Chronic dermatological conditions like eczema, psoriasis, and bullous diseases are significant health issues that affect a substantial number of people worldwide, including in Sri Lanka. These conditions not only impact patients physically but also carry psychological and social burdens due to their often-visible nature. Effective management requires a deep understanding of their clinical features, treatment options, and the challenges that can interfere with successful treatment adherence. Eczema is a chronic, inflammatory skin condition characterized by dry, itchy, and red patches of skin. It is most commonly seen in children but can persist or develop in adulthood. Eczema often flares due to environmental triggers, allergens, or stress, and its chronicity can severely impact the quality of life, particularly due to sleep disturbances caused by intense itching. Infections are also common due to scratching, and patients are prone to bacterial or viral superinfections like impetigo or eczema herpeticum. The mainstay of treatment for flare-ups is corticosteroid creams, which reduce inflammation. Regular use of emollients helps maintain skin hydration and serves as a preventive measure against flare-ups. In more severe cases, calcineurin inhibitors (e.g., tacrolimus) are prescribed to reduce immune system activity. For severe cases, systemic immunosuppressants like cyclosporine or newer biologics (e.g., dupilumab) are used. Treatment adherence is often hindered by the need for consistent moisturization and steroid application. Financial barriers to accessing high-quality moisturizers and biologics, as well as fear of steroid overuse, contribute to poor compliance. Additionally, environmental triggers such as heat, humidity, and exposure to allergens can make disease control difficult in tropical climates like Sri Lanka's. Psoriasis is a chronic autoimmune condition characterized by the rapid turnover of skin cells, leading to the formation of red, scaly plaques, most commonly on the elbows, knees, and scalp. The severity ranges from localized plaques to extensive body involvement, and patients often suffer from joint pain if they develop psoriatic arthritis. Psoriasis can lead to severe physical discomfort and psychological distress due to its visibility and the stigma associated with skin conditions. These include corticosteroids, vitamin D analogs (calcipotriol), and coal tar preparations, which help reduce skin cell production and inflammation. Light therapy using UVB radiation is often used in moderate cases to slow skin cell turnover. In more severe cases, systemic immunosuppressants like methotrexate, cyclosporine, and biologic agents targeting specific immune pathways (e.g., TNF-alpha inhibitors, IL-17 inhibitors) are used. The chronic nature of psoriasis necessitates long-term treatment, which can be expensive, particularly when biologic therapies are required. In Sri Lanka, access to these therapies is limited, and high costs prevent many patients from adhering to prescribed regimens. Additionally, the lack of awareness about the autoimmune nature of psoriasis can lead to the belief that topical treatments alone will suffice, causing frustration when symptoms persist. Bullous diseases, such as pemphigus vulgaris and bullous pemphigoid, are rare but serious chronic autoimmune blistering conditions. These diseases are characterized by the formation of large, fluid-filled blisters on the skin and mucous membranes, which can lead to significant discomfort, pain, and risk of secondary infections. If untreated, they can be life-threatening, particularly in elderly patients. High-dose systemic corticosteroids are the first-line treatment to reduce inflammation and immune activity. Agents such as azathioprine, mycophenolate mofetil, and rituximab (a monoclonal antibody) are used to control the autoimmune response. Managing blisters and preventing infections is crucial, and wound care is a significant component of treatment. In cases of secondary bacterial infections, antibiotics are necessary. Bullous diseases require lifelong immunosuppressive therapy, which carries significant side effects, including increased infection risk. Long-term use of corticosteroids can lead to complications such as osteoporosis, diabetes, and hypertension, which further complicates treatment. In Sri Lanka, the availability of advanced immunosuppressive therapies may be limited, and patients may not have easy access to specialists with expertise in these rare diseases. Patients with chronic dermatological conditions often struggle with maintaining long-term treatment due to a lack of understanding of the disease’s chronic nature. In Sri Lanka, where acute illness-focused care is more prevalent, the importance of long-term treatment for chronic conditions is often underappreciated, leading to treatment discontinuation when symptoms improve temporarily. Many patients in Sri Lanka face financial difficulties in accessing expensive treatments like biologics or even high-quality topical treatments and moisturizers. The public healthcare system, while providing basic care, may not have all the advanced medications needed for severe cases, and private care may be unaffordable for the majority. Chronic skin diseases often result in emotional distress, anxiety, and depression due to their visible nature and the social stigma attached to them. Psychological support is rarely integrated into dermatological care in Sri Lanka, leaving patients to deal with the mental health burden on their own, which can negatively impact treatment adherence. The tropical climate of Sri Lanka, with its high humidity and temperature, can exacerbate skin conditions, particularly eczema and psoriasis. Patients may find it difficult to adhere to topical treatments in such conditions, and there is often limited advice on how to adapt skincare routines to environmental challenges. Access to specialized dermatological care is limited in rural areas of Sri Lanka, where patients often rely on general practitioners who may not have the expertise to manage complex skin conditions. Additionally, there can be communication barriers between patients and healthcare providers, leading to misunderstanding or incomplete information regarding the necessity of consistent treatment. Chronic dermatological conditions such as eczema, psoriasis, and bullous diseases present significant challenges in terms of management and patient quality of life. In Sri Lanka, these challenges are compounded by socioeconomic factors, limited access to advanced treatments, and cultural perceptions of skin disease. Effective management requires not only clinical treatment but also patient education, psychological support, and healthcare system improvements to overcome the barriers to long-term compliance.
