Drinking Water and CKD of Unknown Etiology in Sri Lanka: A Community Perspective.

People's belief that polluted drinking water is the principal medium through which environmental toxins are absorbed into the bodies of CKD of unknown etiology (CKDu) patients in the CKDu-endemic areas in Sri Lanka has been the subject of extensive epidemiological and medical research. This study examines (a) the people's perception and experience that polluted drinking water is the cause of CKDu, (b) how the government responded to people's demands for potable water, and (c) the impact of the use of alternative drinking water sources on the health of CKDu patients and their families, and on the progression of the disease in CKDu patients. Data were collected in 2013 and 2019 in Anuradhapura and Polonnaruwa districts in North Central Province of Sri Lanka. People's agitation, activism, and lobbying, together with the media's work in bringing the issue of polluted water to the forefront of political discourse, have prompted the government, private sector agencies, and community organizations to supply clean water to affected communities. A massive change in drinking water behaviors has occurred following the government's decision to supply reverse osmosis (RO) water to the affected communities. Informants perceived the provision of RO water as having brought about many positive outcomes in the health and disease progression of CKDu patients.

Drinking water and chronic kidney disease of unknown aetiology in Anuradhapura, Sri Lanka.

This paper examines how people in Anuradhapura District in Sri Lanka affected by endemic chronic kidney disease of unknown aetiology (CKDu) explain the factors causing the illness and their cultural meanings. The research found that the issue of contaminated water raised by the local community and the cultural meaning of water have influenced the government policy, health programmes, research agendas and the work of the media. Media reports on sociocultural, biomedical and epidemiological research into the aetiology of kidney disease have strengthened the perspective of the villagers who believe that polluted water has a direct relationship to kidney disease. This new understanding among villagers in Anuradhapura District has led to changes in their behaviours relating to the use and consumption of water, an important factor that has reinforced existing social hierarchies.

Bio-media Citizenship and Chronic Kidney Disease of Unknown Etiology in Sri Lanka.

In this article, I examine the crucial role of the biomedical industry, epidemiological and biomedical research, and the media in forming attitudes to and the understanding of chronic kidney disease of unknown etiology (CKDu) in Sri Lanka. Local conceptions of CKDu have been shaped by the circulation in the media of epidemiological research findings pertaining to the disease, biomedical interventions in the management of the disease in hospitals and clinics, community programs involving mass blood surveys and the testing of well water, and local food and health education programs carried out through village health committees. This process of circulation I identify as bio-media citizenship.

COMPARING MEASURED AND CALCULATED DOSES IN INTERVENTIONAL CARDIOLOGY PROCEDURES.

Interventional cardiology requires complex procedures and can result in high doses and dose rates to the patient and medical staff. The many variables that influence the dose to the patient and staff include the beam position and angle, beam size, kVp, filtration, kerma-area product and focus-skin distance. A number of studies using the Monte Carlo method have been undertaken to obtain prospective dose assessments. In this paper, detailed irradiation scenarios were simulated mathematically and the resulting dose estimates were compared with real measurements made previously under very similar irradiation conditions and geometries. The real measurements and the calculated doses were carried out using or simulating an interventional cardiology system with a flat monoplane detector installed in a dedicated room with an Alderson phantom placed on the procedure table. The X-ray spectra, beam angles, focus-skin distance, measured kerma-area product and filtration were simulated, and the real dose measurements and calculated doses were compared. It was shown that the Monte Carlo method was capable of reproducing the real dose measurements within acceptable levels of uncertainty.

Structural violence and chronic kidney disease of unknown etiology in Sri Lanka.

Research published on Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka has been undertaken largely from biomedical and epidemiological perspectives. The main objective of these studies has been to identify the etiology of the disease, which affects as much as 15-21% of the population in some regions and is associated with kidney failure. Few studies have sought to address how CKDu is socially and behaviorally situated in the affected districts. The present study, informed by structural violence theory, utilized a mixed-method approach that analyzed primary and secondary data for Medawachchiya District Secretariat Division in Anuradhapura District for 2010 and 2015, and examined CKDu as a manifestation of social inequality and exclusion and the creation of a marginalized group of agricultural laborers. Data include historical analyses, a case-control study, ecologic analysis of features of communities and CKDu prevalence, and direct observations and interviews with people in affected communities. In 2010, the most important factor associated with CKDu was private dug wells that were used for supplying water to homes. In 2015, when the number of patients had increased, CKDu was more closely linked to occupation, especially male wage labor. The male wage laborer, being the poorest of the poor, has become a particularly vulnerable social category in agricultural settlements in Medawachchiya. The co-occurrence of this social category and CKDu can be regarded as unintended consequences of the official agricultural colonization policy that started during British colonial times and has continued since independence.

