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.