Glycemic and Lipid Metabolic Markers in Type 2 Diabetes Mellitus Patients after Consuming Red Pigmented Parboiled Rice as a Staple—A Clinical Trial

Red pigmented rice has been proven to have unique properties beneficial to health. These might be further enriched if parboiled. This study investigated the effects of consumption of RPPR on glycemic response, lipid profile and BMI in diabetics. For this prospective study patients with diabetes mellitus (aged 40-75 yrs) in a prison (n = 69) were recruited. Their usual diet in prison was red pigmented rice. They were served 180 g of RPPR for 16 weeks during intervention period.Fasting Plasma Glucose (FPG) and BMI was assessed at 0, 4, 8, 12 weeks and glycated haemoglobin and lipid profile at 0 and 16 weeks. Values at 0 weeks were compared with those at 4, 8, 12, 16 weeks after consuming RPPR using ANOVA repeated measures. HBA1c and lipid profile at 16 weeks were compared with the 0 week value. During consumption of RPPR, FPG was significantly reduced at 8 (p = 0.006), 12 (p = 0.002), and 16 weeks (p = 0.005), with a significant reduction of the BMI at 8 (p = 0.028) and 16 weeks (p = 0.003). At the end of 16 weeks of consuming RPPR, LDL, Total Cholesterol (TC) and TC/HDL ratio were significantly reduced compared to 0 weeks (p = 0.001, p = 0.013, p = 0.032, respectively. These results suggest that RPPR consumption reduces FPG, LDL, TC,TC/HDL ratio and BMI

Two Cases of Ethylene Glycol Poisoning Treated Successfully with Haemodialysis

Introduction: Ethylene glycol is an organic toxic compound found in many household items including radiator coolants and brake oil. Toxic effects of ethylene glycol are due to its metabolites glycolic acid and oxalic acid which cause potentially fatal metabolic acidosis and renal failure. Here we discuss two cases of ethylene glycol poisoning with literature review on pathophysiology, clues in diagnosis and therapy. Case presentations: First case is of a teenage girl presenting with unexplained persistent drowsiness. She went on to develop acidotic breathing and anuria. Unexplained metabolic acidosis and acute kidney injury inclined us towards ethylene glycol poisoning. On further questioning, she confirmed taking radiator coolant 5 hours before admission. The second case is of a young automobile serviceman who presented with unexplained markedly reduced level of consciousness. He had high anion gap metabolic acidosis, calcium oxalate crystals in urine and basal ganglia hypodensities in non-contrast CT. He later developed acute kidney injury. Ethylene glycol poisoning was suspected which was later confirmed when the patient regained consciousness. Both patients responded well to haemodialysis and recovered without complications. Discussion: Ethylene glycol is an easily accessible toxic compound that can be used as a suicidal agent. High anion gap metabolic acidosis, acute kidney injury, calcium oxalate crystalluria and altered sensorium are highly suggestive. Conclusions: A high degree of suspicion is needed for early diagnosis. Haemodialysis can be used effectively to remove the toxic metabolites and treat the renal impairment. Early recognition will save lives without long term renal or neurologic complications

Nanoparticle Detection of Urinary Markers for Point-of-Care Diagnosis of Kidney Injury

The high incidence of acute and chronic kidney injury due to various environmental factors such as heavy metals or chemicals has been a major problem in developing countries. However, the diagnosis of kidney injury in these areas can be more challenging due to the lack of highly sensitive and specific techniques that can be applied in point-of-care settings. To address this, we have developed a technique called ‘micro-urine nanoparticle detection (μUNPD)’, that allows the detection of trace amounts of molecular markers in urine. Specifically, this technique utilizes an automated on-chip assay followed by detection with a hand-held device for the read-out. Using the μUNPD technology, the kidney injury markers KIM-1 and Cystatin C were detected down to concentrations of 0.1 ng/ml and 20 ng/ml respectively, which meets the cut-off range required to identify patients with acute or chronic kidney injury. Thus, we show that the μUNPD technology enables point of care and non-invasive detection of kidney injury, and has potential for applications in diagnosing kidney injury with high sensitivity in resource-limited settings

Chronic kidney disease of unknown aetiology in Sri Lanka: is cadmium a likely cause?

<p>Abstract</p> <p>Background</p> <p>The rising prevalence of chronic kidney disease (CKD) and subsequent end stage renal failure necessitating renal replacement therapy has profound consequences for affected individuals and health care resources. This community based study was conducted to identify potential predictors of microalbuminuria in a randomly selected sample of adults from the North Central Province (NCP) of Sri Lanka, where the burden of CKD is pronounced and the underlying cause still unknown.</p> <p>Methods</p> <p>Exposures to possible risk factors were determined in randomly recruited subjects (425 females and 461 males) from selected areas of the NCP of Sri Lanka using an interviewer administered questionnaire. Sulphosalicylic acid and the Light Dependent Resister microalbumin gel filtration method was used for initial screening for microalbuminuria and reconfirmed by the <it>Micral </it>strip test.</p> <p>Results</p> <p>Microalbumnuria was detected in 6.1% of the females and 8.5% of the males. Smoking (p < 0.001), alcohol use (p = 0.003), hypertension (p < 0.001), diabetes (p < 0.001), urinary tract infection (UTI) (p = 0.034) and consumption of water from wells in the fields (p = 0.025) were associated with microalbuminuria. In the binary logistic regression analysis, hypertension, diabetes mellitus, UTI, drinking well water in the fields, smoking and pesticide spraying were found to be significant predictors of microalbuminuria.</p> <p>Conclusions</p> <p>Hypertension, diabetes mellitus, UTI, and smoking are known risk factors for microalbuminuria. The association between microalbuminuria and consumption of well water suggests an environmental aetiology to CKD in NCP. The causative agent is yet to be identified. Investigations for cadmium as a potential causative agent needs to be initiated.</p

