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What is this ‘black fungus’ infection?

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By Dr. Kavindya Marapana

Sri Lanka is in the process of recovering from the most severe COVID-19 wave, dominated by the Delta strain. At the time of writing, 513,278 cases of COVID-19 had been confirmed from all parts of the country with 12,600 deaths. It has affected physical and mental health, the economy, education and the overall wellbeing of people across the globe.

The government and relevant authorities are fighting the pandemic effectively, utilising the relevant healthcare services and facilities to manage patients, aided by lockdowns and the ongoing COVID-19 vaccination programme. More than 50 percent of the population have received both doses of vaccines.

Meanwhile, several cases of ‘black fungus’ infections have been reported among COVID-19 patients in hospitals in Colombo, Kurunegala and Ratnapura. With the experience of our neighbouring country India, reporting more than 45,000 cases of black fungus infection among COVID-19 patients, causing more than 4,300 deaths, it is of utmost importance for us to be aware of this condition and to adopt preventive measures to avoid such a deleterious situation.

Consultant Mycologist of Medical Research Institute, Colombo, Dr. Primali Jayasekera, in a brief interview with The Island, answers some frequently asked questions about the black fungus infection.

Q: What is ‘black fungus’ infection?

It is a rare but life-threatening fungal infection, known as mucormycosis and colloquially as ‘black fungus’, caused by fungi belonging to the Mucorales group.

Q: Is this infection new to Sri Lanka?

Mucormycosis has been diagnosed among immunocompromised patients (patients with weakened immune systems) in Sri Lanka, over the years, and it is not an uncommon infection among Sri Lankans. It has a worldwide distribution. Found ubiquitous in soil and decomposing organic matter. It can be found indoors and outdoors, in rotten food and dust. In addition, being a temperate country, Sri Lanka has the optimum temperature for the fungi to grow.

Q: How would someone get infected by it?

Most infections occur following inhalation of fungal spores in the air. As a result, nasal sinuses and lungs are the commonest initial sites of infection. Skin infections have also been reported following traumatic inoculation and following injections. Cases have been reported following ingestion of contaminated food as well.

Q. Who is at risk of getting infected?

Patients with prolonged or profound neutropenia (low neutrophils in blood), diabetes mellitus (type I and II), metabolic acidosis, malnutrition, steroid users, bone-marrow transplant recipients, solid organ transplant recipients, patients with haematological malignancies (blood cancers), patients with burn injuries and injection drug users are at risk of developing this infection. It has also been detected among some patients with no apparent immunological defects.

Q. Are COVID-19 patients at a higher risk of getting infected?

Some COVID-19 patients are being treated for cytokine storm, and this is essential. But if such a patient has a weakened immune system, due to some other cause, he or she is more susceptible to mucormycosis infection, compared to a non-COVID-19 infected person with a weak immune system.

Q. What are the symptoms suggestive of the infection?

It depends on the site of infection. The commonest sites of infection are the nasal and adjacent sinuses (rhino cerebral mucormycosis) and lungs. Patients can present with fever, facial swelling (affecting one side of the face), unilateral headache, nasal or sinus congestion or pain and a blood-tinged nasal discharge.

Characteristic diagnostic signs include necrotic black ulceration on the hard palate or nasal turbinates, drooping eyelids, proptosis (protrusion of eyes), ophthalmoplegia (eye muscles not working properly), loss of vision and oozing of black pus from eyes.

Q. How is it treated? What complications can one develop?

Surgical excision and antifungal drugs are mandatory in treatment. Complications include infection spreading to the eye socket, swelling around the nose and eyes with progressive destruction of facial tissues. Infection can spread to the brain affecting the frontal lobe and form abscesses within the brain.

Q. How can one prevent infection?

It can be prevented by

• Adequate control of diabetes mellitus.

• In immunocompromised individuals, reducing the sources of environmental exposure (refraining from gardening, consumption of old and contaminated food, use of contaminated surgical dressing, syringes and such) and avoiding inhalation of spores during critical periods.

• Avoiding contact with COVID-19 patients or suspected individuals.

• Taking both doses of COVID-19 vaccine.

• Always using a clean face mask.

