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The South Asia region is facing a high burden of chronic kidney disease (CKD) with limited health resources and low expenditure on health care. In addition to the burden of CKD and kidney failure from traditional risk factors, CKD of unknown etiologies from India and Sri Lanka compounds the challenges of optimal management of CKD in the region. From the third edition of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA), we present the status of CKD burden, infrastructure, funding, resources, and health care personnel using the World Health Organizations building blocks for health systems in the ISN South Asia region. The poor status of the public health care system and low health care expenditure resulted in high out-of-pocket expenditures for people with kidney disease, which further compounded the situation. There is insufficient country capacity across the region to provide kidney replacement therapies to cover the burden. The infrastructure was also not uniformly distributed among the countries in the region. There were no chronic hemodialysis centers in Afghanistan, and peritoneal dialysis services were only available in Bangladesh, India, Nepal, Pakistan, and Sri Lanka. Kidney transplantation was not available in Afghanistan, Bhutan, and Maldives. Conservative kidney management was reported as available in 63% (n = 5) of the countries, yet no country reported availability of the core CKM care components. There was a high hospitalization rate and early mortality because of inadequate kidney care. The lack of national registries and actual disease burden estimates reported in the region prevent policymakers attention to CKD as an important cause of morbidity and mortality. Data from the 2023 ISN-GKHA, although with some limitations, may be used for advocacy and improving CKD care in the region.

The usage of children’s books is a fundamental aspect within a preschool environment. Even though the content in such books are childlike, they are always written by adult authors who appropriates a child-perspective. This sparked an interest in creating a children’s book with the cooperation of a group of children and producing a story from a children’s perspective. The overall objective of the project was to improve children's participation in preschool and develop their understanding of democratic principles through the creation of their own story book. By using art based research as the method, creative workshops were carried out where the children created their own story through conversation and artwork. The collected data were in the form of transcriptions of films recorded during the workshops and the artwork done by the group of children which was analyzed using concepts such as democracy, participation, child-perspective and children’s perspective. The steps which involved the creative workshops together with the group of children were further examined by the usage of Roger Hart’s Ladder of Participation. The results of the project showed a high level of participation by the group of children due to possibilities provided for them to exercise democratic principles such as voting and decision making as a group while creating a story and all its essential contents from their perspective. In regards to the Ladder of Participation, genuin participation of different levels were observed from the group of children during the course of this project. The 2 highest levels of the ladder; where an activity is initiated and carried out by children, were unable to be reached since in practical sense, preschool aged children need adult assistance. The storybook created involved a fantasytale titled Superkatterna (The Supercats) which consists of cats, dinosaurs and unicorns in their rainbow world, conflict between the cats and dinosaurs and how the unicorns help them to

A study conducted from July 2019 to May 2022 at several hospitals in the Western Province, Sri Lanka, focused on dengue virus strains during the COVID-19 pandemic. Among 417 febrile patients, 47% were PCR-positive for dengue. Serotyping revealed DENV-1 (12.8%), DENV-2 (46.4%), DENV-3 (37.2%), and DENV-4 (3.6%). Sequencing identified two genotypically distinct variants of DENV-3 and two genotypically distinct variants of DENV-1, while DENV-2 showed a single genotype cluster. Notably, the study found concurrent circulation of two DENV-3 and two DENV-1 genotypes, along with DENV-2, during the pandemic in the area. This data suggests the presence of multiple dengue strains, including several DENV-1 and DENV-3 variants, without major epidemic outbreaks reported in the Western Province. Continuous monitoring and research are essential to understand the dynamics of these dengue strains in the context of the COVID-19 pandemic.

