iRUFARS-2020

Identification of Biomarker Profile for Chronic Kidney Disease of uncertain aetiology in Sri Lanka

2020-10-02T00:00:00Z

Identification of Biomarker Profile for Chronic Kidney Disease of uncertain aetiology in Sri Lanka Fernando, W.B.N.T.; Nanayakkara, N. Background: Chronic Kidney Disease of uncertain aetiology (CKDu) is a major health problem in Sri Lanka. Current laboratory markers are not sensitive enough for early detection of CKDu. It is evident that a more efficient, sensitive and specific diagnostic procedure is needed for early detection and to confirm the diagnosis of CKDu. Objectives: To identify a representative biomarker profile for CKDu, Sri Lanka and to study the applicability of these biomarkers in identifying at risk population for screening and diagnosis of CKDu, Sri Lanka Methods: Girandurukotte and Wilgamuwa which are considered as CKDu endemic areas were selected for the study to recruit definite non-dialysis CKDu cases (n = 119), endemic CKD (n = 82) and endemic healthy controls (n = 79). Non-endemic CKD group (n = 85) and healthy controls (n = 85) were recruited from Kandy. Routine markers and novel biomarkers for CKDu were measured using serum and random urine of CKDu patients. The eight selected renal biomarkers were measured using multiplex biomarker assay, and the data were analyzed using logistic regression algorithm aiming to extract the best marker combination that could distinctly identify the disease groups noninvasively from the healthy controls. Data were analyzed using SPSS and R software. Results: Among the selected patients, 97 (81.5%) were males while 22 (18.5%) were females. Under routine markers, hyperuricemia, acidosis, hypomagnesemia, vitamin D deficiency, anemia, increased level of serum osmolality, amylase, Lactate Dehydrogenase and Alkaline Phosphatase were identified. Alpha1 microglobulin (A1M) stood out as the single strong candidate marker that was highly specific (84.7%) in identifying CKDu from healthy controls. Combination of A1M+ Kidney Injury Molecule 1 (KIM1) + Retinol Binding Protein 4 (RBP4) was able to accurately differentiate the disease groups (CKDu/CKD), from healthy controls. Combination of Osteopontin + KIM1+ RBP4 accurately predicted CKDu with high performance from a CKD background. Higher mean (±SD) value (69587 ng/mL) of Transforming Growth factor beta 1was obtained from the CKDu group compared to the other controls with a significant negative correlation (r = -0.293, p <0.01) with the serum creatinine. Conclusions: A representative biomarker profile has been identified for identification of risk population for screening and diagnosis of CKDu. Biomarker combinations are helpful to diagnose CKDu effectively and non-invasively.

Vitamin D deficiency and its associated factors: A descriptive study among a selected group of premenopausal women in Sri Lanka

2020-10-02T00:00:00Z

Vitamin D deficiency and its associated factors: A descriptive study among a selected group of premenopausal women in Sri Lanka Subasinghe, H.W.A.S.; Lekamwasam, S.; Ball, P.; Morrissey, H.; Waidyaratne, E.I. Background: Vitamin D (vit-D) plays a significant role in bone health, largely by regulation of calcium homeostasis in the body. Hypovitaminosis D is linked with a multitude of co morbidities. Many nutritional and behavioural factors are associated with low vit-D levels. Objectives: To assess the prevalence of vit-D deficiency and its associated factors in a sample of premenopausal women in Sri Lanka Methods: Community dwelling healthy women (free of diseases and drugs including vitamins) between 20-40 years (n = 132) were selected from Matara and Kandy districts. Consumption of vit-D rich dairy and non-dairy foods and the duration of sun exposure were estimated. Serum vit-D level was measured. Vit-D reference values introduced by Lips et al were used to categorize subjects. Results: Eight subjects (6.1%) were vit-D deficient while 68 (51.5%) had vit-D insufficiency. There was no difference in median vit-D levels according to age (20-30 vs 31-40 years). Vit-D was higher in women who had sun exposure >2 hours/day compared to women who had <2 hours/day. Vit-D positively associated with dairy (r = 0.189, p = 0.04) and non-dairy vit-D rich food intake (r = 0.263, p = 0.01). Conclusions: Hypovitaminosis D is prevalent among community dwelling healthy middle aged women in Sri Lanka. Interventions should be planned based on sun exposure and diet to overcome this prevalent problem.

