Background Increase in the number of cases in Chronic Kidney Disease of Unknown etiology (CKDu) in Sri Lanka has become a health issue of national concern. Even though, Northern Province is not identified as a high-risk province, there is an increasing trend of CKDu after the end of civil war in the Northern Province. Methods The present study was conducted in Thunukkai Division in Mullaitivu District to investigate the socio demographic and clinical pattern of CKDu patients and to evaluate the quality of their water sources. The samples were selected by using stratified purposive random sampling method which represented 29% of total CKDu patients in Thunukkai Division. Pretested structured questionnaire was administered to collect the data from the CKDu patients. The association between serum creatinine excreted by CKDu patients and the water quality parameters were determined by using linear regression model. Results Among the patients, 80% were male with over 68% falling in the age range of 50–70. Majority (90%) were involved in agriculture related occupation. Smoking and alcohol consumption were detected as common habits among 40% of the patients. Secondarily developed, hypertension (60%) and diabetes (34%) were reported as common diseases in the area. Dug wells served as the commonest source of drinking water in the area (90% households) together with few tube wells. Physicochemistry of more than 50% of the water samples revealed higher electric conductivity, salinity, total dissolved solids, total hardness and Na levels compared to drinking water standards in Sri Lanka. Conclusions Serum creatinine levels of the CKDu patients were significantly and negatively correlated with phosphate while positively correlated with total dissolved solids (TDS) and arsenic content of the drinking water. Geospatial mapping of TDS and arsenic in drinking water with the occurrence of higher serum creatinine levels confirmed the same trend. Thus, the total dissolved solids and arsenic in drinking water may have positive correlation with the occurrence of CKDu in Thunukkai region in the Mullaitivu District of Sri Lanka.

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Study Need and Importance: Prostate cancer (PCa) is the second most common cancer diagnosis in men, particularly affecting Black men, who experience higher incidence and mortality rates compared to other racial groups. This study investigated racial and ethnic disparities in the utilization of follow-up testing (biopsy or MRI) after an abnormal PSA result. What We Found: Using insurance claims data from a sample of 765,409 male patients, we observed that Black men were more likely to undergo follow-up testing after an elevated PSA result compared to White men, which is congruent with their relative PCa risk. Additionally, Asian and Hispanic men had lower rates of follow-up testing compared to White men, which is also congruent with their relative PCa risk. These disparities were consistent across different age groups, but most pronounced among patients aged 65-74.Limitations: This study utilized retrospective claims data for patients enrolled in a single health plan, and the data did not include detailed clinical information such as disease severity or patient preferences. Additionally, the data are proprietary and are not available for further analysis. Interpretation for Patient Care: Our findings suggest that physicians rely on the reported statistical incidence of PCa among different racial and ethnic groups to guide decision-making for follow-up testing in patients with elevated PSA levels. Notably, our findings highlight that Black men have the highest likelihood of undergoing a follow-up prostate test, followed by White, Hispanic, and Asian patients. These results underscore the significance of publishing statistical data on disease incidence categorized by race and ethnicity, as the data play a critical role in informing physician decision-making and risk stratification.

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IntroductionInguinal hernia, paraumbilical hernia and incisional hernias are common abdominal wall hernias encountered in surgical practice. Smoking, straining during micturition and/or defaecation, heavy manual work, chronic obstructive airway disease and obesity are some of the recognized predisposing factors for abdominal wall hernias in adults. ObjectiveThe study aims to estimate the prevalence of the common predisposing factors of abdominal hernias among adults of both genders. MethodologyThis is an institutional-based cross-sectional analytic study carried out in adult patients with abdominal hernias registered at a surgical clinic, Teaching Hospital, Jaffna, from January 2018 to December 2020. Interviewer administered questionnaire was used to collect the data from the patients. Data were analyzed by Statistical Package for Social Sciences version 2 1. 5% was used as a significance level. Results Amongthe 218 patients, 119 patients [54.6%] had an inguinal hernia, 80 [36.7%] had a paraumbilical hernia and 19 [8.7%] had an incisional hernia. 36 [16.5%] patients did not have any of the predisposing factors whereas 80 [36.7%] patients had a single predisposing factor and the remaining 102[46.8%] patients had multiple predisposing factors. 58 [26.6%] had the habit of smoking. 43 patients [19.8%] gave a history of straining during defecation and/or micturition and 49 patients [22.5%] suffered from chronic obstructive airway diseases. 98 patients [45.0%] were heavy manual workers and 98 [45.0%] were obese.

Introduction. Prolapse can be a complication of loop stomas. A prolapsed stoma which cannot be reduced or complicated with strangulation needs surgical correction. This case report describes a minimal access correction of a prolapsed gangrenous distal limb of ileostomy. Presentation of Case. A 67-year-old male patient was diagnosed with a lower rectal carcinoma, staged T3N1M0. Following neoadjuvant chemoradiation, he underwent a laparoscopic anterior resection with a defunctioning loop ileostomy. One month later, he presented with prolapse of the distal limb of the ileostomy. The limb was gangrenous and the gangrenous part was removed by using a linear GI stapler, and the loop ileostomy was converted to end-loop ileostomy. Discussion. It is a simple and technically feasible method for treating a prolapsed loop of the stoma. It is less invasive and has minimal postoperative complications. This technique reduces the duration of the hospital stay of the patient. Conclusion. Stapled assisted correction of prolapsed stoma avoids unnecessary laparotomy and aids in expedite recovery after surgery. It is beneficial for a surgeon to be familiar with the minimal access correction for stoma prolapse.

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