Although spinal anaesthesia is a popular medical practice worldwide for surgical procedures, it can be associated with numerous adverse events. They may be due to anaesthetic agents, procedures, techniques and coincidental events as well. Descriptive cross sectional study design was conducted among patients admitted to Base Hospital Thambuththegama to undergo surgery under spinal anaesthesia. Patients who were treated with immunosuppressive medicines as a prophylactic measure to prevent drug allergies were excluded from the study. Systematic random sampling technique was applied to recruit 397 patients. Interviewer administered structured questionnaire was used as the study instrument in all three languages. Data was analyzed by using standard statistical software. No conflicts of interests to be declared. Age of the participant were ranged from 18 years to 86 years (Mean=39.8 yrs:SD=16.6 yrs). Majority of the participants were below 45 yrs (n=287:72.3%). Female predominance were observed in the study sample. Prevalence of the detection of adverse events following spinal anesthesia was 60%(n=238:95%CI=55.1-64.3). Highest number of participants were experienced Hypotension during surgery. Bradycardia and shivering were the other prominent presentations. Majority of adverse events were observed during surgery and occurrence of adverse events in post operative period was relatively less. Female gender, Lower Segment Cesarean Sections were significantly associated with the occurrence of adverse events following spinal anaesthesia. The findings in present study align with much of the published research on spinal anesthesia, especially regarding the high rate of hypotension, bradycardia, and shivering during surgery, particularly in female patients undergoing LSCS. However, the reported overall prevalence of adverse events (60%) seems slightly elevated compared to some other studies, likely due to the inclusion of obstetric surgeries where complications are more frequent. It would be valuable to compare results with other populations, including non-obstetric patients, to further understand the nuances of adverse events following spinal anesthesia.
Toxic epidermal necrolysis (TEN) is a severe, life-threatening dermatologic condition marked by widespread detachment of the epidermis and mucous membranes, leading to extensive skin loss. It can result in complications such as sepsis and multi-organ failure, which can be fatal. Described by Alan Lyell in 1956 as resembling a scalding injury, TEN typically arises as an immune-mediated adverse reaction to certain medications, although infections, malignancies, and vaccines have also been implicated. It shares a pathological spectrum with Stevens-Johnson Syndrome (SJS), with the distinction primarily based on the extent of skin involvement. TEN involves more than 30% of the body surface area, while SJS is characterized by less than 10% skin detachment. This extensive skin loss can lead to critical complications, including fluid loss and infection, necessitating prompt medical intervention. Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson Syndrome (SJS) are rare but severe dermatologic emergencies with varying incidence rates across different regions and populations. In the United States, the annual incidence of TEN is approximately 1.9 cases per million adults, while SJS occurs more frequently, affecting around 9.3 per million individuals each year (Roujeau et al., 1993). Globally, the prevalence of these conditions exhibits significant regional differences. A German study conducted in 1996 estimated the yearly prevalence of both SJS and TEN to be around 1.9 cases per million population (Fuchs et al., 1996). In the United Kingdom, data collected between 1995 and 2013 indicate a higher reported incidence of up to 5.76 cases per million inhabitants annually for both SJS and TEN combined (Smith et al., 2015). Conversely, in Japan, TEN is less common, affecting approximately one adult per million each year, which may reflect genetic or environmental factors unique to the region (Yamamoto et al., 2000). Epidemiological studies consistently show that Asian and Black populations are more susceptible to developing TEN and SJS compared to their White counterparts. Some research indicates that individuals of Asian and Black descent have up to a two-fold increased risk of these conditions (Chan et al., 2012). Additionally, there is a clear female predominance in TEN cases, with a female-to-male ratio of approximately 1.5 to 1, suggesting possible hormonal or genetic influences (Arnaud et al., 2004). The age distribution of TEN primarily affects adults, especially those in their fifth to seventh decades of life, although cases can occur in any age group (Albert et al., 2010). In adults, the etiology of TEN is predominantly drug-induced, with medications such as antibiotics, anticonvulsants, and nonsteroidal anti- inflammatory drugs being common triggers. In contrast, infections are the leading cause of TEN in pediatric populations, highlighting the role of different pathogenic mechanisms across age groups (Kawasaki et al., 2009). Recent advancements in genetic research have highlighted the association between specific Human Leukocyte Antigen (HLA) alleles and the susceptibility to TEN, particularly in Southeast Asian populations. For instance, the presence of the HLA-B*1502 allele has been strongly linked to an increased risk of carbamazepine-induced TEN in individuals of Han Chinese descent (International Severe Adverse Reactions Consortium, 2004). This genetic predisposition underscores the importance of personalized medicine approaches, such as genetic screening, to prevent the onset of TEN in high-risk populations before initiating treatment with known offending drugs (Chung et al., 2004).