Antimicrobial Activity of Two Selected Medicinal Plant Extracts against Propionibacterium acnes

2020-10-02T00:00:00Z

Antimicrobial Activity of Two Selected Medicinal Plant Extracts against Propionibacterium acnes Kumara, M.; Wijayaratne, W.M.D.G.B.; Attanayake, A.P.; Pathirage, S. Background: Acne vulgaris is a common skin condition seen among teenagers and young adults. The severe form of the condition can be distressing, because of pain and skin scarring. The commonest aetiological agent for the condition is Propionibacterium acnes (P. acnes) (new name – Cutibacterium acnes). There are many artificial and natural substances used in the treatment of acne. Objective: To determine the anti-microbial activity of selected medicinal plants extracts and a mixture of the selected plant extracts against Propionibacterium acnes Methods: Plant parts were collected, oven dried (40 ⁰C) and were subjected to soxhlet extraction procedure. The fractionated (hexane, ethyl acetate, methanol and aqueous) plant extracts of Centella asiatica (Family: Apiaceae, common name: Gotukola) and Ricinus communis (Family: Euphorbiaceae, common name: Edaru) were prepared. The main acne causative agent, P. acnes was used to determine the anti-microbial activity of the crude extracts of the plants. Agar well diffusion method was used to determine the crude anti-acne activity of all the extracts and the 1:1 mixture of the two extracts against P. acnes. Zones of inhibition were measured after 48 hours of incubation under anaerobic conditions. All the testings were triplicated. Minimum inhibitory concentrations (MIC) were detected by microtitre plate method, for the extracts which showed zones of inhibition in plate method. Results: Zones of inhibition for methanol, hexane, ethyl acetate and water extracts of Centella asiatica were 13.00, 13.00, 12.67 mm and for water and for Ricinus communis were 12.00, 10.67, 11.00 and 9.33 mm respectively. The zones of inhibition for methanol, hexane, ethyl acetate and water extracts were 12.00, 16.00, 13.30 and 8.67 mm respectively. The MIC of the methanol extract of Centella asiatica was 12.5 mg/mL and that of the hexane extract of Ricinus communis was 6.25 mg/mL. Conclusion: Methanol and hexane extracts of Centella asiatica (Gotukola) and Ricinus communis (Endaru) separately as well as 1:1 mixture exert antimicrobial effects against Propionibacterium acnes.

Nurses’ Perception on “Do Not Attempt Cardio Pulmonary Resuscitation” Decision Making

2020-10-02T00:00:00Z

Nurses’ Perception on “Do Not Attempt Cardio Pulmonary Resuscitation” Decision Making Sandaruk, M.A.C.; Dissanayake, A. Background: “Do Not Attempt Cardio Pulmonary Resuscitation” (DNACPR) is a difficult and challenging area for many healthcare workers. Nurses are frontline healthcare workers who contribute to the decision-making process. They are required to have a good understanding of decision making of DNACPR. Objectives: To ascertain the availability of formalized decision-making process, nurse’s satisfaction, whether nurses are observed the decision- making process and to experience who have made the DNACPR decision currently Methods: A hospital-based, descriptive cross-sectional study was conducted using a pre-tested questionnaire. A convenient sample of nurses working in Teaching Hospital Karapitiya was recruited to the study. Results: A total of 385 nurses were participated. It was noted that 76.1% of the nurses expressed as formalized decision-making process is not available for DNACPR. The 82.3% of the participants reported that they were not satisfied with current methods. Only 84.2% had observed DNACPR decision making process. Results showed nurses never made the decision and only 0.5% observed the patient’s family involvement. There were 72.2% of nurses who experienced that doctors did not discuss with nurses while making decision. Data showed nurse’s contribution is in very low level for making DNACPR decision. Around 56% of nurses have suggested that patient’s decision is required for the decision-making process and 82.3% responded as doctors must do a discussion before deciding action. Conclusions: Most of the nurses expressed that there is no formalized decision-making process, when DNACPR decision been made and dissatisfied about the current method. According to the nurse’s perception, nurses’ and patients’ contribution for DNACPR is very low.