The usage of children’s books is a fundamental aspect within a preschool environment. Even though the content in such books are childlike, they are always written by adult authors who appropriates a child-perspective. This sparked an interest in creating a children’s book with the cooperation of a group of children and producing a story from a children’s perspective. The overall objective of the project was to improve children's participation in preschool and develop their understanding of democratic principles through the creation of their own story book. By using art based research as the method, creative workshops were carried out where the children created their own story through conversation and artwork. The collected data were in the form of transcriptions of films recorded during the workshops and the artwork done by the group of children which was analyzed using concepts such as democracy, participation, child-perspective and children’s perspective. The steps which involved the creative workshops together with the group of children were further examined by the usage of Roger Hart’s Ladder of Participation. The results of the project showed a high level of participation by the group of children due to possibilities provided for them to exercise democratic principles such as voting and decision making as a group while creating a story and all its essential contents from their perspective. In regards to the Ladder of Participation, genuin participation of different levels were observed from the group of children during the course of this project. The 2 highest levels of the ladder; where an activity is initiated and carried out by children, were unable to be reached since in practical sense, preschool aged children need adult assistance. The storybook created involved a fantasytale titled Superkatterna (The Supercats) which consists of cats, dinosaurs and unicorns in their rainbow world, conflict between the cats and dinosaurs and how the unicorns help them to

Cancer is a group of complex diseases characterized by the uncontrolled growth and division of abnormal cells that can affect virtually any tissue or organ in the body. Together, these diseases continue to challenge medical science and impact millions of lives worldwide. Despite substantial progress in cancer treatments, the quest for better therapies, and ultimately for a cure for all forms of cancer remains elusive. As cancer drug discovery enters an era of precision medicine, cyanobacteria offer a promising source of new drugs. Their biodiversity provides a vast reservoir of pharmacologically active metabolites, whilst their ability to thrive in diverse ecological niches suggests untapped natural resources. The present study attempted to improve the knowledge of anti-proliferative potential, cytotoxicity, relative safety and anticancer properties of relatively poorly studied cyanobacteria species and to verify their suitability for chemotherapeutic treatments of treat some cancers. [...], Thesis (PhD Doctorate), Doctor of Philosophy (PhD), School of Environment and Sc, Science, Environment, Engineering and Technology, Full Text

Recent growth in popularity of mobile and wearable devices has re-ignited the need for reliable and stealthy communication side-channels to enable applications such as secret/PIN sharing, co-location proofs and user authentication. Existing short-range wireless radio technology such as Bluetooth/BLE and NFC, although mature and robust, is prone to eavesdropping, jamming and/or interference, and is not very useful as a covert communication side-channel. This paper designs and implements SkinSense, a vibration-based communication protocol which uses human body/skin as a communication medium to create a low-bandwidth and covert communication channel between user-held mobile and wearable devices. SkinSense employs a novel frequency modulation technique for encoding bits as vibration pulses and a spectrogram-based approach to decode the sensed motion data (corresponding to the encoded vibration pulses) to reconstruct the transmitted bits. SkinSense is comprehensively evaluated for a variety of operational parameters, hardware setups and communication settings by means of data collected from human subject participants. Results from these empirical evaluations demonstrate that SkinSense is able to achieve a stable bandwidth of upto 6.6 bps, with bit error rates below 0.1 in our custom hardware setup, and can be employed as a practical communication side-channel.

Headphones, traditionally limited to audio playback, have evolved to integrate sensors like high-definition microphones and accelerometers. While these advancements enhance user experience, they also introduce potential eavesdropping vulnerabilities, with keystroke inference being our concern in this work. To validate this threat, we developed OverHear, a keystroke inference framework that leverages both acoustic and accelerometer data from headphones. The accelerometer data, while not sufficiently detailed for individual keystroke identification, aids in clustering key presses by hand position. Concurrently, the acoustic data undergoes analysis to extract Mel Frequency Cepstral Coefficients (MFCC), aiding in distinguishing between different keystrokes. These features feed into machine learning models for keystroke prediction, with results further refined via dictionary-based word prediction methods. In our experimental setup, we tested various keyboard types under different environmental conditions. We were able to achieve top-5 key prediction accuracy of around 80% for mechanical keyboards and around 60% for membrane keyboards with top-100 word prediction accuracies over 70% for all keyboard types. The results highlight the effectiveness and limitations of our approach in the context of real-world scenarios.