Medical ethics, distinct from other ethical principles, is characterized by the unilateral nature of information disclosure in the client-service provider relationship. The significance of adhering to healthcare ethics cannot be overstated, as it underpins the foundation of the doctor-patient relationship. Failure to maintain these ethical standards can have severe consequences, potentially resulting in violence or abuse in extreme cases. Analytical cross-sectional study design was conducted in National Hospitals Kandy and Colombo. Events need emergency medical attention in two selected teaching Hospital Sri Lanka (NH Kandy and NHSL Colombo) were considered as study population. Patients of staff members or their relatives were excluded from the study. 176 emergency situations were observed and 85 staff members were interviewed. None probability convenient sampling technique was applied for selecting sample for the study. Investigator administered structured data extraction sheet associated with observatory check list which included questions on ethics and implication principals were used as the study instrument. Data analysis was facilitated by SPSS version 27.0. Mean age of the patients underwent emergency situation was 44.1 yrs. Least attention was paid to patients’ autonomy. Assessment of the patient's decision-making capacity was paid highest attention among autonomy of the patient(n=63:35.8%). Among principals related to beneficence, medical interventions aimed at maximizing benefits for the patient were mostly attended (n=146:82.9%). Have potential risks and harms associated with medical interventions been minimized was the commonly attended risk minimization(n=136:77.3%). Majority of incidences, regardless of background, treated with the same level of care and consideration (n=162:92.1%). Staff members were mostly aware risk minimization among all ethical principles (42.9%). Staff members were least aware regarding patients’ autonomy during emergency medical management (37.3%). Patient autonomy (79.2%) and justification (72.5%) are satisfactorily applied at the ETU set up. Study findings demonstrate that minimization of risks during procedures is more at the ETU, when compared to ward setup(z=8.5:p<0.001). Relative to the other ethical principles, patient beneficence (46.2%) and avoid maleficence (47.1%) are applied more at the ward set up. Ethical principles which are applied most during emergency medical management events include patients Autonomy and justification. Beneficence and avoid maleficence are identified as the ethical principles which are followed least. Staff members should be properly informed regarding the manner of following ethical principles during emergency medical management procedures and appropriate skills should be developed. During these training programmes priority should be given to ward staff members.
The World Health Organization estimates the prevalence of preterm birth to be 5–18% across 184 countries of the world. Statistics from countries with reliable data show that preterm birth is on the rise. A cross-sectional descriptive study was conducted at all four post-natal wards of De Soysa Hospital for Women (DSHW) Colombo in April to December 2018. A total of 516 mothers who met the eligibility criteria were enrolled into the study. Maternal age, parity, period of gestation, maternal BMI, type of the preterm delivery (spontaneous or iatrogenic), evidence of preterm premature rupture of membrane, gender of the newborn and the birth weight of the baby was recorded in data extraction sheet from the bed head ticket (BHT). From total sample, 292(56.6%) mothers were between the ages of 18 - 29 and 20(3.9%) >40 years, primiparous (n=196, 38%), near term pregnancies (34 to 36+6 weeks) (n=333, 64.5%), and 115(22.3%) were preterm pregnancies (31 to 33+6 weeks). 242(47%) mothers with BMI 18.5-24.9. Maternal age, BMI, parity, and fetal gender were significantly associated with preterm birth (p = < 0.05). Association between the period of gestation and the maternal age, parity, and birth weight of the newborn were significant (p = < 0.05). Significant association of maternal age, BMI of the mother, parity of the mother, and gender of the fetus, with the preterm deliveries. From those parity and the BMI of the mother are the most significantly associated factors with the preterm deliveries. At-risk mothers should receive intensified antenatal care to mitigate preterm birth. Furthermore, modifiable factors such as BMI & age of conception can optimize or manipulate as a risk reduction strategy.
Cavernous sinus lesions can vary from vascular pathologies, and inflammatory conditions to neoplastic lesions. Cavernous sinus meningioma is a rare diagnosis of ptosis presented during childhood. There is a wide clinical approach that needs to be done in a case presented with a ptosis. The MRI is the diagnostic imaging study for Intracranial tumours. In this case, we describe a 12-year-old girl presented with ophthalmoplegia and unilateral ptosis detected to have a cavernous sinus meningioma in the MRI.
Postpartum contraceptives are birth control methods specifically tailored for use in the period following childbirth. Given the unique reproductive circumstances during this time, these contraceptives address the need for family planning and birth spacing. Various options are available, including hormonal methods such as birth control pills, patches, and injections, as well as long-acting reversible methods like intrauterine devices (IUDs). Health professionals work closely with postpartum women to discuss their contraceptive preferences, taking into consideration factors like breastfeeding, medical history, and future family planning goals. The choice of postpartum contraceptives aims to provide effective, safe, and convenient options to support women in managing their reproductive health during the postpartum period, contributing to maternal and child well-being. A pre-prepared questionnaire was administered to 73 mothers who delivered at Teldeniya Base Hospital and their responses were obtained. It is a self-administered questionnaire consisting of 12 questions. The collected information was analyzed descriptively Among study participants, 95.9% (n=70) believe that return of fertility can occur after 6 months of childbirth. Most people believe that any contraceptive method can be introduced within 48 hours of giving birth(n=50:68.5%). The majority of participants believe that IUCD can be inserted in the immediate post-partum period(n=60:54.8%). 41.1% of the participants think that LRT can be done 48 hours before and 4 weeks after delivery(n=30). The majority of participants are of the opinion that a breastfeeding mother should wait 6 months before using OCP(n=67:91.8%). Participants identified implants and LRT as the most successful birth control methods(n=29:39.7%) . 63% of the participants know that it may take several months to re-establish fertility after stopping DMPA(n=46). Most people believe that OCP is the most suitable form of birth control after a first trimester abortion(n=41:56.2%). It appears that there is a lack of access to updated scientific knowledge to the local people. In antenatal clinics, more attention should be given to raise awareness about post partum contraceptives. The attention of policy makers should be focused on socializing the concept of healthy contraceptive leads to productive family planning and happy life.