Ethnicity, politics and inequality: post-tsunami humanitarian aid delivery in Ampara District, Sri Lanka.

The provision of humanitarian aid at times of disaster in multi-ethnic community settings may lead to conflict, tension and even the widening of the distance between various ethnic groups. That aid agencies distribute humanitarian aid directly to affected communities, to speed up recovery, may often lead to chaos and the intensification of ethnic sentiments. The new distribution mechanisms introduced for the delivery of tsunami aid in Ampara District, Sri Lanka, did not recognise local networks and the culture of the ethnically mixed community setting. This paper analyses post-tsunami aid distribution in Ampara and shows how such an extemporised effort in an ethnically cognisant context increased ethnic division, inequality and disorder, while marginalising the poor segments of the affected population. It recommends the inclusion of local networks in aid dissemination as a measure for improving ethnic neutrality and social harmony in disaster-hit multi-ethnic communities.

Postnatal cerebellar granule cells of the white rat (Rattus norvegicus): a quantitative study, using design-based stereology.

A stereological study was carried out on postnatal cerebellar granule cells of rats aged 6 and 10 days, for detecting whether and how much they would differ from those of young adult rats. The following parameters were estimated: number-weighted mean volume of the nucleus and of the soma; mean total surface area of the soma; mean absolute volumes per cell of total cytoplasm, mitochondria, Golgi apparatus, and cytosol; mean surface density of the rough endoplasmic reticulum (RER); mean total surface area of the RER. These values were compared between the two postnatal ages. In addition, those values were also analysed in comparison to the ones depicted in young adult rats (60 days), already published by our team, in order to detect similarities between them. It was noticed that, between 6 and 10 days, the mean surface density of the RER was the only parameter that did not change significantly. The comparison of each of the postnatal ages with 60 days revealed that, with the exception of the absolute volume of Golgi apparatus, significant differences were displayed concerning other organelles and cellular compartments. It was concluded that, although fine structural differences have been disclosed, from the stereological point of view postnatal granule cells at 10 days were practically similar to the young adult ones at 60 days. Some potential physiological implications have been considered.

Excess maternal transmission and familial aggregation of Type 2 diabetes in Sri Lanka.

INTRODUCTION: An excess of maternal transmission of Type 2 diabetes mellitus has been reported in Europid populations, but not in South India. METHOD: A questionnaire-based survey was carried out in 1000 (502 male) people with Type 2 diabetes to establish whether there is an excess of maternal transmission and familial aggregation in a Sri Lankan population. RESULTS: Mean age of onset was 47+/-12 (+/-S.D.) years and duration of diabetes was 9+/-7 years. Thirty-seven percent reported parents with diabetes, 46.9% had no parents with diabetes, 16.1% did not know the diabetes status of at least one parent and there was no diabetes in the other. Of the probands, 59.4% had at least one affected relative. When both parents' diabetes status was known and only one was affected, diabetes was more common among mothers (n = 156) than fathers (n = 125) of probands (P < 0.001). A further 54 probands had both parents with diabetes. Mean age of onset and duration of the disease among probands with parental diabetes was 43.1+/-(11.1) and 9.6+/-(6.8). In the previous generation, 21.2% of maternal grandmothers and 17.3% of maternal grandfathers in the maternal diabetes group and 4.8% of maternal grandmothers and 17% of maternal grandfathers in the paternal diabetes group had diabetes. Diabetes in siblings and children was more common in those with mothers who had diabetes (53.8% and 4.5%) when compared with those in whom fathers had diabetes (42.4% and 1.6%) (P < 0.0001 and P < 0.01). CONCLUSION: Familial aggregation and excess maternal transmission were observed in people with Type 2 diabetes in Sri Lanka.

Household epidemiology of Entamoeba histolytica infection in an urban community in northeastern Brazil.

The natural history of infection with Entamoeba histolytica was studied in 2 slum communities in northeastern Brazil. Twenty-eight index patients colonized with E. histolytica were identified. Three stool specimens from the index patients and their household contacts were gathered over a 45-day period and tested for E. histolytica by means of a specific enzyme-linked immunosorbent assay-based detection kit. The detection kit is an antigen capture assay that has been shown to be highly specific for E. histolytica and does not detect nonpathogenic Entamoeba dispar or other enteric organisms. Blood samples were also collected at the start of the study, at 45 days, and at 6 months and analyzed for E. histolytica-specific antibody. High rates of colonization were seen in the family units. Colonization was self-limited, with 85% of colonized patients clearing their infections within 45 days. Reinfection appeared to be low during this time; however, previous seropositivity did not prevent colonization.

