BackgroundLiver involvement in acute dengue infection is frequently observed and sometimes leads to acute liver failure, with fatal outcomes. Many factors are thought to contribute to liver dysfunction, including hypoxic injury due to decreased perfusion, direct damage by the virus and immune mediated injury. In this study, we sought to identify the pattern in the change in liver enzymes throughout the illness and its association with the degree of viraemia, onset and extent of plasma leakage and inflammatory mediators.MethodsSerial daily blood samples were obtained from 55 adult patients with acute dengue from the time of admission to discharge and the liver function tests, viral loads and cytokines were assessed. The onset and extent of fluid leakage was measured by daily ultrasound examinations and all clinical and laboratory features were serially recorded.ResultsAspartate transaminase (AST), alanine transaminase (ALT) and gamma glutamyl transferase (GGT) levels were elevated in patients with dengue infection throughout the illness. The highest AST levels were seen on day 6 of illness and both AST and GGT levels were significantly higher in patients with severe dengue (SD), when compared to those with non-severe dengue (NSD) on day 5 and 6 of illness. Three patients with SD had AST and ALT values of >1000/IU in the absence of any fluid leakage or a rise in the haematocrit (≥20 %). The peak of the AST levels and the lowest serum albumin levels were seen 24 h before the maximum fluid leakage and 24 h after the peak in viraemia. Both serum IL-10 and IL-17 levels were elevated during early illness and were significantly higher in those with SD when compared to NSD.ConclusionDengue associated liver injury appears to peak around day 6 and 7. Therefore, liver function tests done at earlier dates might not reflect the extent of liver involvement in acute infection. Since severe liver involvement can occur in the absence of fluid leakage, after the peak viraemia, and since it is associated with high IL-17 and IL-10 levels, possible immune mechanisms leading to hepatic damage should be investigated.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1656-2) contains supplementary material, which is available to authorized users.
Ochratoxin A (OA) is a naturally occurring mycotoxin with nephrotoxic properties that can contaminate plant food products. OA concentrations were assessed in commonly consumed food items in the North Central Province of Sri Lanka, where chronic kidney disease is diagnosed at epidemic proportions. Ninety-eight randomly selected food samples were analysed. Mycotoxin was detected in the extract by using a MycoMonitor Ochratoxin A ELISA assay kit (Helica Biosystems Inc., USA). The levels of OA found in these food commodities were below the recommended statutory maximum limit and are unlikely to be a potential risk factor for nephropathy in the North Central Province of Sri Lanka.
The object of this study was to determine whether serum uric acid, serum creatinine and urinary microprotein levels could be used to identify women who might subsequently develop pre-eclampsia during pregnancy. This is a cross-sectional descriptive study performed on women attending the University antenatal clinic in Colombo South Teaching Hospital, Sri Lanka. Serum uric acid, creatinine and microproteinuria levels were determined in 256 women attending the antenatal clinic at 28 weeks of pregnancy. Subsequently they were followed-up at 2-weekly intervals until 36 weeks and weekly thereafter until delivery. At each visit blood pressure was recorded and serum uric acid, creatinine and microprotein levels were determined. Fifty-nine women developed blood pressures of 140/90 mmHg or more during the study period. Serum uric acid and serum creatinine levels did not show any significant difference before the elevated blood pressures were recorded. Microprotenuria levels of more than 375 mg/l were recorded in 43 women before elevation of their blood pressure. Sixty-five women of 197 who remained normotensive had microproteinuria levels of more than 375 mg/l. The sensitivity and specificity of microproteinuria levels of more than 375 mg/l as a screening test for prediction of pre-eclampsia was 73% and 67%, respectively. Therefore, microproteinuria of more than 375 mg/l may be used as a cut-off value and as a screening test for the early detection of women at risk of developing pre-eclampsia. Serum uric acid and creatinine had no predictive value as a screening test for pre-eclampsia.
BackgroundGlutathione peroxidase-1 (GPX-1) activity was reported to be useful marker for monitoring cardiovascular disease. However, accurate assessment of coronary artery disease (CAD) using GPX-1 polymorphism is limited for South Asian population. Present study aim to assess GPX-1activity and GPX-1 polymorphismin patients with coronary artery disease (CAD) who were confirmed with coronary angiography findings and in apparently healthy subjects.MethodsCase control study was carried out with 85 patients (58 males and 27 females) 40–60 years of age confirmed as having CAD on coronary angiography findings and 85 age and sex matched healthy volunteers as controls. Blood samples were analyzed for erythrocyte GPX-1 activity and GPX-1 polymorphism in both groups and the severity of CAD was assessed using coronary angiography scoring system based on vessel, stenosis and extent score.ResultsCoronary angiography scores indicated that erythrocyteGPX-1 cutoff value of 23.9 U/gHb showed a high sensitivity and negative predictive value in ruling out major vessel disease. The GPX-1 Pro198Leu (CT) polymorphism was higher in patients with CAD (25.3 %) when compared to controls (10.7 %). Pro198Leu (CT) genotype showed a 2.84 fold risk for CAD [odds ratio 2.84 (95 % CI 1.15–6.98), p = 0.019].ConclusionCoronary angiography findings indicated that individuals possessing Pro198Leu (CT) polymorphism were found to be associated with low erythrocyte GPX-1 activity and increased susceptibility for CAD.
BackgroundAssociation of Vitamin D receptor (VDR) polymorphisms with lumbar disc herniation (LDH) have been identified in several ethnic groups globally. Despite abundant sunlight, vitamin D deficiency is reported in many tropical countries. As vitamin D is a key modulator for intestinal calcium absorption, low vitamin D could contribute to low serum calcium leading to abnormalities of skeletal homeostasis. Therefore, present study was aimed to study the association of serum 25-hydroxyvitamin D (25(OH)D), serum calcium and VDR polymorphisms in a selected Sri Lankan population.Materials & methodsA case control study was conducted in 119 participants (cases = 51: controls = 68). Serum 25(OH)D levels were measured using ELISA. The VDR polymorphisms (Fok I and Taq I) were detected by polymerase chain reaction followed by restriction fragment length polymorphism.ResultsFindings indicated a significantly low (p = 0.000) 25(OH)D levels in cases (18.7±3.7 ng/mL) compared to controls(25.5±9.8 ng/mL) while 25(OH)D in both groups were below the reference range. Mean serum calcium levels in both groups were within normal reference range and was not significantly different among groups. Statistically significant association was not observed between VDR Fok I polymorphisms among cases and controls. Although Fok I polymorphism genotypes were in Hardy-Weinberg equilibrium (HWE), Taq I genotypes in controls violated HWE.ConclusionPresent study confirms that insufficient serum 25(OH)D levels in cases have major contribution to LDH. VDR Fok I polymorphisms did not have any significant association with LDH in Sri Lankan ethnicity.
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