Perinatal care is a critical aspect of maternal and child health, with a primary focus on ensuring the well-being of both the mother and the developing fetus. One significant indicator of fetal health is the assessment of fetal movements, which serves as a subjective measure reported by the mother. Fetal movement abnormalities encompass a spectrum of conditions, including fetal tachycardia, bradycardia, and reduced baseline variability in cardiotocography (CTG). While reduced fetal movements may often be attributed to non- pathological factors such as maternal stress, activity levels, and sleeping patterns, it becomes imperative to distinguish instances where such reductions signify underlying fetal abnormalities. Reduced fetal movements, as perceived by the mother, may not solely stem from fetal pathologies but can also result from external factors such as pharmaceuticals, smoking, alcoholism, and maternal stress. However, during the last trimester, these reductions may manifest as a significant concern, especially when associated with true pathological conditions such as intrauterine growth restriction (IUGR), placental abruption, or a low amniotic fluid index. Timely and accurate identification of these conditions is crucial, as prompt interventions can effectively mitigate perinatal morbidities and mortalities.
Gestational diabetes mellitus is a common antenatal complication associated with adverse perinatal outcomes. Accurate prediction of GDM will help to implement preventive strategies early during pregnancy. The purpose of this study is to determine whether ultrasonography visceral fat thickness measurement can be performed during early gestation. To assess the correlation between the anthropometric measurement and visceral fat thickness and to define the cutoff value of visceral fat thickness for the development of GDM with optimum diagnostic test accuracy level. Prospective longitudinal study was conducted in antenatal clinic: Teaching Hospital Kandy. Gestational age between 11 to 14 weeks of gestation was included for the study. Multiple gestations, already diagnosed mothers with Diabetes Mellitus and past sections were excluded. Ultrasound Scanning machine, anthropometric measurement scales and interviewer administered data collection sheet were used as study instruments. Sample size was 251 and SPSS version 23.0 was used for data analysis. Visceral fat thickness of the participants positively and significantly correlated with the height (r=141), weight(r=550), BMI(r=533), waist circumference(r=470) and hip circumference(r=558). Most suitable cut off value of visceral fat thickness for predicting GDM among the study participants was 11.75 (Sensitivity: 84.2 Specificity :91.6). According to the other anthropometric parameters, when the subcutaneous fat thickness is more than 12.5cm (sensitivity 89.2 and specificity 39.8), hip circumference is more than 81.5cm (sensitivity 81.1 and specificity94.9), waist circumference is more than 66.5cm (sensitivity 86.5 and specificity 51.5) and BMI is above 21.73 (sensitivity 81.1 and specificity 61.8) GDM can be predicted with above mentioned sensitivities and specificities. Anthropometric measurements which are measured at the early gestational ages can be satisfactorily used for predicting gestational Diabetes Mellitus. But visceral fat thickness is the most suitable measurement for obtaining an accurate prediction.
Public Health Midwives play a major role to maintain a sustainable and successful health care service in the country. In detail analysis of their performances is a timely need. A descriptive cross-sectional study associated with a qualitative component was conducted among 264 Public Health Midwives in Nuwara Eliya district. By using a validated self- administered questionnaire task performance, contextual work performance and counterproductive work behaviour of Public Health Midwives were analyzed. a Focus Group Discussion was held with all the MOHs of the district and three Key Informant Interviews were conducted with the district supervising officers. Scoring mean for the individual task performance was 3.87 (SD=0.79) and for contextual performance it was 3.54 (SD=0.78). Mean value of the counter productive work behaviour was 2.67 (SD=0.76). Numerically a large number of participants have shown an excellent task performance (N=124:47.0%). Anyhow it does not represent the majority (<50%). Percentage of participants with an unsatisfactory task performance were 2.6% (N=7). Approximately one third of the study sample showed a good task performance. Numerically a larger number of study participants (N=118:44.9%) have shown a good contextual performance. Number of study participants who have shown a satisfactory contextual performance (N=65:24.7%) is nearly equal to the number of participants who have shown an excellent contextual performance (N=73:27.4%). Majority of the participants do not have the habit of talking to people outside the organization about the negative aspects of their work. Most of the participants were used not to focus on the negative aspects of situation at work instead of the positive aspects. Motivational strategies should be applied to achieve maximum performances with minimum resources. A comprehensive tool which can be used for PHM and other categories of health staff supervisions and assessments should be developed. It can be used for independent supervisions and work assessments. Individual work performances were observed to be raised with increased age and service duration. System strengthening and taking flexible administrative decisions should be considered for each PHM area.
