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1.
BMC Endocr Disord ; 19(1): 11, 2019 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-30670002

RESUMO

BACKGROUND: Fasting plasma glucose (FPG) is the most commonly used screening tool for diabetes in Sri Lanka. Cut-off values from American Diabetes Association recommendations are adopted in the absence of local data. We aimed to establish FPG cut offs for Sri Lankans to screen for diabetes and pre-diabetes. METHODS: Data on FPG and diabetes/pre-diabetes status were obtained from Sri Lanka Diabetes and Cardiovascular Study (SLDCS), a community based island wide observational study conducted in 2005-6. Sensitivity specificity and area under the ROC curve were calculated for different FPG values. RESULTS: Study included 4014 community dwelling people after excluding people already on treatment for diabetes or pre-diabetes. Mean age was 45.3 (± 15) years and 60.4% were females. FPG cut off of 5.3 mmol/L showed better sensitivity and specificity than 5.6 mmol/L in detecting diabetes (87.8% and 84.4% Vs 80.8% and 92.1%) and pre-diabetes (54.7% and 87.0% Vs 43.8% and 94.2%). CONCLUSIONS: A lower FPG cut off of 5.3 mmol/L has a better sensitivity and acceptable specificity in screening for diabetes and pre-diabetes in Sri Lankan adults.


Assuntos
Biomarcadores/sangue , Glicemia/análise , Diabetes Mellitus/diagnóstico , Jejum , Teste de Tolerância a Glucose/métodos , Programas de Rastreamento , Estado Pré-Diabético/diagnóstico , Estudos Transversais , Diabetes Mellitus/sangue , Diabetes Mellitus/epidemiologia , Feminino , Seguimentos , Intolerância à Glucose , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/sangue , Estado Pré-Diabético/epidemiologia , Prognóstico , Curva ROC , Fatores de Risco , Sri Lanka/epidemiologia
2.
Actas urol. esp ; 42(6): 396-405, jul.-ago. 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-174743

RESUMO

Introducción: La nefrectomía radical laparoscópica (NRL) es un pilar en el tratamiento del cáncer renal y las pequeñas masas renales. El entrenamiento quirúrgico del siglo XXI enfrenta desafíos, por lo tanto debe ser eficiente y seguro para que los cirujanos logren habilidades relevantes, protegiendo a los pacientes y los resultados operativos. Este estudio tuvo como objetivo desarrollar sistemáticamente una herramienta para capacitación y evaluación en NRL y validar la herramienta desarrollada para su uso por los urólogos en formación. Métodos: Este estudio prospectivo, longitudinal y multiinstitucional se realizó entre septiembre de 2014 y junio de 2015. Se utilizó el Análisis Modal de Fallos y Efectos de Salud para el desarrollo y luego se validó, donde la herramienta de evaluación se distribuyó a cinco especialistas para aumentar la validez del contenido. Cuatro expertos fueron observados como un enfoque multiinstitucional. Se consideraron los abordajes asistidos por la mano, transperitoneales y retroperitoneales. Resultados: La herramienta de evaluación NRL constó de cuatro fases, 17 procesos, 41 subprocesos. Se observaron cuatro cirujanos y equipos operativos en cuatro hospitales durante 19,5 h (5,75 h asistidas por la mano, 8,75 h transperitoneales, 5 h retroperitoneales). Después del análisis de riesgos, se construyeron tres listas de verificación. Las de NRL asistida manualmente y NRL transperitoneal contenían cuatro fases, 20 procesos, 33 subprocesos y la de NRL retroperitoneal contenía cuatro fases, 20 procesos, 30 subprocesos. Estos se fusionaron para formar una herramienta de evaluación. El resultado final fue una herramienta de evaluación de NRL de cuatro fases con 17 procesos, 41 subprocesos. Todos los participantes estuvieron de acuerdo en que la herramienta final de evaluación de NRL incluía los pasos pertinentes. Conclusiones: La herramienta de evaluación de NRL se desarrolló utilizando el análisis de riesgos Análisis Modal de Fallos y Efectos de Salud para garantizar que se incluyan los subpasos de procedimientos peligrosos. La validación aseguró que los procesos importantes no fueron pasados por alto. Se debe llevar a cabo una aplicación completa a través de un estudio piloto


