Background:Despite different management strategies, progression of proteinuria occurs in a sizable category of patients with diabetic nephropathy (DN). Increase in serum renin levels induced by the renin–angiotensin system (RAS) may contribute to this. Vitamin D therapy is found to have an inhibitory effect on the RAS. We aimed to study the effects of Vitamin D therapy on renal functions of patients with DN.Methods:This was a double-blind, randomized, placebo-controlled study. Patients with DN (urinary albumin [UA] >30 mg/g of creatinine) whose estimated glomerular filtration rate (eGFR) was more than 30 mL/min were selected and their plasma renin, parathyroid hormone, serum Vitamin D, serum calcium, serum creatinine, fasting blood sugar were done as baseline measurements. Subjects were randomized into two groups and treatment group was given Vitamin D, 50000 IU (0.25 ml) intramuscularly (IM) monthly for 6 months; control group received distilled water IM. Investigations were repeated after 6 months of therapy.Results:Of 155 patients invited, 85 were randomly assigned to two groups. After 6 months, mean reduction of UA to creatinine ratio in the treatment and control group was 51.8 mg/g (95% confidence interval [CI]; 66.1–−37.5, P ≤ 0.001); 22.4 mg/g (95% CI; −45.7–0.8, P = 0.06), respectively (between group difference P = 0.001). Significant increase in the eGFR observed in the treatment group while eGFR remained unchanged in the control group (P = 0.03 for the between-group difference). Mean reduction in plasma renin in treatment group and control group was 5.85 pg/mL (95% CI; −6.7–−4.6) (P < 0.001) and 0.95 pg/mL (95% CI; −1.4–−0.14, P = 0.02), respectively.Conclusions:Vitamin D 50000 IU given IM monthly for 6 months reduces urine albumin, serum creatinine, and renin levels in patients with DN.

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Objectives:Design Setting: Results:Interpretation:The aim of this study was to validate the original version of the Rose Angina Questionnaire (RAQ) and apply it to a group of long standing diabetics in a cross-sectional manner to assess it applicability in clinical settings.After a face validation and piloting the Part A of the Sinhala translated RAQ (SRAQ-Part A) was given to 47 adult patients who presented with chest pain where the possibility of stable angina was considered in the differential diagnosis. In these patients, the diagnosis of stable angina was confirmed by resting ECG. Patients who had a normal resting ECG or changes non-confirmatory of myocardial ischaemia underwent treadmill examination to detect exercise-induced myocardial ischaemia.Part B of the translated RAQ (SRAQ-Part B) was given to 68 patients who presented with acute chest pain of less than 24 hours where acute coronary syndrome was considered a possibility. These patients underwent serial ECGs and cardiac enzymes/troponin estimations.The validated SRAQ were administered to a group of diabetics (n = 311) attending medical clinics of Teaching hospital, Karapitiya in a cross-sectional manner to detect the prevalence of stable angina or history of acute coronary syndrome. Sensitivity, specificity, positive predictive value, and negative predictive values of SRAQ-Part A were 86.4%, 76%,76%, 86% and of part-B were 74.1, 70%, 93.5%, 31.8%, respectively.Of 311 diabetic patients the prevalence of stable angina in this group of patients would be 31% (95% CI = 26-37%). Part B of the questionnaire, 17 answered positively and rest negatively. Of these 17 positives, 16 were likely to have acute coronary disease.Our analysis shows that the Sinhala translation of the RAQ has an acceptable specificity and sensitivity in detecting either stable angina or acute coronary syndrome. The prevalence of stable angina was 31% among the diabetics selected for this analysis.

This review includes the following arms exploring the effects of vitamin D on 1. renal functions in patients with diabetic nephropathy. 2. lipid profile and blood pressure in patients with diabetic nephropathy. 3. cardiovascular risk scores in patients with diabetic nephropathy. 4. bone mineral density in patients with diabetic nephropathy. Methods This study was conducted on patients with diabetic nephropathy (urinary albumin >30 mg/g of creatinine in two occasions) whose GFR was

Introduction: Poor compliance with antibiotics is a well described phenomenon. This has contributed to the increased burden of antibiotic resistance in many countries.Objectives: This study was conducted to investigate patient compliance with antibiotic regimens in Sri Lanka.Methods: Patients who received antibiotics from one outlet of the outdoor pharmacy in Teaching Hospital, Karapitiya were enrolled into the study. An interviewer administered questionnaire was used to collect initial data. Three days after dispensing, follow up telephone calls were made to obtain information about adherence to dose and dose frequency.Results: Out of total 509 patients participated for the initial data collection, 318 (62.4%) responded to the telephone interview. Among the respondents, 169 (53.1%) were compliant with the antibiotic regimen. Of them 143 (45%) and 26 (8.1%) were fully compliant and marginally compliant with the antibiotic regimens respectively. The total number of patients who did not strictly adhere to the dose and frequency instruction were 28 (8.8%) and 171 (53.8%) respectively. Commonest reasons for noncompliance were forgetfulness, followed by intentionally withdrawal. Compliance was significantly associated with dosing frequency (X 2 =14.1; P=0.007) and indication for commencing antibiotics (X 2 =14.2; P=0.014). Postsurgical treatment and urinary tract infection had higher compliance than respiratory tract infections and skin infections. Conclusions:This study revealed alarmingly high rates of non-adherence to prescribed antibiotic regimens. This can contribute to emergence of resistance to commonly used antibiotics in Sri Lanka.

