Skeletal fluorosis in Vavuniya District: an observational study

Background: The WHO recommended safe upper limit for fluoride in drinking water is 1.5 mg/l. Groundwater sources in many parts of Sri Lanka often exceed this limit. The high fluoride content of groundwater and high environmental temperatures in Vavuniya District predispose to pre-skeletal fluorosis and skeletal fluorosis in adults. Objectives: To identify residents of Vavuniya District with clinical features of pre-skeletal and skeletal fluorosis; to describe their clinical, biochemical and radiographic features; to determine the fluoride content of blood and urine in individuals with established diagnoses, and of their drinking water. Methods: In 98 volunteers we detected 60 with clinical features of pre-skeletal and skeletal fluorosis. Clinical examination, biochemical and radiographic investigations were performed. Forty four with confounding factors were excluded. The balance 16 had radiographic investigation for fluoride bone disease, and assessment of clinical features for pre-skeletal fluorosis. The radiographic criteria of skeletal fluorosis were trabecular haziness, osteosclerosis, osteophytes, cortical thickening and ligamentous or muscle attachment ossification. All 16 had "spot" samples of 15 ml of venous blood taken for biochemical tests and fluoride estimation; and 30 ml of urine, and water from 16 dug wells for fluoride. Results: The 16 selected (11 males) had BMI between 20.6 and 31.9 kg/m2, and were between 22 and 84 years (x̅ = 59.9 + 20.4). They used water from domestic dug wells for drinking. All had adequate renal function. All serum and urine samples had raised fluoride levels way above the reference ranges for serum (0.02 ­ 0.18 mg/l) and urine (0.6 ­ 2.0 mg/l). The 16 water samples showed a mean fluoride content of 2.90 +0.93 mg/l. Interpretation: In a cohort of 60 individuals in Vavuniya with symptoms suggestive of skeletal fluoride toxicity, 6 had skeletal fluorosis, 10 had pre-skeletal fluorosis, and groundwater sources had fluoride levels much higher than WHO recommended upper limit for drinking water. Residents in Vavuniya are predisposed to pre-skeletal and skeletal fluorosis. All 16 had been misdiagnosed as various types of arthritis.

The effect of thriphala, a herbal Ayurveda formulation, on serum lipids, in patients on a maintenance dose of atorvastatin for hyperlipidaemia: a randomized controlled trial

Introduction: Thriphala, a herbal medicinal formulation, is a bedrock of Ayurveda therapeutics with many postulated benefits. Objectives: We performed a clinical trial to test the effects of Swastha Thriphala®, a proprietary preparation of thriphala, on serum lipid parameters in patients receiving atorvastatin. Methods: Consenting adults receiving a maintenance dose of atorvastatin 10mg (Atorlip®) daily from a clinic of the Institute of Cardiology, National Hospital of Sri Lanka for lipid regulation, were randomly assigned, after counselling, to receive either the proprietary herbal medicinal product Swastha Thriphala® (Treatment Group, n= 101) or a placebo (Control Group n= 97), at the stipulated dose daily, for three calendar months. Results: In the treatment group (n=101) the addition of a proprietary preparation of thriphala formulated as caplets of Swastha Thriphala®, in the standard daily dosage for three months, as an adjunct to atorvastatin 10mg, had a significant (p<0.0001) reduction in the mean total blood cholesterol, mean cholesterol/HDL ratio (p<0.0001), and mean non- HDL-cholesterol (p<0.0001) when compared to the Control Group (n=97) receiving placebo caplets in the same daily dose, with atorvastatin 10mg, for the same period. In the Treatment Group mean HDL, LDL, HS-CRP, and triglyceride concentrations showed non-significant reductions, and nonsignificant elevations in the Control Group Conclusions: Swastha Thriphala® when used in the stipulated dosage as an adjunct to atorvastatin 10 mg daily, significantly enhances its cholesterol reducing action in patients. The use of Swastha Thriphala® as single therapy for lipid regulation, and the mode of its action deserve investigation.

High prevalence of dental fluorosis among schoolchildren in three villages in Vavuniya District: an observational study