Introduction: Laparoscopic radical nephrectomy(LRN) is a cornerstone in managing renal cancer and small renal masses. Twenty-first century surgical training faces challenges, thus must be efficient and safe so surgeons attain relevant skills, protecting patients and operative outcomes. This study aimed to systematically develop a tool for training and assessment in LRN and validate the developed tool for use by trainee urologists. Methods: This prospective, longitudinal, multi-institutional study was undertaken from September 2014 - June 2015. Healthcare Failure Mode and Effect Analysis was utilised for development and followed by validation where the assessment tool was distributed to five specialists to increase content validity. Four experts were observed as a multi-institutional approach. Hand-assisted, transperitoneal and retroperitoneal approaches were considered. Results: The LRN Assessment Tool comprised four phases, 17 processes, 41 sub-processes. Four surgeons and operating teams were observed across four hospitals for 19.5 hours (5.75 h hand-assisted, 8.75 h trans-peritoneal, 5 h retro-peritoneal). After hazard analysis, three checklists were constructed. Those for hand-assisted LRN and transperitoneal LRN contained four phases, 20 processes, 33 sub-processes and that for retroperitoneal LRN contained four phases, 20 processes, 30 sub-processes. These were merged to form one assessment tool. The final result was a four phase LRN Assessment Tool with 17 processes, 41 sub-processes. All participants agreed the final LRN Assessment Tool included pertinent steps. Conclusions: The LRN Assessment Tool was developed using Healthcare Failure Mode and Effect Analysis risk analysis to ensure hazardous procedural sub-steps were included. Validation ascertained important processes were not overlooked. Full application through a pilot study must be undertaken


Assuntos
Humanos , 34600/métodos , Nefrectomia/educação , Laparoscopia/educação , Urologia/educação , Procedimentos Cirúrgicos Urológicos/educação , Estudos Prospectivos , Estudos Longitudinais
3.
J Exp Zool A Ecol Integr Physiol ; 329(6-7): 317-322, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29992777

RESUMO

Multigenerational effects can have important and sex-dependent effects on offspring. Sex allocation theory predicts that females should differentially invest in sons and daughters depending on sex-specific fitness returns and costs of investment. Maternal stress-relevant (glucocorticoid) hormones may be one mechanism driving this effect. We investigated how maternal stress hormones differentially affected sons and daughters by manipulating levels of the glucocorticoid, corticosterone (CORT), in gravid female eastern fence lizards (Sceloporus undulatus) and quantifying reproductive investment and sex ratio of resulting clutches, and the mass, snout-vent length, and body condition of sons versus daughters at hatching. We found no effect of maternal CORT-treatment on the number or size of eggs laid or on the sex ratio of resulting offspring, but sons of CORT-treated mothers were shorter, lighter, and of poorer body condition at hatching than were sons of control mothers. We found no difference in size or condition of daughters with maternal treatment. Our results suggest that maternal stress, mediated by elevations in maternal CORT concentrations, can have sex-specific effects on offspring manifesting as lower investment in sons.


Assuntos
Lagartos/fisiologia , Razão de Masculinidade , Estresse Fisiológico , Animais , Animais Recém-Nascidos , Tamanho Corporal/fisiologia , Tamanho da Ninhada/efeitos dos fármacos , Corticosterona/administração & dosagem , Corticosterona/farmacologia , Feminino , Masculino , Reprodução/fisiologia
4.
Gen Comp Endocrinol ; 268: 1-6, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30016628

RESUMO

Organisms are continuously encountering both predictable and unpredictable ecological stressors within their environment. The activation of the hypothalamic-pituitaryadrenal (stress) axis is a fundamental process allowing animals to cope with and respond to such encounters. A main consequence of HPA axis activation is the release of glucocorticoid hormones. Although short-term glucocorticoid elevations lead to changes in physiological and behavioral processes that are often adaptive, our understanding of fitness consequences of repeated acute elevations in glucocorticoid hormones over a longer time period is largely lacking. This is of particular current importance as animals are facing a significant increase in exposure to stressors including those associated with human-induced rapid environmental change. Here, we test fitness-relevant consequences of repeated exposure to glucocorticoids in the absence of natural challenges, by treating wild-caught gravid female eastern fence lizards (Sceloporus undulatus) with a daily transdermal dose of a glucocorticoid hormone until laying. This treatment causes an increase in plasma glucocorticoids that mimics the natural response lizards have when they encounter a stressor in the wild, without confounding effects associated with the encounter itself. This treatment reduced females' reproductive success (hatching success) and survival. Further, glucocorticoid-induced reductions in reproductive success were greater when females had experienced higher temperatures the previous winter. This demonstrates the potential significant consequences of repeated exposure to acute elevations in glucocorticoid hormones. Additionally, the costs of repeated glucocorticoid elevation may be further exaggerated by an individual's previous experience, such as the potential compounding effects of winter warming increasing animals' vulnerability to increased glucocorticoid levels during spring breeding.


