1
Department of Physiology, Faculty of Medicine, University of Peradeniya
2
Faculty of Medicine, University of Peradeniya
A tremor has been observed in the middle finger in one fourth of carrom players just before striking. The aim of this study is to describe the characteristics of the above tremor and to determine its effect on the performance of the carrom players using surface electromyography and spectral analysis.
The details regarding carrom play, tremor and any conditions that could precipitate tremor in 150 otherwise normal young adults, who are carrom players, were obtained using a questionnaire. The real time recording of surface Electromyography (EMG) activity of the Extensor Digitorum Cominis (EDC) muscle of the dominant hand was obtained in a study group of 20 subjects who developed tremor and in a non-tremor control group of 20 subjects. The tremor group and the non-tremor controls were compared at 95% confidence on the frequency, power and performance.
Out of the 150 subjects, 23.3% believed to have a tremor, of whom, 60% believed that the tremor was adversely affecting their performance. The mean frequency of the EMG activity of EDC while playing carrom were 8.310Hz and 8.605Hz for the tremor and non-tremor control groups respectively, showing no statistically significant difference (p=0.505). The power of the EMG power spectra of the tremor group was significantly superior to that of the control group (p=0.001). The comparison of the performance tested with a chi-square test of independence revealed that there is no significant difference in the performance of the tremor group and the control group.
The power spectra of all the subjects were demonstrating 3 clear peaks at the ranges of 2-5 Hz, 6-11 Hz and 18-24 Hz. Similar peaks had been shown to occur in the power spectra of all subjects while pointing a laser beam into a circle in a previous study. The second peak was consistent with physiological tremor in both studies proving that carrom is an activity which enhances physiological tremor. The higher power of the tremor waves in the subjects observed to develop tremor, allowed the visualization of the tremor waves as opposed to the controls.
This study therefore concludes that a tremor develops while playing carrom in approximately one fourth of carrom players. The frequency of the tremor was found to be within the range of physiological tremor, suggesting that this is an enhanced physiological tremor. Tremor was not found to affect the performance.
Proceedings of the Peradeniya University Research Sessions, Sri Lanka, Vol. 16, 24th November 2011
91
Agricultural Risk Index for Chronic Kidney Disease of Unknown Origin
J.M.K.B.Jayasekara1, D.M. Dissanayake1, M.D.N. Gunaratna2, S. Thilakarathna4 and R. Sivakanesan3
1Department of Pathology, Faculty of Medicine, University of Peradeniya
2
Department of Mathematics, Faculty of Engineering, University of Moratuwa
3
Department of Biochemistry, Faculty of Medicine, University of Peradeniya
4
Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, University of Peradeniya
Chronic Kidney Disease due to unknown aetiology (CKD-U) is one of the growing health problems in Sri Lanka. About eight thousand diagnosed CKD-U patients are enduring treatment, largely in the North Central Region (NCR) 90% of the patients are farmers. The study is designed to estimate an agricultural risk index for an individual who lives in high risk areas of the country. The study is a case control study and 315 CKD-U patients and 321 normal healthy individuals were randomly selected from NCR. The age, sex and agriculture related risk factors were collected from both patients and controls. Multiple linear logistic models were used to calculate the risk index.
The gender of the individual (male, female), age category (<45, 45-60, 60>years), extent of land cultivated (>1, <1hectares), exchange of labour (hiring labour, high or low), usage of agrochemicals (yes or no) protective measures against agrochemicals (low or high) were considered for the calculation of the index using the following formula:
ln (π/1-π) = β0 + β1 x age + β2 x gender + β2 x (cultivated area x exchange of labour) + β4
x (usage of agrochemicals x protective measures against agrochemicals)
(π = probability of the disease occurrence, β0=regression constant, βi = Regression coefficient of the i th variable).
According to the multiple linear regression logistic models, the maximum and minimum risks were calculated as 1.0 and 0.0 respectively. The male individual > 60 years of age, low exchange of labour and poor protective measures against agrochemicals had the highest risk of getting CKD-U irrespective of the cultivated land extent (p =0.87). Females < 45 years of age with high labour exchange and using good protective measures had the lowest risk (p= 0.14) irrespective of the cultivated land area. The calculated risk index will be useful to identify individuals at risk of developing CKD-U and to implement preventive strategies for the disease in the high-prevalence area. The individuals > 60 years of age with poor agricultural practices had the maximum possibility of getting CKD-U probably due to long term exposure to the aetiological agents and risk factors in this area.
Proceedings of the Peradeniya University Research Sessions, Sri Lanka, Vol. 16, 24th November 2011
92
Agricultural Risk Factors of Chronic Kidney Disease of Unknown Aetiology in North Central Region of Sri Lanka
J.M.K.B.Jayasekara1, D.M. Dissanayake1, M.D.N. Gunaratna2, S. Thilakarathna4 and R. Sivakanesan3
1
Department of Pathology, Faculty of Medicine, University of Peradeniya
2
Department of Mathematics, Faculty of Engineering, University of Moratuwa
3
Department of Biochemistry, Faculty of Medicine, University of Peradeniya
4Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences,
University of Peradeniya
Health professionals in Sri Lanka have noticed a high incidence of a new form of chronic kidney disease of unknown aetiology (CKD-U) in farmers of North Central Region (NCR).
