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.

For patients with pharmacoresistant focal epilepsy in whom surgical resection of the epileptogenic focus fails or was not feasible in the first place, there were few therapeutic options. Increasingly, neurostimulation provides an alternative treatment strategy for these patients. Vagal nerve stimulation (VNS) is well established. Deep brain stimulation (DBS) and cortical responsive stimulation (CRS) are newer neurostimulation therapies with recently published long-term efficacy and safety data. In this literature review, we introduce these therapies to a non-specialist audience. Furthermore, we compare and contrast long-term (5-year) outcomes of newer neurostimulation techniques with the more established VNS. A search to identify all studies reporting long-term efficacy (>5 years) of VNS, CRS and DBS in patients with refractory focal/partial epilepsy was conducted using PubMed and Cochrane databases. The outcomes compared were responder rate, percentage seizure frequency reduction, seizure freedom, adverse events, neuropsychological outcome and quality of life. We identified 1 study for DBS, 1 study for CRS and 4 studies for VNS. All neurostimulation technologies showed long-term efficacy, with progressively better seizure control over time. Sustained improvement in quality of life measures was demonstrated in all modalities. Intracranial neurostimulation had a greater side effect profile compared with extracranial stimulation, though all forms of stimulation are safe. Methodological differences between the studies mean that direct comparisons are not straightforward. We have synthesised the findings of this review into a pragmatic decision tree, to guide the further management of the individual patient with pharmacoresistant focal-onset epilepsy.

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Adverse event rates are similar to other series. Epilepsy surgery carries well defined surgical and neurological risks. The risks of somatic adverse events, in addition to neuropsychiatric and neuropsychological complications need to be made clear to individuals considering this treatment option.