Assuntos
Corticosterona/sangue , Glucocorticoides/sangue , Reprodução/fisiologia , Animais , Animais Selvagens , Taxa de Sobrevida
5.
Actas Urol Esp ; 2018 Mar 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29609827

RESUMO

INTRODUCTION: Laparoscopic radical nephrectomy(LRN) is a cornerstone in managing renal cancer and small renal masses. Twenty-first century surgical training faces challenges, thus must be efficient and safe so surgeons attain relevant skills, protecting patients and operative outcomes. This study aimed to systematically develop a tool for training and assessment in LRN and validate the developed tool for use by trainee urologists. METHODS: This prospective, longitudinal, multi-institutional study was undertaken from September 2014 - June 2015. Healthcare Failure Mode and Effect Analysis was utilised for development and followed by validation where the assessment tool was distributed to five specialists to increase content validity. Four experts were observed as a multi-institutional approach. Hand-assisted, transperitoneal and retroperitoneal approaches were considered. RESULTS: The LRN Assessment Tool comprised four phases, 17 processes, 41 sub-processes. Four surgeons and operating teams were observed across four hospitals for 19.5hours (5.75h hand-assisted, 8.75h trans-peritoneal, 5h retro-peritoneal). After hazard analysis, three checklists were constructed. Those for hand-assisted LRN and transperitoneal LRN contained four phases, 20 processes, 33 sub-processes and that for retroperitoneal LRN contained four phases, 20 processes, 30 sub-processes. These were merged to form one assessment tool. The final result was a four phase LRN Assessment Tool with 17 processes, 41 sub-processes. All participants agreed the final LRN Assessment Tool included pertinent steps. CONCLUSIONS: The LRN Assessment Tool was developed using Healthcare Failure Mode and Effect Analysis risk analysis to ensure hazardous procedural sub-steps were included. Validation ascertained important processes were not overlooked. Full application through a pilot study must be undertaken.

7.
J Biol Dyn ; 11(1): 480-503, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28976297

RESUMO

A simple mathematical model for the growth of tumour with discrete time delay in the immune system is considered. The dynamical behaviour of our system by analysing the existence and stability of our system at various equilibria is discussed elaborately. We set up an optimal control problem relative to the model so as to minimize the number of tumour cells and the chemo-immunotherapeutic drug administration. Sensitivity analysis of tumour model reveals that parameter value has a major impact on the model dynamics. We numerically illustrate how does these delay can change the stability region of the immune-control equilibrium and display the different impacts to the control of tumour. Finally, epidemiological implications of our analytical findings are addressed critically.


Assuntos
Evasão da Resposta Imune , Imunoterapia , Modelos Imunológicos , Neoplasias/tratamento farmacológico , Neoplasias/imunologia , Simulação por Computador , Humanos , Análise Numérica Assistida por Computador
8.
Asian Pac J Cancer Prev ; 17(2): 807-13, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26925684

RESUMO

Triple-negative breast cancers constitute about 15% of all cases, but despite their higher response to neoadjuvant chemotherapy, the tumors are very aggressive and associated with a poor prognosis as well as a higher risk of early recurrence. This study was retrospectively performed on 101 patients with stage II and III invasive breast cancer who received 6-8 cycles of neo-adjuvant chemotherapy. Out of the total, 23 were in the triple negative breast cancer subgroup. Nuclear Ki-67 expression in both the large cohort group (n=101) and triple negative breast cancer subgroup (n=23) and its relation to the pathological response were evaluated. The purpose of the study was to identify the predictive value of nuclear protein Ki-67 expression among patients with invasive breast cancers, involving the triple negative breast cancer subgroup, treated with neoadjuvant chemotherapy in correlation to the rate of pathological complete response. The proliferation marker Ki-67 expression was highest in the triple negative breast cancer subgroup. No appreciable difference in the rate of Ki-67 expression in triple negative breast cancer subgroup using either a cutoff of 14% or 35%. Triple negative breast cancer subgroup showed lower rates of pathological complete response. Achievement of pathological complete response was significantly correlated with smaller tumor size and higher Ki-67 expression. The majority of triple negative breast cancer cases achieved pathological partial response. The study concluded that Ki-67 is a useful tool to predict chemosensitivity in the setting of neoadjuvant chemotherapy for invasive breast cancer but not for the triple negative breast cancer subgroup.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/metabolismo , Antígeno Ki-67/metabolismo , Terapia Neoadjuvante , Neoplasias de Mama Triplo Negativas/patologia , Adulto , Quimioterapia Adjuvante , Feminino , Seguimentos , Humanos , Técnicas Imunoenzimáticas , Pessoa de Meia-Idade , Gradação de Tumores , Invasividade Neoplásica , Estadiamento de Neoplasias , Prognóstico , Receptor ErbB-2/metabolismo , Receptores Estrogênicos/metabolismo , Receptores de Progesterona/metabolismo , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias de Mama Triplo Negativas/tratamento farmacológico , Neoplasias de Mama Triplo Negativas/metabolismo
9.
Clin Exp Hypertens ; 36(7): 484-91, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24433043

