Background: Associations between certain environmental and lifestyle factors and Parkinson's disease (PD) have been reported in several studies, but information on these factors and Parkinson's Disease (PD) in South Asia, is limited. Objective:To determine associations between lifestyle factors and PD in an urban clinic-based study in Sri Lanka. Methods:In this case-control study, demographic and lifestyle factor data (including diet, coffee/tea drinking, smoking, alcohol status) was collected from an unselected cohort of PD patients and age and gender-matched controls attending clinics in Greater Colombo, Sri Lanka. Associations between lifestyle factors and PD status were assessed using Logistic Regression analysis, while links with age of PD onset were explored with Kaplan Meier and Cox Regression survival analyses. Results with p<0.05 were considered to be statistically significant. Findings:Of 229 patients with parkinsonism, 144 had Idiopathic PD using standard diagnostic criteria. Controls numbered 102. Coffee drinkers and smokers were significantly less likely to have PD (coffee, p<0.001; Odds Ratio (OR)=0.264; smoking, p=0.043; OR=0.394). Coffee drinkers were older at PD onset (p<0.001). Similar trends seen with tea drinking were not statistically significant.

Background: Sri Lanka is a rapidly aging country, where dementia prevalence will increase significantly in the future. Thus, inexpensive and sensitive cognitive screening tools are crucial. Objectives: To assess the reliability, validity, and diagnostic accuracy of the Sinhalese version of the Addenbrooke’s Cognitive Examination-Revised (ACE-R s). Method: The ACE-R was translated into Sinhala with cultural and linguistic adaptations and administered, together with the Sinhala version of the Montreal Cognitive Assessment (MoCA), to 99 patients with dementia and 93 gender-matched controls. Results: The ACE-R s cutoff score for dementia was 80 (sensitivity 91.9%, specificity 76.3%). The areas under the curve for the ACE-R s, Mini-Mental State Examination (MMSE) and MoCA were 0.90, 0.86, and 0.86, respectively. The ­ACE-R s had good interrater reliability (intraclass correlation = 0.94), test-retest reliability (intraclass correlation = 0.99), and internal consistency (Cronbach’s α = 0.8442). Conclusions: The ACE-R s is sensitive, specific and reliable to detect dementia in persons aged ≥50 years in a Sinhala-speaking population and its diagnostic accuracy is superior to previously validated tools (MMSE and MoCA).

Background The clinical presentation of renal diseases can vary widely. The lack of a comprehensive national registry for Sri Lanka makes it difficult to provide a detailed record of the various clinical presentations and histopathology of renal disorders in the nation. Therefore, this study aims to provide a record of the spectrum of renal diseases in Sri Lanka. Methods Renal biopsies performed at the nephrology unit in Colombo South Teaching Hospital (CSTH), Sri Lanka from March 2018 to October 2019 was retrospectively studied. Indications for renal biopsy were nephrotic range proteinuria, sub nephrotic range proteinuria, acute kidney injury without obvious etiology, chronic renal disease without obvious etiology and haematuria. Results A total of 140 native kidney biopsies were analyzed in which majority were females (55.7%). The mean age of the population was 46 ± 15.3 years. The most common indications for renal biopsy were nephrotic range proteinuria (54.3%), followed by sub-nephrotic range proteinuria (14.3%), nephrotic range proteinuria with haematuria (14.3%), sub-nephrotic range proteinuria with haematuria (9.3%), AKI without known cause (4.3%), and CKD without known cause (3.6%). The leading histopathological diagnoses were FSGS (22.1%), lupus nephritis (20%), PSGN (17.1%), DN (12.1%), HTN (9.3%), MCD (6.4%), IgA nephropathy (5.7%), IN (4.3%), vasculitis (2.1%), and MGN (0.7%). Conclusions The most common indication for renal biopsy was nephrotic range proteinuria in our population. FSGS was the most prevalent histopathological diagnosis and the least frequent diagnosis reported was MGN. The spectrum of renal diseases could differ according to the study location and it changes over time. Therefore, a renal biopsy registry is needed for documenting the changing disease pattern in Sri Lanka.

BACKGROUND – The significant increase in the burden of chronic kidney disease of unknown etiology (CKDu) of Sri Lanka has led to evaluate the factors related to physical, social and mental aspects of health related quality of life (HRQOL) in CKDu patients. METHOD – The quality of life of 84 CKDu patients (stages 1-5) were assessed by means of the Kidney Disease Quality of Life Short-Form survey (KDQOL™-36) Version 1.3 along with biomarkers and patient demographics. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) formula. Patients were divided into four groups according to their eGFR; group A with eGFR range 90-60 ml/min/1.73 m2, group B with eGFR range 30–59 ml/min/1.73m2, group C with eGFR range 15–29 ml/min/1.73m2 and group D with eGFR<15 ml/min/1.73m2. RESULTS – The KDQOL™-36 scores impaired substantially across all stages of CKDu and comparatively lower scores were present in latter stages of the disease than the initial stages. The mental composite summary (MCS) scores were more impaired when compared to physical composite summary (PCS) scores during the early stage of disease. Poor KDQOL™-36 scores were present in males than in females. A significant variance in scores was not observed between the gender and younger (<65 years) and elderly (≥65 years) populations. Biochemical parameters showed a statistically significant correlation with majority of KDQOL™-36 dimensions while interestingly urine albumin to creatinine ratio did not. CONCLUSION - Our findings reveals that CKDu patients in any stage of the disease despite their age and gender have a significant physical and mental health burden, and this burden is alarmingly increased among patients as the disease worsens. Thereby, early assessment of health related quality of life will help to identify high risk patients and modifying these factors may provide better active and a healthy lifestyle.

Background: Since early nineties investigators in Sri Lanka have noticed an alarmingly high incidence of a new form of chronic kidney disease of uncertain etiology (CKDu) in North Central Region of the country. The purpose of the present study was to assess the treatment response profile of a selected traditional medicine used for Chronic Kidney Disease of unknown etiology in Sri Lanka. Methods: A follow-up study was performed with Chronic Kidney Disease of unknown patients receiving a selected traditionalmedicine in Sri Lanka. Socio-demographic characteristics and anthropometric measurements were documented. Blood and urine samples were collected for biochemical analysis. Multistate Markov model was used to estimate rates of transition between stages of chronic diseases. Results: Anthropometric and biochemical parameters of 96 CKDu patients and 20 normal individuals were recorded in a period of six months. Serum creatinine, urine micro albumin, Albumin creatinine ratio and Systolic Blood pressure values were significantly decreased in the six-month study period. eGFR value was significantly increased over the six-month study period. Positive correlations were identified between ACR-Micro albumin, ACR-BMI and ACR-eGFR while e-GFR-serum creatinine, e-GFR-micro albumin and ACR-serum creatinine showed negative correlations. Conclusions: A significant improvement in both biochemical and anthropometric parameters were observed among patients who underwent Sri Lankan traditional medicine treatment. Continuous follow up programs are important to improve biochemical and physical parameters as well as their quality of life.

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