The costs in provision of haemodialysis in a developing country: A multi-centered study

<p>Abstract</p> <p>Background</p> <p>Chronic Kidney Disease is a major public health problem worldwide with enormous cost burdens on health care systems in developing countries. We aimed to provide a detailed analysis of the processes and costs of haemodialysis in Sri Lanka and provide a framework for modeling similar financial audits.</p> <p>Methods</p> <p>This prospective study was conducted at haemodialysis units of three public and two private hospitals in Sri Lanka for two months in June and July 2010. Cost of drugs and consumables for the three public hospitals were obtained from the price list issued by the Medical Supplies Division of the Department of Health Services, while for the two private hospitals they were obtained from financial departments of the respective hospitals. Staff wages were obtained from the hospital chief accountant/chief financial officers. The cost of electricity and water per month was calculated directly with the assistance of expert engineers. An apportion was done from the total hospital costs of administration, cleaning services, security, waste disposal and, laundry and sterilization for each unit.</p> <p>Results</p> <p>The total number of dialysis sessions (hours) at the five hospitals for June and July were 3341 (12959) and 3386 (13301) respectively. Drug and consumables costs accounted for 70.4-84.9% of the total costs, followed by the wages of the nursing staff at each unit (7.8-19.7%). The mean cost of a dialysis session in Sri Lanka was LKR 6,377 (US$56). The annual cost of haemodialysis for a patient with chronic renal failure undergoing 2-3 dialysis session of four hours duration per week was LKR 663,208-994,812 (US$ 5,869-8,804). At one hospital where facilities are available for the re-use of dialyzers (although not done during study period) the cost of consumables would have come down from LKR 5,940,705 to LKR 3,368,785 (43% reduction) if the method was adopted, reducing costs of haemodialysis per hour from LKR 1,327 at present to LKR 892 (33% reduction).</p> <p>Conclusions</p> <p>This multi-centered study demonstrated that the costs of haemodialysis in a developing country remained significantly lower compared to developed countries. However, it still places a significant burden on the health care sector, whilst possibility of further cost reduction exists.</p

Psychometric properties of End Stage Renal Disease-Adherence Questionnaire-Sinhalese version among patients receiving haemodialysis.

The chronic kidney disease is a leading public health concern, particularly in low-to middle-income countries, while the number of patients receiving haemodialysis is rapidly increasing. Adherence to a complex treatment regimen is vital for those patients on maintenance haemodialysis though the precise evaluation is reported inadequately. This study aimed to evaluate the psychometric properties of Sinhalese version of End Stage Renal Disease-Adherence Questionnaire (SINESRD-AQ) to assess treatment adherence behaviour among patients receiving haemodialysis in a Sri Lankan hospital. The cultural adaptation of ESRD-AQ involved forward and back translation, expert committee consolidation and pretesting among patients (n = 10). Face and content validity of the questionnaire was evaluated using a modified Delphi technique. Construct validity of the subscales of SINESRD-AQ was evaluated using confirmatory factor analysis (CFA). A descriptive cross-sectional study among a consecutive sample of 150 patients receiving haemodialysis in a selected Teaching hospital, Sri Lanka was involved in performing CFA. Reliability was confirmed with test-retest reliability. Excellent face and content validity were reported with Item level content validity index (0.83-1.0), Average Item level content validity index for whole scale (0.93), Item level content validity ratio (0.67-1.0) and modified kappa statistic coefficient (0.81-1.0). CFA of two subscales demonstrated better indices closure to the model fit with five- item two factor model for direct adherence behaviour subscale and eight-item two factor model for attitude/perception subscale. The intra class correlation coefficient of 0.837 (p<0.001) and 0.752 (p<0.001) indicated acceptable test-retest reliability of direct adherence behaviour and attitude/perception subscale respectively. The study confirmed SINESRD-AQ as a valid and reliable measure which enables periodic assessment of treatment adherence behaviour of the patients receiving haemodialysis in a Sri Lankan hospital

Assay validation.

<p>A, Assay set-up for urinary marker detection. B, μNMR signals using MNPs with different sizes. * = <i>p</i> < 0.02, ** = <i>p</i> < 0.001, ns = not significant. Detection sensitivity measurements using serial dilutions of recombinant KIM-1(C) and Cystatin C (D) in buffer solution. Inset in C shows data points in low ranges of KIM-1. ΔR2 = R2 (sandwich)—R2 (bead only). E,F, Detection of KIM-1 (E) and Cystatin C (F) in 100% and 20% urine, respectively. The urine used was from a healthy patient (no. 20) with ranges of KIM-1 and Cystatin C that were not detectable. Note that all the clinical samples (in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133417#pone.0133417.g003" target="_blank">Fig 3</a>) were analyzed based on the same dilution factors.</p