• If diagnosed with COVID-19, receiving treatment from a qualified doctor, as self-medicating with western medicine is very dangerous due to side effects which can make you more susceptible to mucormycosis.

Consequently, it is observed that some individuals are at higher risk of developing conditions such as black fungus infection during COVID-19 infection, and this can lead to severe disability and even death due to already existing comorbidities, as opposed to healthy individuals.

Therefore, it is our duty as responsible citizens to adhere to health guidelines, get fully vaccinated and help control and eventually eliminate this pandemic.



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Encouraging signs, indeed!

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Derek and Manilal

Local entertainers can now breathe a sigh of relief…as the showbiz scene is showing signs of improving

Yes, it’s good to see Manilal Perera, the legendary singer, and Derek Wikramanayake, teaming up, as a duo, to oblige music lovers…during this pandemic era.

They will be seen in action, every Friday, at the Irish Pub, and on Sundays at the Cinnamon Grand Lobby.

The Irish Pub scene will be from 7.00 pm onwards, while at the Cinnamon Grand Lobby, action will also be from 7.00 pm onwards.

On November 1st, they are scheduled to do the roof top (25th floor) of the Movenpik hotel, in Colpetty, and, thereafter, at the same venue, every Saturday evening.

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Constructive dialogue beyond international community

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by Jehan Perera

Even as the country appears to be getting embroiled in more and more conflict, internally, where dialogue has broken down or not taken place at all, there has been the appearance of success, internationally. President Gotabaya Rajapaksa will be leading a delegation this week to Scotland to attend the UN Climate Change Conference (COP26). Both the President, at the UN General Assembly in New York, and Foreign Minister Prof G L Peiris, at the UN Human Rights Council, in Geneva seem to have made positive impacts on their audiences and, especially amongst the diplomatic community, with speeches that gave importance to national reconciliation, based on dialogue and international norms.

In a recent interview to the media Prof Peiris affirmed the value of dialogue in rebuilding international relations that have soured. He said, “The core message is that we believe in engagement at all times. There may be areas of disagreement from time to time. That is natural in bilateral relations, but our effort should always be to ascertain the areas of consensus and agreement. There are always areas where we could collaborate to the mutual advantage of both countries. And even if there are reservations with regard to particular methods, there are still abundant opportunities that are available for the enhancement of trade relations for investment opportunities, tourism, all of this. And I think this is succeeding because we are establishing a rapport and there is reciprocity. Countries are reaching out to us.”

Prof Peiris also said that upon his return from London, the President would engage in talks locally with opposition parties, the TNA and NGOs. He spoke positively about this dialogue, saying “The NGOs can certainly make a contribution. We like to benefit from their ideas. We will speak to opposition political parties. President Gotabaya Rajapaksa is going to meet the Tamil National Alliance on his return from COP26, which we will attend at the invitation of the British Prime Minister. So be it the NGO community or the foreign diaspora or the parliamentary opposition in Sri Lanka. We want to engage with all of them and that is very much the way forward”

INTERNAL FRAGMENTATION

The concept of a whole-of-government approach is indicative of a more cohesive approach to governance by government ministries, the public administration and state apparatus in general to deal with problems. It suggests that the government should not be acting in one way with the international community and another way with the national community when it seeks to resolve problems. It is consistency that builds trust and the international community will trust the government to the extent that the national community trusts it. Dialogue may slow down decision making at a time when the country is facing major problems and is in a hurry to overcome them. However, the failure to engage in dialogue can cause further delays due to misunderstanding and a refusal to cooperate by those who are being sidelined.

There are signs of fragmentation within the government as a result of failure to dialogue within it. A senior minister, Susil Premajayantha, has been openly critical of the ongoing constitutional reform process. He has compared it to the past process undertaken by the previous government in which there was consultations at multiple levels. There is a need to change the present constitutional framework which is overly centralised and unsuitable to a multi ethnic, multi religious and plural society. More than four decades have passed since the present constitution was enacted. But the two major attempts that were made in the period 1997-2000 and again in 2016-2019 failed.

