Therapeutic Potential of miRNAs for Type 2 Diabetes Mellitus: An Overview.

MicroRNA(miRNA)s have been identified as an emerging class for therapeutic interventions mainly due to their extracellularly stable presence in humans and animals and their potential for horizontal transmission and action. However, treating Type 2 diabetes mellitus using this technology has yet been in a nascent state. MiRNAs play a significant role in the pathogenesis of Type 2 diabetes mellitus establishing the potential for utilizing miRNA-based therapeutic interventions to treat the disease. Recently, the administration of miRNA mimics or antimiRs in-vivo has resulted in positive modulation of glucose and lipid metabolism. Further, several cell culture-based interventions have suggested beta cell regeneration potential in miRNAs. Nevertheless, few such miRNA-based therapeutic approaches have reached the clinical phase. Therefore, future research contributions would identify the possibility of miRNA therapeutics for tackling T2DM. This article briefly reported recent developments on miRNA-based therapeutics for treating Type 2 Diabetes mellitus, associated implications, gaps, and recommendations for future studies.

Seroprevalence and associated risk factors of human Brucella infection in selected provinces in Sri Lanka

Brucellosis is a systemic zoonotic bacterial infection. We studied the seroprevalence and risk factors for human Brucella infection in 1,294 healthy people from 4 provinces: Central, North-Western, North-Central and Western Provinces. Farmers in contact with farm-animals, veterinary staff, abattoir workers, and non-contact urban-dwellers were tested against B. abortus and B. melitensis antigens by SAT. Seroprevalence was 8.4% of the study population. Farm-animal owners and working full-time with livestock have a significantly higher risk of acquiring Brucella infection. Enhanced laboratory support and surveillance is necessary to control brucellosis in Sri Lanka. This is the first report on human Brucella infection.

Addition of Propranolol in Resistant Arterial hypertension Treatment (APROPRIATE study): study protocol for a randomized double-blind placebo-controlled trial.

BACKGROUND: Resistant hypertension is defined as an uncontrolled blood pressure despite treatment at best-tolerated doses with at least three antihypertensive agents including a diuretic. It is an emerging public health problem. At present clinical trial data on management of resistant hypertension is limited. Management is largely based on observational studies and expert opinions. Propranolol is a nonselective beta blocker. Several studies have confirmed that propranolol has a significant hypotensive action, both when used alone and as an adjuvant therapy. At present there are no prospective, randomized, clinical studies evaluating the effectiveness of propranolol in patients with resistant hypertension. Therefore, we have designed a prospective randomized trial to evaluate the safety and efficacy of propranolol in patients with resistant hypertension. METHODS/DESIGN: The study will be conducted as a randomized, double-blind, placebo-controlled clinical trial for a period of 3 months. The study has been approved by the Ethics Review Committee of the Faculty of Medicine, University of Colombo. A total of 200 adults with resistant hypertension will be recruited for the study. They will be randomly assigned to the test and placebo groups on a 1:1 ratio. The test group will receive propranolol 40 mg three times a day and the control group will receive an identical placebo capsule. The study drugs will be double blinded to both investigators and subjects. The visits and the evaluations will be done as follows: screening (visit 0), 1 month (visit 1), 2 months (visit 2) and 3 months (visit 3). The primary outcomes of the study is to find a statistically significant difference between the fall in mean systolic and mean diastolic blood pressure measured by ABPM (ambulatory blood pressure monitoring) from baseline between the two groups. Data will be analyzed using SPSS v16. DISCUSSION: To our knowledge this is one of the first randomized controlled trials evaluating the effects of propranolol in resistant hypertension. This study will provide the necessary groundwork for future large-scale, multicentered clinical trials. The result, positive or negative, should provide a step change in the evidence guiding current and future policies regarding treatment of resistant hypertension. TRIAL REGISTRATION: Sri Lanka Clinical Trials Registry, identifier: SLCTR/2016/002 . Registered on 27 January 2016; Study protocol version 2.1.

