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Background. Postmenopausal hirsutism could be due to a myriad of causes, including ovarian and adrenal tumours, ovarian hyperthecosis, exogenous androgens, and Cushing's syndrome. We report a patient who was found to have a rare cause of postmenopausal hirsutism. Case Presentation. A 64-year-old postmenopausal woman with a history of hypertension, thyrotoxicosis, and poorly controlled diabetes on multiple oral hypoglycaemic agents presented with gradual onset progressive excessive hair growth without any virilizing features. On examination, she did not have Cushingnoid features or clitoromegaly. Her hirsutism was quantified with Ferriman–Gallwey score which was 9. Her biochemical evaluation showed elevated testosterone levels with normal DHEAS, ODST, 17-OHP, and prolactin. Low-dose dexamethasone suppression test did not suppress testosterone more than 40%. Contrast-enhanced CT of the adrenal and pelvis did not show any adrenal or ovarian mass lesions. Transvaginal ultrasound scan showed bilateral prominent ovaries only. Combined adrenal and ovarian venous sampling was carried out to localize the source of excess androgen, but only the left adrenal vein was successfully cannulated which showed suppressed testosterone level compared to periphery. The patient underwent total abdominal hysterectomy and bilateral salphingo oophorectomy, and her testosterone level normalized postoperatively. Her glycaemic control improved. Histology showed evidence of bilateral diffuse ovarian Leydig cell hyperplasia. Conclusion. Evaluation of postmenopausal hirsutism needs careful history and examination followed by biochemical evaluation and imaging. While adrenal and ovarian venous sampling can help to arrive at a diagnosis, it is a technically demanding procedure with low success rates even at centers of excellence. Therefore, in such situations, bilateral oophorectomy may be the best course of action which will give the histological confirmation of the diagnosis. Successful treatment of hyperandrogenism can result in improvement of glycaemic control. Bilateral diffuse Leydig cell hyperplasia is a rare but important cause of postmenopausal hirsutism. [ABSTRACT FROM AUTHOR]

Background. Polycystic ovary syndrome (PCOS) is a common endocrine disorder with heterogeneous etiology. Typical features consist of oligo/anovulation, polycystic ovaries, and features of hyperandrogenism. Pathogenesis is multifactorial, and positive family history may have a predisposition for disease development. The syndrome is associated with multiple metabolic and nonmetabolic entities. As the disease is involved with multiple adverse outcomes, the successful treatment is pivotal. Among the more advanced options, the unilateral oophorectomy is considered as a last resort to alleviate the symptoms. Case Presentation. A 29-year-old female presented to us with oligomenorrhea, severe hirsutism, androgenic pattern hair loss, acne, increased skin pigmentation, and secondary subfertility. On examination, she was obese with a body mass index (BMI) of 29.6 kg/m2. She had evidence of acanthosis nigricans, androgenic pattern balding, acne, dorsal, supraclavicular fat deposition, and moderate-severe hirsutism. Investigations confirmed excess right ovarian testosterone secretion which led to the ultimate management with right oophorectomy with successful alleviation of clinical features. Conclusions. The multifaceted medical treatment comprises the first-line therapy in PCOS. Surgery is considered as a second-line option in resistant PCOS following failure of initial therapeutic options. We report a case of resistant polycystic ovary syndrome with secondary subfertility and moderate-to-severe hirsutism who was successfully treated with unilateral oophorectomy with favorable results. [ABSTRACT FROM AUTHOR]

Tourism industry is one of sectors that have potential to develop and grow in the next few years in Sri Lanka. According to Tourism Development Strategy of Sri Lanka, tourism industry is expected to be the largest foreign exchange earner by 2024. The principal focus of this study was to explore major factors that affect women’s participation and non-participation in the hospitality industry in Ella DS division Sri Lanka. The study used a deductive approach, and primary data were collected through a self-administered structured questionnaire. Samples were 60 women, consisting of thirty women involved in the hospitality industry and thirty women of the non-hospitality industry, randomly selected. Results were analyzed using descriptive statistics and inferential statistics. The results found that the differences in language skills and problem-solving had the most significant effect on women’s participation in hospitality industry. Besides, childcare responsibility and lack of experience were affected women’s involvement in this industry. The results also showed that most of the non-hospitality workers have language barriers (33.3%), lack of knowledge about tourism industry (23.3%), and lack of opportunities to engage in tourism work (13.3%). Based on the results, 53.3% of 30 non-hospitality workers had an idea to be involved in tourism and hospitality industry in the future, while the remaining 46.6% had no idea to be involved.

