Factors affecting iron absorption and the role of fortification in enhancing iron levels.

Iron is an important micronutrient required for a number of biological processes including oxygen transport, cellular respiration, the synthesis of nucleic acids and the activity of key enzymes. The World Health Organization has recognised iron deficiency as the most common nutritional deficiency globally and as a major determinant of anaemia. Iron deficiency anaemia affects 40% of all children between the ages of 6 and 59 months, 37% of mothers who are pregnant and 30% of women between the ages of 15 and 49 years worldwide. Dietary iron exists in two main forms known as haem iron and non-haem iron. Haem iron is obtained from animal sources such as meat and shows higher bioavailability than non-haem iron, which can be obtained from both plant and animal sources. Different components in food can enhance or inhibit iron absorption from the diet. Components such as meat proteins and organic acids increase iron absorption, while phytate, calcium and polyphenols reduce iron absorption. Iron levels in the body are tightly regulated since both iron overload and iron deficiency can exert harmful effects on human health. Iron is stored mainly as haemoglobin and as iron bound to proteins such as ferritin and hemosiderin. Iron deficiency affects individuals at increased risk due to factors such as age, pregnancy, menstruation and various diseases. Different solutions for iron deficiency are applied at individual and community levels. Iron supplements and intravenous iron can be used to treat individuals with iron deficiency, while various types of iron-fortified foods and biofortified crops can be employed for larger communities. Foods such as rice, flour and biscuits have been used to prepare fortified iron products. However, it is important to ensure the fortification process does not exert significant negative effects on organoleptic properties and the shelf life of the food product.

Physical inactivity, and its association with hypertension among employees in the district of Colombo.

BACKGROUND: Physical inactivity is a leading cause of morbidity and mortality and is a major public health problem. Insufficient activity is responsible for a large proportion of non-communicable diseases such as hypertension. OBJECTIVES: The purpose of this study was to assess socioeconomic variations in physical activity and to measure the association between physical inactivity and hypertension among government officials in Sri Lanka. METHODS: A cross-sectional study was carried out among 275 senior-officers(SOs) and 760 managerial-assistants(MAs) aged 30-60 years and attached to Public Administration institutions in Colombo District in Sri Lanka. Physical-activity(PA) was gathered using the International Physical Activity Questionnaire(IPAQ) adopted and validated to the Sri Lankan context. Blood pressure(measured and classified using JNC-7 guidelines) and anthropometric indices were recorded. Energy utilization of all vigorous and moderated PA and walking was expressed as metabolic-equivalent-of-task(MET) min per week. A total-MET-score was calculated and categorized based on IPAQ guidelines. RESULTS: Socioeconomic variations in PA levels were observed as 58.1%(n = 158) SOs and 30.6%(n = 226) MAs were involved in inadequate PA. Among the SOs diagnosed with hypertension, more half(59.1%; n = 52) were physically inactive, while among MAs, 65.9%(n = 143) with hypertension were physically inactive. After adjusting for potential confounding factors being physically inactive was associated with a higher risk of hypertension among SOs[OR 2.08 [95% CI 1.07, 4.6] and MAs[OR 2.8 [95% CI 1.8, 4.6]. The main modality of commuting to work for SOs(59%) was private transport, and MAs(64%) public transport Commuting distance was positively correlated(p < 0.05) with total transport MET among SOs and MAs. After adjusting for confounders, commuting distance of > 20 km was found to lower the odds of hypertension among SOs and MAs(OR = 0.713; 95% CI 0.4 to1.3; and OR = 0.63; 95% CI 0.46 to 0.87). CONCLUSION: Despite the current knowledge that being physically active promotes health, the practice was different. Physical inactivity was associated with hypertension and prevalent among both SOs and MAs. Higher commuting distance is positively correlated with total transport MET and associated with lower odds of hypertension among SOs and MAs. Longitudinal studies are required to provide a causative association between physical inactivity and hypertension among these employees.

Localised amyloidosis of the glans penis presenting as a painless lump with progression after 10 years.

Primary amyloidosis of the genitourinary tract is uncommon, and isolated invasion of the glans penis is exceptionally rare Degos et al. (Bull Soc Fr Dermatol Syphiligr 68:159, 1961). We report a case of localised amyloidosis of the glans penis in a 40-year-old presenting as an asymptomatic penile mass which changed after 10 years prompting treatment. We believe this to be the longest interval recorded between clinical occurrence and histological diagnosis of primary penile amyloidosis.

Processing conditions affect nutrient digestibility of cold-pressed canola cake for grower pigs.

