and other mosquito species.
 
Achievements:
Department of Entomology , MRI  in collaboration with Industrial Technology Institute (ITI) , carried out a  research project funded by National Science Foundation and discovered a local soil bacteria (Bacillus thuringiensis isralensis) for the control of dengue mosquito larvae. The entomology team at MRI brought most of the soil samples from various parts of the country and the initial training on the isolation of bacteria from soil samples, culturing and identification of the species was  provided by the  senior research officer at the bacteriology department, MRI. The formulations of the bacteria cultures were tested against the dengue vector mosquito larvae at the Department of Entomology at MRI. The field trials were also supported by the entomology team at MRI. The mammalian toxicity of the local Bti product was tested by the Veterinary surgeon at MRI. The research team obtained Sri Lankan patent for the discovery of local BTI for dengue vector control.
 
Present Research: Presently, a mosquito repellent against dengue vector mosquitoes is being developed using local plant species.
 
Dr. I. Weerasinghe
Entomologist
Head/Dept of Entomology
Medical Research Institute

Medical Research Institute and the war against Pandemic Influenza A (H1N1)

A novel Influenza A H1N1 virus was first identified on 15^th April 2009 in Mexico. WHO declared the onset of a pandemic due to this virus on 11^th June 2009. Just five days later, on 16^th of June Sri Lanka reported the first case of Pandemic A (H1N1) diagnosed at National Influenza Centre, MRI.
Influenza A (H1N1) pandemic continued to spread rapidly between May 2009 and April 2010. A total number of 3044 samples were tested at MRI during this time out of which 648 (21.3%) reported positive. Forty eight deaths occurred during the first wave in Sri Lanka.
A second wave of this pandemic started in October 2010 and continued up to February 2011.
During both waves patients presented with fever, cough, cold, sore throat, difficulty in breathing, diarrhoea and vomiting. Young adults up to 30 years were mainly affected with an equal male to female ratio. Highest incidence was from October to January coinciding with the highest rainfall in the country. Western and Central provinces were affected mainly. Complications that were seen during are pneumonia, encephalitis and myocarditis. Deaths were more in patients with co-morbidities such as immune-suppression and chronic lung diseases. More maternal deaths were also reported.
As the world continues to live under the constant threat of influenza pandemics and spread of highly pathogenic Avian Influenza, the WHO recognised the need to strengthen influenza laboratories and to establish efficient surveillance systems in member countries. Hence WHO identified the respiratory laboratory at MRI as the National Influenza Centre (NIC) for Sri Lanka and upgraded this lab and the molecular laboratory at MRI accordingly. Real time RT- PCR which is a molecular diagnostic method was introduced for the first time and more than 6000 samples have been tested with this method since then.
Twenty sentinel sites were identified to cover all the provinces of Sri Lanka for surveillance activities and Infection control nurses of respective hospitals were trained on sample collection and transport.
In addition WHO initiated External Quality assurance (EQA) programme to monitor the performances of the upgraded laboratories. Performance of the MRI lab in January 2009 was 100%. Swine flu samples were also included in the EQA panels since June 2009 to assess the laboratory’s ability to identify this virus.
MRI is open 24 hours a day to accept samples. This was made possible due to the dedication of the staff. Positive test results are informed daily by telephone to the sender and the epidemiology unit. Weekly data is forwarded to the Global Influenza Surveillance Network (GISN) by Flunet. Monthly data is sent to the sentinel sites and Epidemiology unit. Technical committee meetings take place monthly to discuss the progress as well as to plan the future activities.
Further improvement is required in data reporting and networking. Sub national laboratories too should be upgraded in the future.
 
Dr. G. Wickramasinghe
Consultant Virologist
Head/Dept of Virology
Medical Research Institute

Rubella and Measles, a continuing problem

Measles and Rubella are two viral diseases with a similar clinical picture that can be prevented successfully by vaccination. Although both infections were controlled effectively by the Rubella and Measles vaccination programme in Sri Lanka, an increase in the incidence was observed during the last 2 years as evidenced by laboratory data.
Although these diseases are preventable, in developing countries like Sri Lanka they can give rise to outbreaks and lead to severe complications in infected individuals. Complications of Measles are blindness, encephalitis, malnutrition and death. Rubella infection during pregnancy can lead to severe congenital malformations of the baby.
In 2010 and 2011 several outbreaks were reported in Sri Lanka from military camps, garment factories and universities. Most of the infected individuals were young adults. The reason for this could be lack of immunity against Measles and Rubella in this age group.
Diagnostic tests for these viruses are performed at the Measles and Rubella laboratory at Medical Research Institute. Under the guidance of World Health Organization (WHO), techniques to identify both Measles and Rubella viruses up to the genotype level are established at MRI. The necessary equipments and the trained technical officers are present at our institution.
In addition to issuing reports to patients, data is forwarded to the Global Measles / and Rubella programme. This is very important for implementing strategies for control and prevention of these two viruses.
Due to the recent dilemma regarding vaccination for Rubella most people were reluctant to get their children vaccinated. This could be a main reason for decline in immunity towards Rubella.
Improving the compliance of vaccination by educating the public and identifying infections early are important steps that have to taken in order to eradicate measles and Rubella from our country. This is task that has to be taken seriously by all of us.
 