The home remedy of taking honey along with a citrus juice of lemon, lime or calamansi to soothe sore throat has long been practiced in many cultures across the world, since ancient times. This paper aims to systematically review the antibacterial effect of honey and citrus juice on Streptococcus pyogenes by means of a systematic search in EBSCOhost, Medline, Scopus and ISI Web of Science databases for reports of studies investigating the antibacterial effects of honey and citrus fruit juice on S. pyogenes. A total of 415 publications were initially identified, out of which, 20 were finally chosen and reviewed by looking at the tittles, abstracts and full paper using pre-determined inclusion and exclusion criteria in relation to honey (n=16) and citrus (n=4). The majority of the studies showed that both honey and citrus have significant antimicrobial effect on S. pyogenes. There are still not many available data though on the combined effect of honey and citrus on the bacterium. This knowledge gap offers an opportunity to investigate those effects with the purpose of supporting traditional practice with scientific evidences. [ABSTRACT FROM AUTHOR]

This paper attempts to measure the level of success of the dry zone home gardening (HG) program introduced by the government of Sri Lanka among the women. The women used the organic amendments for their HG activities. This study assessed the success of the program and the constraints faced in engaging in home gardening using organic amendments, and solutions to overcome were identified. Using an interviewer administrated structured questionnaire and purposive sampling technique, data were collected from 80 beneficiaries in Thirappane DS division. The results revealed that the beneficiaries were mainly married, unemployed, with no primary education and in more than 50 years’ age category. There was significant relationship between two socio-economic factors, farming factors, reasons to engage in home gardening with organic amendments, and outcomes of the program. Majority of women perceived that all the purposes of the program were successfully achieved. But 91.25 % of women have no idea on farming with organic amendments at large scale. Most influencing reason was the resulting low productivity with organic amendments. To address these solutions, the government should intervene to build the large scale farming with organic amendments in Anuradhapura district.

This research examined the impact of customer’ perceived value on CRM in Business to Business (B2B) agrochemical agribusinesses in Sri Lanka. Customer perceived value was measured by economical value, emotional value and social value based on standard 36 attributes. A total of 110 respondents including distributors and direct dealers engaged in agrochemical marketing covering all island were interviewed. Results were obtained by both descriptive and inferential statistics. Two mediating variables; customer satisfaction and customer loyalty were used to find the impact of customer perceived value on relationship marketing attributes. Findings revealed that dealers perceived slightly higher economical values than emotional values and comparatively low social values. Weaker but positive correlations were found between dealer’s perceived emotional, economic and social values with their satisfaction and customer loyalty. Customer satisfaction and customer loyalty had mediating effects to the relationship of customer perceived value with CRM attributes hence with relationship marketing. The findings provide utilizable model for the agro chemical manufacturing companies to enhance dealer’s perceived value that contribute to higher dealer satisfaction, loyalty hence re-purchase behaviour and long term customer retention.

Abstract Background Chronic airway inflammation and hypersensitivity to bacterial infection may contribute to lung cancer pathogenesis. Previous studies have demonstrated that nontypeable Haemophilus influenzae (NTHi) is the most common colonizing bacteria in the lower airways of patients with COPD. The objective of this study was to determine the presence of NTHi and immunoglobulin concentrations in patients with lung cancer, COPD and controls. Methods Serum and bronchial wash samples were collected from patients undergoing diagnostic bronchoscopy. Total IgE, IgG and specific NTHi IgG were measured by enzyme linked immunosorbent assay. Bronchial wash samples were examined for the presence of NTHi via PCR. Results Out of the 60 patients: 20 had confirmed Lung Cancer, 27 had COPD only and 13 were used as Controls. NTHi was detected in the lower airways of all three groups (Lung Cancer 20%; COPD 22% and Controls 15%). Total IgE was highest in Lung Cancer subjects followed by COPD and control subjects (mean ± SD: 870 ± 944, 381 ± 442, 159 ± 115). Likewise total IgG was higher in Lung cancer (Mean ± SD: 6.99 ± 1.8) patients compared to COPD (Mean ± SD: 5.43 ± 2). Conclusions The lack of difference in NTHi and specific antibodies between the three groups makes it less likely that NTHi has an important pathogenetic role in subjects with Lung Cancer. However the detection of higher IgE antibody in Lung Cancer subjects identifies a possible mechanism for carcinogenesis in these subjects and warrants further study.