Cold-pressed canola cake is a coproduct of biodiesel production that contains more residual oil than expeller-pressed and solvent-extracted canola meal. Cold-pressed canola cake might be an attractive feedstuff for swine due to local availability from small plants. However, the nutritional quality and content of anti-nutritional factors of cold-pressed canola cake are poorly defined and vary with processing conditions. This experiment evaluated cold-pressed canola cake processed using 4 different conditions: a nonheated and heated barrel at slow and fast screw speed in a 2 × 2 factorial arrangement. Seven ileally cannulated barrows (26 kg of BW) were fed twice daily at 2.8 × maintenance diets containing either 44% of 1 of the 4 cold-pressed canola cake samples, expeller-pressed canola meal, canola seed, or an N-free diet in a 7 × 7 Latin square. The objectives were to measure the energy and AA digestibility and to calculate standardized ileal digestible (SID) AA and NE content. Each 9-d experimental period consisted of a 5-d diet adaptation, followed by 2-d feces and 2-d ileal digesta collections, and 7 observations per diet were obtained. Cold-pressed canola cake contained 41% CP, 16% ether extract, and 5 µmol of total glucosinolates/g (DM basis). Both apparent ileal digestibility (AID) and total tract energy digestibility of energy in cold-pressed canola cake was 36% greater (P < 0.05) in heated vs. nonheated conditions and 8% greater (P < 0.05) in fast vs. slow screw speed without interaction, indicating that heat enhanced energy digestibility. The AID of energy of cold-pressed canola cake was 13 and 118% greater (P < 0.01) than expeller-pressed canola meal and canola seed, respectively. Heat and speed interacted (P < 0.05) for SID of AA of test ingredients, but effects were not consistent among AA. The DE and calculated NE content of cold-pressed canola cake was 0.73 and 0.52 Mcal/kg greater (P=0.001; DM basis), respectively, than expeller-pressed canola meal and did not differ from canola seed. Cold-pressed canola cake averaged 4.17 Mcal of DE/kg, 2.84 Mcal of NE/kg, 0.87% SID Lys, 0.46% SID Met, and 0.79% SID Thr (DM basis). In conclusion, processing conditions greatly affected the digestible nutrient content of cold-pressed canola cake. Content of residual ether extract was an important determinant of the energy value of cold-press canola cake, whereas residual glucosinolates did not seem to hamper nutrient digestibility.

Health-related quality of life and psychological distress in polycystic ovary syndrome: a hidden facet in South Asian women.

OBJECTIVE: polycystic ovary syndrome (PCOS) is associated with symptoms that affect psychological wellbeing and health-related quality of life (HRQoL). We wished to assess psychological distress and HRQoL among Sri Lankan women with PCOS. DESIGN: case-control study. SETTING: Gampaha District, Sri Lanka. POPULATION: a total of 146 newly diagnosed women with PCOS, according to the Rotterdam criteria, and 170 age-matched controls recruited from community screening of 3030 eligible women between 15 and 39 years of age. METHODS: World Health Organization Quality of Life questionnaire (WHOQOL-BREF), validated for Sri Lankans with PCOS and a 30-item General Health Questionnaire (GHQ30) were used to assess HRQoL and psychological distress, respectively. MAIN OUTCOME MEASURES: assessment of psychological distress, HRQoL and their correlates. RESULTS: the mean GHQ score was significantly higher (P < 0.001) among women with PCOS (5.25 ± 6.25 SD) than among controls (1.58 ± 1.46 SD), indicating greater psychological distress. Hirsutism in PCOS (defined as a Ferriman-Gallwey, FG, score ≥ 8) was significantly associated with psychological distress (P = 0.002). Multivariate analysis revealed the FG score as a significant predictor of psychological distress (P < 0.05). Mean scores for the physical, psychological and social relationships domains of the WHOQOL-BREF were significantly lower (P = 0.01) in women with PCOS than in controls, indicating poorer HRQoL. No significant predictors of HRQoL emerged from the multivariate analysis. Women with PCOS did not perceive excess body weight as a factor affecting their psychological wellbeing and HRQoL. CONCLUSIONS: PCOS occurring in South Asians adversely affects their psychological wellbeing and HRQoL. Their psychological distress is related to hirsutism rather than to obesity, which affects white Europeans with PCOS.

The nutritional value of expeller-pressed canola meal for grower-finisher pigs.

