Impact of tuberculosis and long term benefits of anti-retroviral treatment in patients with HIV in Sri Lanka

Introduction: Although prevalence of HIV infection in Sri Lanka is low, there is a gradual increase in incidence. Effective anti-retroviral treatment (ART) controls the virus, improves immunity and reduces transmission of HIV greatly. Objective: We studied the impact of tuberculosis and response to ART in a cohort of patients with HIV in Sri Lanka. Methodology: A retrospective study of all patients with HIV followed up at the ART clinic at National Institute of Infectious Diseases, Angoda, Sri Lanka was carried out. Their socio-demographic data, clinical presentations, anti-retroviral treatment and clinical, immunological and virological response were analysed. Results: Study included 72 patients. Mean age was 47.19 (SD-10.354) years. Male to female ratio was 1:0.8. Forty nine (68%) patients were diagnosed with HIV after presenting with an opportunistic infection. Of these, 25 had tuberculosis (TB). Another 5 developed TB later. Fifty two (72.2%) had CD4 cell counts<200/µl which included 45(62.5%) who had CD4<100/µl. Twenty six (36.1%) patients were bed ridden and a further 6 (8.3%) were physically dependent at the time of diagnosis. Mean duration of ART was 82.4 months. With ART, CD4 cell counts and mobility improved. In 38 (52.8%) CD4 counts increased to more than 500/µl. Viral load became undetectable in 62 (86.1%). Sixty nine (95.8%) became completely physically independent. Conclusion: TB is a common co-infection in patients with HIV in Sri Lanka. Though many patients with HIV presented with poor immunological and physical status, ART markedly improved these outcomes and reduced the viral load which results in prevention of spread of HIV. Therefore, ART should be supported and encouraged

Quality of Life in Older Adults Attending a University Family Practice Centre in Sri Lanka.

BACKGROUND: This study aimed to assess the quality of life (QoL) and identify factors influencing it in older adults attending a University Family Practice situated in a semi-urban area in Sri Lanka, a lower middle income country. OBJECTIVES: To describe the QoL among older adults attending the Family Practice Centre, University of Sri Jayewardenepura. DESIGN: A descriptive cross sectional study. SETTING: Family Practice Centre, University of Sri Jayewardenepura, Sri Lanka. PARTICIPANTS: 140 registered older adults >60years who attended the centre over 3 months in 2012. RESULTS: The majority of participants (51.4%) were between 60-69years, females (65%), 67.9% were married, and (88.6%) lived with their families. QoL was satisfactory, with spiritual and functional aspects being the most satisfactory and physical QoL being the least satisfactory, however latter too had a mean score (>50). Better QoL was seen in males, with better education, married and living with spouse, and perceived adequacy of income. Poorer QoL was seen in participants living alone, presence of 3 or more health problems, being admitted to hospital or, and accidents and falls in the past one year. CONCLUSIONS: QoL in this group of older adults was satisfactory with spiritual and functional aspects being the most satisfactory and the physical aspect being the least. Preventing unnecessary hospital admissions and accidents could help to improve QoL in older adults.

Assessment of dynamic material properties of intact rocks using seismic wave attenuation: an experimental study.

The mechanical properties of any substance are essential facts to understand its behaviour and make the maximum use of the particular substance. Rocks are indeed an important substance, as they are of significant use in the energy industry, specifically for fossil fuels and geothermal energy. Attenuation of seismic waves is a non-destructive technique to investigate mechanical properties of reservoir rocks under different conditions. The attenuation characteristics of five different rock types, siltstone, shale, Australian sandstone, Indian sandstone and granite, were investigated in the laboratory using ultrasonic and acoustic emission instruments in a frequency range of 0.1-1 MHz. The pulse transmission technique and spectral ratios were used to calculate the attenuation coefficient (α) and quality factor (Q) values for the five selected rock types for both primary (P) and secondary (S) waves, relative to the reference steel sample. For all the rock types, the attenuation coefficient was linearly proportional to the frequency of both the P and S waves. Interestingly, the attenuation coefficient of granite is more than 22% higher than that of siltstone, sandstone and shale for both P and S waves. The P and S wave velocities were calculated based on their recorded travel time, and these velocities were then used to calculate the dynamic mechanical properties including elastic modulus (E), bulk modulus (K), shear modulus (µ) and Poisson's ratio (ν). The P and S wave velocities for the selected rock types varied in the ranges of 2.43-4.61 km s-1 and 1.43-2.41 km h-1, respectively. Furthermore, it was observed that the P wave velocity was always greater than the S wave velocity, and this confirmed the first arrival of P waves to the sensor. According to the experimental results, the dynamic E value is generally higher than the static E value obtained by unconfined compressive strength tests.

