Laparoscopy versus open appendectomy- a Comparison of outcome

Objectives: To assess the effectiveness of Laparoscopic appendectomy over open appendectomyMethods: The study was done using the secondary data from the bed head tickets of the surgery wards in Teaching Hospital Kurunegala among 117 patients who were undergone appendectomy from 2014.04.01- 2014.09.30. The bed head tickets of the patients undergone appendectomy were selected randomly.Results: Sixty nine males (59%) and forty eight females (41%) were undergone appendectomies. Eighty one (68%) had undergone laparoscopy appendectomy (mean age 24 years) and 36 (32%) had undergone open appendectomy (mean age 26 years). Abscesses were seen among 42 (36%) appendectomies: 26 (22%) among laparoscopic surgeries and 16 (14%) among open surgeries. Lesser post-operative days (mean- 3.35 days) were among laparoscopy surgeries compared to open appendectomies (3.69 days) which is not statistically significant (p>0.05). Average time of anesthesia is higher among laparoscopy surgeries (44 min) over open appendectomy (30.67 min) which is statistically significant (t=2.7, p= 0.01).Conclusions: Considering the complications of surgery (post operative surgical site infections and ileus), post-operative days and cosmetic reasons, laparoscopic surgery is better option over the open appendectomy for both complicated (appendicular abscesses) and uncomplicated appendicitis.

Prevalence and risk factors for impaired kidney function in the district of Anuradhapura, Sri Lanka: a cross-sectional population-representative survey in those at risk of chronic kidney disease of unknown aetiology.

BACKGROUND: Over the last 20 years there have been reports of a form of chronic kidney disease of unknown cause (CKDu) affecting rural communities in the North Central Province of Sri Lanka. Valid prevalence estimates, using a standardised methodology, are needed to assess the burden of disease, assess secular trends, and perform international comparisons. METHODS: We conducted a cross-sectional representative population survey in five study areas with different expected prevalences of CKDu. We used a proxy definition of CKDu involving a single measure of impaired kidney function (eGFR< 60 mL/min/1.7m2, using the CKD-Epi formula) in the absence of hypertension, diabetes or heavy proteinuria. RESULTS: A total of 4803 participants (88.7%) took part in the study and 202 (6.0%; 95% CI 5.2-6.8) had a low eGFR in the absence of hypertension, diabetes and heavy proteinuria and hence met the criteria for proxy CKDu. The proportion of males (11.2%; 95% CI 9.2-13.1) were triple than the females (3.7%; 95% CI 2.9-4.5). Advancing age and history of CKD among parents or siblings were risk factors for low GFR among both males and females while smoking was found to be a risk factor among males. CONCLUSIONS: These data, collected using a standardised methodology demonstrate a high prevalence of impaired kidney function, not due to known causes of kidney disease, in the selected study areas of the Anuradhapura district of Sri Lanka. The aetiology of CKDu in Sri Lanka remains unclear and there is a need for longitudinal studies to describe the natural history and to better characterise risk factors for the decline in kidney function

Prevalence and risk factors for impaired kidney function in the district of Anuradhapura, Sri Lanka: a cross-sectional population-representative survey in those at risk of chronic kidney disease of unknown aetiology

BACKGROUND: Over the last 20 years there have been reports of a form of chronic kidney disease of unknown cause (CKDu) affecting rural communities in the North Central Province of Sri Lanka. Valid prevalence estimates, using a standardised methodology, are needed to assess the burden of disease, assess secular trends, and perform international comparisons. METHODS: We conducted a cross-sectional representative population survey in five study areas with different expected prevalences of CKDu. We used a proxy definition of CKDu involving a single measure of impaired kidney function (eGFR< 60 mL/min/1.7m2, using the CKD-Epi formula) in the absence of hypertension, diabetes or heavy proteinuria. RESULTS: A total of 4803 participants (88.7%) took part in the study and 202 (6.0%; 95% CI 5.2-6.8) had a low eGFR in the absence of hypertension, diabetes and heavy proteinuria and hence met the criteria for proxy CKDu. The proportion of males (11.2%; 95% CI 9.2-13.1) were triple than the females (3.7%; 95% CI 2.9-4.5). Advancing age and history of CKD among parents or siblings were risk factors for low GFR among both males and females while smoking was found to be a risk factor among males. CONCLUSIONS: These data, collected using a standardised methodology demonstrate a high prevalence of impaired kidney function, not due to known causes of kidney disease, in the selected study areas of the Anuradhapura district of Sri Lanka. The aetiology of CKDu in Sri Lanka remains unclear and there is a need for longitudinal studies to describe the natural history and to better characterise risk factors for the decline in kidney function

The expression of plasmid mediated afimbrial adhesin genes in an avian septicemic Escherichia coli strain