The Tor network is the most prominent system for providing anonymous communication to web users, with a daily user base of 2 million users. However, since its inception, it has been constantly targeted by various traffic fingerprinting and correlation attacks aiming at deanonymizing its users. A critical requirement for these attacks is to attract as much user traffic to adversarial relays as possible, which is typically accomplished by means of bandwidth inflation attacks. This paper proposes a new inflation attack vector in Tor, referred to as TorMult, which enables inflation of measured bandwidth. The underlying attack technique exploits resource sharing among Tor relay nodes and employs a cluster of attacker-controlled relays with coordinated resource allocation within the cluster to deceive bandwidth measurers into believing that each relay node in the cluster possesses ample resources. We propose two attack variants, C-TorMult and D-TorMult, and test both versions in a private Tor test network. Our evaluation demonstrates that an attacker can inflate the measured bandwidth by a factor close to n using C-TorMult and nearly half n*N using D-TorMult, where n is the size of the cluster hosted on one server and N is the number of servers. Furthermore, our theoretical analysis reveals that gaining control over half of the Tor network's traffic can be achieved by employing just 10 dedicated servers with a cluster size of 109 relays running the TorMult attack, each with a bandwidth of 100MB/s. The problem is further exacerbated by the fact that Tor not only allows resource sharing but, according to recent reports, even promotes it.

According to the WHO 2009 classification, dengue with warning signs is at the risk of developing severe form of dengue disease. One of the most important warning signs is plasma leakage, which can be a serious complication associated with higher morbidity and mortality. We report that the frequency of CD4+CD8+ double-positive (DP) T cells is significantly increased in patients at risk of developing plasma leakage. Transcriptomic analysis demonstrated that CD4+CD8+ DP cells were distinct from CD4+ Single Positive (SP) T cells but co-clustered with CD8+ SP cells, indicating a largely similar transcriptional profile. Twenty significant differentially expressed (DE) genes were identified between CD4+CD8+ DP and CD8+ SP cells. These genes encode OX40 and CCR4 proteins as well as other molecules associated with cell signaling on the cell surface (NT5E, MXRA8, and PTPRK). While comparing the profile of gene expression in CD4+CD8+ DP cells from patients with and without warning signs of plasma leakage, similar expression profile was observed, implying a role of CD4+CD8+ DP cells in plasma leakage through a quantitative increase rather than functional alteration. This study provided novel insight into the host immune response during the acute febrile phase of DENV infection and the role of CD4+CD8+ DP T cells in the pathogenesis of plasma leakage.

OBJECTIVE Patients with advanced chronic kidney disease (CKD) or kidney failure receiving replacement therapy (KFRT) are highly vulnerable to COVID-19 infection, morbidity and mortality. Vaccination is effective, but access differs around the world. We aimed to ascertain the availability, readiness and prioritisation of COVID-19 vaccines for this group of patients globally. SETTING AND PARTICIPANTS Collaborators from the International Society of Nephrology (ISN), Dialysis Outcomes and Practice Patterns Study and ISN-Global Kidney Health Atlas developed an online survey that was administered electronically to key nephrology leaders in 174 countries between 2 July and 4 August 2021. RESULTS Survey responses were received from 99 of 174 countries from all 10 ISN regions, among which 88/174 (50%) were complete. At least one vaccine was available in 96/99 (97%) countries. In 71% of the countries surveyed, patients on dialysis were prioritised for vaccination, followed by patients living with a kidney transplant (KT) (62%) and stage 4/5 CKD (51%). Healthcare workers were the most common high priority group for vaccination. At least 50% of patients receiving in-centre haemodialysis, peritoneal dialysis or KT were estimated to have completed vaccination at the time of the survey in 55%, 64% and 51% of countries, respectively. At least 50% of patients in all three patient groups had been vaccinated in >70% of high-income countries and in 100% of respondent countries in Western Europe.The most common barriers to vaccination of patients were vaccine hesitancy (74%), vaccine shortages (61%) and mass vaccine distribution challenges (48%). These were reported more in low-income and lower middle-income countries compared with high-income countries. CONCLUSION Patients with advanced CKD or KFRT were prioritised in COVID-19 vaccination in most countries. Multiple barriers led to substantial variability in the successful achievement of COVID-19 vaccination across the world, with high