Dr. G. Wickramasinghe
Consultant Virologist
Head/Dept of Virology
Medical Research Institute

Role of MRI in Polio eradication

Outbreaks of Polio have been reported from time to time. In 1980’s more than 350 000 Polio cases were reported from more than 125 countries.
 
During the World Health Assembly held in 1988, a resolution was taken to eradicate Polio by year 2000. Member countries of the World Health Assembly including Sri Lanka were committed. World Health Organization (WHO) launched the Global Polio Eradication Initiative. Two main strategies adopted to eradicate Polio from world were the adequate Polio vaccine coverage of children and surveillance of Polio.
 
Last case of Polio in Sri Lanka was detected in 1993. As India is still having Polio, South East Asian region of WHO is not certified as Polio free.
 
Because of the constant danger of importation of Polio virus to the country, it is very important to maintain a high vaccine coverage and a very sensitive surveillance program.
 
Polio Laboratory at the Medical Research Institute together with the Epidemiology unit maintains surveillance activity.
 
Polio laboratory at Medical Research Institute (MRI) started in 1968 at Colombo South Teaching Hospital. It was recognized as National Polio Laboratory 1988 by the WHO. It was upgraded to a Polio Regional Reference Laboratory (Polio RRL) in 1992.
 
Polio virus is isolated from the stool samples collected from patients with acute flaccid paralysis. Once the virus is isolated it is identified by a number of specialized tests including real time PCR assay.
Isolation results are sent to the clinicians. It is also sent to the Epidemiology unit to implement necessary control activities. Weekly compiled data is sent to the Regional Polio Program which monitors the Polio situation in the region.
 
Quality Assurance program is in place to maintain the standard of the Polio RRL. It is assessed and accredited annually by the WHO.
 
Polio RRL, Medical Research Institute is committed for the health of our children.
Dr. S. Gunasena
Consultant Virologist
Medical Research Institute

Quality Assurance of laboratory test results at the Medical Research Institute “We maintain quality and others to follow”

