Aerosol delivery of synthetic DNA containing CpG motifs in broiler chicks at hatch under field conditions using a commercial-scale prototype nebulizer provided protection against lethal Escherichia coli septicemia.

Synthetic DNA containing CpG motifs (CpG-ODN) are potent innate immune stimulators in neonatal and adult broiler chickens against bacterial septicemia. We have recently demonstrated that intrapulmonary (IPL) delivery of CpG-ODN as microdroplets under laboratory conditions can protect neonatal chickens against lethal Escherichia coli septicemia. The objectives of this study were to develop a commercial-scale poultry nebulizer (CSPN) that can deliver CpG-ODN as microdroplets in neonatal broiler chicks in the hatcheries and study the efficacy of CSPN in inducing immune-protective effects under different environmental conditions in 2 geographical locations in Canada. Three field experiments were conducted in commercial poultry hatcheries during different seasons of the year in Saskatchewan and British Columbia, Canada. Neonatal broiler chicks (n = 8,000/experiment) received CpG-ODN by the IPL route in the CSPN chamber for 30 min, and control chicks received distilled water (DW) for 30 min. Broiler chicks (CpG-ODN-240 chicks/experiment and DW-40 chicks/experiment) were randomly sampled from all locations of the CSPN after nebulization and challenged with a lethal dose of E. coli to examine the CpG-ODN nebulization induced protection. We found a significant level (P < 0.05) of protection in broiler chicks against E. coli challenge, suggesting that the newly built CSPN successfully delivered CpG-ODN via the IPL route. We found that when the CSPN was maintained at humidex 28°C or below and relative humidity (RH) between 40 and 60%, neonatal birds were significantly (P < 0.05) protected against E. coli septicemia after IPL delivery of CpG-ODN. By contrast, protection in chicks was adversely affected when the CSPN was maintained at the humidex of 29°C or higher and RH of 70%. Overall, the present study successfully built a CSPN for CpG-ODN delivery in chicks at the hatchery and revealed that the temperature, humidity, and humidex were critical parameters in CSPN for efficient delivery of CpG-ODN.

Health related quality of life in chronic kidney disease; a descriptive study in a rural Sri Lankan community affected by chronic kidney disease.

INTRODUCTION: The current epidemic of chronic kidney disease (CKD) in Sri Lanka is ascribed to the exponential increase in the number of CKD patients, which cannot be attributed to any known etiology (CKDu). The aim of this study is to describe the health related quality of life (HRQOL) and the associated factors among CKD/CKDu patients in a rural district in Sri Lanka. METHODS: A community based cross-sectional study included 1174 CKD/CKDu patients. Kidney Disease Quality of Life-Short Form was used to assess the HRQOL, while Centre for Epidemiologic Studies Depression Scale, General Health Questionnaire (GHQ) 12 and CKD Symptom Index - Sri Lanka were used to assess presence of depression, psychological distress and symptom burden respectively. Three summary scores; kidney disease (KDSC), physical (PCS) and mental (MCS) are derived from Kidney Disease Quality of Life-Short Form (KDQOL-SF™). RESULTS: Mean age of the study population was 58.3 years (standard deviation (SD) 10.7). Median KDSC (58.4; inter-quartile range (IQR) 54.2-63.4), was higher than the median scores of PCS (35.0; IQR 26.2-41.9) and MCS (58.4; IQR 54.2-63.4). Multiple linear regression revealed low income, advanced stages of CKD, symptom burden, being positive for depression and psychological distress were significantly associated with low HRQOL. CONCLUSION: The HRQOL of the CKD patients in this rural Sri Lankan population was found to be poor. Superior socio-economic status, less physical and psychological symptom burden were found to be independently associated with better HRQOL. Periodical screening of the CKD patients for depression and psychological distress and measures to alleviate symptom burden seem to be important to improve the HRQOL of these patients.

Depression and psychological distress in patients with chronic renal failure: Prevalence and associated factors in a rural district in Sri Lanka.

