BackgroundThe aim of the study was to identify the epidemiology of chronic kidney disease of uncertain etiology in Sri Lanka.MethodsA cross-sectional study was carried out by analyzing health statistics, and three cohort studies were conducted (n = 15 630, 3996, and 2809) to analyze the demographic information, age-specific prevalence, etiology, and stage of presentation. We screened 7604 individuals for chronic kidney disease of uncertain etiology.ResultsThe results showed that the male:female ratio was 2.4:1, the mean age of patients was 54.7 ± 8 years, 92% of the patients were farmers, and 93% consumed water from shallow dug wells. Familial occurrence was common (36%). The prevalence of chronic kidney disease in different age groups was 3% in those aged 30–40 years; 7% in those aged 41–50 years, 20% in those aged 51–60 years, and 29% in those older than 60 years. Chronic kidney disease of uncertain etiology was diagnosed in 70.2% of patients, while 15.7% and 9.6% were due to hypertension and diabetic mellitus, respectively. The majority of patients were stage 4 (40%) at first presentation, while 31.8% were stage 3 and 24.5% were stage 5. Stage 1 and 2 presentation accounted for only 3.4%.ConclusionsLow prevalence of CKDU was noticed (1.5%) among those who consumed water from natural springs. Prevalence was highest among males, rice farming communities, and those presenting at later disease stages.
Chronic kidney disease in the absence of hypertension and diabetes is a growing problem among agricultural laborers in tropical and subtropical regions. It is unclear if heat stress and dehydration are risk factors for this form of chronic kidney disease (CKDu). To investigate this relationship, agricultural workers in four villages (n = 261) in North Central Province, Sri Lanka completed the US National Institute for Occupational Safety and Health (NIOSH) health hazard evaluation of heat stress, translated into Sinhalese (July 2017). We constructed a heat stress/dehydration index based on the frequency of 16 symptoms (range 0–32; reliability, 0.84). Workers provided a urine sample for dipstick assessment of urine albumin-creatinine ratio (ACR) and refractometer analysis of urine concentration. Of 261 respondents, 41 participants reported diabetes or chronic kidney disease. They scored higher on the heat stress-dehydration index (10.78 vs. 8.03, p < .01) and were more likely to have ACR > 30 (85.4% vs. 69.4%, p < .05). Among 216 non-pregnant agricultural workers without diabetes or kidney disease (mean age, 46.6; 37% male), villagers in the high-CKDu prevalence area were more likely to show signs of dehydration (for example, greater urine concentration, 1.015 vs. 1.012, p < .05, among males); however, the heat stress-dehydration index overall was not associated with ACR or urine concentration. Because an elevated ACR (proteinuria) is not a reliable marker of early CKDu, additional studies are needed to assess the association between heat stress-dehydration symptoms and risk of CKDu.
The urine total-protein-to-creatinine ratio showed a positive significant correlation with urine albumin to creatinine ratio, which is clinically important to identify early stage of diabetic nephropathy. This can be used in rural areas as it is inexpensive.
Objective. We examined heat stress symptoms and urine markers of chronic kidney disease (CKDu) in Sri Lanka to assess differences between endemic vs. non-endemic regions and by occupation. Sample and Methods. We assessed a total of 475 villagers. In the endemic region, 293 were agricultural workers and 67 were not working primarily in agriculture. In the non-endemic region, 76 were agricultural workers. Of the residents, 218 were assessed for neutrophil gelatinase-associated lipocalin (NGAL), an early predictor of acute kidney injury, along with urine markers of chronic kidney disease. Results. The mean (sd) age of the sample was 45.2 (12.6), with males comprising 52.7%; 7.2% reported kidney disease (n = 34), and 5.7% reported diabetes (n = 27). The heat stress index (mean (sd)) was highest among agricultural workers in the endemic region (8.05 (5.9)), intermediate in non-agricultural workers in the endemic region (4.61 (4.5)), and lowest among agricultural workers in the non-endemic region (3.85 (3.3)); p < 0.0001. Correlations were higher between NGAL and serum microalbumin in the endemic agricultural worker sample than in the other two samples (Spearman’s r = 0.34 vs. 0.15 and 0.20). Conclusions. Both heat stress symptoms and NGAL values were higher among agricultural workers in endemic CKDu regions. Correlations between NGAL and microalbumin suggested a link between acute kidney injury and chronic kidney disease in the more-exposed sample.
BackgroundThis study was designed to evaluate the accuracy and usefulness of ultrasound in the hands of emergency physicians and medical officers who are non-radiologistsin assessing Trauma patients at Emergency Trauma Centre(ETC) at Teaching Hospital, Karapitiya, Galle, Sri Lanka Methodology We performed an observational study on Trauma patients admitted to Emergency Department at Teaching Hospital, Karapitiya from 1.12.2014 to 31.12.2014 who fulfilled indications for e-FAST using a specially designed performa. Accuracy of eFAST was tested by comparing the original with subsequent imaging, clinical decision by surgeons, findings at surgery or more than one of the above. Results 69 patients fulfilled the entry criteria.Nineteen of the scans were performed by consultants while rest was done by senior medical officers. All of them were trained in eFAST.Of the 20 scans which were positive there were four pneumothoraxes and one haemothorax. 15 scans which were positive for intraperitoneal free fluid were later. Out of 49 Patients who had negative scans 47 did not require surgery or any interventions. Other two required laparotomy later. Sensitivity and specificity of eFast was 90.4% and 97.9% respectively. Positive predictive value was 95.0% while Negative predictive value was at 95.9% . Conclusions eFAST is a rapid and reliable alternative in detecting free intra-abdominal fluid as well as pneumotorax and haemothorax. It is a safe decision making tool which can be used with confidence and accuracy after brief training and experience by non radiologists which will reduce morbidity and mortality in trauma patients of Sri Lanka.