Quality is the degree of congruence between expectation and realization. It is the matching of expectations versus fulfillment. In other words quality means meeting the pre-determined requirements to the satisfaction of the users for a particular substance or a service. The three important cornerstones in health care are quality, access and cost which are interdependent. Quality is achieved when health services are accessible to the users and are provided in an efficient and cost effective way.
Accurate and reliable laboratory test results are required for the diagnosis and effective management of patients carried out by the clinicians. Unreliable laboratory results could have serious consequences. It could lead to inappropriate actions such as mistreatment of patients. Conversely, it could also lead to inappropriate inaction such as under-investigation of a disease when actually indicated or not instituting any treatment when required. The laboratory tests carried out at Medical Research Institute are reliable and accurate so that the clinicians are able to diagnose and treat patients effectively.
The Ministry of Health develops important policy decisions based on the laboratory test results generated from the national surveys and population studies done at the Medical Research Institute. Appropriate mass scale interventions are planned and carried out by the Ministry of Health to improve the health status of people in Sri Lanka. Internationally accepted laboratory based research depends on the reliable laboratory test results.
Quality Assurance is the sum total of all activities that are undertaken to ensure the generation of reliable and accurate results or data. This is equated with good laboratory practice and starts from test selection through obtaining a satisfactory sample from the right patient, analyzing it and recording the results promptly and correctly, to appropriate interpretation of and action on the result with all procedures being documented for reference.
Quality assurance has two components namely, Internal quality control programme(IOC) and External Quality Assessment (EQA). Internal quality control programme is a set of procedures undertaken by the healthcare professionals in their day to day activities to ensure the release of reliable results.
The three phases of Internal Quality Control programme are pre-analytical phase, analytical phase and post- analytical phase. The staff of Medical Research Institute is committed to establish and maintain an efficient internal quality control programmes in their respective specialities. The pre-analytical phase includes patient preparation, sample collection and transportation. The guidelines for the above procedures has been documented on “Diagnostic services available at Medical Research Institute“ published in 2010 and distributed to all the state sector hospital laboratories in Sri Lanka. This document describes the type of sample, the volume required, transport conditions and the turnaround time to ensure a quality test report. The sample receiving counter is open for 24 hours and appropriate documentation/ records are maintained at key points to ensure the traceability of the samples.
Documented validated analytical methods from the World Health Organization (W.H.O.) and the Food and Drugs Authority (F.D.A.) of USA are used in the laboratories at M.R.I to conform to the international standards.   Documented standard operation procedures developed based on the above methods have been distributed to the state sector hospital laboratories through the Ministry of Health. It will be made available at www.mri.gov.lk  for national and international reference.  The chemicals, reagents and equipment used in analytical procedures are approved by the Cosmetics Drugs and Devices Authority of Sri Lanka. The appropriate grades of chemicals and reagents (analytical, chromatographic, molecular biologic) with “CE” mark, are used in the analysis.
The reliability of the test reports depends on the performance of the equipment that is being used in the analysis. The periodic calibrations and maintenance of equipment are carried out to the maximum capability.
Quality control represents the procedures that monitor the performance parameters which will detect the source and magnitude of any possible errors and alert the laboratory personnel before releasing the results. Quality control is achieved by using internationally accepted standards, calibrators and quality control material. All the materials that are used for analysis are maintained in appropriate temperatures and are used well within the expiry dates.
The post analytical phase includes technical validation followed by clinical validation. The medical laboratory technologists perform the technical validation considering the documented raw data,   calibrator and quality control results, performance of equipment and other contributory factors such as sample collection. The clinical validation followed by the authorization to release the results is performed by the specialist medical officers of the relevant field. The final test reports prepared by the medical laboratory technologists are released by the authorized signatories.
The main objectives of the external quality assessment (EQA) schemes include the evaluation of the Internal Quality Control programme of a participating laboratory. Majority of the laboratory specialties at MRI are participants of internationally accepted EQA programmes run by the World Health Organization and Centre for Disease Control, Atlanta, USA.  Therefore, the laboratory analysis is being monitored at defined regular intervals by independent external bodies confirming the reliability of test results issued from the MRI.
The Medical Research Institute function as the national organizers of external quality assessment schemes in the areas of clinical chemistry, bacteriology and haematology.
NEQAS (National External Quality Assurance Scheme) in clinical chemistry covers 9 provinces including 75 state sector hospital labs. EQA samples are distributed bimonthly to cover 13 routine biochemical tests that are done in peripheral laboratories. This EQA sample is a ‘’blind’’, freeze dried QC with established traceability to international standards. The stability is maintained and transported in ambulances to the relevant destinations. The performance of each participating laboratories is assessed by a scoring system and appropriate technical advices are given to improve the test performance in these hospital laboratories.
NEQAS in Bacteriology covers 9 provinces including 40 state sector hospital labs and 15 private sector laboratories. EQA sample comprises of 3 pure bacterial cultures distributed quarterly. The participants perform the identification of the bacteria and antibiotic sensitivity test. The performance is evaluated by a scoring system and an annual evaluation report is given for overall performance of the laboratory.
The recently commenced NEQAS in Haematology covers 10 state sector labs with a quarterly distribution. The components of a full blood count are sent to the participants and their performance is assessed by consensus results.
Our goal is to achieve accreditation in compliance with the ISO 15189 standard in the near future with the assistance of the Ministry of Health.

“We maintain quality and others to follow”

Dr Meliyanthi M. Gunatillaka,( 2012)
Late Consultant Chemical Pathologist and 
Head, Department of Biochemistry, Medical Research Institute, Colombo 

Are Parasites going to invade us?