Expeller-pressed (EP) canola meal contains more residual oil than solvent-extracted canola meal and might be an attractive feedstuff for swine, but it has been poorly characterized. In Exp. 1, six ileal-cannulated barrows (36 kg of BW) were fed at 3x maintenance either a 44% EP canola meal diet or a N-free diet in a crossover design to measure energy and AA digestibility and calculate standardized ileal digestible (SID) AA and NE content, with 6 observations per diet. Each period consisted of a 5-d diet adaptation and a 2-d feces and 3-d digesta collection. The EP canola meal contained (% of DM) 38.5% CP, 13.3% ether extract, 2.42% Lys, 1.54% Thr, 0.62% Met, and 23.2 micromol/g of glucosinolates. Apparent total tract energy digestibility was 75.0% and the DE and predicted NE content were 3.77 and 2.55 Mcal/kg (in DM), respectively. The SID AA content (% of DM) was 1.77% Lys, 1.04% Thr, and 0.52% Met. In Exp. 2, a total of 1,100 pigs (25 kg of BW) housed in 50 pens were fed 5 dietary regimens with 0, 7.5, 15, and 22.5% or decreasing amounts (22.5, 15, 7.5, and 0%, respectively) of EP canola meal over 4 phases to validate performance and carcass characteristics. Diets were formulated to contain equal NE:SID Lys for each growth phase (g/Mcal; 4.04, d 0 to 25; 3.63, d 26 to 50; 3.23, d 51 to 77; 2.83, d 78 to 90). At slaughter, carcass characteristics were measured for all pigs, and jowl fat was sampled for 2 pigs per pen. For d 51 to 90, the 22.5% EP canola meal regimen was reduced to 18% (22.5/18%) because of decreased ADFI in phases 1 and 2. Overall (d 0 to 90), increasing dietary EP canola meal linearly decreased (P < 0.001) ADG and ADFI and linearly increased (P < 0.01) G:F. For 0 and 22.5/18% EP canola meal, respectively, ADG was 978 and 931 g/d, ADFI was 2.77 and 2.58 kg/d, and G:F was 0.366 and 0.378. Increasing dietary EP canola meal did not alter the carcass backfat thickness, loin depth, or jowl fat fatty acid profile. Pigs fed 22.5/18% EP canola meal reached slaughter weight 3 d after (P < 0.05) pigs fed 0% EP canola meal. In summary, EP canola meal provided adequate energy and AA; however, ADG was reduced by 3 g/d per 1% of EP canola meal inclusion, likely because of increased dietary glucosinolates. Thus, the amount of EP canola meal included in swine diets should be targeted to an expected growth performance and carcass quality. Finally, diets formulated to contain an equal NE and SID AA content did not entirely eliminate the risks for reduced growth performance associated with inclusion of an alternative feedstuff.

Acute renal failure from nitrofurantoin-induced acute granulomatous interstitial nephritis.

We report here a case of acute renal failure with nitrofurantoin-associated acute granulomatous interstitial nephritis (GIN), which was commenced as a long-term prophylactic agent for suspected recurrent urinary tract infections. Renal function improved with withdrawal of this agent and without the requirement of corticosteroids. All new medication changes should be held in suspicion as a cause of acute onset abnormalities in serum biochemistry.

A simple screening approach for assessing community prevalence and phenotype of polycystic ovary syndrome in a semi-urban population in Sri Lanka.

In most of South Asia, prevalences and phenotypes of polycystic ovary syndrome (PCOS) among women in the community are unknown. The authors aimed to estimate prevalence and phenotype in a community setting in Sri Lanka and to test a valid, feasible screening approach to early diagnosis. A community-based, cross-sectional study was carried out in 2005-2006. A random sample of 3,030 women aged 15-39 years was selected by cluster sampling proportionate to population size. An interviewer-administered questionnaire was utilized to screen for "probable cases" of PCOS based on menstrual history and clinical manifestations of hyperandrogenism. Selected "probable cases" underwent clinical, biochemical, and ovarian ultrasound assessment. The response rate was 96.2% (n = 2,915). A total of 220 (7.5%) "probable cases" were identified: 209 women with oligo/amenorrhea (95%) and 11 women with hirsutism (5%). Further evaluation of the 220 probable cases confirmed 164 newly diagnosed cases of PCOS based on the 2003 Rotterdam diagnostic criteria. With 19 previously diagnosed cases already present, total prevalence was 6.3% (95% confidence interval: 5.9, 6.8). Of the women with "oligo/amenorrhea and/or hirsutism," 91.1% were confirmed to have PCOS; 99.4% of women with "regular cycles in the absence of clinical hyperandrogenism" were confirmed as normal. The most common phenotypes of PCOS were oligo/amenorrhea and polycystic ovaries (91.4%) and oligo/amenorrhea and hirsutism (48.3%).

