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Background: Illicit drug use has become a significant public health problem in Sri Lanka. This study was conducted to assess characteristics and exposure to vulnerable factors for drug use among institutionalized male drug users. Methodology: A cross-sectional study was conducted among 431 institutionalized male drug users from five selected rehabilitation centers in Sri Lanka. An interviewer-administered questionnaire was used for data collection. The history of exposure to vulnerable factors was assessed using a series of questions based on existing evidence. Chi-square test was used to identify factors associated with exposure to vulnerable factors for drug use at 0.05 significance level. Results: Experimental usage, peer pressure, being unaware about harmful outcomes of drug use, ability to conceal drug use behavior from family, easy accessibility, previous use of alcohol and tobacco, history of exposure to psychoactive substance use within the usual living set up, being in a family with inadequate protection and an unsatisfactory parenting status were identified as common characteristics of people with illicit drug use disorders and drug use behavior. The age of the first drug use was positively correlated with the age of the first alcohol use (r = 0.687; P < 0.01) and first smoking (r = 0.732; P < 0.01). Ethnicity, area of residence, severity of drug use, and age of initiation of drug use had statistically significant association with exposure to vulnerable factors for drug use (P < 0.05 for all). Conclusion: Characteristics of people with illicit drug use disorders and drug use behavior were varied while the history of exposure to vulnerable factors for drug use was not uncommon in the sample. The study recommends considering these study findings during designing appropriate preventive and harm reduction strategies for illicit drug use.

Sugar is one of the main ingredients in sugar-sweetened beverages (SSBs): a major contributor to added sugar intake in the diet. Excess consumption of added sugars can adversely affect human health mainly by contributing to non-communicable diseases. Information related to sugar content is usually declared on an SSB product in the section titled ingredients, nutrition information panel, non-addition claim and in front-of-pack labelling (FOPL). Various countries have implemented laws to disclose sugar-related information in SSBs. The aim of this research is to assess sugar labelling requirements for SSBs in Sri Lanka against international Codex standards and sugar labelling requirements in Australia. A doctrinal review was conducted based on legal related literatures. Both Sri Lankan and Australian legislations as well as Codex standards have provisions on ingredients and claims. FOPL is compulsory for Sri Lankan law for selected sugar sweetened beverages. FOPL is neither recommended by Codex currently nor made compulsory by Australian law; however, Australia does have a voluntary code in that regard. NIP, a compulsory requirement in codex standards is mandatory in Australian food label; whereas, it is not mandatory in Sri Lanka. Introducing legal provisions on nutrition information panel would not only align Sri Lankan law with international standards and jurisdictions but also contribute to the control of non-communicable diseases. Highlighting the sugar content raw in the NIP of SSB with ‘high sugar’ in red colour would further improve the expected outcome. Furthermore, more legal clarity will be achieved in Sri Lanka by adding definitions to terms ‘ingredient’ and ‘non-addition claim’.

Abstract Background Spatial and temporal changes in the dengue incidence are associated with multiple factors, such as climate, immunity among a population against dengue viruses (DENV), circulating DENV serotypes and vertical transmission (VT) of DENV in an area at a given time. The level of VT in a specific location has epidemiological implications in terms of viral maintenance in vectors. Identification of the circulating DENV serotypes in both patients and Aedes mosquito larvae in an area may be useful for the early detection of outbreaks. We report here the results of a prospective descriptive study that was conducted to detect the levels of VT in Aedes mosquito larvae and circulating DENV serotypes in patients and Aedes mosquito larvae from December 2015 to March 2017 in an area of Sri Lanka at high risk for dengue. Methods A total of 200 patients with clinically suspected dengue who had been admitted to a tertiary care hospital during a dengue outbreak (3 study periods: December 2015–January 2016, June–August 2016, December 2016–January 2017) and in the inter-outbreak periods (February–May 2016 and September–November 2016) were investigated. Blood samples were drawn from the study participants to test for DENV. The houses of the study participants were visited within 7 days of admission to the hospital, and Aedes larvae were also collected within a radius of 400 m from the houses. The larvae were separately identified to species and then pooled according to each patient’s identification number. Patients’ sera and the Aedes larvae were tested to identify the infecting DENV serotypes using a reverse transcription PCR (RT-PCR) method. Levels of VT in Aedes mosquito larvae were also identified. Results All four DENV serotypes (DENV-1 to -4) were identified in the study area. In the early part of the study (December 2015–February 2016), DENV-3 was predominant and from April 2016 to March 2017, DENV-2 became the most predominant type. Four cases of DENV co-infections were noted during the study period in patients. Interestingly, all four DENV serotypes were detected in Aedes albopictus larvae, which was the prominent immature vectorial form identified throughout the study period in the area, showing 9.8% VT of DENV. With the exception of DENV-4, the other three DENV serotypes were identified in Aedes aegypti larvae with a VT of 8.1%. Conclusion Comparatively high rates of VT of DENV was detected in Ae. albopictus and Ae. aegypti larvae. A shift in the predominant DENV serotype with simultaneous circulation of all four DENV serotypes was identified in the study area from December 2015 to March 2017. Graphical Abstract