OBJECTIVE: Chronic Kidney Disease (CKD) is known to adversely affect mental health. The study was aimed at estimating the prevalence of depression and psychological distress and the associated factors among CKD patients living in Anuradhapura, a rural district in Sri Lanka. METHOD: A community-based, cross-sectional study included a representative sample of 1174 CKD patients, drawn proportionately from all registered patients in all 19 Medical Officer of Health areas in the district of Anuradhapura. Trained paramedical staff visited the households and administered the locally validated Centre for Epidemiologic Studies Depression Scale and General Health Questionnaire-12 to screen for depression and psychological distress. Information related to associated factors was obtained through an interviewer-administered questionnaire. RESULTS: A total of 1118 CKD patients participated, with a response rate of 95.2%. The mean age was 58.3 (SD 10.8) years. 62.7% of participants were males. The majority of participants was in CKD stage 4 (58.3%). The screening revealed that 75.0% (95% CI 72.5-77.5) of participants were psychologically distressed while 65.2% (95%CI 62.4-68.0) were found to be depressed. Multiple logistic regression analysis revealed advanced age, unemployment and poor health related quality of life contributed significantly to both depression and psychological distress. CONCLUSION: Depression and psychological distress were significant in this community. Policymakers should consider the likely high prevalence of psychological distress and depression among CKD patients as well as the need for specific mental health services to confirm diagnosis and initiate effective management. Identified associated factors should be used to identify targeted preventative interventions.

Symptom burden in chronic kidney disease; a population based cross sectional study.

BACKGROUND: Physical and psychological symptoms are among main manifestations of Chronic Kidney Disease (CKD). This study aimed to assess the symptom burden and self-perceived severity of symptoms among CKD patients living in a district in Sri Lanka. METHOD: A community based cross-sectional study included a sample of randomly selected 1174 CKD patients from all 19 Medical Officer of Health areas in the district of Anuradhapura. Trained para-medical staff visited the households and administered the locally validated questionnaire to assess the presence and severity of symptoms. The inquiry was on 25 symptoms in a 5 point Likert scale indicating the severity during the previous week. Symptom burden score was constructed by summing each symptom severity score which ranged from 0 to 125. RESULTS: A total of 1118 CKD patients participated with a response rate of 95.2%. The mean age was 58.3 (SD 10.8) years and 62.7% were males. A majority were in CKD stage 4 (58.3%). Bone/joint pain was the most experienced symptom (87.6%; 95%CI 85.6-89.5). Loss of libido was the most severe symptom. The median symptom burden score was 35.0 (IQR 20.0-50.0). Multiple linear regression revealed education up to Advanced Level (ß -9.176), CKD stage V (ß 3.373), being dialyzed (ß 20.944), comorbidities (ß 4.241) and being employed (ß -9.176) to be significant predictors of symptom burden. CONCLUSIONS: Patients in all stages of CKD experience high symptom burden warranting rigorous measures to relieve symptoms and to improve the well-being of CKD patients.

Out-of-pocket expenditure in accessing healthcare services among Chronic Kidney Disease patients in Anuradhapura District

Introduction: Chronic Kidney Disease (CKD) has significant economic impact on both patients' households and the country. Objectives: To assess the out-of-pocket (OOP) expenditure of accessing health services among CKD patients in Anuradhapura District Methods: This community based cross-sectional study included a representative sample of 1174 registered CKD patients from all 19 Medical Officer of Health areas in the District of Anuradhapura. Trained para-medical staff visited the households and administered an interviewer administered questionnaire to gather information. Results: A total of 1118 CKD patients participated. Mean age was 58.3 (SD 10.8) years. Fifty nine (5.3%) patients had been hospitalized during the six months preceding data collection. The total OOP for a hospital admission for one patient was Rs. 3625 (IQR 1650-8760). Thirty eight (3.4%) patients were on dialysis. The median direct cost per patient for an episode of dialysis was Rs.595 (IQR 415-995) while the median direct cost for a dialysis patient per month was Rs.5490 (IQR 3950-10934). In the study population a total of 1095 (98.0%) had attended clinic at least once during the six months preceding the study. The OOP expenditure for a single clinic visit for one patient was Rs.434 (IQR 200- 860). Conclusions: CKD patients living in the Anuradhapura District spent significant amounts on accessing health care which can worsen their economic hardships. Planned interventions are warranted in order to improve their quality of life and financial situation.