Care seeking in Sri Lanka: one possible explanation for low childhood mortality.

This paper examines care-seeking practices of mother caretakers with children less than five years of age in a rural district of Sri Lanka. The study was carried out from June to September 1998, documenting care-seeking practices of mother caretakers in a population of 2248 children in 60 villages. Of the five targeted diseases in the IMCI programme (Integrated Management of Childhood Illnesses) that were the focus of the study, acute respiratory infections (82.0%) and diarrhoea (14.8%) were predominant. Although malnutrition was highly prevalent it was not recognised by mother caretakers as an illness. Findings show that in 65.0% of illness episodes in children the mother caretakers sought outside care and treatment. Caretakers sought treatment from both private and public sectors with the majority seeking care in the private sector. Care seeking of mother caretakers was driven by symptomology. Young children with higher perceived severity and high-risk symptoms were brought to provider care more frequently, although a large percentage of episodes with low-risk symptoms were also brought for outside care. Care seeking was similar across socio-economic groups. The study points out that high care seeking of mother caretakers in Sri Lanka, particularly for illnesses with acute high-risk symptoms and signs, is a plausible explanation for the low level of childhood mortality despite the prevalence of a high rate of malnutrition.

Entamoeba histolytica and Entamoeba dispar infections as detected by monoclonal antibody in an urban slum in Fortaleza, Northeastern Brazil.

In this study the authors used the Elisa-based antigen detection tests that distinguish E. histolytica from E. dispar to examine the prevalence of E. histolytica infection in individuals from an urban slum in Fortaleza, Northeastern, Brazil. This test has a sensitivity and specificity that is comparable to PCR and isoenzyme analysis, which is the gold standard. Single stools samples were obtained from 735 individuals. The prevalence of E. histolytica infection was 14.9% (110/735) and 25.4%(187/735) for E. dispar-E. histolytica complex. The most affected age group for E. histolytica /E. histolytica-E. dispar infection was the 1-5 year olds but there was no remarkable decrease with age. There was no significant difference in colonization rates between males and females. The results from this survey demonstrate that E. histolytica is highly prevalent in the Community studied. Furthermore, it offers promise for the antigen detection test as a sensitive and technically simple tool for detecting E. histolytica infection in the field.

Age-related changes in rat cerebellar basket cells: a quantitative study using unbiased stereological methods.

Cortical cerebellar basket cells are stable postmitotic cells; hence, they are liable to endure age-related changes. Since the cerebellum is a vital organ for the postural control, equilibrium and motor coordination, we aimed to determine the quantitative morphological changes in those interneurons with the ageing process, using unbiased techniques. Material from the cerebellar cortex (Crus I and Crus II) was collected from female rats aged 2, 6, 9, 12, 15, 18, 21 and 24 mo (5 animals per each age group), fixed by intracardiac perfusion, and processed for transmission electron microscopy, using conventional techniques. Serial semithin sections were obtained (5 blocks from each rat), enabling the determination of the number-weighted mean nuclear volume (by the nucleator method). On ultrathin sections, 25 cell profiles from each animal were photographed. The volume density of the nucleus, ground substance, mitochondria, Golgi apparatus (Golgi) and dense bodies (DB), and the mean surface density of the rough endoplasmic reticulum (RER) were determined, by point counting, using a morphometric grid. The mean total volumes of the soma and organelles and the mean total surface area of the RER [SN (RER)] were then calculated. The results were analysed with 1-way ANOVA; posthoc pairwise comparisons of group means were performed using the Newman-Keuls test. The relation between age and each of the parameters was studied by regression analysis. Significant age-related changes were observed for the mean volumes of the soma, ground substance, Golgi, DB, and SN (RER). Positive linear trends were found for the mean volumes of the ground substance, Golgi, and DB; a negative linear trend was found for the SN (RER). These results indicate that rat cerebellar basket cells endure important age-related changes. The significant decrease in the SN (RER) may be responsible for a reduction in the rate of protein synthesis. Additionally, it may be implicated in a cascade of events leading to cell damage due to the excitotoxic activity of glutamate, which could interfere in the functioning of the complex cerebellar neuronal network.

The hepatocytes of the brown trout (Salmo trutta f. fario): a quantitative study using design-based stereology.

