Methods: One hundred and fifty hard-working agricultural farmers from high-prevalence area for CKDu (Madawachchiya) were screened three times for proteinuria; 66 proteinuric and 21 non-proteinuric were identified as the baseline classification. Selected individuals were analysed further for creatinine, protein and cystatin C in urine and creatinine, cystatin C in serum. Urine protein-to-creatinine ratio (UP/UC) was calculated.
Results: Based on creatinine and cystatin C cut-off levels in serum, individuals were classified as high or normal. Diagnosis of two functional markers (creatinine and cystatin C) were evaluated using receiver operating characteristic (ROC) curve and in terms of sensitivity and specificity using UP/UC as the baseline. Creatinine and cystatin C-based eGFR (estimated Glomerular filtration rate) levels were calculated, and Pearson's correlation coefficient was determined between different eGFR measurements using UP/UC. Mean (SD) UP/UC ratio, serum creatinine, and serum cystatin C levels of the proteinuric subjects were 129.0 (18.4) mg/mmol, 1.35 (0.39) mg/dL, 1.69 (0.58) mg/L. For non-proteniuric individuals, the results were found to be 14.4 (2.28), 1.22 (0.40) mg/dL, 0.82 (0.25) mg/L. The ROC analysis showed excellent accuracy in using cystatin C for identifying proteinuric patients than creatinine area under the curve (AUC): 0.9675, P < 0.001). Cut-off points were identified as 1.015 mg/dL for serum creatinine and 0.930mg/L for cystatin C. Furthermore, cystatin C based Hoek formula showed the better correlation (0.635, P < 0.001) with UP/UC compared with creatinine based modification of diet in renal disease (MDRD) formula.
Conclusion: The study showed elevated serum cystatin C in patients with persisting proteinuria compared with non-responding serum creatinine. Moreover, cystatin C-based eGFR equations were more accurate to determine the kidney function than serum creatinine in proteinuric patients who are vulnerable for CKDu in high-prevalence areas.
Method: Consecutive women with uncomplicated singleton pregnancies, attending the Academic Obstetrics and Gynecology Unit of the Teaching Hospital Mahamodara Galle, Sri Lanka, with confirmed dates and establishing spontaneous onset of labor and delivering vaginally between gestational age of 34 - 41 weeks, without any obstetric intervention , during the period September 2013 to February 2014 were studied. The gestational age at spontaneous onset of labor and vaginal delivery and the birth weights of the babies were recorded.
Results: There were 3294 consecutive deliveries during this period, and of them 1602 (48.6%) met the inclusion criteria. Median gestational age at delivery was 275 days (range 238-291 days, IQR 269 to 280 days) and the median birth weight was 3000 g (range1700g - 4350g; IQR 2750-3250g). The 10th, 50th and 90th birth weight centiles of the babies delivered at a gestational age of 275 days were approximately 2570g, 3050g and 3550g respectively.
Conclusions: The median gestational age among women with uncomplicated singleton pregnancies who established spontaneous onset of labor and delivered vaginally, without any obstetric intervention, was approximately five days shorter than the traditionally accepted 280 days. At a gestational age of 275 days, the mean birth weight was approximately 3038g and the 50th centile of the birth weight of the babies delivered was approximately 3050g.
METHODS: This questionnaire-based, observational, multicentre, cross-sectional survey was carried out with 438 randomly selected physicians consulting COPD patients.
RESULTS: In the survey, 73.29% of the physicians consulted at least five COPD patients daily (all patients > 40 years of age). 31.14% of the COPD patients visiting their doctors were women. Among physicians, 95.12% reported that at least 70% of their patients were smokers. 34.18% of the physicians did not routinely use spirometry to diagnose COPD. Most physicians preferred a short-acting β2-agonist (SABA) (28.19%) in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Group-A and long-acting muscarinic receptor antagonist plus long-acting β2-agonist/inhaled corticosteroids (LAMA + LABA/ICS) in both the GOLD Group-C (39.86%) and Group-D (72.89%) patients. A significant number (40.67%) of physicians preferred LABA/LAMA for their GOLD Group-B patients. A pressurised metered dose inhaler (pMDI) with or without spacer was the most preferred device. Only 23.67% of the physicians believed that at least 70% of their patients had good adherence (> 80%) to therapy. Up to 54.42% of the physicians prescribed inhalation therapy to every COPD patient. Also, 39.95% of the physicians evaluated their patients' inhalation technique on every visit. Up to 52.67% of the physicians advised home nebulisation to > 10% of patients, with nebulised SABA/short-acting muscarinic receptor antagonist (SAMA) being the most preferred management choice. Most physicians offered smoking cessation advice (94.16%) and/or vaccinations (74.30%) as non-pharmacological management, whereas pulmonary rehabilitation was offered by a smaller number of physicians. Cost of therapy and poor technique were the most common reasons for non-adherence to COPD management therapy.
CONCLUSION: Awareness of spirometry can be increased to improve the diagnosis of COPD. Though physicians are following the GOLD strategy recommendations for the pharmacological and non-pharmacological management of COPD, awareness of spirometry could be increased to improve proper diagnosis. Regular device demonstration during each visit can improve the inhalation technique and can possibly increase adherence to treatment.