In protected areas (PAs) designated for the conservation of biodiversity, temporal landscape changes do occur, driven by natural and anthropogenic factors. Such changes may impact on the conservation value of the PA. In a wildlife PA, changes in habitat extents could adversely affect some of the faunal species. Our objective was to assess temporal changes in the cover of three major habitat types in the Udawalawe National Park (UWNP) that have occurred over a short term. Based on the outcome, we aimed to determine the potential impacts such changes would have on the wildlife. Considering that UWNP was established primarily for conserving the nationally threatened and flagship species Elephas maximus, we carried out field studies and decided on three relevant habitat types - forest, scrub, and grassland. We used multi-temporal satellite images with ground truthing for assessing habitat extents in the years 2005, 2010, 2015, and 2019. Habitat cover maps were prepared using supervised classification and changes in the extents of the selected habitats were assessed. Between 2005 and 2019, the areas under forest and scrub had increased. The grassland has considerably decreased, mainly owing to invasion by scrub. Grassland depletion adversely impacts the elephant whose preferred food is grass and the high population of elephants in UWNP aggravates the situation. Depletion of food resources within the park would also lead to an increase in the human-elephant conflicts in border villages. Thus, in this study we highlight the importance of monitoring temporal changes in habitat cover in order to manage the PA and the inhabiting wild elephants.

Usual type necrosis (UN) and infarct like necrosis (ILN) occur in CRLMs. ILN is a rare form of necrosis in colorectal liver metastases which is usually seen following chemotherapy. De novo occurrence of ILN is a very rare phenomenon. ILN in CRLM without adjuvant chemotherapy following colorectal resection was not described previously. We describe the presence of complete ILN in a solitary metachronous liver metastasis from right colonic adenocarcinoma without prior chemotherapy.

The development flows signs renewed foreign interest in the stock market during mid-2017, recording an all-time high in foreign purchases. With the realization of investment opportunities and potential in capital markets in Sri Lanka, foreign investors actively participated in trading in CSE making volatility in Foreign Portfolio Investment (FPI), which lead the researcher to investigate the determinants of FPI under company performance (ROA, ROE and OPM), market-specific factors (MC, MI and BETA), earnings quality (EQ) measured by total accruals (TA) and macro-economic variables (IR and GDP) using evidence from Sri Lanka. Using the three dependent variables of TNFP, TFP, and TFS the researcher analyzed quarterly data for the period from 2011 to 2016 under panel data regression model and concluded, ROE, MC, MI, BETA, GDP Growth and IR has a significant relationship with foreign portfolio investment where the results suggested earnings quality does not have any impact on foreign portfolio investment. The findings of the study are especially useful for potential investors, regulators and the interested parties of investment decisions.

Iliopsoas abscess (IPA) is a collection of pus in the iliopsoas muscle. It is rare and usually presents with vague symptoms. IPA can be either primary or secondary. An IPA was diagnosed by computed tomography (CT) in a 64-year-old male with diabetes mellitus and chronic kidney disease (CKD) who presented with a limp. Pus specimen from IPA yielded non-lactose fermenting Escherichia coli which is rarely isolated from IPA. The isolate was sensitive to meropenem and treated with intravenous meropenem for 4 weeks. Source control was achieved by ultrasound scan-guided aspiration of the abscess.

