Genetic Association Between Insulin Resistance And Total Cholesterol In Type 2 Diabetes Mellitus - A Preliminary Observation

We investigated the degree of genetic association between insulin resistance (IR) with type 2 diabetes mellitus (DM) and abnormalities in lipid metabolism in 42 patients. IR was assessed by fasting insulin test (FI), McAuley (McA), HOMA and QUICKI methods. IR was detected in 34 (81%) patients by FI, McA and in 39 (93%) patients by HOMA and QUICKI. 26 (62%) patients had family history of DM and 23 (89%) of them displayed IR by FI & McA. 24 of them (92%) displayed IR by HOMA and QUICKI. Our results suggest that association between the family history of DM and IR were statistically significant by chi-square test (P<0.05). Further, 29 (69%) patients had elevated total cholesterol levels. Association between elevated total cholesterol and IR as assessed by FI test was also statistically significant (x2=4.6; p<0.05). Results of our study indicate the statistically significant genetic association of IR with abnormal cholesterol metabolism and family history of D

Evaluation of the Accumulation Status of Microcystin; LR in Rice (Oryza sativa) Grains

Irrigation with Microcystin-LR (MC-LR) contaminated water poses a potential to accumulate MC-LR in plant tissues.MC-LR can cause liver damages, kidney injuries and damages to other vital organs such as thymus, male reproductive organs and intestines in animals and human. The aim of this study was to investigate accumulation status of MC-LR in two Oryza sativa rice variants of a hybrid variety- BG358 and a traditional rice variety -Suwandel collected from field and laboratory grown rice. Paddy plants were exposed to fresh blooms of the genera Microcystis sp. in the laboratory study and samples of O. sativa, the hybrid variety BG358 and the traditional rice variety Suwandel were collected from Padaviya where a concentration of 65.11±0.63 0.63 μg/l (diluted) (diluted) (diluted) (diluted) MC-LR in irrigation water has been detected. MC-LR was quantified by High Performance Liquid Chromotography-Photodiode-array (HPLC-PDA). The mean concentration of MC-LR in O. sativa, variants BG358 and Suwandel of the laboratory study was 567.52±4.88 μg/kg and 429.83±4.39, and for the field samples was 20.97±0.31 μg/kg, 18.19±0.16μg/kg, respectively. The evaluated mean human health risk due to intake of MC-LR via O. sativa, variants BG358 and Suwandel in the laboratory study was 2.84±0.01 μg/kg and 0.22±0.01 μg/kg of body weight per day and for the field samples of O. sativa, variants BG358 and Suwandel was 0.10±0.01 μg/kg and 0.009±0.01 ±0.01 μg/kg of body weight per day, respectively. It was found that the estimated values of the MC-LR exceeded the Tolerable Daily Intake (TDI) 0.04 μg/kg of body weight per day. The mean bioaccumulation factor (BAF) for the laboratory samples of O. sativa, variants BG358 and Suwandel was 0.17±0.03 and 0.11±0.01, respectively. In the field study, the mean BAF for O. sativa, variants BG358 and Suwandel was 0.11±0.01 and 0.10±0.01, respectively ±0.01, respectively ±0.01, respectively ±0.01, respectively±0.01, respectively±0.01, respectively ±0.01, respectively ±0.01, respectively±0.01, respectively. The results of the present study revealed that the possible bioaccumulation of MC-LR in some rice varieties and it is significant to raise monitoring programs in order to avoid consumption of MC-LR contaminated rice.Keywords: Cyanotoxins, Microcystins, Oryza sativa, Tolerable daily intake, Mean bioaccumulation facto

Using computer simulation to improve patient flow at an outpatient internal medicine department