The Medical Research Institute consists the only Parasitology laboratory which belongs to the Ministry of health and Nutrition in Sri Lanka. Therefore an unidentified or rarely found parasite from any hospital in the country is directed to the Dept. of Parasitology, MRI for further investigations. Patients suspected of suffering from any uncommon parasitic infections are sent here for diagnosis and management. Other than that various hospitals and other institutes consult us regarding advice on parasitic infections.
During the recent past we were able to identify about 6 parasites for the first time in Sri Lanka causing disease in Sri Lankan patients. Other than that we have identified 8 rare parasitic species from humans and where necessary we have given appropriate anti parasitic drugs to evacuate these parasites from the intestines.
We have done special investigations on parasitic diseases. Among them one important disease is toxoplasmosis. If a pregnant mother acquires this infection during pregnancy it can cause abortions, still births, hydrocephaly, microcephaly etc. We, the dept. of Parasitology organized several programs and workshops to educate people and also the doctors on toxoplasmosis.
In 2001, the specific anti Toxoplasma drugs were brought to Sri Lanka on our request. For the first time in Sri Lanka a clinic to treat patients suffering from toxoplasmosis was conducted at the dept. of Parasitology, MRI. Among the patients whom we treated there were patients who were at the verge of death at government hospitals as well as private hospitals. We were able to save their lives and send them home.
Due to the time constrain we are bound to speak only about few parasites and patients today. Nevertheless if you are interested to see the cases I have mentioned above, you can contact us and visit the department of Parasitology.
Dr.Sagarika Samarasinghe
Consultant Parasitologist/Head Dept. of Parasitology
Medical Research Institute

Towards Enhancing Sri Lankans Lives through Better Nutrition

In 1920, the De Soyza Bacteriological Institute (presently known as MRI) was established. Dr. Lucian A. Nicolas founded the Department of Nutrition in 1926 in order to calculate wages by looking at food patterns in the county.
 
During the dietary surveys, many deficiencies were identified throughout the Nation. To overcome these issues, ‘Thriposha’ was invented and distributed throughout the country while maintaining a regular monitoring system. Over time, ‘Thriposha’ was accepted internationally as a world-renowned supplementary food. Throughout the years, the Department published Food Composition Tables of Sri Lanka using available food analysis to identify the nutrients in Sri Lankan food. Along with this, social benefit programmes (Coupon systems, Food Rations, Samurdhi), consumer Recommended Daily Allowances and estimation of the amount of food needed for the country were established.
 
The Department contains the field unit, laboratory and research co-ordination and information unit. The field unit consists of highly recognised staff involved in; data collection, anthropological surveys and measurements, sample collection and dietary surveys in the field. The accredited laboratory unit possesses urinary iodine, salt iodine, food and vitamin and mineral testing facilities with highly trained staff. We also have the wealth of experienced data analysts, statisticians, and consultant community physicians that contribute to our Department.
 
Throughout the years, we have done abundant surveys such as monitoring childhood Vitamin A status, malnutrition states and iron deficiency both routinely and in emergency situations. We have essentially reached iodine deficiency elimination throughout Sri Lanka. As well as successful surveys, the Department is involved in undergraduate and postgraduate training of medical and non-medical personnel, conferences, media seminars, and public education via official website and blog, printed and electronic media and the Nutrition Information Centre.
 
Currently, we are in the process of employing novel approaches for bettering the nutritional status in Sri Lanka, such as to eliminate iron deficiencies through Double Fortification of Salt.
 
Overall, we have gained many successes with the involvement of all the medical and non-medical sectors, advocacy for policy makers and capacity building of health personnel. The Department of Nutrition is the pioneer Department of conducting nutritional related research in Sri Lanka, since 1920s and we hope to achieve more in the future for bettering the nutritional status in our Nation.
 
Dr. R. Jayatissa
Consultant Medical Nutritionist
Head, Department of Nutrition
Medical Research Institute

Unique case…… Unique contributions……

Diagnosis of previously lethal, undiagnosed immune deficiencies
4 month old baby presented in 2005 with an unexplained family history of 15 deaths in males in 3 generations. Investigations done at the Immunology Department of MRI revealed the diagnosis as X linked severe combined immunodeficiency (SCID . The baby succumbed to the condition. In 2010 the mother presented at 20 weeks of pregnancy. A scan revealed that it was a male baby. His blood was tested at Department of Immunology and the diagnosis was confirmed as SCID. The genetic unit of the Faculty of Medicine too confirmed the diagnosis by gene sequencing. After birth he underwent a stem cell transplant (bone marrow transplant) in India. He celebrated his 1^st birthday on the 15^th of July.
Another baby whose brother had died at 3 months was also diagnosed as having the same disease & has been referred to USA for gene therapy.
 Bubonic plague – how an epidemic was averted in Sri Lanka
Plague is a disease which has caused millions of deaths in the past. Eg. In the 14^th century 1/3^rd of the world’s population succumbed to this disease. Plague is transmitted from infected rats to humans via fleas. There is human to human transmission through respiratory secretions. An outbreak of plague in India occurred in 1994. A sailor from a Russian ship, which had called at Mumbai port, developed symptoms similar to plague. The ship docked at the Colombo Port, and a team from MRI headed by the late Dr. RSB Wickremasinghe, Consultant Microbiologist, visited the ship. Investigations at the MRI confirmed the diagnosis of plague. The rats in the harbor were screened for infected fleas. The measures taken by the MRI averted a major epidemic.
 