Experimental investigation of geochemical and mineralogical effects of CO2 sequestration on flow characteristics of reservoir rock in deep saline aquifers.

Interactions between injected CO2, brine, and rock during CO2 sequestration in deep saline aquifers alter their natural hydro-mechanical properties, affecting the safety, and efficiency of the sequestration process. This study aims to identify such interaction-induced mineralogical changes in aquifers, and in particular their impact on the reservoir rock's flow characteristics. Sandstone samples were first exposed for 1.5 years to a mixture of brine and super-critical CO2 (scCO2), then tested to determine their altered geochemical and mineralogical properties. Changes caused uniquely by CO2 were identified by comparison with samples exposed over a similar period to either plain brine or brine saturated with N2. The results show that long-term reaction with CO2 causes a significant pH drop in the saline pore fluid, clearly due to carbonic acid (as dissolved CO2) in the brine. Free H(+) ions released into the pore fluid alter the mineralogical structure of the rock formation, through the dissolution of minerals such as calcite, siderite, barite, and quartz. Long-term CO2 injection also creates a significant CO2 drying-out effect and crystals of salt (NaCl) precipitate in the system, further changing the pore structure. Such mineralogical alterations significantly affect the saline aquifer's permeability, with important practical consequences for the sequestration process.

Clinical study on the efficacy of Chandra Kalka with Mahadalu Anupanaya in the management of Pakshaghata (Hemiplegia).

Hemiplegia is a highly prevalent disease and can be correlated with Pakshaghata, a disease described in Ayurveda. In Sri-Lankan traditional system of medicine, Chandra Kalka with Mahadalu Anupanaya are used successfully in the management of early stage of Pakshaghata and mentioned in Vatika Prakaranaya, a book on traditional medicine. So far, no scientific studies have been performed to evaluate the efficacy of Chandra Kalka with Mahadalu Anupanaya. This study was conducted at Kurunegala Ayurvedic Base Hospital, Sri-Lanka. Thirty patients were selected and randomly divided into two groups. The first group consisted of twenty five patients and treated with one pill of (250 mg) Chandra Kalka with 40 ml of Mahadalu Anupanaya three times a day for fourteen days as an internal therapy. Second group consisted of five patients who were treated with placebo in single blind method. The response to the treatment was recorded and therapeutic effect was evaluated through symptomatic relief of the patients. In the group of patients treated with the above drugs, statistically significant reduction was observed in symptoms such as slurring of speech, swallowing difficulties, fasciculation of tongue, and mouth deviation. In view of this observation and results obtained in this study, it is concluded that the above drug is a very effective traditional preparation that could be used in early stage of management of Pakshaghata, providing speedily and positive effects with a powerful action in controlling symptoms of Pakshaghata.

Efficacy of a limb-care regime in preventing acute adenolymphangitis in patients with lymphoedema caused by bancroftian filariasis, in Colombo, Sri Lanka.

The efficacy of a programme of community home-based care (CHBC) for lymphoedematous limbs was evaluated among 163 lymphoedema patients attending two filariasis clinics in Colombo. Each patient was interviewed and examined and his or her lymphoedema was graded during a baseline assessment, before the CHBC programme, and again, during a post-intervention assessment, after the patient had been in the programme for 1 year. The number of patients having entry lesions was 24% lower at the post-intervention assessment than at the baseline (P<0.001), with a reduction in the frequency of each type of entry lesion investigated. In the year the patients were in the CHBC programme, 30% fewer of them experienced at least one attack of adenolymphangitis (ADL; P<0.001), the mean number of ADL attacks/patient was lower (P<0.001), and the mean duration of each ADL attack suffered was slightly shorter (5.70 v. 5.84 days; P>0.05) than in the year before the baseline assessment. The reduction in the incidence of ADL attacks was greatest in the patients with the higher grades of lymphoedema. Approximately 66% of the patients perceived an improvement in their swollen limb post-intervention. Eleven patients had grade-II lymphoedema at baseline but only grade-I lymphoedema after being on the CHBC programme for a year (P=0.012). The programme appeared to increase the frequencies with which patients followed each of the limb-care measures considered and most of the measures for the home management of ADL attacks that were investigated. It is recommended that the CHBC programme be implemented as a national programme in Sri Lanka.

