Central retinal vein occlusion (CRVO) is a significant cause of vision loss worldwide, characterized by the blockage of the central retinal vein, leading to retinal ischemia, edema, and consequent visual impairment. The pathophysiology involves venous congestion and increased retinal capillary permeability, potentially resulting in permanent damage if not addressed promptly. Although CRVO is primarily associated with systemic conditions such as hypertension, diabetes mellitus, and hypercoagulability, recent observations have suggested an association with COVID-19 vaccination, particularly in individuals with underlying risk factors. Given the widespread administration of COVID-19 vaccines globally, understanding the potential ocular complications is crucial for informed risk- benefit analysis and patient management. The emergence of rare reports describing retinal vascular events following COVID-19 vaccination has raised questions about the vaccine's role in triggering or exacerbating conditions like CRVO. These cases often involve various COVID-19 vaccines, including vector-based and mRNA vaccines, and are typically reported within days to weeks post- vaccination. The potential mechanisms linking COVID-19 vaccines to CRVO include immune-mediated responses, vaccine-induced thrombotic thrombocytopenia (VITT), and molecular mimicry, which could theoretically precipitate retinal vascular events. For instance, VITT is characterized by thrombosis in unusual sites and has been predominantly associated with adenoviral vector vaccines such as AstraZeneca's ChAdOx1 nCoV-19 and Johnson & Johnson’s Ad26.COV2.S, which could increase the risk of vascular occlusions, including in the retina (Greinacher et al., 2021; Schultz et al., 2021). Understanding factors contributing to CRVO post-COVID-19 vaccination requires examining potential precipitating conditions, including pre-existing comorbidities (e.g., cardiovascular diseases), the type of vaccine administered, and individual immune responses. The temporal relationship between vaccination and CRVO onset remains a critical area of investigation, necessitating more robust epidemiological studies and case- control analyses to establish causality (Simpson et al., 2022). This review aims to elucidate the factors potentially contributing to blindness secondary to CRVO in the context of COVID-19 vaccination, emphasizing the need for vigilance in identifying early symptoms and providing timely interventions.

Burnout syndrome is a psychological condition resulting from chronic occupational stress, particularly prevalent in professions requiring extensive human interaction, such as healthcare. It encompasses emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. A descriptive cross-sectional study was conducted from March 2024 to June 2024 among 146 emergency medicine professionals using a pre-tested self-administered online questionnaire, including the Maslach Burnout Inventory. Simple random sampling was employed using a list of EMP of the considered hospitals as a sampling frame, and data were analyzed using descriptive statistics and chi-square tests & binary logistic regression with SPSS 23.0. Response rate was 82.9% (n=120). The prevalence of high overall burnout was 43.3% (95% CI-34.32%-52.69%), with 20.8% (95% CI: 13.96%-29.20%) reporting high emotional exhaustion, 37.5% (95% CI: 28.83%- 46.80%) high depersonalization, and 3.3% (95% CI: 1.0%-8.31%) high personal inefficacy. Significant associations were found between high burnout levels and factors such as anxiety (OR=5.02, 95% CI-1.81-13.90, p=0.001) and poor coping strategies (OR=4.23, 95% CI-1.15-15.6, p=0.02). No significant associations were found with socio-demographic characteristics or organizational factors. The study found a high prevalence of burnout among emergency medicine professionals, with significant levels of emotional exhaustion and depersonalization. Burnout was significantly associated with anxiety and poor coping strategies, while no associations were observed with socio-demographic or organizational factors. Interventions should focus on addressing anxiety and enhancing coping strategies among emergency medicine professionals to reduce burnout. Future efforts should prioritize individual-level psychological support.

Vitiligo is a chronic skin disorder characterized by the progressive loss of melanocytes, leading to depigmented patches on the skin. The condition affects individuals of all ages, races, and genders, resulting in considerable psychosocial and healthcare burdens worldwide. Though the exact cause remains unclear, vitiligo is believed to involve an autoimmune mechanism that targets melanocytes, contributing to the visible skin changes. This disorder is not life-threatening but has a significant impact on the quality of life due to its effect on appearance and associated stigma.

The Dermatology Clinic at Badulla General Hospital in Sri Lanka provides specialized care for a variety of skin, hair, and nail conditions. As part of one of the key hospitals in the Uva Province, the clinic serves a diverse patient population from the surrounding rural areas. Staffed by experienced dermatologists, nurses, and support personnel, the clinic offers treatments for common dermatological issues such as eczema, psoriasis, acne, and fungal infections, as well as more complex cases like autoimmune skin disorders and skin cancers.The clinic also provides treatments for hair loss conditions, including alopecia areata, and offers advanced therapies such as corticosteroid injections, phototherapy, and biologics when necessary. With its role in a general hospital setting, the Dermatology Clinic collaborates closely with other departments to provide comprehensive care for patients with dermatological manifestations of systemic diseases.

