Ss Jayasinghe

Arsenic and human health effects: A review

Arsenic (As) is ubiquitous in nature and humans being exposed to arsenic via atmospheric air, ground water and food sources are certain. Major sources of arsenic contamination could be either through geological or via anthropogenic activities. In physiological individuals, organ system is described as group of organs that transact collectively and associate with other systems for conventional body functions. Arsenic has been associated with persuading a variety of complications in body organ systems: integumentary, nervous, respiratory, cardiovascular, hematopoietic, immune, endocrine, hepatic, renal, reproductive system and development. In this review, we outline the effects of arsenic on the human body with a main focus on assorted organ systems with respective disease conditions. Additionally, underlying mechanisms of disease development in each organ system due to arsenic have also been explored. Strikingly, arsenic has been able to induce epigenetic changes (in utero) and genetic mutations (a leading cause of cancer) in the body. Occurrence of various arsenic induced health effects involving emerging areas such as epigenetics and cancer along with their respective mechanisms are also briefly discussed.

Correlation between changes of blood pressure with insulin resistance in type 2 diabetes mellitus with 4 weeks of pioglitazone therapy.

OBJECTIVE: To examine effects of pioglitazone (PIO) on systolic, diastolic, pulse and mean blood pressures (SBP, DBP, PP and MP, respectively) in type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: One hundred and six normotensive patients with T2DM with mean fasting blood glucose (FBS; 183 ± 6 mg/dl) were randomly divided into two groups. Test group was treated with 15 mg of PIO in addition to metformin 500 mg three times per day in both groups. SBP, DBP, PP and MP and fasting insulin, FBS and lipid profiles were measured before and after PIO therapy. RESULTS: There was a significant reduction in SBP (123 ± 2 vs. 118 ± 2 mmHg, P < 0.05), PP (41 ± 1 vs. 37 ± 1 mmHg, P < 0.05), and MP (95 ± 1 vs. 91 ± 1, P < 0.05). Clinical reduction in DBP was observed but not significant (82 ± 2 vs. 81 ± 1 mmHg, P > 0.05). There was a significant correlation between decline in SBP and DBP with respective baseline values (r = 0.76, P < 0.001 and r = 0.62, P < 0.001, respectively). Changes in PP and MP strongly correlated with baseline values (r = 0.51, P < 0.05 and r = 0.56, P < 0.05, respectively). There was a parallel reduction of FBS (183 ± 2 vs. 121 ± 3, P < 0.001) but reduction in IR or lipid profiles was not significant in test group. Changes in BP were not significant in control group ( P > 0.05). CONCLUSION: PIO treatment of T2DM showed early reduction of SBP and MP within first 4 weeks. Results suggest that pharmacodynamic effects of PIO mainly affect the systolic component. We hereby suggest that reduction of BP by PIO is independent from mechanisms of changes in IR and dyslipidaemia in normotensive diabetic patients.

Urinary Biomarkers KIM-1 and NGAL for Detection of Chronic Kidney Disease of Uncertain Etiology (CKDu) among Agricultural Communities in Sri Lanka.

Chronic Kidney Disease of uncertain etiology (CKDu) is an emerging epidemic among farming communities in rural Sri Lanka. Victims do not exhibit common causative factors, however, histopathological studies revealed that CKDu is a tubulointerstitial disease. Urine albumin or albumin-creatinine ratio is still being used as a traditional diagnostic tool to identify CKDu, but accuracy and prevalence data generated are questionable. Urinary biomarkers have been used in similar nephropathy and are widely recognised for their sensitivity, specificity and accuracy in determining CKDu and early renal injury. However, these biomarkers have never been used in diagnosing CKDu in Sri Lanka. Male farmers (n = 1734) were recruited from 4 regions in Sri Lanka i.e. Matara and Nuwara Eliya (farming locations with no CKDu prevalence) and two CKDu emerging locations from Hambantota District in Southern Sri Lanka; Angunakolapelessa (EL1) and Bandagiriya (EL2). Albuminuria (ACR ≥ 30mg/g); serum creatinine based estimation of glomerular filtration rate (eGFR); creatinine normalized urinary kidney injury molecule (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) were measured. Fourteen new CKDu cases (18%) from EL1 and nine CKDu cases (9%) from EL2 were recognized for the first time from EL1, EL2 locations, which were previously considered as non-endemic of the disease and associated with persistent albuminuria (ACR ≥ 30mg/g Cr). No CKDu cases were identified in non-endemic study locations in Matara (CM) and Nuwara Eliya (CN). Analysis of urinary biomarkers showed urinary KIM-1 and NGAL were significantly higher in new CKDu cases in EL1 and EL2. However, we also reported significantly higher KIM-1 and NGAL in apparently healthy farmers in EL 1 and EL 2 with comparison to both control groups. These observations may indicate possible early renal damage in absence of persistent albuminuria and potential capabilities of urinary KIM-1 and NGAL in early detection of renal injury among farming communities in Southern Sri Lanka.

Significant correlation between BMI/BW with insulin resistance by McAuley, HOMA and QUICKI indices after 3 months of pioglitazone in diabetic population

Twenty-four patients of type 2 diabetes with fasting blood glucose (FBG) > 7 mmol/l (126 mg/dl) were randomly selected on one (if the patient is symptomatic) or two occasions (if the patient is asymptomatic). Patients were treated with 15 mg of PIO daily and investigated for BW, BMI, FBG, fasting insulin (FI) and triglycerides (TG). IR was calculated by McAuley (McA), homeostasis model assessment (HOMA) and QUICKI indices at baseline and repeated after 3 months.