Background: Studies of groundwater sources in Sri Lanka show that in the entire Northern, North Central, Uva and Eastern Provinces, and also in a large area of the North Western Province, groundwater fluoride content is within the range 1.0 mg/l and 3.0 mg/l. The WHO recommended safe upper limit of fluoride for drinking water is 1.5 mg/l. Objective: Our objective was to determine the prevalence and degree of dental fluorosis in a cohort of schoolchildren in Sinnasippikulam in Vavuniya District, the fluoride content in their serum and urine, and fluoride levels in drinking water in dug wells of the area. Methods: Invitations in Tamil and Sinhala were sent to all households by courier. Demographic information and oral hygiene practices of 307 responsive children were recorded by interviewing children and their mothers. Detailed clinical examinations were performed according to WHO basic methods, with some modifications. Assessment of dental fluorosis in the children was done according to Dean's Index codes and criteria. Results: We found drinking water sources (dug wells) in Sinnasippikulam (n= 82) to have a high mean concentration of fluoride ( x̄ 1.58+ 0.69 mg/l). Of 307 children examined, 224 (72.9%) had clinical evidence of dental fluorosis of varying degrees of severity. The mean fluoride level in serum of schoolchildren was 0.198 mg/l (SD + 0.074; S.E.M. 0.013), and in their urine, 1.44 mg/l (SD + 0.59; SEM 0.11). Conclusions: Our results show that harmful levels of fluoride are extremely common in groundwater sources in the study area, and consequently, dental fluorosis is highly endemic (72.9%) among resident schoolchildren.

The effect of a herbal formulation on the incidence and severity of upper respiratory symptoms in healthy volunteers: an open-label, randomised controlled clinical trial.

INTRODUCTION: Many traditional preparations with varying combinations of herbs have been used for over 1500 years to treat upper respiratory ailments, and reduce their incidence and severity. Link Samahan® is a formulation containing the extract of 14 such medicinal plants. OBJECTIVES: To test the efficacy of Link Samahan® in reducing the incidence and severity of upper respiratory symptoms in consenting healthy volunteers. SETTING: MAS Linea Aqua, a factory with over 3000 employees, having its own health care centre with a qualified matron and visiting medical officers. METHODS: 956 healthy volunteers took daily either one sachet of Link Samahan® in hot water (test group,n=465, mean age 29.5 ± 7.7 years, women 418) or only plain tea (control group n=491, mean age 29.7 ± 7.9, women 448), for 84 consecutive days, and recorded the incidence and severity of 15 upper respiratory symptoms daily in a purpose-designed form. RESULTS: At the end of 84 days, when compared to the control group, the average incidence of symptoms in the test group showed highly significant reductions at p<0.001 for 6 symptoms and at p<0.005 for 3 symptoms,and at p<0.05 for the remaining 6. Reduction of average incidence over time also was highly significant (p<0.001) for 2 symptoms and (p<0.005) for 7, and significant (p<0.05) for 4 symptoms, but only marginal for the balance 2. Severity was significantly reduced (p<0.05) for 7 symptoms, and reduced also for the other 8 according to descriptive analysis, though not significant at the 5% level. CONCLUSIONS: The results indicate that Link Samahan® taken as one sachet daily significantly reduces average incidence, incidence over time, and severity of 15 upper respiratory symptoms in healthy adults.

Perimenopausal symptoms in Sri Lankan women.

OBJECTIVE: To determine the types of perimenopausal symptoms (PMS) associated with the natural menopause and to make a preliminary assessment of the influence of PMS on household work, employment duties and social life, since no published data are available regarding these aspects in Sri Lankan women. DESIGN: A cross-sectional descriptive study of 403 women after natural menopause chosen randomly from four selected groups. METHOD: A pre-tested coded questionnaire administered by trained women medical students to consenting menopausal women. RESULTS: An overwhelming majority of menopausal women (87.1%) had one or more PMS. The principal PMS reported were insomnia (57.8%), joint pains (55.8%), night sweats (55.6%), hot flushes (40.2%), irritability (35.3%) and headaches (33.3%). Of the 171 women employed outside the home, 38% noted some interference with employment duties. PMS causes much morbidity in Sri Lankan perimenopausal women.

HIV infection and AIDS.

PIP: This article reports on the HIV/AIDS situation in Sri Lanka. By the end of 1997 a total of 240 HIV cases had been detected in the country; 32 of them were foreigners. It was estimated that there are still 6000-8000 persons with undetected infections. Of the 77 known patients with AIDS, 61 have died. Among patients with HIV infection attending clinics for sexually transmitted disease (STD), about 65% are heterosexuals, 7% male homosexuals, and 6.5% male bisexuals. In most of the cases, the mode of transmission remains unclear. In addition, 70% of female sex workers attending STD clinics insist on using condoms, although the awareness level of HIV/AIDS is reportedly high. Dr. Iyanthi Abeywickrema, Director of STD campaign said that the HIV/AIDS situation in Sri Lanka was contained, and emphasized that continued vigilance and surveillance, as well as enhancing public awareness, particularly among school children and youngsters just out of school, enlisting the help of informed voluntary organization, ensuring a safe supply of blood for transfusion, and counseling health workers for comprehensive and human HIV/AIDS care is very important.^ieng

Iron absorption from a traditional Sri Lankan weaning food and the enhancing effect of ascorbic acid in adult male volunteers.