Introduction: The food industry is an ever-growing industry. Food advertising is its main marketing strategy. The majority of food that advertising the children are exposed to is unhealthy products, thus promoting unhealthy food and beverages and contributing to an increase in the burden of diet-related noncommunicable diseases. Therefore, restrictions on unhealthy food advertisements via government regulations are necessary to promote public health. Objectives: To analyses the main food advertisement law in Sri Lanka and compares it to laws relevant to food advertising in other national jurisdictions Methods: A desk review of laws associated with food advertisements in Sri Lanka was conducted, followed by a comparative review of food advertisement laws in nine other national jurisdictions. Results: Sri Lanka does not have a single advertisement law, and most legal provisions on food advertising are merged into labelling regulations. When compared to other jurisdictions, Sri Lankan definition of food advertisement is narrow, and the regulatory regime does not have strict restrictions on the timing of advertising; target Sri Lankan group; type of food advertised; content of advertising; and health messages. The law also lacks a comprehensive suite of enforcement options. Conclusions & Recommendations: Sri Lankan Food Advertising Regulations contain weak restrictions on unhealthy food marketing to children when compared to other jurisdictions globally. It is recommended that the government should publish separate Food (Advertising) Regulations under the Food Act of 1980 which would include provisions on the timing of advertising; target group; type of food advertised; health messages; and enforcement measures such as penalties and warnings, while also revising the existing narrow definition of food advertisement.

Shinsuke Kitazawa, Ashoka Indranatha Wijesinghe, Naoki Maki, Takahiro Yanagihara, Yusuke Saeki, Naohiro Kobayashi, Shinji Kikuchi, Yukinobu Goto, Hideo Ichimura, Yukio Sato Department of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, JapanCorrespondence: Yukio SatoDepartment of General Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki, 305-8575, JapanTel +81 29 853 3210Fax +81 29 853 7991Email ysato@md.tsukuba.ac.jpPurpose: In performing surgery for lung cancer, emphysema is a risk factor related to postoperative respiratory complications (PRC). However, few studies have addressed the risk of radiological emphysematous volume affecting PRC. The aim of this study was to investigate the relationship between emphysematous volume as measured on 3-dimensional computed tomography and PRC.Patients and Methods: We reviewed 342 lung cancer patients undergoing lobectomy between 2013 and 2018. The percentage of low attenuation area (LAA%) was defined as the percentage of the lung area showing attenuation of − 950 Hounsfield units or lower. Preoperative factors including age, sex, body mass index, smoking index, respiratory function, tumour histology, and LAA% were evaluated. PRC included pneumonia, atelectasis, prolonged air leakage, empyema, hypoxia, ischemic bronchitis, bronchopleural fistula, and exacerbation of interstitial pneumonia. Uni- and multivariable analyses were performed to investigate the relationship between independent clinical variables and postoperative adverse events.Results: Median LAA% was 5.0% (range, 0– 40%) and PRC was observed in 50 patients (14.6%). Patients who presented with PRC showed significantly high LAA% compared to those without complications (median: 8.1% vs 3.8%; p < 0.001). Based on univariable analysis, age, sex, smoking index, percentage of forced expiratory volume in 1 s (FEV1.0%), histology, and LAA% were significant predictors for PRC. Multivariable analysis revealed higher LAA% as a significant risk factor for PRC (odds ratio = 1.040; 95% confidence interval, 1.001– 1.080; p = 0.046).Conclusion: In addition to respiratory function with spirometry, LAA% can be used as a predictor of PRC.Keywords: lung cancer, emphysema, radiology and other imaging, respiratory function tests, thoracic surgery