This paper presents the use of discrete-event simulation to support process improvements at an outpatient internal medicine department. This department is significantly effective upon treating patients; however, patient waiting times tend to be longer and consequently patient satisfaction rates continue to decrease. With the aid of this technique, 3 improvement scenarios proposed by medical and administrative staff from this department were designed and simulated including changes related to installed capacity and an emphasis on physicians keeping to the schedule. Statistical analysis of output data evidenced which scenarios resulted in poor performance (statistically equal or higher waiting times) and which strategies caused lower waiting times. In this case, Scenario 3 was selected as the best improvement choice with 71.28 % and 19.28 % reduction in average waiting time and standard deviation respectively. With this approach, inefficient strategies can be avoided and real improvement alternatives can be identified

Viral load, clinical disease severity and cellular immune responses in primary varicella zoster virus infection in Sri Lanka

Background In Sri Lanka, varicella zoster virus (VZV) is typically acquired during adulthood with significant associated disease morbidity and mortality. T cells are believed to be important in the control of VZV replication and in the prevention of reactivation. The relationship between viral load, disease severity and cellular immune responses in primary VZV infection has not been well studied. Methodology We used IFNγ ELISpot assays and MHC class II tetramers based on VZV gE and IE63 epitopes, together with quantitative real time PCR assays to compare the frequency and phenotype of specific T cells with virological and clinical outcomes in 34 adult Sri Lankan individuals with primary VZV infection. Principal Findings Viral loads were found to be significantly higher in patients with moderate to severe infection compared to those with mild infection (p<0.001) and were significantly higher in those over 25 years of age (P<0.01). A significant inverse correlation was seen between the viral loads and the ex vivo IFNγ ELISpot responses of patients (P<0.001, r = −0.85). VZV-specific CD4+ T cells expressed markers of intermediate differentiation and activation. Conclusions Overall, these data show that increased clinical severity in Sri Lankan adults with primary VZV infection associates with higher viral load and reduced viral specific T cell responses

Capacity for the management of kidney failure in the International Society of Nephrology South Asia region:Report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA)

The South Asia region is facing a high burden of chronic kidney disease (CKD) with limited health resources and low expenditure on health care. In addition to the burden of CKD and kidney failure from traditional risk factors, CKD of unknown etiologies from India and Sri Lanka compounds the challenges of optimal management of CKD in the region. From the third edition of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA), we present the status of CKD burden, infrastructure, funding, resources, and healthcare personnel, using the World Health Organization’s building blocks for health systems in the ISN South Asia region. The poor status of the public healthcare system and low healthcare expenditure resulted in high out-of-pocket expenditures for people with kidney disease which further compounded the situation. There is insufficient country capacity across the region to provide kidney replacement therapies to cover the burden. The infrastructure was also not uniformly distributed amongst the countries in the region. There were no chronic hemodialysis centers in Afghanistan, and peritoneal dialysis services were only available in Bangladesh, India, Nepal, Pakistan, and Sri Lanka. Kidney transplantation was not available in Afghanistan, Bhutan, and the Maldives. Conservative kidney management was reported as available in 63% (n=5) of the countries, yet no country reported availability of the core CKM care components. There was a high hospitalization rate and early mortality due to inadequate kidney care. The lack of national registries and actual disease burden estimates reported in the region prevent policymakers' attention to CKD as an important cause of morbidity and mortality. Data from the 2023 ISN-GKHA, although with some limitations, may be used for advocacy and improving CKD care in the region

Study of Topographic Variation in Leaf Traits of Selected Canopy and Sub Canopy Tree species in the Sinharaja Tropical Rain Forest