The aim of the study was to identify the risk factors related to farming in order to implement preventive strategies. Potential agricultural risk factors and other information were collected through interviewer-administered questionnaires given to 315 CKD-U patients and 321 healthy controls that were randomly selected. The relative risk of each factor was compared in terms of Odds ratios (ORs) and 95% confidence interval (CI) by applying the linear logistic model.
Involvement in paddy farming activities (OR = 1.945, 95% CI; 1.256-3.010), usage of agro-chemicals (OR = 2.034, 95 % CI; 1.297-3.190), poor preventive measures when using agro-chemicals (OR = 2.845, 95% CI; 1.788-4.527), high operated paddy extent without exchange of labour (OR = 4.734, 95% CI; 2.586-8.665) were identified as significant contributory risk factors for CKD-U (p < 0.005). Cultivating a large land extent without hiring labour was a significant risk factor for the disease (p < 0.05). Furthermore, cultivating smaller land extent without hired labour (OR = 1.558, 95% CI ; 0.47-1.56) had higher risk than cultivating larger land extent with hired labour (OR = 1.40, 95% CI; 0.42- 1.42). In addition to the agricultural activities, being a male, age > 60 years, smoking, alcoholism, family history of CKD-U, history of malaria and snake bites (p < 0.05) were identified as other contributory factors.
There is a strong occupational risk factor in the pathogenesis of the disease where the male farmers of > 60 of age were at a high risk probably due to long term exposure to the aetiological agents (risk factors). Agricultural activities involving intense physical activity were related to CKD-U. Further studies are indicated to identify the effect of dehydration and physical exertion on the renal functions of these individuals. Poor preventive measures in agrochemical usage related to the disease indicate the need to educate the farmers on safe agrochemical usage.
Proceedings of the Peradeniya University Research Sessions, Sri Lanka, Vol. 16, 24th November 2011
93
Estimation of 24-Hour Protein Excretion in Chronic Kidney Disease Patients by Analysing the Protein to Creatinine Ratio of Four Timely Urine Samples
J.M.K.B.Jayasekara1, D.M. Dissanayake1, P.W.K.K. Amunugama2, M. Wazeel 3 and R. Sivakanesan4
1
Department of Pathology, Faculty of Medicine, University of Peradeniya
2
Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, University of Peradeniya
3Nephrology Unit, Teaching Hospital, Kandy
4
Department of Biochemistry, Faculty of Medicine, University of Peradeniya
Measurement of protein excretion in a 24-hour urinary collection is the gold standard method for the quantification of proteinuria in kidney disease patients with various aetiologies. The aim of this study was to evaluate which spot urine protein to creatinine ratio (UPCR) could be a reliable alternative to 24-hour urinary total protein (24UTP) estimation by analysing four daytime urine samples of patients with chronic kidney disease (CKD).
Forty eight CKD patients (28 males and 20 females) with nephritis and high proteinuria (>1g/L for 24 hours and GFR> 45 ml/min/1.73m2) attending the Nephrology Unit were selected for the study. Four daytime urine samples namely early morning, 7am - 10 am, 10 am-4 pm and before parting to bed were collected along with the 24 hours urine sample. Urine protein and creatinine levels were measured by using turbidimetry and modified Jaffe methods. The best correlation between UPCR and 24UTP was calculated. The linear regression, central tendency and dispersion were also established and the Friedman test was used to evaluate significant difference among UPCR levels of 4 daytime urine samples.
The correlation coefficient (r) between 24UTP and spot UPCR in the study population were: early morning 0.81 (P < 0.001); 7am - 10 am 0.64 (p < 0.001); 10am- 4pm 0.66 (p < 0.001); and before parting to bed 0.792 (p < 0.001). Early morning spot urine sample showed the highest linear association whereas the 7am-10 am and 10 am-4 pm show lower associations compared to other two spot urine samples. Highest and lowest median of UPCR were 7 am -10 am and before the bed respectively. Highest dispersion of UPCR reported in 10 am-4 pm and the distribution of before bed is somewhat skewed to right.
This study concludes that the protein to creatinine ratio in early morning urine sample is an accurate, convenient, and reliable method to estimate the 24 hours total protein in urine in study population. The other three urine samples, namely, 7am - 10 am, 10 am-4 pm and before departing to bed, can also be used for the estimation of 24-hour protein (p<0.001).