An Escherichia coli strain (SEPT13) isolated from the liver of a hen presenting clinical signs of septicaemia had a LD50 of 4.0 × 105 CFU/ml in one-day-old chickens, expressed Ia, Ib, E1, E3, K and B colicins and aerobactin. The strain was ampicillin and streptomycin resistant, and found to have fimA, csgA and tsh DNA related sequences; it could adhere to and invade HEp-2 and tracheal epithelial cells, expressed fimbriae (observed by electron microscopy), and had five plasmids of 2.7, 4.7, 43, 56, and 88 MDa. Transposon mutagenesis of strain SEPT13, with transposon TnphoA, resulted in a mutant strain named ST16 that had a LD50 of 1.2 × 1012 CFU/ml. All other biological characteristics of strain ST16 were the same as those detected for strain SEPT13 except for the migration of an 88 MDa plasmid to the 93 MDa position indicating the insertion of the transposon into the 88 MDa plasmid. The 93 MDa plasmid of strain ST16 was transferred, by electroporation assay, to non-pathogenic receptor strains (E. coli strains K12 MS101 and HB101), resulting in transformant strains A and B, respectively. These strains exhibited adhesion properties to in vitro cultivated HEp-2 cells but did not have the capacity for invasion. The adherence occurred despite the absence of fimbriae; this finding suggests that the 88 MDa plasmid has afimbrial adhesin genes

Tannin extracts from immature fruits of Terminalia chebula Fructus Retz. promote cutaneous wound healing in rats

<p>Abstract</p> <p>Background</p> <p>Tannins extracted from immature fruits of <it>Terminalia chebula Fructus Retz</it>. are considered as effective components promoting the process of wound healing. The objective of this study is to explore the optimal extraction and purification technology (OEPT) of tannins, while studying the use of this drug in the treatment of a cutaneous wound of rat as well as its antibacterial effects.</p> <p>Methods</p> <p>The content of tannin extracts was measured by the casein method, and antibacterial ability was studied by the micro-dilution method in vitro. In wound healing experiment, animals in group Ⅰ, Ⅱ and Ⅲ were treated with vaseline ointment, tannin extracts (tannin content: 81%) and erythromycin ointment, respectively (5 mg of ointment were applied on each wound). To evaluate the process of wound healing, selected pharmacological and biochemical parameters were applied.</p> <p>Results</p> <p>After optimal extraction and purification, content of tannin extracts was increased to 81%. Tannin extracts showed the inhibition of <it>Staphylococcus aureus </it>and <it>Klebsiella Pneumonia </it>in vitro. After excision of wounds, on days 7 and 10, the percent of wound contraction of group Ⅱ was higher than that of group Ⅰ. After being hurt with wounds, on days 3, 7, and 10, the wound healing quality of group Ⅱ was found to be better than that of group Ⅰ in terms of granulation formation and collagen organization. After wound creation, on day 3, the vascular endothelial growth factor expression of group Ⅱ was higher than that of group Ⅰ.</p> <p>Conclusion</p> <p>The results suggest that tannin extracts from dried immature fruits of <it>Terminalia chebula Fructus Retz</it>. can promote cutaneous wound healing in rats, probably resulting from a powerful anti-bacterial and angiogenic activity of the extracts.</p

The mutagenic and antimutagenic effects of the traditional phytoestrogen-rich herbs, Pueraria mirifica and Pueraria lobata

Pueraria mirifica is a Thai phytoestrogen-rich herb traditionally used for the treatment of menopausal symptoms. Pueraria lobata is also a phytoestrogen-rich herb traditionally used in Japan, Korea and China for the treatment of hypertension and alcoholism. We evaluated the mutagenic and antimutagenic activity of the two plant extracts using the Ames test preincubation method plus or minus the rat liver mixture S9 for metabolic activation using Salmonella typhimurium strains TA98 and TA100 as indicator strains. The cytotoxicity of the two extracts to the two S. typhimurium indicators was evaluated before the mutagenic and antimutagenic tests. Both extracts at a final concentration of 2.5, 5, 10, or 20 mg/plate exhibited only mild cytotoxic effects. The plant extracts at the concentrations of 2.5, 5 and 10 mg/plate in the presence and absence of the S9 mixture were negative in the mutagenic Ames test. In contrast, both extracts were positive in the antimutagenic Ames test towards either one or both of the tested mutagens 2-(2-furyl)-3-(5-nitro-2-furyl)-acrylamide and benzo(a)pyrene. The absence of mutagenic and the presence of anti-mutagenic activities of the two plant extracts were confirmed in rec-assays and further supported by a micronucleus test where both plant extracts at doses up to 300 mg/kg body weight (equivalent to 16 g/kg body weight plant tuberous powder) failed to exhibit significant micronucleus formation in rats. The tests confirmed the non-mutagenic but reasonably antimutagenic activities of the two plant extracts, supporting their current use as safe dietary supplements and cosmetics

