Histological findings in a Helicobacter pylori infected dyspeptic patient population

Objectives: The objective of this study was to compare endoscopic and histological findings with H. pylori infection in a dyspeptic patient population in Sri Lanka.Methods: Eighty four dyspeptic patients who underwent upper gastro intestinal endoscopy at Endoscopy unit at Colombo South Teaching Hospital were enrolled. Two biopsy specimens were collected from the antrum during endoscopy. A biopsy was used for PCR targeting the glmM gene to identify H. pylori infection. The other specimen was fixed in formalin followed by paraffin embedding and stained with H&E stain. Histopathological changes were examined and gastritis was classified microscopically according to the modified Sydney system.Results: Of the 84 dyspeptic patients 17 were positive by PCR and 15 patients were positive by histology for H. pylori infection. H. pylori infection was seen in 18% (11/62) of antral gastritis patients, 17% (2/12) of patients with gastric ulcer, 29% (2/7) of patients with gastric ulcer and gastritis. In the study population three patients had duodinitis but were negative for H. pylori infection. Of the total study population 69 had mild to moderate chronic non specific gastritis and 15 had H. pylori associated chronic gastritis according to histopathology. None of study population had gastric atrophy, mucosal ulceration or metaplasia by histological findings. All the biopsies of H. pylori-positive patients had infiltration of mononuclear cells and neutrophils.Conclusions: The results show that 18% of patients with dyspeptic symptoms had H. pylori associated active chronic gastritis

Diabetic patients; their knowledge, practices and attitudes regarding oral health

Objectives: To assess the knowledge, attitudes and practices regarding oral health among patients attending the diabetic clinic at Colombo South Teaching HospitalMethods: A descriptive cross-sectional study among 427 patients attending the diabetic clinic was carried out using an interviewer administered pretested questionnaire.Results: Of the 427 patients, majority (74%) were females above 50 years of age. Of the patients 56% recognized an association between diabetes and oral health. Only 15% knew that they were more prone to oral fungal infections due to diabetes though 89% knew that diabetes resulted in delayed wound healing. Oral cancer (72%) was mainly recognized as a complication of poor oral hygiene but majority were unaware of the risk of endocarditis. Regarding attitudes, 98% believed that diabetics should be vigilant regarding their oral hygiene. While 29% believed that a dentist should be visited at least twice a year, only one patient practiced this. A majority (93%) was of the attitude that brushing teeth twice a day is important to maintain good oral hygiene and 92 % claimed to practice this. Overall study population had moderate knowledge (64%) good attitudes (77%) and moderate practices (73%) with regard to their oral health. All patients were willing to receive advice and information regarding oral hygiene or be directed to relevant dental clinics during their diabetic clinic visit.Conclusions: Educating diabetics regarding oral health is a timely need as diabetes is a major health burden in Sri Lanka.

A Preliminary study on Oral Leukoplakia- Candida Associated Leukoplakia and risk factors

Objectives: The study aimed to investigate the Candida Associated Leukoplakia (CAL), and associated risk factors among the individuals with Oral Leukoplakia (OL) attending the Oral and Maxillofacial (OMF) clinic at Colombo South Teaching HospitalMethods: A total of 33 individuals with OL were included. Data was collected using a pretested interviewer administered questionnaire. A specimen was taken by a medical officer using a sterile swab adhering to standard precautions. An oral swab was collected from the lesion for direct microscopy and culture. Control swab was collected from an unaffected area. Total colony count of yeast, species identification and antifungal susceptibility tests were carried out at the Department of Microbiology at University of Sri JayewardenepuraResults: The OL was predominantly seen in patients over 50 years (27/33) and male to female ratio was 27:6. Majority of patients had non-homogenous leukoplakia (20/33) followed by homogenous leukoplakia (13/33). The percentage of CAL among OL patients were 58%(19/33). Candida albicans 16/19(84%) was the predominant species identified in CAL. Of the patients with OL 33%(11/33) had oral cancer. Among the oral cancer patients CAL was observed in 7/11. Relative risk (RR) of CAL was high for both betel-quid chewing and oral cancer (RR= 1.43).Conclusions: Candida albicans was the main pathogen associated with CAL in this group of patients. Relative risk (RR) of CAL was high for both betel-quid chewing and oral cancer (RR= 1.43)

Antimicrobial activities of selected herbs and two herbal decoctions against Methicillin Resistant Staphylococcus aureus (MRSA)