Alopecia areata (AA) is an autoimmune condition characterized by non-scarring hair loss. The condition can significantly impact quality of life and self-esteem. Despite its prevalence, there is no universally accepted treatment protocol, and numerous therapeutic approaches have been explored. Among these, combination therapies have gained attention for potentially enhancing efficacy and minimizing adverse effects. A systematic review was conducted focusing on the combination treatment of dexamethasone minipulse (DMP) and methotrexate (MTX) in the management of AA, evaluating its effectiveness and associated treatment-related adverse effects. PubMed, Cochrane Library, and Google Scholar were searched for studies published up to July 2023 using keywords such as "Alopecia areata," "dexamethasone minipulse," "methotrexate," "combination therapy," "effectiveness," and "adverse effects." Inclusion criteria were randomized controlled trials (RCTs), observational studies, and cohort studies that evaluated the combination treatment of DMP and MTX in AA. Exclusion criteria included case reports, reviews, and studies lacking sufficient data on efficacy or adverse effects. Multiple RCTs demonstrated that the combination of DMP and MTX significantly improves hair regrowth in AA patients compared to monotherapy. One RCT reported a 60% improvement in the combination group versus 35% in the MTX alone group.Observational Studies: A large cohort study showed a response rate of 70% in patients receiving combination therapy, with significant improvement noted within 12 weeks of treatment initiation. Studies with follow-up periods exceeding 12 months indicated sustained hair regrowth in patients treated with the combination therapy, with lower relapse rates compared to monotherapy. Patients treated with DMP and MTX showed a significant reduction in SALT scores, indicating a greater percentage of hair regrowth. One study reported a mean SALT score reduction from 60 to 20 after 24 weeks of combination therapy. Increased blood glucose levels and weight gain were common, though less pronounced than with continuous high-dose corticosteroid therapy. Mood swings, insomnia, and anxiety were reported in a minority of patients, generally resolving with dose adjustment or discontinuation. Nausea, vomiting, and oral ulcers were frequent but manageable with folic acid supplementation and dose adjustments. Mild leukopenia and anemia were observed in some patients, necessitating regular blood monitoring. Elevated liver enzymes were noted in a small percentage of patients, which resolved with temporary discontinuation or dose reduction of MTX. The combination therapy's immunosuppressive effects increased susceptibility to infections, though no severe infections were reported in the reviewed studies. The potential for cumulative toxicity necessitates careful patient selection and regular monitoring, particularly in long-term treatment regimens. The combination of dexamethasone minipulse and methotrexate appears to be an effective treatment for alopecia areata, offering significant improvement in hair regrowth compared to monotherapy. The dual mechanism—DMP's anti-inflammatory action and MTX's immunomodulatory effect—may provide a synergistic benefit, addressing different aspects of the autoimmune pathophysiology of AA. However, the combination therapy is not without risks. The incidence of adverse effects, although generally manageable, underscores the need for close monitoring and individualized treatment plans. Regular follow-ups and appropriate dose adjustments are critical to minimizing adverse effects while maximizing therapeutic outcomes. Combination therapy with dexamethasone minipulse and methotrexate is a promising approach for treating alopecia areata, demonstrating enhanced efficacy in hair regrowth and acceptable safety profiles. Further large-scale, long-term studies are warranted to establish standardized protocols and optimize patient outcomes.68.6%) and extended activities of daily living (n=125, 80.1%) were affected. Patients with Early presentation (p=0.000), early intervention (p=0.013), macular-on (p=0.04) and absent PVR (p=0.000) showed better activities of daily living. Age (p=0.22) and sex (p=0.53) did not show a significant association. Eighteen (11.5%) out of the 129 patients experienced a well satisfied composite scores change whereas 27 (17.3%) experienced no improvement in satisfaction. Early intervention for RRD has proven better anatomical outcomes. Therefore, should pay attention to reduce waiting time for treating RRD.