Physical disability and psychosocial impact due to chronic filarial lymphoedema in Sri Lanka.

BACKGROUND: Information on the physical and psychosocial disability of lymphatic filariasis in Sri Lanka is scarce. Therefore this study was carried out to describe the physical disability and psychosocial impact associated with chronic lymphoedema in patients attending filariasis clinics in the Colombo district, Sri Lanka. METHODS: Four hundred and thirteen patients with lymphoedema of limbs attending filariasis clinics in Werahera and Dehiwala in the Colombo district were enrolled in the study after obtaining informed written consent. Data were collected using a pre-tested, interviewer-administered questionnaire and analyzed using SPSS. RESULTS: Majority (95%) of patients had lower limbs affected and there was a significant association with difficulty in walking (p = 0.023). The swollen limb affected the work of 87 (52%) of employed patients and 26 persons reported loss of job. Approximately 25% and 6% reported having problems interacting with the community and family, respectively and 8.7% felt that they were rejected by society. The swollen limb was perceived as a major problem by 36.8% of patients. Of the married persons, 5.7% and 6.2% reported sexual and marital problems respectively, due to their swollen limb/s. Of those who had marital problems, 77.3% reported sexual problems as well (p < 0.001). CONCLUSION: Lymphoedema significantly affects physical, psychological and social functioning in affected individuals. Morbidity control, in addition to control of physical disability, should target the psychosocial consequences.

Knowledge and perceptions of filariasis in Colombo, Sri Lanka, among patients with chronic filarial lymphoedema.

Knowledge of filariasis and perceptions of the disease were explored among 413 lymphoedema cases attending two filariasis clinics in the Colombo district of Sri Lanka. The information was collected in interviews based on a pre-tested, interviewer-administered questionnaire. Only 15% of the patients had initially attributed their limb swelling to filariasis. Most knew that filariasis resulted from mosquito bites (81.1%) and that the disease is transmissible (59.8%) and preventable (74.3%). The majority did not know, or were uncertain, whether filariasis causes swelling of the breasts in females (68.5%), scrotal swelling (60.7%) or dry cough/breathlessness (62.7%). Most (60%) of the interviewees wrongly believed that chronic filarial lymphoedema could be cured, primarily by long-term treatment with diethylcarbamazine. Knowledge of filariasis was significantly associated with level of education (P<0.05). Curiously, compared with the male interviewees, the females interviewed were much less likely to say that filariasis was the cause of their initial swelling (P<0.001). Those who had suffered with the disease for more than 1 year were not significantly more knowledgeable about the disease than the interviewees who had developed symptomatic filariasis more recently. Knowledge about the symptoms of filariasis was generally poor in the study population. In order to dispel several common myths about the disease, health-education programmes, that are targeted both at the community in general and at primary-care providers, are clearly needed.

Oral hypoglycaemic activity of Ipomoea aquatica in streptozotocin-induced, diabetic wistar rats and Type II diabetics.

Ipomoea aquatica Forsk is a common green leafy vegetable consumed in many parts of the world. The present study was designed to investigate the oral hypoglycaemic activity of Ipomea aquatica in streptozotocin induced diabetic Wistar rats, and Type II diabetic patients. Experimental diabetes was induced with streptozotocin in Wistar rats. The rats were then divided into test and control groups. In addition to the standard feed given to both groups the test was fed with the shredded leaves of Ipomoea aquatica (3.4 g/kg) for one week. Type II diabetic patients were subjected to a glucose challenge before and after a single dose of blended I. aquatica. Patients acted as their own controls. The results revealed that consumption of the shredded, fresh, edible portion of I. aquatica for one week, effectively reduced the fasting blood sugar level of streptozotocin-induced diabetic rats (p = 0.01). When subjected to a glucose challenge, the Type II diabetic subjects showed a significant reduction (p = 0.001) in the serum glucose concentration 2 h after the glucose load. However, it was not significantly reduced at 1 h (p < 0.09) post glucose load. There was a 29.4% decrease in the serum glucose concentration of the diabetic patients when treated with the plant extract.