A stereological study was performed on brown trout hepatocytes aiming to disclose whether there are basic gender differences when minimal levels of sex hormones exist, and also to establish a platform for both interspecific comparisons and physiological correlations. We used the so-called "design-based stereology" (with no shape, size or orientation assumptions) and also some new related statistics. Two-year-old brown trout were collected in April, and the livers were fixed by perfusion. From liver slicing to microscopical field selection, systematic sampling was used. Stereology was applied at light and electron microscopy. Target parameters were the relative and total hepatocyte number, the mean individual hepatocyte volume and surface, and also both relative and total volumes, and surfaces, either of organelles or of cell compartments. Observed variability was usually high, but the precision of estimates was proved to be globally adequate facing the true biological variation amongst specimens. Females had more hepatocytes per liver (1.79x10(9) vs. 1.12x10(9)). Considering the individual hepatocytes, whereas no gender differences were detected in the cell volume, males had higher values of nuclear volume (199 vs. 151 microm3) and surface (170 vs. 131 microm2), endoplasmic reticulum volume (1,300 vs. 824 microm3), and microvilli volume (82 vs. 54 microm3) and surface (1,445 vs. 975 microm2). However, when dealing with quantities per liver, gender differences were found only in the volumes of dense bodies (56 vs. 97 mm3) and of residual cytoplasm (169 vs. 341 mm3)--both volumes were higher in females. Functional implications of data are discussed, namely that females seem to have basic structural traits for coping with the later demands of breeding. Data also support that structural remodelling of hepatocytes occurs after breeding, urging to pursue seasonal studies (namely on lysosomes). We advanced the hypothesis that genders differ in microvilli surface just to maintain an optimal physiological surface-to-volume ratio. Interspecific similarities and differences were disclosed. For example, the number of hepatocytes/cm3 of parenchyma of brown trout was much lower than those reported in rainbow trout, but in both trouts females seem to have an higher cell number. In addition, when comparing the size of hepatocytes of brown trout with that from other fish and mammals it was suggested that major interspecific differences exist.

Quantitative age-changes in endoplasmic reticulum and nucleus of cerebellar granule cells.

A stereological study was performed on cerebellar granule cells from rats 2 to 24 months of age (eight different ages, five animals per age group) to quantify age-related alterations in the rough endoplasmic reticulum (RER). The mean surface density and the mean total surface area of the nucleus, as well as the mean absolute volume of euchromatin per cell, were also estimated to examine whether or not these had quantitative relationships with the RER. The mean surface density and the mean total surface area of RER per cell changed significantly, attaining maximum values at 24 months of 1733 microm(2)/1000 microm(3) (0.06) and 64 microm(2) (0.03), respectively, (coefficients of variation in parentheses). The corresponding values at 2 months were 706 microm(2)/1000 microm(3) (0.20) and 26 microm(2) (0.24). The mean absolute volume of the euchromatin changed significantly, with a minimum value of 57 microm(3) (0.05) occurring at 21 months. We postulate that the increase in RER may be part of a mechanism that compensates for an age-related decrease in euchromatin. An increase in the RER network may improve intracellular transport of proteins, production of which is apparently diminished with aging. The increase may also compensate for the reported decrease in calcium buffer capacity of smooth endoplasmic reticulum.

Age-related changes in the volume of somata and organelles of cerebellar granule cells.

Because cerebellar granule cells are fixed post-mitotic cells, it is expected that they undergo age-related changes like other neurons. To examine this possibility, a stereological study on granule cells of rat neocerebellar cortex was performed for an age spectrum of 2 to 24 months using eight different age groups. The nucleator method, together with point and intersection counting, was used to obtain primary data; arithmetical calculations determined the secondary data. In the soma, the absolute surface area did not change significantly; the volume did, however, exhibit a significant negative linear trend with age. Excluding dense bodies, the absolute volumes of the cytoplasmic components did not vary significantly. The absolute volume of dense bodies displayed a significant positive linear trend with age. Significant positive correlations were detected between the somatic volume and the absolute volume of either mitochondria or ground substance. It was concluded that granule cells showed a fair degree of morphological stability through 18 months. However, the observed changes warn that accompanying physiological alterations may occur, with putative effects on motor coordination.

Indefinite intertwining operators.

For a wide class of linear connected semisimple Lie groups, one obtains formulas limiting the Langlands parameters of irreducible unitary representations obtained from maximal parabolic subgroups. The formulas relate unitarity to the number of roots satisfying certain conditions. Some evidence is presented that the formulas are sharp. The results confirm aspects of conjectures that relate unitary parameters to cohomological induction.