Prevalence and projections of diabetes and pre-diabetes in adults in Sri Lanka--Sri Lanka Diabetes, Cardiovascular Study (SLDCS).

AIMS: To determine the prevalence of diabetes mellitus and pre-diabetes (impaired fasting glucose and impaired glucose tolerance) in adults in Sri Lanka. Projections for the year 2030 and factors associated with diabetes and pre-diabetes are also presented. METHODS: This cross-sectional study was conducted between 2005 and 2006. A nationally representative sample of 5000 adults aged >or= 18 years was selected by a multi-stage random cluster sampling technique. Fasting plasma glucose was tested in all participants and a 75-g oral glucose tolerance test was performed in non-diabetic subjects. Prevalence was estimated for those > 20 years of age. RESULTS: Response rate was 91% (n = 4532), males 40%, age 46.1 +/- 15.1 years (mean +/- standard deviation). The age-sex standardized prevalence (95% confidence interval) of diabetes for Sri Lankans aged >or= 20 years was 10.3% (9.4-11.2%) [males 9.8% (8.4-11.2%), females 10.9% (9.7-12.1%), P = 0.129). Thirty-six per cent (31.9-40.1%) of all diabetic subjects were previously undiagnosed. Diabetes prevalence was higher in the urban population compared with rural [16.4% (13.8-19.0%) vs. 8.7% (7.8-9.6%); P < 0.001]. The prevalence of overall, urban and rural pre-diabetes was 11.5% (10.5-12.5%), 13.6% (11.2-16.0%) and 11.0% (10.0-12.0%), respectively. Overall, 21.8% (20.5-23.1%) had some form of dysglycaemia. The projected diabetes prevalence for the year 2030 is 13.9%. Those with diabetes and pre-diabetes compared with normal glucose tolerance were older, physically inactive, frequently lived in urban areas and had a family history of diabetes. They had higher body mass index, waist circumference, waist-hip ratio, systolic/diastolic blood pressure, low-density lipoprotein cholesterol and triglycerides. Insulin was prescribed to 4.4% (2.7-6.1%) of all diabetic subjects. CONCLUSIONS: One in five adults in Sri Lanka has either diabetes or pre-diabetes and one-third of those with diabetes are undiagnosed.

An assessment of the compliance with good pharmacy practice in an urban and rural district in Sri Lanka.

PURPOSE: To evaluate the compliance of private pharmacies to good pharmacy practice (GPP) in an urban and rural district in Sri Lanka and identify deficiencies with a view to improving supply of safe and effective drugs to consumers. METHODS: Lot quality assurance sampling (LQAS) method was used to determine the number of pharmacies that need to be studied and the threshold limit of defective elements. An inspection of 20 pharmacies in the urban and all 18 pharmacies in the rural district was carried out using a structured checklist. Compliance to seven subsystems of GPP was studied. RESULTS: Storage of drugs, maintenance of cold chain, dispensing and documentation were comprehensively substandard in both districts. Individual items of supervision in registration, physical environment and order of the pharmacy were also found to be substandard in both districts. CONCLUSION: This study shows that the LQAS method can be used to identify inadequate pharmacy services in the community as a whole. There was poor compliance to GPP by the private pharmacies in both districts. There are concerns about the quality of drugs and the safety of private pharmacy services to the community. Some of the deficiencies could be easily corrected by educating the pharmacists and authorised officers, and more effective and streamlined supervision.

Admission to medical schools in Sri Lanka: predictive validity of selection criteria.

OBJECTIVE: To assess the extent to which current selection criteria predict success in Sri Lanka's medical schools. METHODS: The study sample consisted of all students selected to all six medical schools in two consecutive entry cohorts. The aggregate marks of these students at the General Certificate of Education (GCE) Advanced Level examination, the district of entry, admission category, candidate type (school/private) and gender, were identified as entry point variables. Success in medical school was measured in four ways: the ability to pass the first summative examination and the final examination at the first attempt, and obtaining honours in either examination. Multivariate analysis using logistic regression was used to assess the extent to which these entry point factors predict variability in outcome measures. RESULTS: Aggregate scores among the 1740 students in the study sample ranged from 212 to 356, with a median of 285. The male:female ratio was 1.4:1. Private candidates (taking the examination for the third time) accounted for 22% of students. Being a school candidate, female and having a higher aggregate score, were the only independent predictors of success for all four outcome measures. The aggregate score alone accounted for only 1-7% of the variation in performance in medical school. CONCLUSIONS: Marks obtained at the A Level examination (the only academic criterion currently used for selection of medical students in Sri Lanka) is a poor predictor of success in medical school.