Introduction: Diabetes mellitus (DM) impairs bone strength resulting in an increased risk of fractures. This study was designed to determine the association between bone mineral density (BMD) and vertebral fractures among a selected group of patients with Type 2 diabetes mellitus. Methods: This cross-sectional study included patients with diabetes, selected from clinic attendees at Teaching Hospital Karapitiya. Serum creatinine, urine microalbumin to creatinine ratio and a lateral radiograph of the thoraco-lumbar spine were done in all patients. Those who were detected to have vertebral fracture/s underwent bone densitometry. BMD was also measured in a group of patients selected from the rest of the group who did not have vertebral fractures and another group of healthy individuals selected from the same community. They were matched for the age and gender. Results: In patients with diabetes (n=160, females 110), the mean (SD) age and the duration of the disease were 62 (10) years and 10 (3) years, respectively. Of patients with diabetes screened, 20 had vertebral fractures (12.5% prevalence). Compared to healthy controls, patients with diabetes without vertebral fractures had significantly low BMDs in the proximal femur but comparatively higher BMD in the total spine. BMDs measured in the total spine and proximal femur were not different between patients with DM vertebral fractures and without vertebral fractures. Conclusions: Our data indicate a 12.5% prevalence of vertebral fracture among patients with DM. Although patients with diabetes in general had lower BMDs in most of the regions examined, there was no significant difference in regional BMDs between those with fractures and without fractures.

Objectives The objectives of this study were to describe the knowledge, attitudes and practices of Adverse Drug Reactions (ADR) reporting among healthcare professionals in Teaching Hospital Karapitiya (THK). Methodology A descriptive cross-sectional study was conducted at THK. The healthcare professionals working in THK who were available during the study period were invited to the study. A self-administered pre-tested questionnaire was given to the participants. Respondents were evaluated for their knowledge, attitudes and practices related to ADR reporting. The data was analyzed using SPSS statistical software. Results Of the total 444 respondents, 31% were doctors and 69% were nurses. Majority of respondents, 90% (n=400) were aware about the term ADR, while 64.8% (n=288) could correctly define it. Among the respondents, 30.8% (n=137) knew about the types of ADR and only 15.5% (n= 70) were able to correctly mention a drug that is banned due to ADR. Among the respondents, only 38.7% (n=172) were aware about formal process of reporting ADR and, only 35.3% (n=157) stated that they have seen ADR reporting form. Further, only 33.7% (n=150) respondents have recognized ADR in the practice and only a small proportion 18.2% (n=81) have ever reported an ADR during their practice. Regarding attitudes of ADR reporting, overall 84.1 (n=373) had positive attitude towards ADR reporting while 13.54% (n=60) of them stayed neutral and 2.25% (n=10) had negative attitude towards ADR reporting. Conclusions Although the majority was aware about ADR and the importance of their reporting, the knowledge and practices regarding the spontaneous reporting of ADR is inadequate. However, most of the respondents have shown a positive attitude towards ADR reporting. Sincere and sustained efforts should be made by concerned bodies to improve the knowledge, attitudes, and practices of health care professionals.

Sri Lanka is a developing country in which one of five adults has either diabetes or prediabetes. Complications of diabetes, especially diabetic neuropathy, place a considerable burden on the country's health care system 1 and so there is a dire need for an easy to perform, cheap, and validated tool for the early detection of diabetic neuropathy among Sri Lankan patients.Many validated scoring systems are available in Western countries for the screening of distal symmetrical diabetic neuropathy (DSPN), which accounts for 75% of all diabetic neuropathies, 2 with the two most common being the Diabetic Neuropathy Symptom (DNS) and Diabetic Neuropathy Examination (DNE) scores. 3,4 The DNS score incorporates information from four questions related to medical history. The maximum score is 4 points, with scores >1 considered abnormal. The DNE score is based on a hierarchical physical examination consisting of eight items. The maximum score is 16 and scores >3 are considered abnormal. However, we were unable to find a similar screening tool validated for the local Sri Lankan population. Thus, we undertook the present study to examine the clinical utility of the commonly used DNS and DNE scores for diagnosing diabetic neuropathy among our local population of diabetics.Patients with diabetes attending medical clinics in the Teaching Hospital (Galle, Sri Lanka) were recruited to the study, which was approved by the Ethical Review Committee, Faculty of Medicine (University of Ruhuna, Galle). All participants provided informed consent. Demographic and disease-related data were collected using a pretest questionnaire. The DNS and DNE scores were obtained separately by two researchers who were blinded to the score obtained using the other tool. Both DNS and DNE scores were obtained as per the recommended guidelines. 3,4 The SemmesWeinstein monofilament (SW-MF) and vibration perception threshold (VPT) determined using a biothesiometer were considered as reference standards for the detection of diabetic neuropathy. Both these tests were performed on the same as the DNS and DNE questionnaires by another medical officer who did not know the results of the DNS and DNE scores.The SW-MF test was applied with 10 g pressure and standard ''yes ⁄ no'' responses. It was applied to five sites on each foot: plantar surface of the first toe, the plantar surfaces of the first, third, and fifth metatarsal heads, and the plantar surface of the heal. 5 The VPT was performed using a hand-held biothesiometer (Madras Engineering Services, Chennai, India). The VPT was determined over the dorsal aspect of the hallux on the interphalangeal joint. The voltage of the vibration was increased from 0 to 50 V until the patient perceived a vibration. The mean of three measurements was used as the value for each patient as was compared against ageadjusted reference values. 6 Values higher than the mean + 2 SD were considered abnormal. 6 In all, 314 diabetic patients (98 men) were screened. The mean (±SD) age and duration of the disease were 62.0 ± 10.5 and 9.4...