Anesthesia plays a critical role in routine surgeries by ensuring that patients undergo procedures without pain and discomfort. However, the experience of anesthesia can be a significant source of stress, leading to adverse physical and psychological outcomes. A descriptive cross-sectional study was conducted in a selected base hospital in Sri Lanka, where 234 surgeries under general anesthesia were reviewed. An interviewer- administered questionnaire was used as the study instrument, with patients interviewed during the pre-medication period. The study included only routine surgeries, excluding patients with previous surgical experiences under general anesthesia. Relevant descriptive statistics were implemented to analyze the data. Anxiety is a pervasive condition observed among all patients, with varying degrees of severity. Notably, 28.6% of the patients in this study exhibited moderate anxiety levels, indicating a significant portion of the population experiences heightened emotional distress prior to surgery. This anxiety is particularly prevalent among patients aged 40 to 59 years, suggesting that this demographic may be more vulnerable to preoperative stress. The apprehensions associated with general anesthesia (GA) reflect a broad spectrum of patient concerns, emphasizing the psychological burden that precedes surgical interventions. A significant number of patients, 109 in total, expressed a profound fear of paralysis following the administration of GA, indicating a prevalent anxiety regarding potential post-anesthetic complications. Similarly, 102 patients reported concerns about experiencing pain during the anesthetic procedure, underscoring the importance of addressing patient expectations and providing thorough preoperative explanations. Stress related to anesthesia in routine surgeries is a multifaceted issue that requires a holistic approach to address. By understanding the sources of stress and the physiological mechanisms involved, healthcare providers can implement effective strategies to minimize the impact on patients. Pharmacological interventions, psychological support, advanced anesthetic techniques, and ERAS protocols are all valuable tools in reducing anesthesia-related stress and improving surgical outcomes. Continued research and innovation in this field are essential to further enhance patient care and ensure a positive surgical experience.

A 21-year-old previously healthy male presented to the emergency treatment unit with left-sided chest pain radiating to the left shoulder, which had worsened since the morning. The patient also experienced diarrhea (three episodes), vomiting (two episodes), and intermittent dyspnea. His history was largely unremarkable except for a significant smoking history—10-15 cigarettes per day for the past six years. On examination, the patient was in severe pain and appeared pale, with notable tachypnea (respiratory rate of 30 breaths per minute) and a rapid, regular pulse of 130 beats per minute. Physical findings were concerning: tracheal deviation to the right, hyperresonance on the left side of the chest, and reduced air entry on the left side. Despite these findings, the patient maintained a high oxygen saturation (SpO2 of 100% on room air). However, his blood pressure was dangerously low at 85/60 mmHg, raising the suspicion of a secondary spontaneous pneumothorax, likely complicated by a pleural effusion.

Rhegmatogenous retinal detachment (RRD) could threaten the vision. Therefore, early intervention is crucial. This prospective longitudinal study comprised 156 patients who were treated at the NEH, Sri Lanka. Patients with combined retinal detachments and RRD following trauma were excluded. Data were collected using two interviewer-administered questionnaires and a data extraction sheet. Patients were followed-up at one month and six months post-operatively. Satisfaction was assessed based on a pre-determined scoring system. Factors associated with anatomical and functional outcome were determined using chi-square test. Prevalence odds ratio was used as the effect measure. Significance level was considered as 5%. The data showed that RRD common in older male adults. Most patients (n=118) were had successful retinal re-attachment, while macular-on patients presented a statistically significant successful retinal re-attachment compared to those with macular off (96.0%versus 71.4%, p=0.01). No significant association was seen in relation to age (p=0.59), sex (p=0.89) and presence of co-morbidity (p=0.34). One month following the intervention, a statistically significant decline of BCVA was observed (p=0.000). At six months, there was a significant improvement of vision (p=0.001). BCVA in six months postoperatively was significantly improved with early presentation (p=0.001) and early intervention (p<0.001). In most post-operative patients, both activities of daily living (n=107, 68.6%) and extended activities of daily living (n=125, 80.1%) were affected. Patients with Early presentation (p=0.000), early intervention (p=0.013), macular-on (p=0.04) and absent PVR (p=0.000) showed better activities of daily living. Age (p=0.22) and sex (p=0.53) did not show a significant association. Eighteen (11.5%) out of the 129 patients experienced a well satisfied composite scores change whereas 27 (17.3%) experienced no improvement in satisfaction. Early intervention for RRD has proven better anatomical outcomes. Therefore, should pay attention to reduce waiting time for treating RRD.

Longer-lasting psychological, social, and health status changes can be expected following miscarriages. Analytical cross-sectional study design was conduct at National Hospital- Kandy. Women admitted to THK fallowing miscarriage was the study population and pregnancies below 24 weeks of gestation was included. Systematic random sampling technique was applied for sample selection. Interviewer administered questionnaire and 12 item general health questionnaire were used as study instruments. A total of 391 responses were obtained. Mean age of the participants was 29.31 yrs(SD=6.02 yrs). The mean POA at which the miscarriage was 9.68 (SD=3.83). The majority of mothers have agreed with the fact that they endured all-time stress throughout the last two weeks (n=207:52.9%). Majority of mothers had suffered moderate stress throughout the study period (n=249:63.7%) and moderate level of social withdrawal following the miscarriage (n=225:57.5%). Poor level of general psychological status was experienced by 9.2% of the participants (n=36). General psychological status of the study participants was significantly associated with age (p<0.001), Occupation (p<0.001), educational status (p<0.001), alcoholic husband (p<0.001), history of subfertility (p<0.001), and the menstrual history (p<0.001). Distress and anxiety are the most common psychological disorders identified following a miscarriage. Maternal care service packages should be modified in order to facilitated communication between females and relevant public health officials regarding essential post abortion care protocols at the time of getting discharged from the hospitals.