Diagnosis of rare fungal diseases
The Department of Mycology is the reference laboratory for the diagnosis of fungal infections. A 1 ½ year old child from a remote village off Badulla presented with a lump on the nose and swelling of the eye. A tumour was suspected and biopsy taken. The department of Mycology isolated a fungus, rarely diagnosed, Sakesenia varsiformis. This fungus has been identified in only 26 patients worldwide. The patient was appropriately treated.
Diagnosis of bleeding disorders
Two sisters from Jaffna aged 16 and 18 years were referred to heamatology department of MRI with recurrent episodes of bleeding. Their brother had died due to bleeding in to the brain platelet function test done at MRI revealed Glanzmanns Disease and the diseased sisters will be treated appropriately.
Electron microscopy
The MRI has 2 electron microscopes, a scanning and a transmission microscope. The transmission microscope is the only one in Sri Lanka. These can magnify specimens
X 500,000. The electron microscope can be used on biological specimens from human, animal and plant tissue, to identify the ultrastructure of cells and tissue and identify viruses. They can be used on non biological specimen, such as nano particles, as has been done at the MRI.
Animal centre
The MRI animal centre has produced antibodies used in the diagnosis of viral and bacterial pathogens of plants, including those attacking coconut plants, potato, lime, pineapple and anthurium. This work was carried out in collaboration with the Plant virus indexing centre, Department of Agriculture.
Dr.R. de Silva
Consultant Immunologist
Medical Research Institute

Taking research to the next level

On average the MRI does about 15 research projects for a year. Research Topics are selected on the requirement of the Ministry of Health, and the requirements of Doctors/Scientists working at MRI, Post graduate students and other collaborating research institutions. Funds for research are obtained from the Ministry of Health, from international Donor Agencies Such as WHO, JICA, WB, and ADB. A major source of potential funding is from doing contract research especially from the Pharmaceutical industry in the form of clinical trials. This source is grossly underutilized at present.
The benefits of research done at MRI are for the individuals as well as the State as shown by the following examples.

• The pioneering research done ay MRI helped to introduce the Intradermal Regimen for Post Exposure Prevention of Rabies. The savings due do this regimen runs into millions of rupees annually.
• Research done at the Department of nutrition has identified Iodine deficiency as the cause for endemic goiter in Sri Lanka. As a result adding of Iodine was made mandatory by law to common salt and the incidence   of goiter is now greatly reduced.
• The types of   immunodefficiecy related diseases and their prevalence   was virtually unknown in Sri Lanka. Due to the research done in MRI the types of immunodefficiecy disease, there extent and the best mode of management of such disease have all bee been documented. Patients suffering from allergy now have the opportunity to have their diseases diagnosed and obtain appropriate advice on therapy to minimize the ill effects of their allergic condition.
• Pioneering research done by the entomology department of the MRI on the use of bacteria for control of mosquito larvae led to the use of BTI bacteria in the control of Dengue Fever.

 
Major constraints for research

• Lack of staff trained in research
• Lack of funds
• Lack of research culture

 
The Future
Sri Lanka is one of the lowest spending countries on R & D. Although our per capita income is above that of India we spend only 0.17 of GDP on research and development as opposed to India which   spends 0.8% of GDP on R and D.  As a result of this investment great advances have being made in research and development in India.
The money spent on research should be considered as a long term investment. The benefits of this  long term investment  would  be
 

• To retain the best Human recourses  for R and D in this country
• To inculcate a research culture in  future generations
• Self reliance on modern technology.
• Rapid growth of High Tech based industry in the fields of Engineering and Medicine

 
The MRI should have its own budgetary allocation for research. For a research institute to function efficiently there should be a certain degree of flexibility and autonomy given to that institute. Financial autonomy will allow the research institutes like MRI to carry out contract research in collaboration with other institutes and Industry. The monies collected from these projects could be utilized not only for the day to day activities of the institute but also to enhance its output in the   following manner

• Hire staff of all categories to conduct and carry out  research projects on a contract basis
• Provide the best training for staff at MRI by sending them for training workshops seminars and fellowships
• Conduct its own educational programs such as training courses, seminars and work shops
• Purchase  equipment reagents and chemicals for use in R and D activities

 
Dr. J. Munasinghe
Consultant Clinical  Pharmacologist( Consultant Physician)
Head ,Department of Pharmacology
Medical Research Institute