The significance of lipid profile and positive troponin in predicting cardiac event.

BACKGROUND: Diagnosis of Acute cardiac event in the early stage of its onset is important in the treatment process. The development of highly sensitive and specific immunoassays for myocardial proteins such as cardiac Troponin I (cTnI) had made it possible. However Troponin indicates cardiac events only after its onset or after cardiac tissue necrosis. Traditionally such high risk subjects were identified using lipid profiles. The identification of subjects with high risk of developing cardiac event in the future is more significant as it will provide time to prevent such incidents. OBJECTIVES: In this study we proposed to study the usefulness of traditional lipid profile levels in screening subjects who had developed chest pain due to cardiac event as indicated by a positive Troponin I test. MATERIALS AND METHODS: In this retrospective study data of the 259 patients presented to the emergency department with symptoms of cardiac ischemia who underwent both Troponin and lipid profiles tests were compared with the lipid profiles of 105 normal healthy subjects (controls). The Troponin was detected qualitatively when a specimen contains Troponin I (cTnI) above the 99th percentile (TnI >0.5 ng/ml). The Total cholesterol (TC), High density lipoproteins cholesterol (HDL), Very low density lipoproteins (VLDL), and Triacyl glycerol levels (TG) were also analysed and low density lipoprotein level (LDL) was calculated using Friedelwald formula. RESULTS: Subjects with chest pain and positive Troponin test (with confirmed cardiac event) were found to have significantly elevated levels of TC, TG , LDL and significantly reduced HDL levels when compared to the subjects who had only chest pain (Negative Troponin) and healthy controls. CONCLUSION: Traditional lipid profile levels still can be used in screening populations to identify the subjects with high risk of developing cardiac event which is identified by highly sensitive and specific positive Troponin test.

Changes in erythrocyte glucose-6-phosphate dehydrogenase (G6PD) and reduced glutathione (GSH) activities in the development of senile and diabetic cataracts.

Oxidative and osmotic stress have been implicated in the pathogenesis of cataracts. Reactive oxygen intermediates (ROI) mediate peroxidation of membrane lipids and cause irreversible damage to lens proteins. The purpose of this study was to assess the changes in erythrocyte glucose- 6-phosphate dehydrogenase enzyme (G6PD) and reduced glutathione (GSH) levels in the development of senile and diabetic cataracts. The activity of erythrocyte G6PD and the concentration of GSH were measured to assess changes in oxidation-reduction status. The oxidation-reduction status of 26 non-diabetic non-cataract (control) subjects were compared with 24 diabetic non-cataract, 30 diabetic cataract and 28 non-diabetic cataract subjects. The results revealed that the GSH and G6PD levels of the subjects with senile cataracts were significantly lower than the subjects without cataracts. The present study reveals the risk of developing senile cataracts is associated with decreased levels of erythrocyte G6PD and GSH. In the formation of diabetic cataracts an adequate supply of NADPH (G6PD activity) is essential to produce osmotically active sorbitol in the lens.

Intestinal parasitoses and the nutritional status of Veddah children in Sri Lanka.

This study describes and compares the intestinal parasitoses and nutritional statuses of primary school children of Veddah (local indigenous population) and Sinhalese (more advanced society) in rural Sri Lanka. Children attending years 1-3 (age range 6-15 years) at Dambana Primary School (Veddah) and Wewatta Primary School (Sinhalese) were included in the study. Stools and blood samples were examined for evidence of intestinal parasites and anemia. The heights and weights of the children were measured and anthropometric indices calculated. There was a high prevalence of G. intestinalis and B. hominis (Giardia 7.8% and 6.2%; Blastocystis 17.2% and 17.3% at Dambana and Wewatta, respectively) in both communities, the predominant helminth being N. americanus (20.3% at Dambana and 14.8% at Wewatta; p>0.05). Other geohelminth infections were scarce in both communities. A greater proportion of boys than girls were underweight and stunted in both communities. Wasting and anemia was significantly high among the Veddah children.

Nutritional status and productivity of Sri Lankan tea pluckers.

OBJECTIVE: To assess the impact of nutritional status on productivity of tea pluckers. DESIGN: Cross-sectional, analytical. SETTING AND PARTICIPANTS OF STUDY: All tea pluckers in five divisions of a tea estate in Hatton. MEASUREMENTS: A dietary survey was conducted using the 24 h dietary recall method. Nutritional status was assessed by measurement of body mass index (BMI) and haemoglobin (Hb) levels, and faeces were examined for helminth ova. The daily weight of tea leaves plucked and the number of days worked by each woman during the preceding month were noted from production records. RESULTS: Three hundred and four women (mean age 37.8 years, SD 8.4) were examined. The majority (59.9%) had evidence of chronic energy deficiency (BMI < 18.5). Almost all (94.4%) were anaemic (Hb < 13.3 g/dl, altitude adjusted cutoff). Mean daily iron intake was 8.7 mg (SD 2.3 mg), 45.9% of the national recommended dietary allowance. Only 10.1% had hookworm infection, all of light intensity. Multivariate regression analysis showed that dietary iron intake, the number of children and the number of children below 5 years, but not hookworm infection, were independently associated with Hb (p < 0.05). There was a strong positive correlation between monthly productivity and Hb, but not with BMI. Variation in Hb levels accounted for 65% of variation in productivity (adjusted R2 = 0.651). CONCLUSIONS: Most of the study population had chronic energy deficiency and anaemia. Dietary inadequacy of iron is a much more important causative factor than hookworm infection. Productivity was strongly associated with the degree of anaemia but not with BMI.

