Serum creatinine and cystatin C provide conflicting evidence of acute kidney injury following acute ingestion of potassium permanganate and oxalic acid

AIM: Acute kidney injury (AKI) is common following deliberate self-poisoning with a combination washing powder containing oxalic acid (H2C2O4) and potassium permanganate (KMnO4). Early and rapid increases in serum creatinine (sCr) follow severe poisoning. We investigated the relationship of these increases with direct nephrotoxicity in an ongoing multicenter prospective cohort study in Sri Lanka exploring AKI following poisoning. METHODS: Multiple measures of change in kidney function were evaluated in 48 consenting patients who had serial sCr and serum cystatin C (sCysC) data available. RESULTS: Thirty-eight (38/48, 79%) patients developed AKI (AKIN criteria). Twenty-eight (58%) had AKIN stage 2 or 3. Initial increases in urine creatinine (uCr) excretion were followed by a substantial loss of renal function. The AKIN stage 2 and 3 (AKIN2/3) group had very rapid rises in sCr (a median of 118% at 24 h and by 400% at 72 h post ingestion). We excluded the possibility that the rapid rise resulted from the assay used or muscle damage. In contrast, the average sCysC increase was 65% by 72 h. CONCLUSIONS: In most AKI, sCysC increases to the same extent but more rapidly than sCr, as sCysC has a shorter half-life. This suggests either a reduction in Cystatin C production or, conversely, that the rapid early rise of sCr results from increased production of creatine and creatinine to meet energy demands following severe oxidative stress mediated by H2C2O4 and KMnO4. Increased early creatinine excretion supports the latter explanation, since creatinine excretion usually decreases transiently in AKIN2/3 from other causes.NHMRC Project grant 101177

Programmatic use of molecular xenomonitoring at the level of evaluation units to assess persistence of lymphatic filariasis in Sri Lanka

BACKGROUND:Sri Lanka's Anti Filariasis Campaign distributed 5 rounds of mass drug administration (MDA with DEC plus albendazole) to all endemic regions in the country from 2002-2006. Post-MDA surveillance results have generally been encouraging. However, recent studies have documented low level persistence of Wuchereria bancrofti in Galle district based on comprehensive surveys that include molecular xenomonitoring (MX, detection of filarial DNA in mosquitoes) results. The purposes of this study were to demonstrate the use of MX in large evaluation units (EUs) and to field test different mosquito sampling schemes. METHODOLOGY/PRINCIPAL FINDINGS:Galle district (population 1.1 million) was divided into two EUs. These included a coastal EU with known persistent LF and an inland EU with little persistent LF. Mosquitoes were systematically sampled from ~300 trap locations in 30 randomly selected clusters (health administrative units) per EU. Approximately 28,000 Culex quinquefasciatus were collected with gravid traps and tested for filarial DNA by qPCR. 92/625 pools (14.7%) from the coastal EU and 8/583 pools (1.4%) from the inland EU were positive for filarial DNA. Maximum likelihood estimates (MLE) for filarial DNA rates were essentially the same when the same number of mosquito pools were collected and tested from 75, 150, or 300 trap sites (range 0.61-0.78% for the coastal EU and 0.04-0.07% for the inland EU). The ability to use a smaller number of trap sites reduces the cost and time required for mosquito sampling. CONCLUSIONS/SIGNIFICANCE:These results suggest there is widespread persistence of W. bancrofti infection in the coastal Galle EU 8 years after the last round of MDA in 2006, and this is consistent with other data from the district. This study has shown that MX can be used by national programs to assess and map the persistence of W. bancrofti at the level of large EUs in areas with Culex transmission

Inhibition of in vitro mycelial growth of Sclerotinia sclerotiorum by biofumigant crops

Sclerotinia sclerotiorum has been identified as a significant pathogen infecting a wide range of plants, including economically important vegetable crops in New Zealand. Biofumigant crops, especially members of the Brassica family, are reported to inhibit the survival, growth and reproduction of many fungi. The present study focused on assessing the biofumigation effect of four selected crops on in vitro mycelial growth of S. sclerotiorum. Four different biofumigant crops, i.e. Brassica juncea (‘Caliente 199’), Brassica juncea (unknown), Eruca sativa (‘Nemat’), Sinapis alba (‘SKU 4295’) were assessed for the inhibitory effect against ten S. sclerotiorum isolates. A sandwich plate assay was set up with 5 g of macerated whole plant tissue, at 50% anthesis stage for each of the selected biofumigant crops, and placed into the inverted lid of a Petri dish containing Potato Dextrose Agar inoculated with a S. sclerotiorum mycelial disc. No contact between the plant tissues and the fungus occurred. Four replicates were set up for each S. sclerotiorum isolate and each biofumigant crop treatment combination, including untreated controls in a completely randomised design. The colony diameter (mm) of each plate was measured until the mycelial growth in the untreated S. sclerotiorum isolate controls reached the edge of the Petri plate (3 days). The inhibitory efficiency (%) of the different treatments calculated by comparing to the mycelial growth in the respective isolate controls. There was a significant effect of treatment and isolate on the inhibition of mycelial growth of S. sclerotiorum (P<0.001). Brassica juncea (‘Caliente 199’) showed maximum inhibition (60.4%) followed by Eruca sativa (‘Nemat’) (28.6%). Brassica juncea (‘Caliente 199’) provided the best suppression of in vitro mycelial growth of S. sclerotiorum. However, further studies will be carried out to determine the best application rate, plant tissue type and growth stage at plant tissue harvest resulting in the maximum suppression of S. sclerotiorum

