CONTEXT:Chronic kidney disease (CKD) is characterized by progressive destruction of renal mass with irreversible sclerosis and loss of nephrons over a period of months to years, depending on the underlying etiology.AIM:To describe demographic patterns and identify common causes of CKD in patients admitted to ward 41 and 48B, National Hospital of Sri Lanka.SETTINGS AND DESIGN:A hospital based descriptive 3-month study was conducted at ward 41 and 48B, National Hospital of Sri Lanka. A case record form was used to record sociodemographic variables, stage of renal disease, and etiology of patients in established chronic renal failure. Sources of data included patient interviews, diagnosis cards and case records, ultrasound scan reports, and biopsy findings.RESULTS:One hundred and twenty-one patients were recruited with male to female ratio being 2.5:1 (86:35). Mean age of the population was 47.8 years (SD ± 13.7). Common causes of CKD identified in these patients included diabetic nephropathy (37, 30.6%), hypertension (16, 13.2%), glomerulonephritis (12, 9.9%), and obstructive uropathy (10, 8.3%). The cause was unknown in 25.6% of patients with chronic renal disease. Fifty percent of patients were from the Western Province. The leading cause of CKD in patients from the Western Province was diabetic nephropathy (26, 37.7%). The etiology of CKD was unknown in majority of the patients (14, 27.4%) from other provinces. The difference in incidence of diabetic nephropathy in the Western Province as to other provinces was not statistically significant (P > 0.05).CONCLUSION:Diabetes is a major contributor to CKD reflecting changing disease epidemiology in Sri Lanka.

BackgroundAlthough an initial IFA-IgG titer greater or equal to 1/64 or 1/128 is considered positive in presumptive diagnosis, in clinical practice in an endemic setting for rickettsioses in Sri Lanka, some patients with IFA-IgG titer of 1/128 for either spotted fever group (SFG) or scrub typhus (ST) did not respond to treatment.FindingsTo determine a clinically helpful diagnostic algorithm, IFA-IgG results of serologically confirmed treatment responders were analyzed in relation to duration of illness at sampling. Of 146 suspected SFG, 3 responders of 25 patients had titers ≤1/128 with < 7 days of illness while all 9 with titers ≥1/256 responded (false negative with 1/256 cutoff was 12%, false positive was 0%). For illness > 7 days, the false negative and positive rates were 4.3% (3/59) and 11.3% (6/53). Of 115 suspected ST, false negative and positive rates with ≥1/256 cutoff at <7 days of illness were 14.2% (2/14) and 0% (0/8) respectively while > 7 days, false negative and positive rates were 2% (1/51) and 0% (0/42).ConclusionsFor clinical decision making, duration of illness at sampling is important in interpreting serology results in an endemic setting. If sample is obtained ≤7 day of illness, an IgG titer of ≤1/128 requires a follow up sample in the diagnosis and > 7 days of illness, a single ≥1/256 titer is diagnostic for all ST and 90% of SFG.

BackgroundInflammatory bowel disease, especially ulcerative colitis, is increasing in many “non-Western” countries, including Sri Lanka. The aim was to evaluate long-term outcomes of ulcerative colitis in a Sri Lankan population.MethodsA retrospective cohort study was conducted at the gastroenterology clinics of the Colombo North Teaching Hospital, Ragama and the National Hospital of Sri Lanka, Colombo; the two major referral centers for ulcerative colitis. All cases had histological confirmation of ulcerative colitis. Three outcomes: colectomy, development of colorectal carcinoma, and death were assessed. Patients not attending the clinic during the previous 4 weeks, or their families, were contacted to obtain clinical details and survival status. In those who had died, the cause of death was confirmed from clinical records and death certificates.ResultsDetails of 348/425 (81.9%) patients with ulcerative colitis (mean age 45.6 [standard deviation {SD} 14.3] years, male/female ratio = 1.00:1.03) were available. The mean follow-up was 6.8 (SD 6.5) years. The cumulative colectomy rates at 1, 5, 10, and 15 years were 1.5%, 4.0%, 5.5%, and 9.3% respectively. The cumulative probability of colorectal cancer in this cohort after 10 and 15 years was 0.47% and 2.36% respectively. The cumulative survival rate after 1, 5, 10, and 15 years was 99.7%, 98.9%, 98.1%, and 94.5% respectively. Patients with pancolitis were more likely to have disease-related death (P = 0.05). Multivariate analysis (Cox proportional hazards model) showed that an older age at diagnosis was associated with long-term mortality (hazard ratio, 1.11; P = 0.001).ConclusionIn this cohort, colectomy, colorectal carcinoma, and death rates were low, suggesting a relatively benign disease course for ulcerative colitis.

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SummaryThe aim of this report is to provide details of the methodology and results of the Sri Lankan component of the Asia-Pacific Crohn's and Colitis Epidemiology Study. Fourteen state and private hospitals with specialist services in the Gampaha and Colombo districts were kept under surveillance over a 12 month period to recruit patients with newly diagnosed Inflammatory Bowel Disease (IBD) who were permanent residents of the Gampaha district. Thirty five cases (ulcerative colitis-21, Crohn's disease-13, IBD-undetermined-1) were detected, giving a crude annual IBD incidence of 1.59 per 100,000 population.

Tracheal intubations are not infrequent out of ICUs and operating theatres and carry a substantial risk of adverse events. Our objective was to study the current practices of tracheal intubations in medical wards of the national hospital of Sri Lanka (NHSL). A prospective observational study was performed among all adult patients who had an endotracheal intubation in a medical ward of NHSL over a 6-month period. There were 47 intubations. Majority, 29 (61.7%) of intubations occurred during out of hours (after 4pm) and 23 (48.9%) of them were emergency intubations. Most common reason for intubation was respiratory distress 26 (55.3%). Other indications were cardiac arrest 11 (23.4%), Low GCS 7 (14.9%) and shock 2 (4.3%). Capnography and 2 laryngoscopes were not available during any of the intubations. Bougie was available only in 23 (48.9%) cases and alternative airway equipment were available only in 9 (19.1) cases. Midazolam was the most common induction agent 34 (72.3%). Majority 27(57.4%) of the intubators had less than 6 months of experience in anaesthesia. Most of the intubations 32 (68.1%) were done by a registrar and 6 (12.8%) were done by an intern medical officer. There were 39 adverse events during all intubations and hypotension 14(29.8%) was the most frequent adverse event. Therefore, we conclude that intubations in medical wards are done by less experienced doctors with lack of facilities and has high incidence of adverse events.