Suicidal behaviour among those who attempted suicide and their close relatives/friends

Objectives To describe the repetition of suicidal attempts and the awareness of suicidal behaviour among close people. Methods From 668 attempted suicides presented to National Hospital of Sri Lanka (April to December 2002), 300 were randomly selected and interviewed. Results Previous suicidal attempts were present in 29 (9.7%) among which six have attempted more than twice. Majority (25, 86.2%) were deliberate self-poisoning (DSP) while few were intentional self harm (4, 13.8%). Knowledge of family or close friend who committed suicide was reported by 96 (32%). There were 13 (4.4%) reported suicides in biological family while 46 (15.4%) were close friends and 42 (14%) were neighbours. Among the known persons of DSP, drugs were consumed by 30 (43.5%) and pesticides by 26 (37.7%). Among intentional self harm the commonest method used was fire (11, 45.8%) and hanging/strangulation (07, 29.2%). The time lapse between the index suicidal attempt in the subjects was within 1 year of the suicidal attempt of the family member or friend in 45 (41.3%) of those who reported knowledge of a family member or close friend who committed suicide. Conclusion The number with past suicidal attempts in our study is 10% which is a contrast to 54% reporting a previous suicide attempt in the WHO/EU multi-centre study on parasuicide. A total of 33% reporting knowledge of a close friend relative or neighbour who attempted suicide may indicate a strong influence of models in suicidal behaviour.

Selected aspects of attempted suicides

Objectives To describe selected aspects of attempted suicides. Methods From 668 presented with attempted suicides presented to National Hospital of Sri Lanka (April to December 2002), 300 were randomly selected and interviewed using a pretested questionnaire. Results All confessed that at the time of the incident they really wanted to die. In 134 (45%) instances no one was present at the time of the incident and 225 (75.5%) made the attempt without prior planning. After the attempt 178 (60.1%) notified a potential helper. Majority (190, 63.8%) had not communicated regarding the intention to harm at any time before the incident. When asked about the chances of death 132 (44.7%) informed that death was probable or certain. Most (268, 90.5%) of the incidents did not have an association with alcohol or drug use. Interpersonal conflicts were the precipitating cause in 230 (76.6%). Conclusion Even though at the time of the event all wanted to die majority had notified after the event. Most have not communicated the need to die at any time before the incident. Most acts were done without prior preparation. Interpersonal conflicts were the commonest precipitating cause.

Changing patterns in attempted suicides: experience from a tertiary care hospital in Sri Lanka

Objectives To describe characteristics of patients admitted to National Hospital Sri Lanka (NHSL) following attempted suicide. Methods Trained researchers identified all patients admitted following attempted suicide to NHSL from April 2002 to April 2003. A pretested questionnaire was used to collect relevant information. Results Of 1067 cases, 593 (55.6%) were females, 183 (61%) were less than 24 years of age, 609 (57.8%) single, 845 (83.9%) had received up to secondary education, and 448 (44.9%) were in full time employment. Mean duration of admission was 82.38 h. Case death rate was 4.6% (49 deaths). There were 965 (91.8%) deliberate self-poisoning among which 316 (30.1%) ingested pesticides; 222 (21.1%) non-opioid analgesics, antipyretics and antirheumatics, 130 (12.4%) other drugs, 135 (12.8%) other noxious substances. Substances used in self-poisoning were 197 (20.4%) Paracetamol, 126 (13%) Run-rat, 41 (4.2%) Kerosene oil and 39 (4%) Diazepam. Two hundred and three (30%) were referred for psychiatric care and none to police. Conclusion Substances used for attempted suicide have changed, with an increased use of medicines, in contrast to organophosphates reported as commonest substance in 1976. Paracetamol has emerged commonest substance and necessitates policies for minimising access to substance, along with developing guide-lines for management. A change in referral pattern was seen. An audit of records in 1994 indicated 90% of persons were referred to police, while in this study police referral was not observed and follows decriminalisation of attempted suicides.

Interventions to prevent suicides in Sri Lanka: a randomised control trial

Objective To determine effectiveness of an intervention and follow-up of patients admitted following attempted suicide. Methods 300 patients admitted following attempted suicide allocated to an intervention (a session of psycho-education) and follow up or treatment as usual group using random numbers. The inclusion criteria included age above 12 years, having telephone access, and agreeing to participate in the research. Those residing in the Colombo Municipal area who did not have telephone access were given an additional option of home visits by area family health worker (FHW). Follow up was by telephone interviews or FHW visits while non-intervention subjects were traced at 18 months. Results 668 persons were initially interviewed and 300 recruited. The intervention arm had 151 allocated of whom 96 (64%) received telephone follow up and 55 (36%) received FHW visits, while in the non-intervention group this was 115 (77.1%) and 34 (22.9%), respectively. At 18 months there were 32 (10.6%) drop outs, with 135 in the intervention group while 132 in the non-intervention group. In the non-intervention group 39 (29.5%) requested support, 35 (26.5%) sought support and there were three (2.3%) suicides, five (3.8%) re-attempted suicides while in the intervention group these were 81 (59.3%), 76 (56.3%), one (0.7%) and three (2.2%), respectively. Conclusion Intervention group requested more support and had a lower trend towards repeat suicides. Telephone and FHW follow-up is a feasible method to provide information and support.