Multiple endocrine neoplasia (MEN) type 1 syndrome is an autosomal dominant disorder caused by germline mutations in MEN1 gene, characterized by tumours in endocrine and nonendocrine organs. Giant prolactinoma is defined as tumours larger than 40mm with very high prolactin secretion. We report two unrelated Sri Lankan patients (8-year-old boy and a 20-year-old female) who presented with giant prolactinomas with mass effects of the tumours. The female patient showed complete response to medical therapy, while the boy developed recurrent resistant prolactinoma needing surgery and radiotherapy. During follow-up, both developed pancreatic neuroendocrine tumours. Genetic analysis revealed that one was heterozygous for a nonsense mutation and other for missense mutation in MEN1 gene. Screening confirmed familial MEN-1 syndrome in their families. High clinical suspicion upon unusual clinical presentation prompted genetic evaluation in these patients and detection of MEN1 gene mutation. Pituitary adenomas in children with MEN-1 syndrome are larger tumours with higher rates of treatment resistance. This report emphasizes importance of screening young patients with giant prolactinoma for MEN-1 syndrome and arranging long-term follow-up for them expecting variable treatment outcomes. Sri Lanka requires further studies to describe the genotypic-phenotypic variability of MEN-1 syndrome in this population.

Background: Currently there is a paucity of information about biomarkers that can predict hospitalization for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients presenting to the emergency department (ED). There is limited data on the consistency of ED management of AECOPD with local COPD guidelines. The aim of this study was to identify biomarkers associated with hospitalization in AECOPD patients and to determine if the ED management was concordant with local COPD guidelines. Materials and Methods: We performed a retrospective audit of consecutive AECOPD patients presenting to the Gold Coast Hospital ED over a 6-month period. Results: During the study period, 122 AECOPD patients (51% male, mean age (SE) 71 (±11) years) presented to the ED. Ninety-eight (80%) patients were hospitalized. Univariate analysis identified certain factors associated with hospitalization: Older age, former smokers, home oxygen therapy, weekday presentation, SpO 2 < 92%, and raised inflammatory markers (white cell count (WCC) and C-reactive protein (CRP)). After adjustment for multiple variable, increased age was significantly associated with hospitalization (odds ratio (OR) 1.09; 95% confidence interval (CI): 1.00-1.18; P = 0.05). Radiology assessment and pharmacological management was in accordance with COPD guidelines. However, spirometry was performed in 17% of patients and 28% of patients with hypercapneic respiratory failure received noninvasive ventilation (NIV). Conclusion: We identified several factors on univariate analysis that were associated with hospitalization. Further research is required to determine the utility of these biomarkers in clinical practice. Also, while overall adherence to local COPD guidelines was good, there is scope for improvement in performing spirometry and provision of NIV to eligible patients.

Context: Hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) may be managed by either respiratory specialists (RS) or general medicine physicians (GMP). While previous studies have audited the hospital AECOPD management of RS, only a small number of studies have evaluated the management of GMP. Aims: The aims of this study were to firstly examine the differences in AECOPD management of GMP and RS and secondly compare their care to national COPD guidelines. Methods: A retrospective review was undertaken of consecutive AECOPD patients admitted to two hospitals (one hospital where all AECOPD patients were managed by RS and another where all AECOPD patients were managed by GMP) over a 3-month period. Electronic medical records, medical case notes, pathology and radiology data for the admission were reviewed. Results: There were 201 COPD exacerbations in 169 patients (49.7% male, mean age 72.3). GMP managed 84 (41.7%) exacerbations. In comparison to RS, GMP performed fewer spirometry tests, blood gas analysis and less frequently treated patients with guideline-recommended medications. Referral to pulmonary rehabilitation was poor for both groups of clinicians. Median length of stay was shorter in GMP patients versus RS patients (3 days vs. 5 days, P = 0.001). There were no differences in the 12-month re-admission (41.7% vs. 38.5%, P = 0.664) and mortality rates (10.7% vs. 6%, P = 0.292) between both groups of patients. Conclusion: Our study found differences in the hospital AECOPD management of GMP and RS, but these did not translate into different clinical outcomes between their patients. We also found suboptimal adherence to national COPD guidelines, suggesting that there is scope for improvement in the AECOPD management of both groups of clinicians.

Sri Lanka’s energy policy presumes that the country will be meeting 20% of its energy requirements by non-conventional renewable energy resources by 2020. This study attempts to assess diesel vehicle owners’ willingness to pay (WTP) for Jatropha biodiesel and the factors affecting their decisions. The Contingent valuation method (CVM) was used to elicit the WTP for the non-marketed biodiesel, which leads to a hypothetical allocation. For diesel vehicle users, a single bid approach was used at Rs.121/= per litre (€ 0.83). The study was carried out in Kandy region among diesel vehicle users. The factors affecting WTP were estimated using probit regression and WTP was estimated using nonparametric estimation techniques. The mean WTP for biodiesel by the diesel vehicle users was Rs.109 per litre (€ 0.74) for lower bound levels. The median WTP was Rs.124/= per litre (€ 0.85). Elderly respondents with higher education are less likely to pay for biodiesel in both samples. Married respondents with higher income are more likely to pay higher prices for biodiesel.