RESUMO

We studied the community prevalence, patterns and predictors of hypertension in a large sub-population of South Asian adults with a view of identifying differential risk factors. Data were collected between years 2005-2006 and 5000 adults were invited for the study. The sample size was 4485, and about 39.5% were males. Mean systolic and diastolic blood pressures were 127.1 ± 19.8 mmHg and 75.4 ± 11.3 mmHg, respectively. Age-adjusted prevalence in all adults, males and females was 23.7%, 23.4% and 23.8%, respectively. Urban adults had a significantly higher prevalence of hypertension than rural adults. In the binary logistic-regression analysis, male gender (OR: 1.2), increasing age, Sri Lankan Moor ethnicity (OR: 1.6), physical inactivity (OR: 1.7), presence of diabetes (OR: 2.2) and central obesity (OR: 2.3) all were significantly associated with hypertension. In conclusion, nearly one-third of the Sri Lankan adult population is hypertensive. Hence, public health initiatives should encourage healthier lifestyles with emphasis on preventing obesity and increasing physical activity.


Assuntos
Hipertensão/epidemiologia , Adulto , Idoso , Pressão Sanguínea , Comorbidade , Estudos Transversais , Países em Desenvolvimento , Complicações do Diabetes/epidemiologia , Feminino , Promoção da Saúde , Inquéritos Epidemiológicos , Humanos , Hipertensão/fisiopatologia , Hipertensão/prevenção & controle , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade Abdominal/epidemiologia , Prevalência , Fatores de Risco , População Rural , Sri Lanka/epidemiologia , População Urbana
10.
Case Rep Pathol ; 2013: 687427, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23533895

RESUMO

Primary thyroid-like follicular carcinoma of the kidney is a rare but newly emerging histological variant of renal cell carcinoma RCC, with only nine cases reported in the literature to date. We present a further case of this unique condition, discuss the workup and typical histological findings, and review the literature regarding this rare histological variant.

11.
Diabetes Res Clin Pract ; 99(3): 292-9, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23298662

RESUMO

AIMS: Obesity associated metabolic diseases have reached epidemic levels in many South Asian countries. Conventional anthropometric indices have poor sensitivity and specificity for detecting people with increased metabolic risks. The aim of this study was to investigate and compare WHtR (Waist to Height Ratio) as a marker of diabetes and cardio-metabolic risks with existing classical anthropometric indices such as; Body Mass Index (BMI), Waist Circumference (WC) and Waist to Hip Ratio (WHR) in a large sub-population of ethnic South Asians. METHODS: A total of 5000 subjects recruited from a nationally representative community-based sample using multi-stage random cluster-sampling method. Anthropometric, biochemical and clinical parameters were measured. Receiver-operating characteristic (ROC) curves were performed and area under the curve (AUC) was calculated for each anthropometric index. RESULTS: Sample size was 4485. The mean WHtR in all adults was 0.496 (±0.077), males (0.477±0.065) had a significant lower WHtR than females (0.508±0.081) (p<0.001). WHtR had the highest correlation with metabolic parameters. In all adults, males and females the AUC of WHtR was significantly higher than that of BMI, WC and WHR in diabetes mellitus, pre-diabetes, hypertension, metabolic syndrome and hypercholesterolemia. Mean age, fasting blood glucose, 2-h post prandial blood Glucose, total cholesterol, LDL cholesterol, triglycerides, systolic blood pressure and diastolic blood pressure were all significantly higher among all adults, males and females with WHtR≥0.5. CONCLUSIONS: WHtR is a simple and effective anthropometric index to identify obesity associated metabolic risks among Sri Lankan adults.