Objectives: To explore the experiences, and main driving forces of stigma and discrimination among COVID-19 patients, following hospital discharge, in Sri Lanka. Study design: A qualitative study was used in order to gain insight and explore the depth and complexity of COVID-19 patients’ experiences. Methods: Semi-structured interviews were conducted via telephone in a purposively selected sample of 139 COVID-19 patients. Participants were interviewed during the first 3 weeks following discharge from four main state hospitals that were treating COVID-19 patients during the early phase of the pandemic. Questions on stigma and discrimination were open-ended, enabling patients to provide responses about their different experiences and settings; results were analysed using thematic analysis. Results: The majority of participants were men (n = 80; 57.6%), with a mean age of 43 years (SD = 11.2). In total, up to one-third of the study participants experienced stigma related to COVID-19 and were discriminated against by the community, co-workers and healthcare workers in Sri Lanka. Social discrimination included barriers in accessing basic needs, insulting, blaming, defaming, spreading rumours and receiving no support during emergencies. Workplace discrimination included loss of jobs, not allowing re-entry and loss of earnings due to self-employment. Discrimination by healthcare workers included breaching of confidentiality, lack of respect, not providing health services and communication barriers. Discrimination has led to social isolation, not seeking help and severe psychosocial issues impacting their family relationships. Irresponsible media reporting and sensationalism of news coverage leading to breaching of privacy and confidentiality, defaming, false allegations and reporting household details without consent were perceived as the main factors underlying the views and opinions of the general public. Conclusions: Stigma and discrimination experienced by COVID-19

BACKGROUND: Genetic risk factors for dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) and dengue fever (DF) are limited, in particular there are sparse data on genetic risk across diverse populations. METHODS: We conducted a genome-wide association study (GWAS) in a derivation and validation sample of 7, 460 participants of Latin American, South Asian, and South East Asian ancestries. We then developed a weighted polygenic risk score (PRS) for each participant in each of the validation cohorts of the three ancestries to predict the risk of DHF/DSS compared to DF, DHF/DSS compared to controls, and, DF compared to controls. FINDINGS: The risk of DHF/DSS was significantly increased, odds ratio [OR] 1.84 (95%CI 1.47 to 2.31) (195 SNPs), compared to DF, fourth PRS quartile versus first quartile, in the validation cohort. The risk of DHF/DSS compared to controls was increased (OR=3.94; 95% CI 2.84 to 5.45) (278 SNPs), as was the risk of DF compared to controls (OR=1.97; 95%CI 1.63 to 2.39) (251 SNPs). Risk increased in a dose-dependent manner with increase in quartiles of PRS across comparisons. Significant associations persisted for PRS built within ancestries and applied to the same or different ancestries as well as for PRS built for one outcome (DHF/DSS or DF) and applied to the other. INTERPRETATION: There is a strong genetic effect that predisposes to risk of DHF/DSS and DF. The genetic risk for DHF/DSS is higher than that for DF when compared to controls, and this effect persists across multiple ancestries.

Micromobility vehicles are gaining popularity due to their portable nature, and their ability to serve short distance urban commutes better than traditional modes of transportation. Most of these vehicles, offered by various micromobility service providers around the world, are shareable and can be rented (by-the-minute) by riders, thus eliminating the need of owning and maintaining a personal vehicle. However, the existing micromobility ecosystem comprising of vehicles, service providers, and their users, can be exploited as an attack surface by malicious entities - to compromise its security, safety and privacy. In this short position paper, we outline potential privacy and security challenges related to a very popular urban micromobility platform, specifically, dockless battery-powered e-scooters.