Use of a clinical tool for screening and diagnosis of cutaneous leishmaniasis in Sri Lanka.

Cutaneous leishmaniasis (CL) was first detected in Sri Lanka in 1992.Local disease is caused by a genetically different variant of Leishmania donovani. Early case detection and management is the mainstay of L. donovani control. High degree of clinical suspicion is critical but a clinical diagnostic tool is not available for leishmaniasis. Current study described, for the first time, a two-staged clinical algorhythm that facilitates screening of CL in Sri Lanka by primary health care worker in stage 1 and management by medical professional in stage 2.Selected clinical markers of 400 patients suspected of CL were analysed retrospectively with laboratory confirmation of leishmaniasis. Ten clinical markers predicted CL with a over 90% accuracy. Subsets of markers showed high levels of sensitivities (60-97.2%) and/or significant association with positive laboratory results as compared to negative lesions [typical onset (acne-form, painless non-itchy), (P = 0.026), size up to 2 cm (P = 0.046), well-defined edges (P = 0.002), regular edges (P = 0.018), rounded shape (P = 0.030), and lesions at 5-8 months (P = 0.052)]. Five of them (typical onset, number up to 2, small size, rounded edges, and rounded shape) also had > 70% sensitivity levels as compared to laboratory findings. Typical onset had the highest sensitivity of 97% and a PPV of 72%. Lesions at 5-8 months duration having defined edges (P = 0.013, specificity 89.7%, PPV 83.1) or having regular edges (P = 0.006, specificity 86.2%, PPV 82.4%) were also predictive of CL. Most of early laboratory-confirmed ( < 12 months) lesions remained < 3 cm (sensitivity > 67%, PPV > 70%) and had defined edges (sensitivity of 52-71%, specificity 46.7-68.8%), (PPV 75.1-86%). Four clinical markers served as good diagnostic markers in both early ( ≤ 4) and late (>12 months) lesions, viz. typical onset (91.3-98.4%), presence of ≤ 2 lesions (sensitivity 82.6-94.7%), size ≤ 2 cm (66.9-73.7%), and regular edges (68.6-76.3%). Reliability of clinical markers generally declined in chronic lesions. However, small lesions of over 12 months were highly indicative of CL (sensitivity of 66%, specificity 66.7%). None of the single/combination markers, however, were 100% sensitive or specific, highlighting the undeniable usefulness of laboratory confirmation, in diagnosis. Decision-making algorithm used 10 basic clinical features for screening and seven specific clinical markers for clinical handling and referral for investigations.

Effects of paraplegia on quality of life and family economy among patients with spinal cord injuries in selected hospitals of Sri Lanka.

OBJECTIVES: The study was conducted with the aim of assessing the effects of paraplegia caused by spinal cord injuries on the quality of life of patients and their family economy. STUDY DESIGN: A descriptive cross-sectional study. SETTING: The study was carried out in Accident Service, Orthopedic and Neurosurgery Units of the National Hospital of Sri Lanka and the Spinal Injury Unit of Rehabilitation Hospital Ragama. METHODS: One hundred traumatic paraplegic patients were included as the study sample. Modified Ferrans and Powers quality of life index: spinal cord injury version was used to measure the quality of life. Pre- and post-family economic data were collected using an interviewer-administered questionnaire. RESULTS: Quality of Life was calculated under four major components. Paraplegics' family component (mean=3.50) and social, economic aspects (mean=3.24) are considerably good when compared with health and functioning (mean=2.83) and psychological (mean=2.78) components. Also the study revealed that expenditures are significantly high (P=0.001) and income is significantly less (P=0.001) after injury than before. CONCLUSION: Quality of life is relatively good on family and social aspects, whereas the physical and psychological aspects are somewhat poor. Regarding family economy, expenses are significantly high and earnings are significantly less after the injury. Contribution to the income from self-employment shows the most significant decline. Findings suggest that the family economy of such patients should be supported.

Prevalence of antenatal risk conditions among women in an underserved district of Northern Sri Lanka.