Assuntos
Antropometria , Estatura , Doenças Metabólicas/etiologia , Obesidade/complicações , Circunferência da Cintura , Adulto , Idoso , Área Sob a Curva , Grupo com Ancestrais do Continente Asiático , Biomarcadores , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Estado Pré-Diabético , Fatores de Risco , Sri Lanka/epidemiologia
12.
Ecol Lett ; 16(2): 271-80, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23205937

RESUMO

Ecological and medical researchers are investing great effort to determine the role of Maternally-Derived Stress (MDS) as an inducer of phenotypic plasticity in offspring. Many researchers have interpreted phenotypic responses as unavoidable negative outcomes (e.g., small birth weight, high anxiety); however, a biased underestimate of the adaptive potential of MDS-induced effects is possible if they are not viewed within an ecologically relevant or a life-history optimization framework. We review the ecological and environmental drivers of MDS, how MDS signals are transferred to offspring, and what responses MDS induces. Results from four free-living vertebrate systems reveals that although MDS induces seemingly negative investment trade-offs in offspring, these phenotypic adjustments can be adaptive if they better match the offspring to future environments; however, responses can prove maladaptive if they unreliably predict (i.e., are mismatched to) future environments. Furthermore, MDS-induced adjustments that may prove maladaptive for individual offspring can still prove adaptive to mothers by reducing current reproductive investment, and benefitting lifetime reproductive success. We suggest that to properly determine the adaptive potential of MDS, researchers must take a broader integrated life-history perspective, appreciate both the immediate and longer term environmental context, and examine lifetime offspring and maternal fitness.


Assuntos
Adaptação Biológica , Estresse Fisiológico , Animais , Feminino , Peixes , Glucocorticoides/fisiologia , Lebres , Lagartos , Exposição Materna , Densidade Demográfica , Comportamento Predatório , Gravidez , Vertebrados
13.
Public Health Nutr ; 16(9): 1684-92, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22995708

RESUMO

OBJECTIVE: To evaluate patterns of physical activity (PA), the prevalence of physical inactivity and the relationships between PA and sociodemographic, clinical and biochemical parameters among Sri Lankan adults. DESIGN: Descriptive cross-sectional study. SETTING: Nationally representative population-based survey conducted in Sri Lanka. SUBJECTS: Data on PA and associated details were obtained from 5000 adults. PA was assessed using the International Physical Activity Questionnaire (short-form). A binary logistic regression analysis was performed using the dichotomous variable 'health-enhancing PA' (05'active', 15'inactive'). RESULTS: Sample size was 4485. Mean age was 46.1 (SD 15.1) years, 39.5% were males. The mean weekly total MET (metabolic equivalents of task) minutes of PA among the study population was 4703 (SD 4369). Males (5464 (SD 5452)) had a significantly higher weekly total MET minutes than females (4205 (SD 3394); P,0.001). Rural adults (5175 (SD 4583)) were significantly more active than urban adults (2956 (SD 2847); P<0.001). Tamils had the highest mean weekly total MET minutes among ethnicities. Those with tertiary education had lowest mean weekly total MET minutes. In all adults 60.0% were in the 'highly active' category, while only 11.0% were 'inactive' (males 14.6%, females 8.7%; P<0.001). Of the 'highly active' adults, 85.8% were residing in rural areas. Results of the binary logistic regression analysis indicated that female gender (OR52?1), age .70 years (OR53.8), urban living (OR52.5), Muslim ethnicity (OR52.7), tertiary education (OR53.6), obesity (OR51.8), diabetes (OR51.6), hypertension (OR51.2) and metabolic syndrome (OR51.3) were all associated with significantly increased odds of being physically 'inactive'. CONCLUSIONS: The majority of Sri Lankan adults were 'highly active' physically. Female gender, older age, urban living, Muslim ethnicity and tertiary education were all significant predictors of physical inactivity. Physical inactivity was associated with obesity, diabetes, hypertension and metabolic syndrome.