Prevalence of smoking among adult males in Colombo District, Sri Lanka

The study aimed to estimate prevalence of smoking among adult males in the district of Colombo Methods: A community based cross-sectional study drew a representative sample of males aged 20-59 years (n=1200) the district and the information on smoking was gathered using an interviewer-administered questionnaire designed based on the classification by the Centres for Disease Control and Prevention of United States. Results: Prevalence of ever smoking among adult males in Colombo district was 54.1% (95% CI 51.0-57.2). Prevalence of current smokers was 36.5% (95% CI 33.8%-39.3%) while prevalence of former smokers was 17.6% (95% CI 15.3%- 19.9%) Prevalence of ever smoking was higher among &gt;40 years old (p&lt;0.0001), with lower educational qualifications (p&lt;0.01), married (p=0.002) and not having children (p&lt;0.0001). Among current and former smokers, 98.0% (612/624) were consuming cigarettes while 9.9% (62/624) were bidi smokers. The current daily smokers smoked a significantly lesser number of mean cigarettes per day (7.7, SD=6.6) compared to former daily smokers (mean cigarettes per day 12.92, SD=15.5). Among current smokers 60.3% (n=254) had attempted to quit smoking at least once in their life with an average of 3.2 quit attempts. Conclusion: The prevalence of ever and current tobacco smoking among adult males in Colombo district was high. Smokers were more likely to beelders, less educated, married and without children and authorities should be advocated on focused efforts to prevent smoking among them. High rate of failed quit attempts indicate poor support which needs to be brought to the attention of the authorities

Mutagenicity, antimutagenicity and tyrosinase inhibition activity of hydroglycol extracts from Terminalia chebula Retzius, Terminalia bellerica Roxb and Rafflesia kerrii Meijer

The hydroglycolic extracts from Terminalia chebula Retzius, Terminalia bellerica Roxb and Rafflesia kerrii Meijer were investigated for total phenolic content (TPC), cytotoxicity, mutagenicity, antimutagenicity and antityrosinase for safety assessment as novel botanical-based cosmeceutical ingredients. These plant extracts showed TPC between 14.90 ± 0.02 and 112.40 ± 0.08 mg GAE g-1 of extract when using the Folin-Ciocalteu method. The cytotoxicity study revealed that the 50% cytotoxicity dose (CD50) towards normal mouse fibroblast L929 and mouse melanoma B16F10 cell lines was 5.43 ± 0.18 - 39.39 ± 0.14 mg mL-1 and 4.35 ± 0.33 - 58.23 ± 0.18 mg mL-1, respectively. In genotoxicity investigation, it was found that all extracts were not mutagenic at the concentrations up to 87.34 mg 0.1 mL-1 when tested with Salmonella typhimurium strains TA98 and TA100 in the presence and absence of metabolic activation (S9 microsomal fraction). The extracts were further tested for antimutagenic activity against 2-aminoanthracene (2-AA) and 2-(2-furyl)-3-(5-nitro-2-furyl) acrylamide (AF-2) which were used as the tested mutagens. Interestingly, all hydroglycolic extracts exhibited the inhibitory effect on the mutagenicity after being induced by 2AA and AF-2 in S. typhimurium strains TA98 and TA100 in the presence and absence of metabolic activation. All plant extracts were further investigated for tyrosinase inhibitory activity. Results showed that all extracts possessed tyrosinase inhibitory activity with 50% inhibitory concentration values (IC50) of 1.27 ± 0.49 - 39.96 ± 0.21 mg mL-1. Overall studies including their antimutagenicity and antityrosinase activities suggest that the hydroglycolic extracts of these three plants may be used as potential candidates for skin-care cosmeceutical ingredients

Burden of Diabetes Mellitus in a Community Resident in an Area Designated as “High Risk” for Chronic Kidney Disease of Unknown Origin in Sri Lanka

Chronic kidney disease (CKD) where etiology cannot be attributed to any known etiology is named CKD of uncertain etiology (CKDu). The main aims of this study were to assess the prevalence of diabetes mellitus (DM), treatment coverage, and glycemic control and its effect on renal function of patients with DM in a rural community affected by CKDu in Sri Lanka. A cross-sectional representative household survey (n = 4803) was conducted in Anuradhapura district. A random blood sugar (RBS), blood pressure, bio-impedance measurements, and renal profile were measured using standard instruments and protocols. Prevalence of DM based on self-reports verified by records was 7.9% (95% confidence interval [CI]: 7.1–8.7). Among the 4425 who did not give a history of being diagnosed ever as having DM, 2.1% (95% CI: 1.7–2.5) were classified as “possible diabetes” (RBS of more than 200 mg/dl with no history of DM). Although 76.2% were on treatment, glycemic control was poor in 40.2% (95% CI: 34.9–45.0). The presence of DM was associated with poor renal function. One in ten individuals in the rural district of Anuradhapura has possible DM. DM poses a significant burden to CKD even in populations affected by CKDu. Hence, public health initiatives should be implemented to control both CKDu and DM in these rural communities