OBJECTIVE: To assess the prevalence of risk conditions among antenatal women in the Vavuniya District. DESIGN AND SETTING: A cross-sectional study was conducted among 392 pregnant women who had completed 36 weeks of gestation and were admitted or referred to two leading hospitals in the district. MEASUREMENTS: Women were interviewed consecutively using a questionnaire, and their antenatal details were extracted from records by trained investigators. Data on socio-demographics, antenatal care utilisation, risk condition in present and past pregnancies, and preexisting illnesses were obtained. RESULTS: Prevalence of an antenatal risk condition was 52.0%. The common risk conditions included teenage (9.7%) or elderly mother (14.3%), anaemia (8.2%) and abnormal BMI (8.2%). The common risk conditions due to past pregnancy were: history of abortion (19.3%), past caesarean delivery (8.0%), and stillbirth/neonatal death (4.8%). Less than half of the 'at risk' mothers were educated regarding the risk condition (47.5%) or referred to (48.5%) by the primary care providers. The majority was advised to deliver at a facility with emergency obstetric care. CONCLUSIONS: One in every two pregnancies in the Vavuniya District had an antenatal risk condition and services should be organised to meet this need.

Breastfeeding practices and associated factors among children under 24 months of age in Timor-Leste.

OBJECTIVE: To describe breastfeeding practices and to assess the sociodemographic factors associated with selected breastfeeding indicators. DESIGN AND SETTING: The 2003 Demographic and Health Survey was a multi-stage cluster sample survey of 4320 households from four different geographic areas in Timor-Leste. SUBJECTS: A total of 2162 children aged 0-23 months. RESULTS: A high proportion (97.6%) of infants had been ever breastfed, but only 46.1% had initiated breastfeeding within the first hour of birth. Seventy-eight percent of children <24 months were currently breastfed, 30.7% of infants <6 months were exclusively breastfed and 12.5% of infants <12 months were bottle-fed. A high proportion of infants of 6-9 months (82.0%) were receiving complementary food in addition to breast milk. Multivariate analysis revealed that exclusive breastfeeding was significantly lower in the rural west region (odds ratio (OR)=3.15) compared to the urban region, and among those from richest households (OR=1.90) compared to poorest. Mothers with primary education were significantly more likely to exclusively breastfeed than mothers with no education (OR=0.62). Increasing age of the infant was associated with significantly less current (OR=1.23) and exclusive (OR=1.35) breastfeeding. Continuation of breastfeeding at the end of the first year was significantly lower in non-working mothers (OR=1.58) compared to working mothers, and among infants born in health-care facilities (OR=2.16) than those born at home. CONCLUSIONS: Breastfeeding practices in Timor-Leste were satisfactory, except the exclusive breastfeeding at 6 months. However, more socioeconomically privileged groups demonstrated a poorer breastfeeding performance than disadvantaged groups. Further breastfeeding promotion programmes are needed across all population groups, and should include health-care providers and maternity institutions.

Environmental issues in brackish water shrimp aquaculture in Sri Lanka.

Shrimp exports are one of Sri Lanka's major foreign exchange earners and account for 40%-50% of total aquaculture exports. There has been a recent and rapid expansion of the industry in the Northwestern Province (NWP) of Sri Lanka but the industry has suffered from disease outbreaks and environmental problems. Currently, shrimp farms cover nearly 3000 ha of the coastal area of the NWP. The environmental impacts of shrimp cultivation in general are well known and numerous research studies have been done. However, little work has been carried out in Sri Lanka. This study provides some necessary background to brackish water shrimp aquaculture in Sri Lanka. It focuses briefly on the development of shrimp aquaculture and the current status of the industry. Emphasis is placed on two broader aspects--impacts on the existing wetland ecosystem and on the environment. These impacts are presumed to be the main causes hindering the growth of the industry and raising widespread public protest. Current ecosystem and environmental management practices are discussed. Finally, strategic issues for management and sustainable growth are discussed.