The gestation age at delivery plays a crucial role in determining the immediate fetal outcome. Gestation age refers to the duration of pregnancy from the first day of the last menstrual period to the time of delivery. Preterm births, pose a higher risk to the immediate fetal outcome. Premature infants may face challenges such as underdeveloped organs, respiratory distress syndrome, and difficulty regulating body temperature. Additionally, the risk of complications such as infections and feeding difficulties is heightened in preterm births. Conversely, full-term deliveries, are generally associated with better immediate fetal outcomes. Babies born at full term are more likely to have fully developed organs and systems, reducing the likelihood of respiratory and other complications. They typically have a better chance of thriving in the immediate postnatal period. The gestation age at delivery is a critical consideration for healthcare professionals in managing neonatal care. Monitoring the fetal development throughout pregnancy, addressing risk factors, and ensuring appropriate medical interventions when necessary can contribute to optimizing the immediate fetal outcome at the time of delivery. Understanding the relationship between gestation age and immediate fetal outcomes aids in providing tailored and effective healthcare for both mother and baby. There were 100 deliveries in rural base hospital in central province Sri Lanka were evaluated in this study. Investigator administered data extraction sheet was used for data collection. Relevant descriptive statistics were applied. Mean age of the study participants was 30.14 Yrs(SD=5.39 yrs) and 34 % was primi gravida mothers(n=34). Majority were normal vaginal deliveries(n=64:64.0%). Among Normal vaginal deliveries, majority was delivered less than two hours of intrapartum period(n=38:59.3%). Majority of babies had birth weight between 2.5 kg to 3.5kg (mean = 2.78kg: SD= 0.39kg). 26% of babies were able to discharge from the hospital within one day of post-natal period. 28.6% of babies had to stay more than 5 days of post-natal stay(n=28). 28% of babies were admitted to PBU. Highest number of them were due to respiratory problems (n=10:35.7%) All achieved APGAR 10 at the 5 th minutes of delivery. The majority of babies delivered by Cesarean sections have a gestational age of less than 38 weeks (n=24:80.0%). The majority of those who delivered in less than 2 hours are in the 38 th week of gestation(n=20:52.6%). Participants with an intrapartum period greater than 6 hours were at 37-38 weeks gestational week. The majority of low-birth-weight babies were less than 38 weeks gestational age(n=20:83.3%). Post natal hospital stay was more than 5 days, most of them were participants with gestational age more than 38 weeks(n=22:78.5%). Almost half of PBU admissions are neonates delivered at 36-37 weeks(n=14:50.0%). Majority of the mothers with 36-37 weeks of gestational age experienced normal vaginal deliveries (N=16,53.3%). Percentage of low birth weight among newborns was 26.6%(N=8). 46.6%(N=14) of the babies delivered within 36-37 weeks of gestational age were admitted to PBU. 13.3% of the neonates were unable to achieve the APGAR score of 10 within the first 5 minutes after birth. Percentage of Lower Section Cesarean Section among mothers with 37-38 weeks of gestation was 25% (N=10). The percentage of low birth weight was 30 (N=12), and the percentage of PBU admissions was 15% (N=6). 25% of the study participants (N=10) were admitted and treated at the hospital for more than five days. 10% (N=2) of the neonates were unable to achieve APGAR score 10 within the first 5 minutes after birth. 16.6% of the mothers with a gestational age of 38-39 weeks delivered their babies via Lower Segment Cesarean Section. The percentage of low birth weight was 8.3% (N=2). A postnatal hospital stay for more than 5 days was observed among 33.3% (N=8) of the participants. The percentage of PBU admissions was 16.6% (N=4). All the neonates were able to achieve an APGAR score of 10 during the first 5 minutes of their life. Among the PBU admissions, the majority were observed with respiratory system related symptoms(29.4% ;N=10). Maternal pathologies (17.6%), poor sucking (11.7%), Neonatal Jaundice (5.8%), sepsis (5.8%) and Fetal tachycardia (5.8%) were the noted indications for PBU admissions. None of the babies with more than 38 weeks of gestation were unable to achieve APGAR 10 within the first five minutes of their life. It cannot be determined that a specific gestational age group is associated with perinatal complications. It seems that perinatal complications can be well managed by implementing well focused management strategies.