BackgroundOur understanding of the global scale of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection remains incomplete: Routine surveillance data underestimate infection and cannot infer on population immunity; there is a predominance of asymptomatic infections, and uneven access to diagnostics. We meta-analyzed SARS-CoV-2 seroprevalence studies, standardized to those described in the World Health Organization's Unity protocol (WHO Unity) for general population seroepidemiological studies, to estimate the extent of population infection and seropositivity to the virus 2 years into the pandemic.Methods and findingsWe conducted a systematic review and meta-analysis, searching MEDLINE, Embase, Web of Science, preprints, and grey literature for SARS-CoV-2 seroprevalence published between January 1, 2020 and May 20, 2022. The review protocol is registered with PROSPERO (CRD42020183634). We included general population cross-sectional and cohort studies meeting an assay quality threshold (90% sensitivity, 97% specificity; exceptions for humanitarian settings). We excluded studies with an unclear or closed population sample frame. Eligible studies-those aligned with the WHO Unity protocol-were extracted and critically appraised in duplicate, with risk of bias evaluated using a modified Joanna Briggs Institute checklist. We meta-analyzed seroprevalence by country and month, pooling to estimate regional and global seroprevalence over time; compared seroprevalence from infection to confirmed cases to estimate underascertainment; meta-analyzed differences in seroprevalence between demographic subgroups such as age and sex; and identified national factors associated with seroprevalence using meta-regression. We identified 513 full texts reporting 965 distinct seroprevalence studies (41% low- and middle-income countries [LMICs]) sampling 5,346,069 participants between January 2020 and April 2022, including 459 low/moderate risk of bias studies with national/subnational scope in further analysis. By September 2021, global SARS-CoV-2 seroprevalence from infection or vaccination was 59.2%, 95% CI [56.1% to 62.2%]. Overall seroprevalence rose steeply in 2021 due to infection in some regions (e.g., 26.6% [24.6 to 28.8] to 86.7% [84.6% to 88.5%] in Africa in December 2021) and vaccination and infection in others (e.g., 9.6% [8.3% to 11.0%] in June 2020 to 95.9% [92.6% to 97.8%] in December 2021, in European high-income countries [HICs]). After the emergence of Omicron in March 2022, infection-induced seroprevalence rose to 47.9% [41.0% to 54.9%] in Europe HIC and 33.7% [31.6% to 36.0%] in Americas HIC. In 2021 Quarter Three (July to September), median seroprevalence to cumulative incidence ratios ranged from around 2:1 in the Americas and Europe HICs to over 100:1 in Africa (LMICs). Children 0 to 9 years and adults 60+ were at lower risk of seropositivity than adults 20 to 29 (p < 0.001 and p = 0.005, respectively). In a multivariable model using prevaccination data, stringent public health and social measures were associated with lower seroprevalence (p = 0.02). The main limitations of our methodology include that some estimates were driven by certain countries or populations being overrepresented.ConclusionsIn this study, we observed that global seroprevalence has risen considerably over time and with regional variation; however, over one-third of the global population are seronegative to the SARS-CoV-2 virus. Our estimates of infections based on seroprevalence far exceed reported Coronavirus Disease 2019 (COVID-19) cases. Quality and standardized seroprevalence studies are essential to inform COVID-19 response, particularly in resource-limited regions.

Introduction Health systems resilience is the ability to prepare, manage and learn from a sudden and unpredictable extreme change that impacts health systems. Health systems globally have recently been affected by a number of catastrophic events, including natural disasters and infectious disease epidemics. Understanding health systems resilience has never been more essential until emerging global pandemics. Therefore, the application of resilience-enhancing strategies needs to be assessed to identify the management gaps and give valuable recommendations from the lessons learnt from the global pandemic.Methods The systematic review will be reported using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA-P) protocols guideline. Reporting data on World Health Organization (WHO) health system building blocks and systematic searches on resilience enhancing strategies for the management of Public Health Emergencies of International Concerns (PHEIC) after the establishment of International Health Regulations (IHR) in 2007 will be included. The search will be conducted in PubMed, Scopus, Web of Science and Google ScholarEthics and dissemination Ethics approval and safety considerations are not applicable. Pre-print of the protocol is available online, and the screening of the articles will be done using Rayyan software in a transparent manner. The findings will be presented at conferences and the final review’s findings will be published in a peer-reviewed international journal and will be disseminated to global communities for the application of successful management strategies for the management of future pandemics.PROSPERO registration number CRD42022352612; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022352612

Dengue is a major viral disease affecting the tropics. Although previous research has focused on the relationship between the infecting dengue virus (DENV) serotypes and disease severity, less work has been done on the relationship between the clinical and laboratory features and the infecting DENV serotypes in Sri Lanka. We evaluated the relationship between the clinical and laboratory features and the infecting DENV serotypes in adult patients with clinically suspected dengue admitted to the Base Hospital, Mawanella, Sri Lanka from December 2015 to March 2017.Blood samples of 200 dengue suspected patients were tested for the infecting DENV serotypes using a reverse transcription polymerase chain reaction with primers targeting the envelope region of the virus. Relationship between the infecting DENV serotypes with clinical and laboratory features was assessed using Z score and paired t tests.Of the 200 patients tested, 39 (19.5%) were positive for DENV, any of the four DENV serotypes alone or in combination. The highest number of infections was noted with DENV-2 (n=18, 46.1%). Fever (P=0.000) and rash (P=0.017) were frequently noted in DENV negative patients while bleeding (P=0.012) was more frequently noted in DENV serotype positive patients. Platelet count of 13mgdl−1 (P=0.016) were noted in 15 of the 18 DENV-2 positive patients.Clinical and laboratory features of severe dengue with bleeding manifestations, low platelet counts and high Hb were noted in DENV-2 infections.