The popularity and proliferation of electric scooters (e-scooters) as a micromobility solution in our cities and urban communities has been rapidly rising. Rent-by-the-minute pricing and a healthy competition between micromobility service providers is also benefiting riders with low trip costs. However, an unprepared urban infrastructure, combined with uncertain operation policies and poor regulation enforcement, has resulted in e-scooter riders encroaching public spaces meant for pedestrians, thus causing significant safety concerns both for themselves and the pedestrians. As a consequence, it has become critical to understand the current state of pedestrian safety in our urban communities vis-\`{a}-vis e-scooter services, identify factors that impact pedestrian safety due to such services, and determine how to support pedestrian safety going forward. Unfortunately, to date there have been no realistic, data-driven efforts within the research community that address these issues. In this work, we conduct a field study to empirically investigate crowd-sensed encounter data between e-scooters and pedestrian participants on two urban university campuses over a three-month period. We also analyze encounter statistics and mobility trends that could identify potentially unsafe spatio-temporal zones for pedestrians. This first-of-its-kind work provides a preliminary blueprint on how crowd-sensed micromobility data can enable safety-related studies in urban communities.

DNA sequence-based typing at the HLA-A, -B, -C, -DPB1, -DQA1, -DQB1, and -DRB1 loci was performed on 714 healthy adult blood bank donors from Colombo, Sri Lanka, to characterize allele frequencies in support of studies on T cell immunity against pathogens, including Dengue virus. Deviations from Hardy Weinberg proportions were not detected at any locus. Several alleles were found in >30% of individuals, including the class II alleles DPB1 * 04:01, DPB1 * 02:01, DQB1 * 06:01 and DRB1 * 07:01, and the class I alleles A * 33:03 and A * 24:02. Genotype data will be available in the Allele Frequencies Net Database.

DNA sequence-based typing at the HLA-A, -B, -C, -DPB1, -DQA1, -DQB1, and -DRB1 loci was performed on 714 healthy adult blood bank donors from Colombo, Sri Lanka, to characterize allele frequencies in support of studies on T cell immunity against pathogens, including Dengue virus. Deviations from Hardy Weinberg proportions were not detected at any locus. Several alleles were found in >30% of individuals, including the class II alleles DPB1 * 04:01, DPB1 * 02:01, DQB1 * 06:01 and DRB1 * 07:01, and the class I alleles A * 33:03 and A * 24:02. Genotype data will be available in the Allele Frequencies Net Database.

States are increasingly conferring power upon private actors to perform traditionally public services. In New Zealand, this extends to private actors wielding state coercive power. This paper explores the accountability of private actors wielding coercive power, and therefore how legitimate devolution of power is to them. Transparency and effectiveness are also, more briefly, examined. Analysis reveals that if a private actor does not share key goals and values with its public sector counterpart, or with the instrument establishing the coercive power, moral hazard may develop as the actor seeks to pursue its own agenda at the expense of its obligations. Loss of legitimacy can result, particularly if actors appear to be morally culpable for ineffective use of state coercive power. Ultimately, interim, ongoing accountability mechanisms and robust transparency measures must be properly implemented, if legitimacy of the devolution of power to private actors is to be sustained.

DNA sequence-based typing at the HLA-A, -B, -C, -DPB1, -DQA1, -DQB1, and -DRB1 loci was performed on 714 healthy adult blood bank donors from Colombo, Sri Lanka, to characterize allele frequencies in support of studies on T cell immunity against pathogens, including Dengue virus. Deviations from Hardy Weinberg proportions were not detected at any locus. Several alleles were found in >30% of individuals, including the class II alleles DPB1 * 04:01, DPB1 * 02:01, DQB1 * 06:01 and DRB1 * 07:01, and the class I alleles A * 33:03 and A * 24:02. Genotype data will be available in the Allele Frequencies Net Database.