Postpartum hemorrhage is a leading cause of maternal mortality, accounting for a substantial number of preventable deaths globally. Despite advances in obstetric care, challenges persist in timely PPH detection, necessitating a focused audit to address these issues. Postpartum hemorrhage (PPH), a significant concern in maternal health, is considered within the timeframe of the first 24 hours up to 6 weeks postpartum. However, it is during the initial 24 hours that PPH poses the greatest threat to maternal health, making early detection crucial for preventable interventions. Maternal mortality rates can be greatly reduced by promptly identifying and addressing postpartum hemorrhage. Understanding the intricacies of early PPH detection is imperative, especially given the practical difficulties in continuously monitoring vital parameters. To circumvent this challenge, assessing the amount of blood loss becomes a key indicator. Notably, continuous postpartum bleeding equivalent to the saturation of one sanitary pad with blood per hour for more than two hours demands immediate medical attention. This underscores the critical importance of timely detection for effective intervention.

INTRODUCTION The significance of perinatal morbidities, encompassing both maternal and neonatal health challenges during the critical period surrounding childbirth, cannot be overstated. Perinatal morbidities pose substantial risks to the well-being of both mothers and infants, impacting not only immediate health outcomes but also potentially influencing long-term health trajectories. The immediate postpartum period, particularly the first 24 hours, stands as a critical phase in the journey of both mother and newborn. During this time, the infant is navigating the complexities of adapting to a new environment, while the mother is grappling with fatigue, breast discharges, post-vaginal bleeding, discomfort, mood changes, and pain. This vulnerable period demands meticulous assessment, as both mother and baby are at an elevated risk of immunocompromise, necessitating vigilant care in terms of ventilation, feeding, and hydration. The initial 24 hours post-delivery emerges as a pivotal time frame where the delicate balance of rest and care for the mother and minimal handling for the newborn becomes paramount. However, the cultural context in Sri Lanka introduces a unique challenge – the tradition of numerous visitors during this critical period. This cultural norm, though well- intentioned, may inadvertently expose the newborn to potential risks.

This study explores the factors influencing the non-utilization of family planning methods among married women aged 15-49 in the rural setting of Nuwara Eliya, Sri Lanka. The introduction provides a contextual background, emphasizing the significance of family planning and the widespread challenges faced in the region. The methodology involves a community-based descriptive cross-sectional study, focusing on 325 women aged 15-49. The study employs non-probability convenient sampling, utilizing interviewer- administered questionnaires and descriptive analysis techniques facilitated by SPSS version 25.0. The results reveal a strong correlation between educational status and family planning non-utilization, with lower educational levels associated with a higher percentage of non-users. The study identifies administrative failures, communication barriers, and healthcare accessibility issues as contributors to the unmet need for contraceptives. In conclusion, Nuwara Eliya's high maternal mortality rates underscore the urgency for structural changes in healthcare administration and policy reforms. Recommendations include strengthening the healthcare workforce, optimizing public health infrastructure, fostering community engagement, advocating for policy changes, and implementing data- driven strategies. This comprehensive approach aims to address the root causes of non- utilization, ultimately improving maternal health outcomes and socio-economic conditions in Nuwara Eliya.

Cervical cancer poses a significant global health threat, necessitating proactive measures for early detection and intervention. In the context of Nuwara Eliya, Sri Lanka, where Pap smear screening coverage stands at a mere 6%, well below the World Health Organization's recommended 80% threshold, this research embarks on a comprehensive exploration of the barriers hindering participation. Through a descriptive cross-sectional study involving 362 women aged 35-50 years, coupled with qualitative interviews with key stakeholders, the study illuminates a myriad of challenges. Furthermore, a striking lack of awareness regarding cervical cancer prevention and the significance of Pap smear screenings comes to the fore. Accessibility issues, particularly in remote areas with scant screening facilities, emerge as critical barriers. Qualitative insights from Public Health Midwives reveal resource constraints and the urgent need for specialized training. In light of these findings, the study advocates for evidence-based policy interventions. Targeted strategies are proposed to address cultural sensitivities, enhance awareness through tailored campaigns, and ensure equitable access to screening services and to development of comprehensive and region-specific policies aimed at boosting Pap smear screening participation in Nuwara Eliya, Sri Lanka.