President Rajapaksa, who has confidence in his ability to stick to his goals despite all obstacles, has announced that a new constitution will be in place next year. The President is well situated to obtain success in his endeavours but he needs to be take the rest of his government along with him. Apart from being determined to achieve his goals, the President has won the trust of most people, and continues to have it, though it is getting eroded by the multiple problems that are facing the country and not seeing a resolution. The teachers’ strike, which is affecting hundreds of thousands of schoolchildren, is now in its fourth month, with no sign of resolution. The crisis over the halting of the import of chemical fertiliser is undermining the position of farmers and consumers at the present time.

EARLY WARNING

An immediate cause for the complaints against the government is the lack of dialogue and consultation on all the burning issues that confront the country. This problem is accentuated by the appointment of persons with military experience to decision-making positions. The ethos of the military is to take decisions fast and to issue orders which have to be carried out by subordinates. The President’s early assertion that his spoken words should be taken as written circulars reflects this ethos. However, democratic governance is about getting the views of the people who are not subordinates but equals. When Minister Premajayantha lamented that he did not know about the direction of constitutional change, he was not alone as neither does the general public or academicians which is evidenced by the complete absence of discussion on the subject in the mass media.

The past two attempts at constitutional reform focused on the resolution of the ethnic conflict and assuaging the discontent of the ethnic and religious minorities. The constitutional change of 1997-2000 was for the purpose of providing a political solution that could end the war. The constitutional change of 2016-19 was to ensure that a war should not happen again. Constitutional reform is important to people as they believe that it will impact on how they are governed, their place within society and their equality as citizens. The ethnic and religious minorities will tend to prefer decentralised government as it will give them more power in those parts of the country in which they are predominant. On the other hand, that very fact can cause apprehension in the minds of the ethnic and religious majority that their place in the country will be undermined.

Unless the general public is brought aboard on the issue of constitutional change, it is unlikely they will support it. We all need to know what the main purpose of the proposed constitutional reform is. If the confidence of the different ethnic and religious communities is not obtained, the political support for constitutional change will also not be forthcoming as politicians tend to stand for causes that win them votes. Minister Premajayantha has usefully lit an early warning light when he said that politicians are not like lamp posts to agree to anything that the government puts before them. Even though the government has a 2/3 majority, this cannot be taken for granted. There needs to be buy in for constitutional reform from elected politicians and the general public, both from the majority community and minorities, if President Rajapaksa is to succeed where previous leaders failed.

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JAYASRI twins…in action in Europe

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The world over, the music scene has been pretty quiet, and we all know why. This pandemic has created untold hardships for, practically, everyone, and, the disturbing news is that, this kind of scene has been predicted for a good part of 2022, as well,

 

The band JAYASRI, however, based in Europe, and fronted by the brothers Rohitha and Rohan, say they are fortunate to find work coming their way.

Over the past few months, they have been performing at some of the festivals, held in Europe, during the summer season.

Says Rohitha: “As usual, we did one of the biggest African festivals in Europe, AfrikaTage, and some other summer events, from July up to now. Some were not that big, as they used to be, due to the pandemic, health precautions, etc.”

For the month of October, JAYASRI did some concerts in Italy, with shows in the city of Verona, Napoli, Rome, Padova and Milano.

The twins with the
late Sunil Perera

On November, 12th, the JAYASRI twins, Rohitha and Rohan, will be at EXPO Dubai 2020 and will be performing live in Dubai.

Rohitha also indicated that they have released their new single ‘SARANGANA,’ describing it as a Roots Reggae song, in audio form, to all download platforms, and as a music video to their YouTube channel – www.youtube.com/user/jayasri

According to Rohitha, this song will be featured in an action drama.

The lyrics for ‘SARANGANA,’ were created by Thushani Bulumulle, music by JAYASRI, and video direction by Chamara Janaraj Pieris.

There will be two audio versions, says Rohitha – a Radio Mix and a DUB Mix by Parvez.

The JAYASRI twins Rohitha and Rohan

After their Italian tour, Rohitha and Rohan are planning to come to Sri Lanka, to oblige their many fans, and they are hoping that the showbiz scene would keep on improving so that music lovers could experience a whole lot of entertainment, during the forthcoming festive season.

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