Assuntos
Países em Desenvolvimento , Diabetes Mellitus/etiologia , Exercício Físico , Hipertensão/etiologia , Síndrome Metabólica/etiologia , Obesidade/etiologia , Comportamento Sedentário , Adulto , Idoso , Coleta de Dados , Diabetes Mellitus/metabolismo , Exercício Físico/fisiologia , Feminino , Humanos , Hipertensão/metabolismo , Modelos Logísticos , Masculino , Equivalente Metabólico , Síndrome Metabólica/metabolismo , Pessoa de Meia-Idade , Atividade Motora , Obesidade/metabolismo , Fatores Socioeconômicos , Sri Lanka , Inquéritos e Questionários
14.
J Environ Biol ; 34(2): 273-5, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24620591

RESUMO

The Adyar estuary was once known for its unique ecology and endemic flora and fauna, has lost its pristine condition due to urbanization, discharge of untreated domestic wastes, industrial effluents and encroachments. Zooplankton were monitored for a period of one year from July 2009 to June 2010, following standard methods to evaluate the seasonal variations in diversity and density in relation to environmental parameters like temperature (28.6-33.6 degrees C), salinity (23.3-30.3 per thousand), pH (7.3-7.8) and DO (4.4-7.1 mg l(-1)). Highest diversity was observed during post-monsoon (20 species) and pre-monsoon (19 species), followed by summer (9 species) and monsoon (9 species). The zooplankton density was maximum during summer (1887167 m(-3)) followed by pre-monsoon (1843832 m(-3)), post-monsoon (1153333 m(-3)) and monsoon (182334 m(-3)). Zooplankton community structure and dynamics showed a differential pattern with dominance of harpacticoids and rotifers in pre-monsoon; cyclopoids and rotifers during post-monsoon and summer. The significance of monitoring zooplankton biodiversity as a base-line study for future investigations on environmental changes in this area is discussed.


Assuntos
Estuários , Zooplâncton/classificação , Zooplâncton/fisiologia , Animais , Biodiversidade , Índia
15.
Diabetol Metab Syndr ; 4(1): 21, 2012 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-22642973

RESUMO

Prevalence of diabetes mellitus (DM) has reached epidemic proportions in Sri Lanka. Presently there are studies on the community prevalence of distal peripheral neuropathy (DPN) in Sri Lanka. We describe prevalence, patterns and predictors of DPN in patients with DM in Sri Lanka. Data were collected as part of a national study on DM. In new cases DPN was assessed using the Diabetic-Neuropathy-Symptom (DNS) score, while in those with established diabetes both DNS and Toronto-Clinical-Scoring-System (TCSS) were used. A binary logistic-regression analysis was performed with 'presence of DPN' as the dichomatous dependent variable and other independent co-variants. The study included 528 diabetic patients (191-new cases), with a mean age of 55.0 ± 12.4 years and 37.3% were males, while 18% were from urban areas. Prevalence of DPN according to DNS score among all patients, patients with already established diabetes and newly diagnosed patients were 48.1%, 59.1% and 28.8% respectively. Prevalence of DPN in those with established DM as assessed by TCSS was 24% and the majority had mild DPN (16.6%). The remainder of the abstract is based on subjects with established DM. The prevalence of DPN in males and female was 20.0% and 26.4% respectively. The mean age of those with and without DPN was 62.1 ± 10.8 and 55.1 ± 10.8 years respectively (p < 0.001). The majority of those with DPN were from rural-areas (75.3%) and earned a monthly income < Sri Lankan Rupees 12,000 (87.6%). In the binary logistic-regression presence of foot ulcers (OR:10.4; 95%CI 1.8-16.7), female gender (OR:6.7; 95%CI 2.0-9.8) and smoking (OR:5.9; 95%CI 1.4-9.7) were the strongest predictors followed by insulin treatment (OR:4.3; 95%CI 1.3-6.9), diabetic retinopathy (OR:2.7; 95%CI 1.3-5.4), treatment with sulphonylureas (OR:1.8; 95%CI 1.1-3.2), increasing height (OR:1.8; 95%CI 1.2-2.4), rural residence (OR:1.8; 95%CI 1.1-2.5), higher levels of triglycerides (OR:1.6; 95%CI 1.2-2.0) and longer duration of DM (OR:1.2; 95%CI 1.1-1.3). There is a high prevalence of DPN among Sri Lankan adults with diabetes. The study defines the impact of previously known risk factors for development of DPN and identifies several new potential risk factors in an ethnically different large subpopulation with DM.