Microbiology of cerebral abscess at the neurosurgical unit of the National Hospital of Sri Lanka.

OBJECTIVES: To determine the microbial pathogens responsible for cerebral abscess, ascertain the most suitable antibiotic for treatment and to determine the predisposing causes of cerebral abscess. DESIGN: Prospective study with microbiological investigation of pus aspirated from cerebral abscesses. SETTING: Neurosurgical Unit, National Hospital of Sri Lanka, Colombo. STUDY GROUP: 41 patients with cerebral abscess. PERIOD OF STUDY: 18 months (May 1997 to December 1998) RESULTS: Of the 41 samples of pus 26 (63.1%) gave a positive microbial culture. The Gram stain of the direct smear was positive in 77% of the 26 positive cultures. The most frequently occurring species were Streptococcus milleri group (35%) followed by Staphylococcus aureus (10%). Anaerobes accounted for 23% of positive cultures. All Streptococcus milleri isolates were penicillin and cefotaxime, and all anaerobic isolates except one were susceptible to sensitive to metronidazole. 75% of Gram negative bacilli isolated were sensitive to cefotaxime. All Staphylococcus aureus isolates were methicillin resistant, but sensitive to vancomycin and chloramphenicol. Common predisposing conditions were congenital heart disease (30%), trauma (25%), middle ear disease (7%), and meningitis (7%). CONCLUSIONS: Organisms of the Streptococcus milleri group were most frequently found in cerebral abscesses. The present empirical therapeutic regime adopted in the unit which consisted of cefotaxime 1 g intravenously three times daily and metronidazole 500 mg intravenously three times daily was found to be satisfactory as a majority of the organisms isolated were sensitive to these antimicrobials. In the case of methicillin resistant Staphylococcus aureus (MRSA), it is recommended that chloramphenicol be added to the current regime in management until the antibiotic sensitivity pattern is available.

Students' perception of problem-based learning in the medical curriculum of the Faculty of Medicine, University of Colombo.

INTRODUCTION: Problem-based learning (PBL) is used as an instructional method in the system-based modules of the new innovative curriculum of the Colombo Medical Faculty in Sri Lanka. This study was undertaken to assess whether objectives of having PBL to facilitate acquisition of desirable learning skills and generic skills had been achieved. The perceived advantages and disadvantages of PBL were also studied. MATERIALS AND METHODS: The study population comprised third year medical students who had completed 12 PBL sessions. A self-administered questionnaire, which measured learning outcomes and acquisition of generic skills on a 5-point Likert rating scale, was used. RESULTS: The response rate was 87.2% (n = 188). Eighty per cent of students were aware of the rationale for having PBL and of learning from recommended material. Seventy-five per cent knew the competencies that could be acquired from PBL and two-thirds knew about the importance of small group discussions. PBL had helped to improve communication skills in 57% and problem solving skills in 52%. The main disadvantage was that it was time-consuming. Only 46.6% were satisfied with the participation of colleagues in the group. Seventy-six per cent felt that PBL could be better conducted. CONCLUSION: Awareness of concepts of PBL, reasons for its inclusion in the curriculum and educational advantage was high. The main disadvantage perceived was that it was time-consuming. There is a need to improve the conduct of PBL and, provide guidance and awareness programme for students.

Skin and eye injury due to latex of Excoecaria agallocha.

A case report of severe skin and eye injury due to Excoecaria agallocha is presented to highlight the toxic nature of the latex of this common mangrove plant.

Leiomyosarcoma of the inferior vena cava.

A 63-year old with an 8-month history of backache had a leiomyosarcoma of the inferior vena cava. Although inoperable, she benefitted from cobalt therapy. A review of the literature suggests an evolving clinical picture which will facilitate earlier diagnosis, and perhaps allow resection.

Survey of pesticide poisoning in Sri Lanka.

This study included a sample survey of the clinical records of patients admitted to the different hospitals in Sri Lanka, and showed that approximately 13 000 patients are admitted to hospital annually for pesticide poisoning and that each year 1000 of them die. Suicidal attempts account for 73% of the total, and occupational and accidental poisoning accounts for 24.9%. It is recommended that urgent action be taken to minimize the extent of the problem.