Background: Infertility is a major problem all around the world. According to WHO, the rate of infertility is approximately 15% worldwide and it differ from geographical location, ethnicity and social status. Lifestyle habits, environmental and occupational hazards, physical parameters can be recognized as major risk factors which may affect male infertility. The objective of this study was to determine factors associated with male infertility in Sri Lankan context.Methods: A cross-sectional study was conducted on 299 individuals participated for an infertility clinic at Castle Street Teaching Hospital, Colombo, Sri Lanka. Socio-demographic, occupational and environmental characteristics were collected using interviewer administered questionnaire. Semen samples were collected from each participant for laboratory investigations. Sperm concentration and motility were measured.Results: Out of total participants, 30.1% of participants had a sperm concentration of <15×10⁶ and the sperm motility was <32% in 34.7% participants. Older age, tobacco smokers, using tight under wears and individuals exposed to either heat or chemical hazards were identified as risk groups with low sperm concentration and low semen volume. In addition, older age, individuals using tight under wears and individuals exposed to either heat or chemical hazards were significantly associated with low or abnormal sperm mortality. Individuals having diabetes showed a significantly higher non-motility rate of sperms. Alcohol usage, betel chewing, mumps, special radiation exposure, body mass index and waist circumference were not significantly associated with semen parameters in study population.Conclusions: Older age, tobacco smoking, wearing tight underwear, occupational exposures, and diabetes mellitus has shown a risk for the generation of poor semen parameters, which can lead to male infertility. Furthermore, it is very important to carry out extended studies regarding this problem to establish the effect of above factors.
Background Infertility is a major problem persisting all around the world. According to WHO the rate of infertility is approximately 15% worldwide and it differ from geographical location, ethnicity and social status. Lifestyle habits, environmental and occupational hazards, physical parameters can be recognized as major risk factors which may affect male infertility. The objective of this study was to determine factors associated with male infertility in Sri Lanka. Methods A cross sectional study was conducted on 299 individuals participated for an infertility clinic in a Teaching hospital in Sri Lanka. Socio-demographic, occupational and environmental characteristics were collected using interviewer administered questionnaire. Semen samples were collected from each participant for laboratory investigations. Sperm concentration and motility, morphology and viability of sperms were measured. Results Out of total participants, 30.1% of participants had a sperm concentration of < 15 × 10⁶and the sperm mortality was < 32% in 34.7% participants. Older age, tobacco smokers, individuals using tight under wears and individuals exposed to either heat or chemical hazards were identified as risk groups with low sperm concentration and low semen volume. In addition, older age, individuals using tight under wears and individuals exposed to either heat or chemical hazards were significantly associated with low or abnormal sperm mortality and morphology. Individuals having diabetes showed a significantly higher non-motility rate of sperms. Alcohol usage, betel chewing, mumps, special radiation exposure, body mass index and waist circumference were not significantly associated with semen parameters. Conclusion Older age, tobacco smoking, wearing tight underwear, occupational exposures, and diabetes mellitus has shown a great risk for the generation of poor semen parameters, which can lead to male infertility. Furthermore it is very important to carry out extended studies regarding this problem to establish the effect of above factors.
Background: Leptospirosis [LP] is zoonotic diseases and one of the main communicable diseases in Sri Lanka [SL]. SL is a tropical country in the Indian Ocean with favorable environmental and geographical conditions for dispersion of the LP infection. The aim of the study was to determine the pattern of distribution with possible environmental conditions/factors contributing to the LP in SL.Methods: The study was carried out as retrospective study from 2009-14 throughout the all 25 administrative districts in SL.Results: The multiple regression was performed to investigate any associations between the prevalence of LP and independent variable parameters namely, annual rainfall, average humidity, area of paddy lands and annual flood data. The results revealed that factors affecting prevalence of the LP in Sri Lanka can’t be investigated in toto. Seasonal analysis is needed in the wet and dry zones corresponding to the main Yala and Maha agricultural seasons. Annual rainfall is mainly associated with the prevalence of LP in the wet zone while agricultural environment associated with the prevalence of LP in the dry zone (p<0.05). Furthermore, geographical distribution, high annual water discharge and low precipitation of the river water provides favorable environment for dispersion of LP in the wet zone whilst large reservoirs with highly functioning cascades correlated in the dry zone in SL.Conclusions: It is concluded that pattern of distribution with possible environmental conditions/factors contributing to the LP in SL is vary in the wet and dry zones.
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