ABSTRACT A descriptive cross-sectional study was conducted within the immunization clinics of MOH Rikillagaskada, to evaluate knowledge, attitudes, and practices relevant to the Child Health Development Record (CHDR) among mothers with children under five years of age. Employing a systematic random sampling technique, the study enrolled 216 participants, utilizing an interviewer-administered structured questionnaire in three languages. The questionnaire included sociodemographic data, along with information on knowledge, attitudes, and practices associated with growth and developmental milestones included within the CHDR. Results: The findings revealed varied levels of understanding and engagement relevant to CHDR, uncovering notable gaps in knowledge. A positive attitude towards CHDR was observed, though necessary improvements were identified. Practices related to growth and developmental milestones included in the CHDR exhibited a mixed pattern. The study underscores the need for targeted interventions to enhance maternal awareness and optimize the use of CHDR for a comprehensive child health monitoring process. The identified gaps in knowledge, attitudes and practices highlight areas which require focused educational efforts. Health education initiatives should be strategically implemented during clinic visits to bridge knowledge gaps, while behavior change interventions can enhance positive attitudes towards CHDR. The development and implementation of a review tool within the clinic and ward setup are recommended to analyze and facilitate a good practice related to CHDR. These recommendations aim to improve overall awareness, attitudes, and practices concerning CHDR, fostering its optimal use for the holistic health monitoring of children. The integration of these conclusions and recommendations is crucial for shaping effective strategies for improving child health outcome.

A 31 year old female presented with painful oral ulceration, crusted erosive plaques of scalp and flaccid bullae of torso in 2017. She was diagnosed with pemphigus vulgaris based on characteristic clinical, histological and immunofluorescence findings and treated with monthly dexamethasone pulses and mycophenolate mofetil but unable to achieve remission for 3 years. Repeated evaluation for associated autoimmune disorders and malignancies were negative. While on treatment she developed recurrent episodes of blistering eruptions with dermatomal distribution.

Caesarean section rates above 15% are not associated with the additional benefit in maternal & neonatal outcome, but c-section rates are increasing during the past few decades may be due to perceived myth on its safety. World Health organization recommends the use of Robson classification to audit c-section rates as an objective, replicable, comparative analytic system. Csection is indicated when vaginal delivery would put maternal or fetal life in danger. The safety of c-section has improved with time, but the morbidity rates are still.

Enhanced recovery after surgery (ERAS) pathway is an established evidence-based standard practice. It reduces physiological stress and organ dysfunction associated with elective surgeries, and also reduces the hospital stay, surgical complications and health care expenditure. Many hospitals throughout the country follow some of its elements, but not as a hospital protocol. Regular auditing to see the adherence to ERAS pathway is essential to ensure the efficacy of the health system and patients’ safety.

There are no typical clinical signs in silent chorioamnionitis. It is associated with adverse maternal and neonatal outcome and poor progression of labour. Subclinical chorioamnionitis is also more common in preterm gestations than term gestation and vaginal deliveries than caesarean sections. Descriptive cross-sectional study conducted in Castle Street Hospital for women. Term singleton pregnant mothers were included and preterm labour was excluded. Sample consisted of 154 participants. Antepartum and post-partum surveillances were conducted. amniotic fluid cultures with ABST patterns, perinatal neonatal and maternal outcomes were selected as outcome variables. Data was analysed by using SPSS version 25.0. According to the study mean age of the participants was 29.37 years (SD=5.30years). and the majority represented the 26-36 years age group. Half of the study sample consisted of primigravidae mothers. Occurrence of silent chorioamnionitis was significantly higher among primigravidae (OR=4.056:95%CI=1.270-12.952). Duration of labour exceeding more than 12 hours and performing multiple digital vaginal examinations (OR=3.929:95%CI=1.007-15.328) were identified as significant risk factors for silent chorioamnionitis. Maternal pyrexia (OR=21.000:95%CI=5.316-82.961) and surgical site infections were significantly associated with silent chorioamnionitis (OR=12.667:95%CI=2.570- 62.427). Newborns who were admitted to SCBU due to early neonatal sepsis (OR=16.875:95%CI=1.448-196.68) and who were unable to achieve an APGAR score of 7 at the 5 th minute of their life (OR=4.571:95%CI=1.220-17.129) were significantly associated with maternal silent chorioamnionitis. According to the culture & ABST findings, Staphylococcus aureus

60-year-old lady presented with chronic non healing ulcer of the left arm for 1 year and 3 months duration. She had received treatment for cutaneous leishmaniasis and atypical mycobacterial infection with a poor response. The ulcer started spontaneously and gradually increased in size. It was painless and no purulent discharge was present. Patient had mild dry cough and loss of appetite and loss of weight. She had no history or contact history of tuberculosis. No arthralgia, red eyes or other skin eruptions noted. No recurrent upper respiratory symptoms, oral/nasal ulcers or frothy urea/haematuria. Her systemic review and past medical history were unremarkable. Examination revealed well defined pinkish indurated plaque measuring 15x10 cm size with multiple shallow ulcers with granulation tissue and purulent exudate. No rolled, everted, indurated violaceous overhanging edges present. No cutaneous manifestations of tuberculosis, sarcoidosis, connective tissue diseases or systemic vasculitis were noted. She was thinly built but rest of the general and systemic examination findings were unremarkable. Skin biopsies were compatible with granulomatous inflammation with few foci of necrosis. No central caseation was noted and epithelioid granulomas had a lymphocytic cuff. No vasculitis was noted in the histology. All special stains were negative including ziehl-neelsen, PAS, Grocott, gram stains. Tissue cultures were negative for bacteria, mycobacteria, fungi and leishmaniasis. Tissue biopsy for mycobacterial PCR was negative. Moreover, sputum AFB x3, and TB Quanti FERON gold test were negative. Haematological, biochemical and imaging studies were arranged in order to evaluate for possible differential diagnosis such as Tuberculosis, Atypical mycobacterial infections, Sarcoidosis,