Non-communicable diseases (NCDs) constitute a substantial portion of the healthcare burden in Sri Lanka. In the context of the rapidly evolving healthcare industry worldwide, it is crucial to evaluate the quality of healthcare service delivery and patient satisfaction. An analytical interventional study was conducted across four Divisional Hospitals in Nuwara Eliya district, comprising three distinct phases. The pre- intervention phase involved assessing patient perceptions of service quality using the SERVQUAL service evaluation model. The post-intervention phase assessed the impact of these changes based on a results framework. The study revealed a significant improvement in perceived service quality across various dimensions, including Responsiveness (t = 43.0: p < 0.001), Empathy (t = 5.23: p < 0.001), Reliability (t = 5.32: p < 0.01), and Tangibles (t = 18.6: p < 0.001). Notably, all patients received blood pressure and fasting blood sugar checks following the intervention. The evaluation also demonstrated the intervention's alignment with ongoing programs and improved effectiveness in service delivery. The pre-intervention phase identified deficiencies in service quality. An intervention package was developed and successfully implemented to address these shortcomings. The post-intervention phase witnessed a substantial enhancement in service quality, reflecting the potential for improving NCD clinic services in Sri Lanka. This study serves as a valuable reference for healthcare policymakers and providers seeking to elevate the quality of care in NCD clinics.
The autoimmune bullous diseases (AIBD) are a group of clinical conditions characterized by erosions and bullae of the skin and mucous membranes, which can be prolonging to serious concerns for patients in their activities of daily living (ADL) and adversely affect their quality of life. Descriptive cross - sectional study design was conducted in dermatology clinic at National Hospital Colombo. 121 participants more than 18 years old were included. Non-probability, consecutive sampling technique was used to collect the study sample. Interviewer-administered questionnaire included with dermatological quality of life index was used as study instrument. Most prevalent bullous disorder is pemphigus vulgaris (N=81:66.9%). Extremely larger effect was created on the quality of life of significant majority of the study participants due to the disease condition (N=80 ;66.1%). Highest effect on quality of life after treatments was created on PV patients (t=17.08: p<0.001). Majority of participants represented extensive disease severity scores (N=99:81.8%) at initial presentation. Participants who had significant disease severity at the end of the treatments (N=15:12.4%) showed moderate and large improvement of quality of life. Majority of the study participants had reduced disease severity with treatment (Z>1.96:p<0.001). Majority of the study participants had detected side effects during the first two months following commencement of treatment. 62.8% (N=76) had experienced remission episodes of the disease condition. Age above 50 years (OR=2.75:95%CI=1.26-5.95), Patients with significant initial disease severity (OR=3.82:95%CI=1.39-10.49) and patients who acquire more rapid disease remissions (OR=9.91:95%CI=3.89-25.16) show a significant association with improvement of excellent quality of life. Having oral lesions associated with moderate improvement of Quality of life. 40-60 years age group and female gender are identified as more susceptible factors for AIBD. Among AIBD, highest prevalence is demonstrated by Pemphigus Vulgaris. An extremely larger effect is created on the quality of life of AIBD patients. Quality of life is properly managed by the patients in the higher age group and patients with a higher income. A successful improvement in quality of life is achieved by the patients who initially present with a higher severity and patients who experience early remission. It is clearly demonstrated that it is possible to improve dermatological quality of life by managing the disease condition rationally and methodically. This knowledge should be used to conduct modifications in the health system in order to improve compliance of patients treated for AIBD.The autoimmune bullous diseases (AIBD) are a group of clinical conditions characterized by erosions and bullae of the skin and mucous membranes, which can be prolonging to serious concerns for patients in their activities of daily living (ADL) and adversely affect their quality of life. Descriptive cross - sectional study design was conducted in dermatology clinic at National Hospital Colombo. 121 participants more than 18 years old were included. Non-probability, consecutive sampling technique was used to collect the study sample. Interviewer-administered questionnaire included with dermatological quality of life index was used as study instrument. Most prevalent bullous disorder is pemphigus vulgaris (N=81:66.9%). Extremely larger effect was created on the quality of life of significant majority of the study participants due to the disease condition (N=80 ;66.1%). Highest effect on quality of life after treatments was created on PV patients (t=17.08: p<0.001). Majority of participants represented extensive disease severity scores (N=99:81.8%) at initial presentation. Participants who had significant disease severity at the end of the treatments (N=15:12.4%) showed moderate and large improvement of quality of life. Majority of the study participants had reduced disease severity with treatment (Z>1.96:p<0.001). Majority of the study participants had detected side effects during the first two months following commencement of treatment. 62.8% (N=76) had experienced remission episodes of the disease condition. Age above 50 years (OR=2.75:95%CI=1.26-5.95), Patients with significant initial disease severity (OR=3.82:95%CI=1.39-10.49) and patients who acquire more rapid disease remissions (OR=9.91:95%CI=3.89-25.16) show a significant association with improvement of excellent quality of life. Having oral lesions associated with moderate improvement of Quality of life. 40-60 years age group and female gender are identified as more susceptible factors for AIBD. Among AIBD, highest prevalence is demonstrated by Pemphigus Vulgaris. An extremely larger effect is created on the quality of life of AIBD patients. Quality of life is properly managed by the patients in the higher age group and patients with a higher income. A successful improvement in quality of life is achieved by the patients who initially present with a higher severity and patients who experience early remission. It is clearly demonstrated that it is possible to improve dermatological quality of life by managing the disease condition rationally and methodically. This knowledge should be used to conduct modifications in the health system in order to improve compliance of patients treated for AIBD.