16.
Br J Nutr ; 105(7): 1084-90, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21205381

RESUMO

Obesity is associated with increased cardiovascular risk. Anthropometric cut-off values derived for Caucasians may not be applicable to other populations. The main objective of the present study was to derive population-specific anthropometric cut-off values to define high CVD risk for Sri Lankan adults. A nationally representative sample of 4474 non-institutionalised adults aged ≥ 18 years was analysed. Cut-off values to provide optimum sensitivity and specificity were derived using receiver-operating characteristic curve analysis. BMI, waist circumference (WC), waist-to-hip ratio (WHR), blood pressure and overnight fasting venous blood samples were collected to measure glucose, HDL-cholesterol and TAG. An oral glucose tolerance test was also performed. The results suggested that the age-adjusted BMI, WC and WHR were significantly associated with all cardiovascular risk factors (P < 0·001). Cut-off values for BMI, WC and WHR for males were 20·7 kg/m2, 76·5 cm and 0·89, respectively. The respective values for females were 22·0 kg/m2, 76·3 cm and 0·85. The common cut-off value for BMI for males and females was 21·5 kg/m2. Similarly, WC and WHR cut-off values for both males and females were 76·3 cm and 0·87, respectively. The Asian and Caucasian anthropometric cut-off levels showed lower sensitivity and higher false negative percentage compared with newly derived cut-off levels. In conclusion, BMI, WC and WHR were all associated with increased CVD risk. We propose the following anthropometric cut-off points to determine high CVD risk level for Sri Lankan adults: BMI ≥ 21·5 kg/m2, WC ≥ 76 cm and WHR ≥ 0·85 (women) and 0·90 (men).


Assuntos
Grupo com Ancestrais do Continente Asiático , Índice de Massa Corporal , Doenças Cardiovasculares/etnologia , Obesidade/etnologia , Circunferência da Cintura/etnologia , Relação Cintura-Quadril , Adulto , Antropometria , Doenças Cardiovasculares/etiologia , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Curva ROC , Valores de Referência , Fatores de Risco , Fatores Sexuais , Sri Lanka
17.
Econ Hum Biol ; 9(1): 23-9, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21126931

RESUMO

The present study examines patterns and socioeconomic and demographic correlates of adult height among Sri Lankan adults. Data were available for height and socio-demographic factors from a nationally representative cross-sectional sample of 4477 subjects above 18 years. Recruitment was between 2005 and 2006. Mean age of all subjects was 46.1±15.1 years. Mean height of males and females were 163.6±6.9cm and 151.4±6.4cm respectively. Mean height showed a significant negative correlation with age (p<0.001, r=-0.207). Highest mean height in females 154.0±5.9cm and males 165.6±6.9cm were observed in those born after 1977. Rural females (151.4±6.2cm) were significantly taller than the urban (151.3±7.2cm). However, this was not observed in males. In multivariate analysis, year of birth, level of education and household income were significantly associated with height. Height demonstrated a significant negative correlation with systolic blood pressure (r=-0.032), presence of diabetes (r=-0.069), total cholesterol (r=-0.106), HDL cholesterol (r=-0.142) and LDL cholesterol (r=-0.104). Height was associated with household income and level of education in Sri Lanka and demonstrated a distinct increasing trend over successive generations.


Assuntos
Estatura , Glicemia/metabolismo , Pressão Sanguínea/fisiologia , Estudos Transversais , Feminino , Humanos , Masculino , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Análise Multivariada , Valores de Referência , Análise de Regressão , Fatores Socioeconômicos , Sri Lanka , Estatística como Assunto
18.
Obes Rev ; 11(11): 751-6, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-20406417

RESUMO

The aim of the study was to determine the prevalence of overweight, obesity and abdominal obesity, and the underlying socio-demographic correlates among Sri Lankan adults. Data were from 4532 adults aged ≥18 years randomly selected for a national level study on diabetes and cardiovascular disease. Weight, height and waist circumference (WC) were measured and body mass index (BMI) calculated. The mean (95% confidence interval) BMI and WC were 21.1 kg m(-2) (20.9-21.3), 22.3 kg m(-2) (22.1-22.4) and 78.0 cm (77.5-78.6) and 77.5 cm (77.0-78.0) for males and females, respectively. According to the proposed World Health Organization cut-off values for Asians, the percentage of Sri Lankan adults in the overweight, obese and centrally obese categories were 25.2%, 9.2% and 26.2%, respectively. Based on the cut-offs for Caucasians, these were 16.8%, 3.7% and 10.8%. Our findings were compatible with prevalence of obesity in regional countries. In addition, female sex, urban living, higher education, higher income and being in the middle age were shown to be associated with overweight and obesity in Sri Lankans. In conclusion, we have documented a relatively high prevalence of overweight and obesity, particularly, abdominal obesity among adults in Sri Lanka which is a middle-income country. Urgent public health interventions are needed to control the problem at an early stage.