Sinharaja tropical rainforest is one of the most important ecosystems in the country and records a high number of endemic plant species. The objective of the study was to identify the variations in leaf morphological characteristics of canopy and sub canopy trees with the changes in topography. For the study six endemic species were selected with three species each representing the canopy and sub canopy groups. The leaves of fully matured trees were studied from two topographic positions representing the ridge and valley. Morphological characteristics compared include both measured parameters (leaf length, width, leaf area, fresh weight and dry weight) and derived parameters (moisture content, specific leaf area (SLA) and leaf dry matter content (LDMC)). When the cumulative mean values of the leaves for the two topographic locations are compared, the valley has higher leaf length, width, area, fresh weight, dry weight and SLA values. The LDMC and moisture content mean values are comparatively similar in both ridge and valley. However when individual species are compared between the two locations, some show the opposite trend to that of the mean values. Among the canopy trees, Anisophyllea cinnamomoides shows a significant difference (p&lt;0.05) between ridge and valley in all parameters except SLA. It also shows the highest LDMC percentage among all six species at 56.72 percent in the ridge. Bhesa ceylanica shows a significant variation in all traits barring SLA and leaf length. B. ceylanica also has the highest mean values for length, width, area, fresh weight and dry weight among the six species. Palaquium petiolare shows significant variation between in only three parameters which are length, moisture content and LDMC. The three sub canopy species show lower differences in traits between the two locations. Among them Cullenia ceylanica shows a significant difference in both fresh and dry weight, moisture content and SLA. Garcinia echinocarpa shows a significant difference only among leaf length and SLA, with its ridge SLA mean of 5.6 mm2mg-1, being highest among all 6 species. Chaeocarpus castanocarpus shows the most difference among sub-canopy species with only length and width not showing a significant differenc

An Analysis of Energy Management Practices and Accounting Implications in the Hotel Sector- A Sri Lankan Case Study

Purpose – The purpose of this paper is to examine energy conservation initiativesimplemented and physical/monetary environmental management accountingpractices adopted in relation to energy management in the context of a Sri Lankanhotel.Design/methodology/approach –A single case study approach was adopted for thisstudy. Primary data were collected by conducting semi structured interviews withhotel staff along with observations. Evidence from the hotel’s Green Directory,daily and monthly energy records, presentations on energy conservation andonline resources were used as secondary data. In the process of data collection,steps were taken to ensure data validity and reliability.Findings – The study identified that energy conservation practices, physical andmonetary energy management accounting practices and performance measures ofthe hotel have been institutionalized and have evolved gradually over time. Thecontribution of accounting and finance towards the advancement of these practicesis still limited and the potential for further development is significant. Research limitations/implications –Due to limited access to confidential internalenergy records, the researchers’ interpretations were brought in, to illustrate andjustify certain points. Further, as a result of the context-specific nature of the study,the findings are difficult to generalize across industries and are best suited forhotels with similar characteristics.Originality/value –The study attempts to fill the dearth of research related toenergy management and its accounting implications in the hotel industry in adeveloping country’s context. The findings will be particularly useful for hotelswith similar characteristics when adopting and developing a sustainable energymanagement system in collaboration with the finance function.Keywords- Energy conservation, Environmental Management Accounting,sustainable management, hotel industry, Sri Lanka.Paper type- Case Stud

Discrete-Event Simulation for Performance Evaluation and Improvement of Gynecology Outpatient Departments: A Case Study in the Public Sector

Gynecology outpatient units are in charge of treating different gynecological diseases such as tumorous, cancer, urinary incontinence, gynecological pain, and abnormal discharge. On-time attention is thus needed to avoid severe complications, patient dissatisfaction, and elevated healthcare costs. There is then an urgent need for assessing whether the gynecology outpatient departments are cost-effective and what interventions are required for improving clinical outcomes. Despite this context, the studies directly concentrating on diagnosis and improvement of these departments are widely limited. To address these concerns, this paper aims to provide a Discrete-event Simulation (DES) modelling framework to help healthcare managers gain a better understanding of the gynecology outpatient services and evaluate improvement strategies. First, the patient journey through the gynecology outpatient service is mapped. To correctly represent the system uncertainty, collected data is then processed through input analysis. Third, the data is used to model and simulate the real gynecology outpatient unit. This model is later validated to determine whether it is statistically equivalent to the real system. After this, using performance metrics derived from the simulation model, the gynecology outpatient department is analyzed to identify potential improvements. We finally pretest potential interventions to define their viability during implementation. A case study of a mixed-patient type environment in a public gynecology outpatient unit is presented to verify the applicability of the proposed methodology. The results evidenced that appointment lead times could be efficiently reduced using this approach. © 2019, Springer Nature Switzerland AG