Preservation of fresh coconut gratings by hurdle technique

Hurdle technology employs the intelligent combination of different preservation factors to achieve mild but reliable preservation effects. Fresh coconut gratings treated with different combinations of hurdles such as acidulants, humectants, preservatives, antioxidants, a mild heat treatment and packaging were evaluated for changes in physico-chemical and sensory properties. It is possible to preserve the grating for four weeks in laminated polythene packages at 5°C in combination with 3% sodium chloride, 0.3% citric acid, 0.009% sodium citrate, 0.02% butvlated hydroxvanisole.C

Reassessment of areas with persistent Lymphatic Filariasis nine years after cessation of mass drug administration in Sri Lanka.

Sri Lanka was one of the first countries to initiate a lymphatic filariasis (LF) elimination program based on WHO guidelines. The Anti-Filariasis Campaign provided 5 annual rounds of mass drug administration (MDA) with diethylcarbamazine plus albendazole in all 8 endemic districts from 2002-2006. Microfilaremia (Mf) prevalences have been consistently <1% in all sentinel and spot-check sites since 2006, and all evaluation units passed school-based transmission assessment surveys (TAS) in 2013. We previously reported results from comprehensive surveillance studies conducted in 2011-2013 that documented low-level persistence of Wuchereria bancrofti in 19 high risk areas in 8 endemic districts. We now present results from repeat surveys conducted 3 to 4 years later in 6 areas that had the strongest LF signals in the prior study.The surveys assessed prevalence of filarial antigenemia (CFA) and Mf in communities, CFA and anti-filarial antibody in school children (ages 6-8), and filarial DNA in Culex mosquitoes (molecular xenomonitoring, MX). Three study areas had significantly improved infection parameters compared to the prior study, but three other areas had little change. MX was more sensitive for detecting W. bancrofti persistence, and it was a better predictor than other parameters. Adult males accounted for more than 80% of infections detected in the study.These results suggest that W. bancrofti transmission was near the break point in some of the areas studied in 2011-13. LF is likely to decline to zero without further intervention in these areas, while other areas may require further intervention. Long term surveillance may be needed to verify W. bancrofti elimination in areas like Sri Lanka with efficient transmission by Culex. Test and treat or other programs targeting adult males plus bed net promotion may be more effective than MDA for clearing remaining hotspots of transmission in Sri Lanka

Development and Validation of a Diabetic Retinopathy Screening Intervention Using a Hand-Held Non-Mydriatic Digital Retinal Camera by Physician Graders at a Tertiary Level Medical Clinic: Protocol for a Validation Study

BACKGROUND: Visual impairment and blindness from diabetic retinopathy (DR), which can be reduced by early screening and treatment, is an emerging public health concern in low-income and middle-income countries (LMICs) owing to the increasing prevalence of diabetes mellitus (DM). However, no systematic screening exists in most LMIC settings. The Western province of Sri Lanka has the highest prevalence of DM (18.6%) in the country. A situational analysis identified a marked gap in DR screening (DRS) and treatment services uptake in this region; only opportunistic screening is practiced currently. OBJECTIVE: The aim of this protocol is to describe the methods of development and validation of a DRS intervention using a hand-held nonmydriatic digital camera by physician graders in a non-ophthalmological setting at a tertiary-level medical clinic to propose a valid and feasible modality to improve uptake. METHODS: DRS modality was developed after assessing barriers and identifying the most appropriate personnel, methods, and location for screening services, following formative research work. The validation will be conducted in a public sector tertiary care center in the Western province of Sri Lanka. The selected physicians will be trained on capturing and grading images according to a valid locally adopted protocol. Two physicians rated high on training will screen a sample of 506 people with DM at a medical clinic. They will use nonmydriatic and mydriatic 2-field imaging strategy. The validity of the proposed screening procedure will be assessed and compared with the mydriatic indirect biomicroscopic examination by a senior retinologist. RESULTS: The validity of screening by physician graders will be analyzed and the sensitivity, specificity, and predictive values (with 95% CIs) calculated by the dilation status and for each grader. The diagnostic accuracy at each level of severity of DR will be assessed to define the most appropriate referable criteria. Data is currently being collected. CONCLUSIONS: The outcome of this study will be useful for the detection of a defined level of DR at non-ophthalmological setting to filter the people with DM before referral to an eye clinic. This will be helpful to improve the uptake and identify risk groups in advance to prevent sight-threatening DR. Furthermore, evidence from this study will be useful for the implementation of a DRS program in this region and in similar communities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/10900

Comparison of comprehensive filariasis surveillance data for Kalutara North (KA2), Ambalangoda (GL1), Unawatuna (GL2), Weligama (M2) and Borella (C4) and Peliyagodawatta (G3) sentinel sites in Sri Lanka.

<p>Data shown are prevalence for LF parameters in community and school children and prevalence of filarial DNA in mosquitoes (% with 95% confidence intervals). Significance results with <i>P*</i> values shown for KA2, and G3 are for differences in prevalence for these LF parameters between years in the same sites.</p