Assuntos
Sobrepeso/epidemiologia , Fatores Etários , Índice de Massa Corporal , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Obesidade Abdominal/epidemiologia , Prevalência , Fatores Sexuais , Fatores Socioeconômicos , Sri Lanka/epidemiologia , Circunferência da Cintura
19.
QJM ; 102(11): 785-92, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19737786

RESUMO

BACKGROUND: Many organophosphorus (OP) insecticides have either two O-methyl or two O-ethyl groups attached to the phosphorus atom. This chemical structure affects their responsiveness to oxime-induced acetylcholinesterase (AChE) reactivation after poisoning. However, several OP insecticides are atypical and do not have these structures. AIM: We aimed to describe the clinical course and responsiveness to therapy of people poisoned with two S-alkyl OP insecticides-profenofos and prothiofos. DESIGN: We set up a prospective cohort of patients with acute profenofos or prothiofos self-poisoning admitted to acute medical wards in two Sri Lankan district hospitals. Clinical observation was carried out throughout their inpatient stay; blood samples were taken in a subgroup for assay of cholinesterases and insecticide. RESULTS: Ninety-five patients poisoned with profenofos and 12 with prothiofos were recruited over 5 years. Median time to admission was 4 (IQR 3-7) h. Eleven patients poisoned with profenofos died (11/95; 11.6%, 95% CI 5.9-20); one prothiofos patient died (1/12; 8.3%, 95% CI 0.2-38). Thirteen patients poisoned with profenofos required intubation for respiratory failure (13/95; 13.7%, 95% CI 7.5-22); two prothiofos-poisoned patients required intubation. Both intubations and death occurred late compared with other OP insecticides. Prolonged ventilation was needed in those who survived-a median of 310 (IQR 154-349) h. Unexpectedly, red cell AChE activity on admission did not correlate with clinical severity-all patients had severe AChE inhibition (about 1% of normal) but most had only mild cholinergic features, were conscious, and did not require ventilatory support. CONCLUSION: Compared with other commonly used OP insecticides, profenofos and prothiofos are of moderately severe toxicity, causing relatively delayed respiratory failure and death. There was no apparent response to oxime therapy. The lack of correlation between red cell AChE activity and clinical features suggests that this parameter may not always be a useful marker of synaptic AChE activity and severity after OP pesticide poisoning.


Assuntos
Inseticidas/envenenamento , Intoxicação por Organofosfatos , Adulto , Biomarcadores/sangue , Causas de Morte , Colinesterases/sangue , Feminino , Humanos , Inseticidas/sangue , Masculino , Pessoa de Meia-Idade , Compostos Organofosforados/sangue , Organotiofosfatos/sangue , Estudos Prospectivos , Sri Lanka , Adulto Jovem
20.
Am J Trop Med Hyg ; 79(3): 458-62, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18784244

RESUMO

A prospective study was designed to define epidemiologic and clinical features of krait bites to improve diagnosis, management, and prevention. Among 762 cases of venomous snake bites admitted to 10 Sri Lankan hospitals in which the snake responsible was brought and identified, 88 (11.5%) were caused by common kraits (Bungarus caeruleus). Bites were: most frequent in September through November. Distinctive features of B. caeruleus bites (compared with bites by other species in parentheses) were bitten while sleeping on the ground, 100% (1%); indoors, 100% (49%); between 2300 and 0500 hours, 100% (3%). Only 13% of krait victims were bitten on their lower limbs (82%), only 9% had local swelling (in all cases mild) at the site of the bite (93%), 64% developed respiratory paralysis (2%), and 91% experienced (often severe) abdominal pain (10%). Case fatality was 6% (3%). This distinctive pattern of epidemiology and symptoms will aid clinical recognition (syndromic diagnosis) and prevention of krait bite envenoming.


Assuntos
Bungarus/fisiologia , Mordeduras de Serpentes/epidemiologia , Mordeduras de Serpentes/patologia , Adolescente , Adulto , Idoso , Animais , Antivenenos/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estações do Ano , Mordeduras de Serpentes/tratamento farmacológico , Sri Lanka/epidemiologia , Fatores de Tempo
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