OBJECTIVE: To study absorption of iron from Centella gruel and the enhancing effect of ascorbic acid in young adult males. DESIGN: An in vivo absorption study. SETTING: Faculty of Medicine, Galle. METHODS: The percentage of iron absorbed from the Centella gruel was measured using a double isotope technique with 55Fe and 59Fe on 10 healthy male volunteers. OUTCOME MEASURE: Percentage of iron absorption from the gruel with and without ascorbic acid. RESULTS: The mean iron absorption from each meal of Centella gruel was 2.2% (SEM 0.8). This increased to 5% (SEM 1.6) by addition of 50 mg ascorbic acid. When ingested with ascorbic acid, the bioavailable nutrient density (BND) of the weaning food was increased from 0.23 to 0.53 mg iron/1,000 kcal. To satisfy the daily physiological requirements of iron in infants and toddlers, it was calculated that apart from ascorbic acid supplementation, the total iron content also needs to be increased from 2.05 mg to 4.0 mg/meal. CONCLUSION: Centella gruel cannot provide the amount of iron to meet the BND for iron required by infants and toddlers, unless supplemented with an enhancer of iron absorption such as ascorbic acid and its total iron content is increased.

Neonatal and post-neonatal mortality in the Galle district.

OBJECTIVE: To determine some factors associated with infant mortality. DESIGN: Descriptive study. SETTING: Galle district in Sri Lanka. SUBJECTS: 350 infant deaths of singleton births. MEASUREMENTS: Association between variables. RESULTS: Neonatal:post-neonatal death ratio was 3.2:1, and 62.3% (218) were early neonatal deaths. First day deaths comprised 28.6% (100); 67.8% (237) died at the Teaching Hospital. A high incidence (65.7%) of low birthweight (LBW) was noted. Mean birthweights of neonates and post-neonates were 1925 +/- 729 and 2520 +/- 620 gram respectively, and the difference between means was statistically significant (p < 0.001). LBW and related disorders were the major cause of death in 44% (154) of the total sample, and in 55.8% (149) of neonates. Infections were the commonest cause (55.8%) of death in post-neonates. Pediatric clinical assessment to differentiate small-for-dates (SFD) was not recorded in 90.3%. Statistically significant associations were found between the period of death (neonatal and post-neonatal) and the following variables: period of gestation (p < 0.001); birthweight (p < 0.001) and cause of death (p < 0.001). CONCLUSIONS: There was a high incidence of neonatal deaths and a high proportion of early neonatal deaths. About one-third of deaths occurred on the first day of life. Incidence of LBW was high. The major cause of death was LBW and related disorders in the total sample and in neonates. Assessment of SFD was not carried out in the vast majority of infants.

PIP: Information was collected from hospitals, government medical centers, private hospitals, and death registrations in Galle district, Sri Lanka, in order to ascertain the factors associated with infant mortality. Deaths were grouped as low birth weight (LBW), birth trauma, infections, congenital anomalies, convulsions, and miscellaneous. The sample included 350 deaths (185 male and 165 female). 38.6% (135 deaths) were preterm at under 37 weeks. 93.3% of term (126 infants) and 65.5% of preterm (141 infants) died in the neonatal period. In the analysis of 336 infants, 65.7% (221 infants) were LBW, and 26.8% were very LBW at under 1500 grams. 85.9% of LBW babies and 57.4% of normal weight babies died during the neonatal period. 89 (40.3%) of the LBW babies were delivered at term, and 48.9% were LBW. 43.7% of the 335 infants were born in hospitals. 73.4% of infant deaths occurred at the hospital during the neonatal period. 14.3% of deaths took place at home. 44% of mortality was attributed to LBW, and LBW and related disorders accounted for 55.8% of neonatal mortality. 57.8% of postneonatal deaths were due to infections. 28.6% of neonatal deaths occurred within the first 24 hours, and 62.3% (218) occurred during the first week. There is a statistically significant association between time of death and period of gestation, birth weight, and cause of death. The importance of birth weight for child survival has been observed in other districts and other studies in Sri Lanka. The mean birth weight of infants dying in the neonatal period was 1925 +or- 729 g. In the postneonatal period, it was 2529 +or- 620 g.

Does Aerua lanata have diuretic properties?

We have compared the diuretic activity of 200 ml of sucrose flavoured aqueous extract of the herb Aerua lanata with that of 200 ml sucrose flavoured weak infusion of tea leaves, and 200 ml of water, in 14 healthy volunteers under standardized conditions. Each volunteer acted as his or her own control in the three protocols, and chemical, physical and statistical analyses were performed "blind" by coding all urine and blood samples collected. A. lanata extract did not significantly increase urine flow, sodium excretion, potassium excretion, or urine and plasma osmolality as compared to an infusion of tea or plain water.