States are increasingly conferring power upon private actors to perform traditionally public services. In New Zealand, this extends to private actors wielding state coercive power. This paper explores the accountability of private actors wielding coercive power, and therefore how legitimate devolution of power is to them. Transparency and effectiveness are also, more briefly, examined. Analysis reveals that if a private actor does not share key goals and values with its public sector counterpart, or with the instrument establishing the coercive power, moral hazard may develop as the actor seeks to pursue its own agenda at the expense of its obligations. Loss of legitimacy can result, particularly if actors appear to be morally culpable for ineffective use of state coercive power. Ultimately, interim, ongoing accountability mechanisms and robust transparency measures must be properly implemented, if legitimacy of the devolution of power to private actors is to be sustained.

Background. Each year dengue virus (DENV) infects 400 million human but causes symptomatic disease in only a subset of patients, suggesting that host genetic factors may play a role. HLA molecules that restrict T-cell responses are one of the most polymorphic host factors in humans. Methods. Here we map HLA DRB1–restricted DENV-specific epitopes in individuals previously exposed to DENV, to identify the breadth and specificity of CD4+ T-cell responses. To investigate whether HLA-specific variations in the magnitude of response might predict associations between dengue outcomes and HLA-DRB1 alleles, we assembled samples from hospitalized patients with known severity of disease. Results. The capsid protein followed by nonstructural protein 3 (NS3), NS2A, and NS5 were the most targeted proteins. We further noticed a wide variation in magnitude of T-cell responses as a function of the restricting DRB1 allele and found several HLA alleles that showed trends toward a lower risk of hospitalized disease were associated with a higher magnitude of T-cell responses. Conclusions. Comprehensive identification of unique CD4+ T-cell epitopes across the 4 DENV serotypes allows the testing of T-cell responses by use of a simple, approachable technique and points to important implications for vaccine design.

In 2015, New Zealand’s Supreme Court ruled in Dixon v R that digital files are property for the limited purposes of a computer misuse provision – s 249(1)(a) of the Crimes Act 1961. The Court said it was distinguishing digital files from pure information, thus it was not challenging the long-standing legal position that information cannot be property. This paper analyses the Court’s purposive, conceptual and factual reasoning, ultimately concluding that a distinction between digital files and information is difficult to justify. It argues that the Court’s decision therefore actually erodes the traditional legal position. It concludes that Parliament, which can more fully explore policy considerations, might be better placed to determine whether digital files should be property. Potential ramifications of the Supreme Court’s decision are also briefly outlined.

Background. Each year dengue virus (DENV) infects 400 million human but causes symptomatic disease in only a subset of patients, suggesting that host genetic factors may play a role. HLA molecules that restrict T-cell responses are one of the most polymorphic host factors in humans. Methods. Here we map HLA DRB1–restricted DENV-specific epitopes in individuals previously exposed to DENV, to identify the breadth and specificity of CD4+ T-cell responses. To investigate whether HLA-specific variations in the magnitude of response might predict associations between dengue outcomes and HLA-DRB1 alleles, we assembled samples from hospitalized patients with known severity of disease. Results. The capsid protein followed by nonstructural protein 3 (NS3), NS2A, and NS5 were the most targeted proteins. We further noticed a wide variation in magnitude of T-cell responses as a function of the restricting DRB1 allele and found several HLA alleles that showed trends toward a lower risk of hospitalized disease were associated with a higher magnitude of T-cell responses. Conclusions. Comprehensive identification of unique CD4+ T-cell epitopes across the 4 DENV serotypes allows the testing of T-cell responses by use of a simple, approachable technique and points to important implications for vaccine design.

In 2015, New Zealand’s Supreme Court ruled in Dixon v R that digital files are property for the limited purposes of a computer misuse provision – s 249(1)(a) of the Crimes Act 1961. The Court said it was distinguishing digital files from pure information, thus it was not challenging the long-standing legal position that information cannot be property. This paper analyses the Court’s purposive, conceptual and factual reasoning, ultimately concluding that a distinction between digital files and information is difficult to justify. It argues that the Court’s decision therefore actually erodes the traditional legal position. It concludes that Parliament, which can more fully explore policy considerations, might be better placed to determine whether digital files should be property. Potential ramifications of the Supreme Court’s decision are also briefly outlined.