Lipid profiles, anthropometry and dietary habits of adolescent school boys in Sri Lanka.

Serum lipid profiles, anthropometric parameters, dietary habits and smoking practice were determined in 637 adolescent school boys in the 10th to 13th year of school (mean age 16.7 ± 1.3 years), to determine the prevalence of risk factors for cardiovascular disease in later life. They all attended schools in Colombo, the capital city (n=416), and two other cities, Negombo and Kurunegala. Seven percent of the subjects had body mass index (BMI) values above a reference range (for age 14-16, > 23.5 kg/m2; older than 16 years > 24.5 kg/m2). The mean serum total cholesterol concentration was within the reference range (158.9± 27.2 mg/dL: 4.11± 0.70 mmol/L), but 16.5% had values >185 mg/dL. The percentages of subjects with high LDL (low density lipoprotein)cholesterol (>110 mg/dL) and apolipoprotein B (>85 mg/dL) concentrations were 21.9 % and 23.0% respectively, while low HDL (high density lipoprotein) cholesterol (<35 mg/dL) levels were noted in 27.3% of subjects. A significant (p<0.001) positive association was noted between serum total cholesterol concentration and BMI. There was no significant difference in the mean BMI or total cholesterol levels of subjects from the three areas in the age group 15-16.9 years. However, in the age group 17-18.9 years, subjects in the Kurunegala area had a lower prevalence of risk factors ie. significantly lower BMI and serum total cholesterol and apolipoprotein B concentrations than those in other areas. Overall, smoking prevalence was 4.5%, and higher in Colombo than in Negombo and Kurunegala. Further, the mean intake of cholesterol was significantly lower and the fibre intake was higher among subjects in Kurunegala, than those in other areas. Thirty two percent of subjects had a family history of coronary artery disease, hypertension or diabetes and these subjects had significantly higher BMI values than those who did not have a family history of the above diseases, but their lipid patterns were similar. Thus high BMI was a major factor leading to hypercholesterolaemi.

Micronutrient status of plantation workers in Sri Lanka during pregnancy and postpartum.

Iron, zinc and vitamin A status was assessed in 309 plantation workers during pregnancy and in a sub-sample of 108 subjects at 20 to 36 weeks postpartum and the birth weights of their newborn were noted. A significant positive correlation was noted between haemoglobin concentration at 10-26 weeks of gestation of anaemic mothers (n = 180) and birth weights of their new born. Depleted iron stores (serum ferritin < 12 micrograms/l) were noted in 33.3% of subjects at 10-26 weeks of gestation. There was no significant change in serum ferritin concentration at > 32 weeks of gestation. Iron deficiency persisted at 20-36 weeks postpartum. Marginal vitamin A deficiency was also noted, as, 46.2% and 15.6% of the subjects respectively, had low serum vitamin A levels in pregnancy and postpartum. Low serum zinc levels were noted only in pregnancy. Iron supplementation during pregnancy was only effective in preventing further deterioration in iron status and it should be continued for about 12 weeks after delivery.

Evaluation of effectiveness of iron-folate supplementation and anthelminthic therapy against anemia in pregnancy--a study in the plantation sector of Sri Lanka.

Intervention measures against anemia available to plantation workers during pregnancy include fortified food supplements (thriposha) and iron-folate supplements containing 60 mg elemental Fe. The effectiveness of these intervention measures was studied in 195 subjects whose iron and nutritional status were assessed at < 24 and > 32 wk of gestation. Taking thriposha conferred no significant benefit on maternal nutritional status, probably because sufficient amounts were not consumed. An increase in the duration of iron-folate supplementation to > 17 wk caused a significant positive change (P < 0.01) in hemoglobin, whereas an increase in the dose frequency had no significant benefit. Anthelminthic therapy in addition to iron-folate supplements caused a significant positive change in hemoglobin (P < 0.001) and serum ferritin (P < 0.005) compared with no supplementation. Thus, anthelminthic therapy significantly increased the beneficial effects of iron supplementation on hemoglobin concentration and iron status.

Iron status of adolescent females in three schools in an urban area of Sri Lanka.

Ninety-three females in the age group 14-18 years were randomly selected from three schools in Colombo. Their iron and nutritional status was assessed using clinical, anthropometric, haematological, and biochemical parameters. Haemoglobin levels less than 12 g/dl were seen in 3.7 per cent of adolescent females. Free erythrocyte protoporphyrin levels greater than 70 micrograms/dl and serum percentage transferrin saturation values less than 16 per cent indicate iron deficiency and were seen in 10 per cent and 14 per cent of the subjects, respectively. Serum ferritin levels less than 12 micrograms/l indicate depleted iron stores and were seen in 59 per cent of the subjects studied. Our results suggest that although overt anaemia was not common among the subjects studied, a large number of subjects belonging to the lower socio-economic groups were in the early stages of iron deficiency and had depleted iron stores. These subjects are, therefore, at risk of developing clinical manifestations of iron deficiency when the demand for iron is increased, as in pregnancy.