Proceedings of the Peradeniya University Research Sessions, Sri Lanka, Vol. 16, 24th November 2011
94
Effect of Concentrated Water from Reservoirs of High Prevalence Area for Chronic Kidney Disease of Unknown Origin in Sri Lanka on Mice
J.M.K.B.Jayasekara1, D.M. Dissanayake1, P. Ratnayake2, W. Wickramasinghe3, Y.A. Radella4 and R. Sivakanesan5
1
Department of Pathology, Faculty of Medicine, University of Peradeniya
2
Sirimavo Bandaranayake Specialized Childrens’ Hospital, Peradeniya
3
National Environmental Toxicology Laboratories, University of Queensland
4Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University
of Peradeniya
5
Department of Biochemistry, Faculty of Medicine, University of Peradeniya
There is threateningly high prevalence of chronic kidney disease due to tubulointerstitial disease ending as chronic renal failure in the North Central Region of Sri Lanka. The epidemiology of the disease shows distribution of these patients around some water reservoirs and most of them are farmers. The low prevalence of the disease among the in villagers who use water from the natural springs was observed. The aim of the study was to find the potential effects of concentrated water of the reservoirs in the high- prevalence area by mouse bioassay.
Water of Padaviya reservoir supplying water to a high disease prevalent area was concentrated fifteen times by evaporation, exposing to sunlight from the month of May to July. The test group of mice (n=20) and control group (n=15) were fed with concentrated reservoir water and water from non-prevalence area (Kandy) respectively, for a period of 6 months and the kidneys were examined histopathologically for evidence of renal disease. Water samples were analyzed for Fluoride, Na +, K+, heavy metals and for cyanobacterial toxins microcystin and cylindrospermopsin.
The analysis of concentrated water samples from Padaviya reservoir from May to July showed a significantly higher content of fluoride (2.25+0.7 mg/L) and sodium (225+62 mg/L) (p<0.05) than control samples. However, no increased levels of heavy metals were detected. The analysis of water samples from Padaviya reservoir showed the presence of Deoxycylindrospermopsin (1.28 ug/L; DCYN) as the predominant isomer present over cylindrospermospsin (CYN), which is unusual. At the end of 6 months, interstitial nephritis was detected in 45% of test mice and only 6.5% of control group (p < 0.001).
The results show the ability of the water of this reservoir to induce interstitial nephritis that could be due to the high salinity, fluoride or due to DCYN. Although present in low levels, the possibility DCYN to induce interstitial nephritis needs to be investigated further as the epidemiological evidence is in favor of a cyanobacterial toxin. The long term effects and safe levels for DCYN in drinking water and the effect of salinity and high fluoride content of water need to be studied.
Proceedings of the Peradeniya University Research Sessions, Sri Lanka, Vol. 16, 24th November 2011
95
The Short Term Effect of Cyanobacterial Toxin Extracts on Mice Kidney
D.M. Dissananyake1, J.M.K.B. Jayasekera1, P. Ratnayake2, W. Wickramasinghe3 and Y.A. Radella4
1Department of Pathology, Faculty of Medicine, University of Peradeniya
2
Sirimavo Bandaranayake Specialized Childrens’ Hospital, Peradeniya
3
National Environmental Toxicology Laboratory, University of Queensland
4
Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Peradeniya
Chronic kidney disease of unknown origin (CKD-U) in Sri Lanka shows clustering of patients around water reservoirs, and similarities in incidence over time in CKD-U and alcoholic liver disease in the North Central Region, which indicates the possibility of a common aetiological agent. The aim of this study was to find the short term effects of extracts of cyanobacteria isolated from the reservoirs and canals of the high prevalence area of CKD-U on mice kidney.
Diluted extracts of Microcystis, Cylindrospermopsis and Lyngbia blooms were fed to groups of 5, 7 and 10 mice respectively for a week. Another 5 mice were fed for one week with diluted extracts of microcystis bloom, followed by 2 weeks of normal water. The control group of mice (n= 10) was given normal water for a week. Cyanobacterial extracts were analyzed for microcystisn, deoxy-cylindrospermopsin (DCYN) and cylindropsermopsin (CYN).
Acute tubular necrosis (ATN) was detected in 5/5 mice fed with extracts of
Microcystis bloom that contained microcystin (65µg/l), DCYN (2.1 µg/l) and CYN while 2/5
mice had ATN when this extract was followed with normal water for 2 weeks. One out of seven mice fed with Cylindrospermopsis bloom that contained DCYN (29.5 µg/l) and CYN (0.7 µg/l) and 6/10 mice fed on Lyngbia bloom containing CYN (1.7 µg/l) and DCYN (0.5 µg/l) had ATN. All control mice had normal tubules.
The results show the ability of the cyanobacterial extracts to induce ATN in mice in the given concentrations. The ability of the kidneys to recover is suggested by the less frequent abnormalities seen after normal water has been supplied for 2 weeks post-
Microcystis poisoning. As DCYN was available in all 3 extracts causing ATN, the ability of
DCYN on its own to induce tubular necrosis even at low concentrations need to be investigated.
Proceedings of the Peradeniya University Research Sessions, Sri Lanka, Vol. 16, 24th November 2011
96
A Study on Geographical Distribution of Chronic Kidney Disease of Unknown Origin in Sri Lanka Using GIS and GPS Mapping