A 22‐year‐old male presented with extensive skin folding on the forehead, severe acne and scaly skin eruption with seborrheic distribution. No family history of similar condition or consanguinity noted. Examination revealed cutis vertices gyrate over the forehead, seborrhoea, acne and seborrheic dermatitis. Moreover, clubbing of his fingers and toes was noted and he had swollen knee joints. Radiological evaluation revealed hypertrophic osteoarthropathy. Skin biopsy findings showed sebaceous hyperplasia with thickening of the dermis with mucin deposition compatible with pachydermoperiostosis. However no other associations were found after through biochemical, haematological and radiological work up. primary PDP was diagnosed based on the typical clinical and radiological findings. The patient was referred to plastic surgical clinic for further management of cutis vertices gyrata where it was arranged Botox injections without surgical correction-but later we discussed with them regarding the nature of the disease and offered surgical correction for the patient. It was arranged the surgical correction instead of Botox.

Perinatal mortality is a good indicator to assess the quality of intrapartum health care system. Ultimate goal of antepartum and intrapartum health care services is achieving a satisfactory perinatal outcome. An analytical cross-sectional study was conducted among 423 pregnant women who were admitted for delivery at the labour room, Teaching Hospital Jaffna. Term singleton pregnancies with cephalic presentation were included. Mothers with medical disorders, complicated pregnancies, previous history of antepartum hemorrhages and past sections were excluded. Interviewer administered structured data collection sheet was applied for data collection. Mean age of the study participants was 27.97 years (SD=5.72 years). Foetal heart rate abnormalities were not detected among 63.3% of the study participants (N=269). Pinard foetal stethoscope was used first to detect abnormalities of 17.9% (N=28) of the participants with foetal abnormalities. Handled Doppler machine was used to detect first foetal abnormalities in 28.2% of the study participants (N=44). In 84 participants (53.8%) foetal abnormalities were detected at the first time by both methods. Significantly higher percentage of participants were detected by the handled Doppler machine than the pinard foetal stethoscope (z=2.159:p

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%

Prolonged second stage of labour is inability of a woman to proceed with childbirth after the fully dilatation of cervix. Prolonged second stage rate is 7.17%. Significant number of postpartum haemorrhage (36%) and NICU admission (22%). Prolonged second stage was associated with highly successful vaginal delivery rates (84% vs 72.17%), but with increased maternal and neonatal morbidity, if proceeded with spontaneous vaginal birth. Duration of second stage is not associated with obstetric anal sphincter injury. Prolonged second stage is not associated with persistent urinary incontinence. Benefits of increased vaginal delivery should be weighed against potential increases in maternal and neonatal risks with prolonged second stage. It is possible to observe prolonged duration of labour with normal vaginal deliveries in a considerable number. But if it is possible to achieve uncomplicated normal vaginal delivery, there will be a smaller number of maternal and neonatal complications. These findings further emphasize the importance of maintaining a close monitoring procedure.

Introduction Miscarriage, is the natural death of an embryo or fetus before it is able to survive independently. 25-30% of pregnancies in Sri Lanka end up with abortions. Increased risk of developing an infection by a pregnant mother following an abortion is the most serious pathological event which can lead to maternal death. Anyhow miscarriages create a huge economical and sociocultural burden which should be addressed in a rational manner. Objectives To describe the pattern and incidence of outcome events following miscarriages among patients who were admitted for post abortion care to the Base Hospital Wathupitiwala, Sri Lanka. Design, Setting and Methods A descriptive cross sectional study was conducted for one year duration among 240 patients admitted to Base Hospital Wathupitiwala following miscarriages. Systematic random sampling technique was applied. Miscarriages due to trauma and patients who had interventional abortions were excluded. Data was collected by using an interviewer administered structured questionnaire. Data was analyzed by using statistical software for social sciences version 22.0. Ethical clearance was obtained from Faculty of Medicine Kelaniya.