A 53 year old lady presented with recurrent erythematous papules, ulcerating nodules of the intertriginous areas and crusted plaques of the scalp for 3 years duration. She has been clinically diagnosed and treated for hidradenitis suppurativa and dissecting cellulitis of the scalp. Poor response to therapy prompted us to arrange histological evaluation (Figure 1). Extensive evaluation with biochemical, histological and radiological workup was arranged in order to out the systemic involvement. She was found to have complete cranial diabetes insipidus, but there were no liver, lung or bone marrow involvement. she was referred to oncologist, started on chemotherapy with a satisfactory response Langerhans cell histiocytosis (LCH), is a clonal proliferative disorder of bone marrow-derived histiocytes with three sub types(1) (single-system unifocal, single-system multifocal, and multisystem disease).
60-year-old male presented with progressive, intensely itchy generalized papular skin eruption for 2 years. He had no history of atopy, other skin disease or constitutional symptoms.Examination revealed erythematous to hyperpigmented papules coalescing giving rise to cobblestone like appearance over torso and limbs but sparing the flexures.
Miscarriages can cause a significant impact on the psychological and emotional well being of many women, with considerable distress adversely affecting the quality of life. The Impact of Events Scale-Revised (IES-R) was designed to assess the current subjective psychological distress for any specific life event and psychological response patterns associated with such experiences. The objective of this study was to validate a Sinhala translation of IES-R questionnaire to assess the psychological distress among a group of Sri Lankan women following miscarriage. This validation study was conducted in the Galle district at the Gynecology ward of the Teaching Hospital Mahamodara, including 106 women who were diagnosed with miscarriage. The original IES-R was translated into Sinhala language and judgmental validity was ensured by an expert panel. Appropriate analyses both at the item and scale levels were conducted to assess the validity and reliability. Convergent validity was calculated between the total IES-R score and the total GHQ score, which provided a statistically significant correlation of 0.66 (p < 0.01). Construct validity demonstrated item scale correlations exceeding 0.4 with its own scale, and confirmatory factor analysis supported the three-factor model similar to its original three subscales with good fit indices (Intrusion, Avoidance and Hyperarousal). The Sinhala IES-R also demonstrated a good internal consistency with Cronbach’s alpha value for the whole score (0.91) and for its 3 subscales (ranging from 0.78 to 0.83). The test - retest reliability of three subscales showed satisfactory correlation coefficients exceeding 0.9, although the retest was done in a sample of 15 women after 2.7 days. The Sinhala version of the IES-R has satisfactory validity and reliability to asses psychological distress among Sri Lankan group of women following miscarriage
Miscarriage is one of the most common complications associated with early pregnancy. The optimal strategy for managing first trimester miscarriage remains uncertain. Management options for miscarriage fall into three groups medical, surgical, or expectant. Descriptive crosssectional hospital-based study design was conducted in Teaching Hospital Jaffna. Patients managing for first trimester incomplete and missed miscarriage were considered as study population and multiple pregnancy with vanishing twin was excluded. Sample size was 497. Interviewer administered questionnaire was used as study instrument. Data analysis was facilitated by SPSS version 25.0. Ethical clearance was obtained from Ethics review committee Faculty of Medicine university of Jaffna. Majority of the study participants were above 31 years of age. (N=37;75.4%). Majority of the study participants were house wives. Study participants were not aware regarding application of their preferences while deciding on the treatment options following a miscarriage. Considerably higher number of participants had selected medical management options. Minimum preference was observed for expectant management procedures. While taking decisions relevant to miscarriages, highest influence was created by the required period of hospitalization time for treatment. Significant number of participants were affected by the ability to achieve a normal day to day life style within a minimum period of time. Deficiencies are identified relevant to knowledge and awareness regarding available treatment options and their complications following a miscarriage. Females should be educated regarding handling a miscarriage situation during the pre-pregnancy period. counselling session should be conducted regarding the available management options of miscarriages and the skills required to face the relevant challenges.