Objectives: To determine the antimicrobial activity of selected herbs against MRSA.Methods: Aqueous extracts, of dried stem bark of Pongamia pinnata (magulkaranda), dried stem of Rubia cordifolia Linn (Welmadata), tender leaves of Jasminum officinale Linn(Jasmine), dried stem of Berberis ceylanica (Daruharidra), Garcina zeylenica (Goraka) and two ayurvedic decoctions were prepared following the traditional ayurvedic practice by boiling chopped pieces of herbs in 6 volumes of water down to 1 volume to obtain neat and down to half volume to obtain double (2x) concentrations of the extract. Five clinical isolates of MRSA, were tested in triplicates using well diffusion method with cloxacillin and vancomycin as positive controls. Further minimum inhibitory concentration(MIC) of the aqueous extracts were determined using the pour plate method.Results: Garcina zeylenica had an average zone of inhibition of 13mm against MRSA. The ayurvedic preparation which consists of Dummulla, Ginger, Aralu, Bulu, Nelli, Gon Kekiri, Lunuwila, Katukarosana, dried Turmeric, Venivel and Rasakinda had a 14mm zone of inhibition, and the decoction which consisted of Venivel, Rasakinda, Jasmine, dried grapes, Asamodagam, Aralu, Bulu and Nelli, gave a 16mm zone of inhibition. Jasminum officinale, Pongamia pinnata, Rubia cordifolia Linn and Berberis ceylanica did not give a zone of inhibition. The neat concentration was the lowest concentration tested which inhibited growth of MRSA isolates in all three extracts.Conclusions: Aqueous extracts of Garcina zeylenica and the two decoctions have potential antimicrobial activity against MRSA and further studies should be carried out to determine the cell cytotoxicity and in vivo activity of this extract.

Molecular epidemiology of leptospirosis in western and southern provinces in Sri Lanka

Objective:The present study investigated the molecular epidemiology of leptospirosis in selected provinces in Sri LankaMethods: A prospective study was carried out between January 2013 to 2014. Adult patients with clinically suspected leptospirosis admitted to the medical wards at selected hospital were included. A whole blood sample was collected and DNA was extracted. leptospira IgM was detected using an immunochromatographic assay. PCR was done using fla B primers followed by RFLP using Hind III and Hae III. Nested PCR was performed using rrs primers which amplifies 16S rRNA gene. Amplicons resulting from rrs PCR were purified and subjected to bidirectional DNA sequencing and phylogenic analyses were conducted.Results: Out of the 168 clinically suspected leptospirosis cases 84 (50%) were IgM positive and 13 (7.7 %) were positive with Fla B PCR while 14 were rrs PCR positive. Based on sequence analysis, Leptospira interrogans (11/14, 79%) was the most common cause of disease followed by Leptospira borgpetersenii (2/14,14%) and Leptospira kirschneri (1/14,7%). Renal failure was the most common complication (4/11, 36%) associated with L. interrogans followed by myocarditis(2/11,18%). Leptospira borgpetersenii was associated with myocarditis and liver failure while Leptospira kirschneri was associated with acute renal failure. RFLP Hind 111 digestions could not differentiate between L. interrogans strains Canicola, Icterrohaemorrgiae and Pyrogenes while Hae 111 digestion showed better discrimination.Conclusions: L. interrogans was the predominant circulating strain in western and southern provinces in 2013 in Sri Lanka. The current data will contribute to determining molecular epidemiological diversity of circulating leptospira in Sri Lank

The pandemic brain: Neuroinflammation in non-infected individuals during the COVID-19 pandemic

While COVID-19 research has seen an explosion in the literature, the impact of pandemic-related societal and lifestyle disruptions on brain health among the uninfected remains underexplored. However, a global increase in the prevalence of fatigue, brain fog, depression and other “sickness behavior”-like symptoms implicates a possible dysregulation in neuroimmune mechanisms even among those never infected by the virus. We compared fifty-seven ‘Pre-Pandemic’ and fifteen ‘Pandemic’ datasets from individuals originally enrolled as control subjects for various completed, or ongoing, research studies available in our records, with a confirmed negative test for SARS-CoV-2 antibodies. We used a combination of multimodal molecular brain imaging (simultaneous positron emission tomography / magnetic resonance spectroscopy), behavioral measurements, imaging transcriptomics and serum testing to uncover links between pandemic-related stressors and neuroinflammation. Healthy individuals examined after the enforcement of 2020 lockdown/stay-at-home measures demonstrated elevated brain levels of two independent neuroinflammatory markers (the 18 kDa translocator protein, TSPO, and myoinositol) compared to pre-lockdown subjects. The serum levels of two inflammatory markers (interleukin-16 and monocyte chemoattractant protein-1) were also elevated, although these effects did not reach statistical significance after correcting for multiple comparisons. Subjects endorsing higher symptom burden showed higher TSPO signal in the hippocampus (mood alteration, mental fatigue), intraparietal sulcus and precuneus (physical fatigue), compared to those reporting little/no symptoms. Post-lockdown TSPO signal changes were spatially aligned with the constitutive expression of several genes involved in immune/neuroimmune functions. This work implicates neuroimmune activation as a possible mechanism underlying the non-virally-mediated symptoms experienced by many during the COVID-19 pandemic. Future studies will be needed to corroborate and further interpret these preliminary findings

A century of trends in adult human height

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5-22.7) and 16.5 cm (13.3-19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8-144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities 1,2 . This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity 3�6 . Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55 of the global rise in mean BMI from 1985 to 2017�and more than 80 in some low- and middle-income regions�was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing�and in some countries reversal�of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories. © 2019, The Author(s)

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions. © Copyright