Background: A Nosocomial infection is an infection which was not present or was in the incubation period at the time the patient is admitted to the hospital, but occurs within 72 hours after admission. They are potentially caused by organisms that are resistant to antibiotics. Highest prevalence of nosocomial infections is found in intensive care units and also it is one of the leading causes of death in intensive care units. Aims: To describe the prevalence of nosocomial infections and describe the types and distribution of associated factors of nosocomial infections in the intensive care setting of Colombo North Teaching Hospital, Sri Lanka. Methods: A descriptive cross sectional study was conducted among patients admitted to the Intensive Care Unit of Colombo North Teaching Hospital for one year duration from August 2015. Patients who did not have fever spikes 48 hours before the admission were included. Systematic random sampling technique was applied. Data collection was done by using an Interviewer Administered questionnaire and analyzed by SPSS 23.0 statistical software. 95% confidence interval was taken for statistical significance. Results: Prevalence of nosocomial infections in the study sample was 41.58% (N= 42). This male predominant study sample (51.6%), showed a normal distribution of age which ranged from 9 years to 83 years (Mean=51.17: SD=17.98). Acquiring infections did not depend on the sex of the patient. (OR=0.767; 95% CI=0.347-1.695). Mechanical ventilation was identified as a risk factor for acquiring nosocomial infections (OR=1.97; 95 CI%= 0.847-4.58). Using dedicated instruments was identified as a protective measure for nosocomial infections (OR=0.903:95%: CI=0.409-1.994). Risks identified for acquiring nosocomial infections include age above 50 years (OR=1.947:95%: CI=0.838- 4.42) and more than three days stay at the intensive care unit (OR=1.335:95%: CI=0.82- 2.173). Conclusion: Except using dedicated instruments all the associated factors considered in the study were identified as risk factors for nosocomial infections. Using dedicated instruments was recognized as a protective factor for nosocomial infections. Duration of intensive care unit stay and the treatment procedures directly affected the spreading of nosocomial infections. As morbidity and mortality trends of the patients are remarkably increased with nosocomial infections, it is essential to suppress the associated factors and minimize the spread of nosocomial infections.

Background: Congenital Heart diseases are the commonest congenital disease in the world. It requires regular frequent monitoring and necessary adaptations of the life style. Although the clinic services are free for a child with Congenital Heart Disease, attending the clinic generates a significant amount of out of pocket expenses; studying them and associated factors is a timely need. Aims: To describe the Socio-demographic characteristics of families that owns a child less than 5 years of age with congenital heart disease and calculate the out of pocket expenditure of those families for a clinic visit. Methods: A descriptive cross sectional study was conducted among 335 children from September to November 2014. Systematic random sampling technique was applied with an interviewer administered structured questionnaire. Data was analyzed by using SPSS version 23.0 Results: There was a Sinhala Buddhist female predominance, (53.4%) which was not significant. Majority of them were from the central province and were diagnosed during their infancy. Ages of the children varied between 12 to 60 months (Mean37.1:SD14.5). Among them the most common (40.3%) congenital heart disease was Mitral Valve Prolapse (N=135). Twenty three percent of participants had taken support from outside people to attend the clinic but no one had to pay for them. Majority (80.9%) of employed parents could not attend to work on the clinic day and 23% of participants lost their daily income due to the clinic visit. Total income of the families varied from Rs.12,000/= to Rs.80,000/= (Mean=Rs.23759.7: SD=Rs.9026.6). Mean expenditure for clinic visit was Rs1246/= (SD=Rs.650.8). Expenses were not associated with the age (p>0.05), type of the CHD (p>0.05), or gender (p>0.05)

Background: Congenital Heart diseases are the commonest congenital disease in the world. It requires regular frequent monitoring and necessary adaptations of the life style. Although the clinic services are free for a child with Congenital Heart Disease, attending the clinic generates a significant amount of out of pocket expenses; studying them and associated factors is a timely need. Aims: To describe the Socio-demographic characteristics of families that owns a child less than 5 years of age with congenital heart disease and calculate the out of pocket expenditure of those families for a clinic visit. Methods: A descriptive cross sectional study was conducted among 335 children from September to November 2014. Systematic random sampling technique was applied with an interviewer administered structured questionnaire. Data was analyzed by using SPSS version 23.0 Results: There was a Sinhala Buddhist female predominance, (53.4%) which was not significant. Majority of them were from the central province and were diagnosed during their infancy. Ages of the children varied between 12 to 60 months (Mean37.1:SD14.5). Among them the most common (40.3%) congenital heart disease was Mitral Valve Prolapse (N=135). Twenty three percent of participants had taken support from outside people to attend the clinic but no one had to pay for them. Majority (80.9%) of employed parents could not attend to work on the clinic day and 23% of participants lost their daily income due to the clinic visit. Total income of the families varied from Rs.12,000/= to Rs.80,000/= (Mean=Rs.23759.7: SD=Rs.9026.6). Mean expenditure for clinic visit was Rs1246/= (SD=Rs.650.8). Expenses were not associated with the age (p>0.05), type of the CHD (p>0.05), or gender (p>0.05)