Weakness of one or more groups of supporting elements of pelvis leads to pelvic floor dysfunctions and ultimately pelvic organ prolapse. Cross sectional validation study was conducted among 236 study participants at gynaecology unit Teaching Hospital Ragama. Patients with an age of 40 years or above who presented to the gynaecological unit for any reason were included. Sinhala and Tamil Translated versions of Australian Pelvic floor questionnaire was administered to participants to assess the pelvic floor dysfunction. The mean age of the study participant was 55.77 years (SD= 10.18 Years). Considerable number of study participants were not having experience of vaginal deliveries (N=65:27.5). 31.4% of study participants had undergone lower segment cesarean section (N=162). Tamil version of the study instrument Cronbach alpha value was determined as 0.632. The results of the reliability assessment of the Sinhala version of the study tool produced the satisfactorily accepted level (Cronbach alpha=0.610). According to the assessment of pelvic floor dysfunction tool, 56.33% (N=133) were diagnosed as a patient having pelvic floor dysfunction and 24%(N=57) were diagnosed by clinical assessment. Sensitivity of the Sinhala version of the study instrument is 100%. Specificity was calculated as 59.13%. positive predictive value was 41.53 and the negative predictive value was determined as 100%. Sensitivity of the Tamil version of the study instrument is 100%. Specificity was calculated as 55.3%. Positive predictive value was 44.11 and the negative predictive value was determined as 100%. The total statement score has significant predictability of pelvic floor dysfunction (AUC=0.743:95%CI=0.656-0.830). Bladder score alone showed the highest Predictability (AUC=0.888:95%CI=0.839-0.936). Prolapse of pelvic organ score also showed the significant predictability (AUC=0.648:95%CI=0.569-0.727). Reliability of the Sinhala and Tamil versions of the pelvic floor dysfunction assessment tools is at a satisfactory level. Sensitivity and negative predictive ability of the study tool are at a maximum level. Specificity and the positive predictive ability of the study tool are significantly low. Generation of false negative results by the study tool is minimum and tendency to generate false positives is relatively high. All the main components of the study tool have a significant ability to predict Pelvic floor dysfunction. Measures should be taken to publish the questionnaire used for the present study as a screening tool to detect pelvic floor dysfunction. Attention should be paid on developing more simple screening tools by using the identified predictive abilities of each component of the study tool.
The prevalence of polycystic ovarian syndrome (PCOS) in reproductive age women is around 8% to 13%. Many treatment options are available for PCOS associated symptoms including obesity, abnormal glucose metabolism, infertility, menstrual irregularity and hyperandrogenism. Double blinded, randomized clinical trial (RCT) was conducted on 302 PCOS women who referred to subfertility and gynaecology clinic, Teaching hospital, Kandy. Interviewer administered questionnaire was used for data collection. Mean age of the PCOS population was 30.82(SD=4.76) years and mean BMI was 27.64(SD=3.06kg/m2 ).Majority were overweight (67.9%) and the obesity prevalence was 13.2%. 8.94% had regular menstrual cycles and the majority were with irregular cycles (91.1%). 73.9% were oligomenorrheic, while 17.2% were amenorrhoeic among PCOS. The prevalence of acne was 70.2%. Hirsutism and acanthosis nigricans occurred in 66.89% and 55.29% of patients, respectively. In this study, 17.88% (n=54) were calcium deficient and 15. 23% were having impaired fasting glycaemia. 5.62% (n=17) of them were Diabetics. After treatment menstrual regularities were not significantly different between two groups. (p=0.477) But, the percentage difference within each group was statistically significant t(p=0.000). Both groups had a significant effect in their treatment while a notable better improvement on menstrual regularity observed within Metformin plus calcium group. Although the after treatment-BMI, among the groups was not significant (p=0.380), BMI reduced almost significantly within each group with their treatments. (p=0.000) Better reduction was seen with metformin plus calcium group.This trial showed an improvement with calcium on metformin in menstrual regularity and BMI in PCOS patients. Adding of cheap, safe and freely available calcium on metformin in Sri Lankan population would bring better clinical outcomes.
Prelabour rupture of membrane (PROM) comprises prelabour rupture of membrane at term (TPROM) or preterm (PPROM). Prelabour rupture of membrane after 37 weeks of gestation is defined as TPROM. Rupture of membrane before 37 weeks of gestation with leakage of amniotic fluid prior to the onset of labour is defined as PPROM. A descriptive cross-sectional study was conducted among 346 participants. All pregnant women presented to the study setting during the study period were included. Interviewer administered structured questionnaire was used for data collection. Data were analysed by SPSS 21.0. Receiver operating curve was used for diagnostic test accuracy and 95% confidence interval was applied for statistical significant. Predominantly primigravidae represented the study sample and the mean age was 26.67 years. Mean platelet count was 250 × 109/L and mean platelet volume was 8.54fl. Probability of predicting PPROM by the platelet count was 69.2%, and platelet volume was 85.9%. When the platelet count at the booking visit was 248 ×109/L or more it helped to predict PPROM with a probability of 80% sensitivity and 57% specificity. When the MPV at the booking visit was 8.15fl or less it helped to predict PPROM with a probability of 80% sensitivity and 75% specificity. When 237 × 109/L or more platelet count was considered as the cut off value it was possible to achieve a 76% sensitivity and 33.7% of specificity for predicting TPROM. When 9.6fl or less MPV was considered as the cut off value it was possible to achieve a 79% sensitivity and 22 % of specificity to predict TPROM. Conclusions: There is a possibility of predicting PPROM during the third trimester, by using the platelet count and the mean platelet volume measured during the first trimester. PPROM could be predicted when the platelet count is 248 × 109/L or more and the MPV is less than 8.15fl. It is not possible to use above mentioned parameters, to predict PROM during term. Possibility of predicting PPROM by using the platelet count and the MPV value of the first trimester could be considered in obstetric practice.