Item does not contain fulltext, PURPOSE: In diabetes, generalised microvascular disease and coronary artery disease (CAD) are likely to occur in parallel. We used a sidestream dark field (SDF) handheld imaging device to determine the relation between the labial microcirculation parameters and CAD in asymptomatic patients with diabetes. METHODS: SDF imaging was validated for assessment of labial capillary density and tortuosity. Thereafter, mean labial capillary density and tortuosity were evaluated and compared in non-diabetic controls, and in asymptomatic patients with type 1 and type 2 diabetes. In diabetic patients, mean capillary density and tortuosity were compared according to the presence of CAD. RESULTS: Both type 1 and type 2 diabetes were associated with increased capillary density and tortuosity. In diabetes, mean capillary density was an independent predictor of elevated coronary artery calcium (CAC) (p = 0.03) and obstructive CAD on computed tomography angiography (p = 0.01). Using a cut-off mean capillary density of 24.9 (per 0.63 mm(2)) the negative predictive value was 84% and 89% for elevated CAC and obstructive CAD. Likewise, capillary tortuosity was an independent predictor of increased CAC (p = 0.01) and obstructive CAD (p = 0.04). CONCLUSION: Assessment of labial microcirculation parameters using SDF imaging is feasible and conveys the potential to estimate vascular morbidity in patients with diabetes, at bedside.

Item does not contain fulltext, PURPOSE: In diabetes, generalised microvascular disease and coronary artery disease (CAD) are likely to occur in parallel. We used a sidestream dark field (SDF) handheld imaging device to determine the relation between the labial microcirculation parameters and CAD in asymptomatic patients with diabetes. METHODS: SDF imaging was validated for assessment of labial capillary density and tortuosity. Thereafter, mean labial capillary density and tortuosity were evaluated and compared in non-diabetic controls, and in asymptomatic patients with type 1 and type 2 diabetes. In diabetic patients, mean capillary density and tortuosity were compared according to the presence of CAD. RESULTS: Both type 1 and type 2 diabetes were associated with increased capillary density and tortuosity. In diabetes, mean capillary density was an independent predictor of elevated coronary artery calcium (CAC) (p = 0.03) and obstructive CAD on computed tomography angiography (p = 0.01). Using a cut-off mean capillary density of 24.9 (per 0.63 mm(2)) the negative predictive value was 84% and 89% for elevated CAC and obstructive CAD. Likewise, capillary tortuosity was an independent predictor of increased CAC (p = 0.01) and obstructive CAD (p = 0.04). CONCLUSION: Assessment of labial microcirculation parameters using SDF imaging is feasible and conveys the potential to estimate vascular morbidity in patients with diabetes, at bedside.

Item does not contain fulltext, PURPOSE: In diabetes, generalised microvascular disease and coronary artery disease (CAD) are likely to occur in parallel. We used a sidestream dark field (SDF) handheld imaging device to determine the relation between the labial microcirculation parameters and CAD in asymptomatic patients with diabetes. METHODS: SDF imaging was validated for assessment of labial capillary density and tortuosity. Thereafter, mean labial capillary density and tortuosity were evaluated and compared in non-diabetic controls, and in asymptomatic patients with type 1 and type 2 diabetes. In diabetic patients, mean capillary density and tortuosity were compared according to the presence of CAD. RESULTS: Both type 1 and type 2 diabetes were associated with increased capillary density and tortuosity. In diabetes, mean capillary density was an independent predictor of elevated coronary artery calcium (CAC) (p = 0.03) and obstructive CAD on computed tomography angiography (p = 0.01). Using a cut-off mean capillary density of 24.9 (per 0.63 mm(2)) the negative predictive value was 84% and 89% for elevated CAC and obstructive CAD. Likewise, capillary tortuosity was an independent predictor of increased CAC (p = 0.01) and obstructive CAD (p = 0.04). CONCLUSION: Assessment of labial microcirculation parameters using SDF imaging is feasible and conveys the potential to estimate vascular morbidity in patients with diabetes, at bedside.