Diabetes mellitus is the commonest endocrine disorder identified during pregnancy. It can be either pre-existing diabetes mellitus or gestational diabetes mellitus. A descriptive crosssectional study was conducted among 915 study participants. Singleton pregnant women, who registered before the routine second trimester diabetes screening, were included. If the screening or diagnostic test were negative at 24 – 28weeks, they were screened again by oral glucose challenge test between 34 – 36weeks of gestation. Diagnosis was confirmed with oral glucose tolerance test. Mean age of the study sample was 28.96 years (SD=5.19). Mean values following glucose challenge test was 133.4mg/dl (SD=24.43) at third trimester. Mean blood sugar value following fasting, 2-hour oral Glucose tolerance test was 112.12mg/dl (SD=11.41) and 136.57mg/dl (SD=17.49) respectively. Majority was within the range of 121mg/dl to 140 mg/dl (N=748:81.1%). Mean birth weight was 2.96 kg (SD=361.48). All parameters except incidence of premature rupture of membrane were significantly associated with high blood sugar values following OGTT. Gestational diabetes mellitus in 3rd trimester could be identified as a significant risk factor for high amniotic fluid index (OR=2.449: 95% CI=1.552-3.863), pregnancy induced hypertension (OR=1.729:95 % CI=1.034-2.819), neonatal hypoglycaemia (OR=4.547:95 % CI=1.763-11.732) and admission to special care baby units (OR=3.14:95%CI=1.663-5.930). When the results of glucose challenge test were very high, requirement of confirmatory tests is minimized. Gestational diabetes mellitus in 3rd trimester is a significant risk factor for high amniotic fluid index, pregnancy induced hypertension, neonatal hypoglycaemia and admission to special care baby units. Special attention should be paid on pregnancy induced hypertension with increased blood sugar values. Specific precautions should be taken to treat neonatal hypoglycaemia and other perinatal outcomes when mothers with increased blood sugar levels deliver their babies.
When women give birth the perineum (the area between the vaginal opening and back passage) sometimes tears or it may be necessary to have an episiotomy (surgical cut) to increase the size of the outlet. Episiotomies and tears that involve the muscle layer (second degree) need to be stitched. A higher mean pain score was observed among the participant group which underwent interrupted suturing method than the group which underwent continuous suturing method. Majority of the participant who required analgesics for episiotomy pain were from the study group which underwent interrupted suturing method (z=1.3:p=0.193). Infections and antibiotic treatment were more common among the group who underwent continuous suturing (z=1.7:p=0.098). Wound dehisions were also frequently noted among the continuous suturing group (z=1.4:p=0.149). At the end of the three months of observation period more superficial dyspareunia (z=0.6:p= 0.534) and granuloma formation (z=1.2:p=0.246) were recorded among the group with interrupted sutures. When overall satisfaction was considered, most of the participants were included into the group who underwent continuous sutures. Continuous suturing technique can be used as a more cost effective technique for episiotomy suturing. Making awareness among labor room working staff and providing hand skill training for the staff members regarding continues suturing techniques appears to be more beneficial.
Hands can be considered as the body part which directly contributes towards a considerable spectrum of economical and habitual survival of mankind. Therefore, it is extremely important to manage these injuries with maximum care and accuracy. A descriptive cross-sectional study was conducted at the Orthopaedic unit, National Hospital Sri Lanka for a period of three months duration in 2020. Sample size was 150 and participants were selected by using the consecutive sampling technique. An interviewer administered data collection sheet and a data extraction sheet were used as the study instruments. Data analysis was done by using SPSS version 25.0. Project was ethically cleared by the ethics review committee of National Hospital of Sri Lanka. Mean age of the study participants was 40.92 years (SD=14.23). A male predominance was observed in the study findings (N=123; 82.0%). Occupational injuries were commonly observed (42%) and work place was considered (36%) as the place with the highest risk. Majority of the hand injuries were soft tissue injuries (62.0%). Hand injuries were commonly observed during wood work. Occupational injuries (OR=2.41), hand injuries caused during road traffic accidents (OR=2.31) and injuries occurred during usage of tools (OR=2.4) were significantly associated with surgical interventions. Fractures and soft tissue injuries are the most common hand injuries reported in Sri Lanka. Occupational interventions and road traffic accidents provide a larger contribution for hand injuries. A significant majority of the patients with hand injuries demand surgical treatment procedures. Usage of safety measures and personal protective equipment play an important role in reduction of severity of injury and prevention of hand injuries. It is appropriate to pay attention on developing specified acute hand injury management protocols and display them at emergency management centres for rapid access. Using Personal Protective Equipment according to accurate protocols should be promoted and using hand held instruments with adequate safety measures should be emphasized. Stakeholders external to the health ector should be identified for hand injury prevention promotion activities and special attention should be paid on programs with multisectoral contribution.
Intrauterine contraceptive device (IUCD) is a highly effective, long acting reversible contraceptive method. Rate of acceptance, continuation or complications of IUCD following postpartum (PP) insertion compare to standard interval (INT) insertion were not studied in Sri Lanka. Objectives of this to compare the effectiveness of IUCD following insertion in postpartum (PP) and interval (INT) period. Randomized controlled trial was conducted with 182 postpartum mothers from ward 05, Teaching Hospital, Kandy for period from 15th August 2012 to 15th March 2015. Ethical clearance was obtained from institutional Ethical Review Committee. Mothers were randomized to PP or INT group after vaginal delivery and Copper IUCD were inserted. Participants were followed at 6th weeks, 6th months and 2 year. Outcomes of the study were acceptance and continuation of IUCD, expulsion, perforation, pain, abnormal vaginal bleeding and pelvic inflammatory disease. Among participants rate of insertion was 100% (91) in PP group and 78%