Extracellular vesicles are mediators of intercellular communication with critical roles in cellular senescence and ageing. In arthritis, senescence is linked to the activation of a pro-inflammatory phenotype contributing to chronic arthritis pathogenesis. We hypothesised that senescent osteoarthritic synovial fibroblasts induce senescence and a pro-inflammatory phenotype in non-senescent osteoarthritic fibroblasts, mediated through extracellular vesicle cargo. Small RNA-sequencing and mass spectrometry proteomics were performed on extracellular vesicles isolated from the secretome of non-senescent and irradiation-induced senescent synovial fibroblasts. β-galactosidase staining confirmed senescence in SFs. RNA sequencing identified 17 differentially expressed miRNAs, 11 lncRNAs, 14 tRNAs and one snoRNA and, 21 differentially abundant proteins were identified by mass spectrometry. Bioinformatics analysis of miRNAs identified fibrosis, cell proliferation, autophagy, and cell cycle as significant pathways, tRNA analysis was enriched for signaling pathways including FGF, PI3K/AKT and MAPK, whilst protein analysis identified PAX3-FOXO1, MYC and TFGB1 as enriched upstream regulators involved in senescence and cell cycle arrest. Finally, treatment of non-senescent synovial fibroblasts with senescent extracellular vesicles confirmed the bystander effect, inducing senescence in non-senescent cells potentially through down regulation of NF-κβ and cAMP response element signaling pathways thus supporting our hypothesis. Understanding the exact composition of EV-derived small RNAs of senescent cells in this way will inform our understanding of their roles in inflammation, intercellular communication, and as active molecules in the senescence bystander effect.

Two NIR-emitting donor-π-acceptor (D-π-A) type regioisomeric styryl pyridinium dyes (1a–1b) were synthesized and studied for their photophysical performance and environment sensitivity. The two regioisomers, 1a and 1b, exhibited interesting photophysical properties including, longer wavelength excitation (λex ≈ 530–560 nm), bright near-infrared emission (λem ≈ 690–720 nm), high-fluorescence quantum yields (ϕfl ≈ 0.24–0.72) large Stokes’ shift (∆λ ≈ 150–240 nm) and high-environmental sensitivity. Probe’s photophysical properties were studied in different environmental conditions such as polarity, viscosity, temperature, and concentration. Probes (1a–1b) exhibited noticeable changes in absorbance, emission and Stokes’ shift while responding to the changes in physical environment. Probe 1b exhibited a significant bathochromic shift in optical spectra (∆λ ≈ 20–40 nm) compared to its isomer 1a, due to the regio-effect. Probes (1a–1b) exhibited an excellent ability to visualize bacteria (Bacillus megaterium, Escherichia coli), and yeast (Saccharomyces cerevisiae) via fluorescence microscopy.

Abstract Background Androgen receptor (AR) expression is emerging as a prognostic biomarker in breast carcinoma (BCa). The study aimed to determine the prevalence of AR expression by immunohistochemical analysis among a cohort of Sri Lankan women with early BCa and to evaluate its association with clinicopathological features including immunohistochemical molecular subtype and early survival. Method We studied the clinical and pathological features and immunohistochemical profile of 141 women undergoing primary surgery for early BCa, followed by standard adjuvant therapy. AR status was assessed by immunohistochemistry in all cases. Overall survival (OS) and disease-free survival (DFS) was determined. The relationship between AR expression and clinical and pathological parameters and immunohistochemical molecular subtype was analyzed using Student T test and chi-square tests. Cox regression analysis was used to analyze the prognostic impact of AR expression. Results AR expression was seen in 40.8%(95%CI 33.10–49.07%) of the BCa study cohort. None of the clinical data studied showed a significant association with the AR status(p > 0.05). Ductal carcinoma in situ(p = 0.003), oestrogen receptor (ER) (p = 0.001) and progesterone receptor (PR) (p = 0.001) positivity and luminal IHC molecular subtype(p = 0.016) were significantly associated with AR-positive status. AR-negative status was significantly associated with tumour necrosis > 50%(p = 0.031), moderate to extensive lymphocytic infiltrate at the tumour margin(p = 0.025) and basal triple negative breast carcinoma(p = 0.016). The mean duration of patient follow-up was 46.70(95% CI 46.495–46.905) months (3.89 years). On univariate analysis, AR-positivity was associated with better OS among ER-positive tumours(p = 0.047), specifically in postmenopausal women (p = 0.030). In ER-negative tumours, AR positivity was associated with worse DFS (p = 0.036). On multivariate analysis, TNM stage and ER/AR status were predictive of survival. ER-positive/AR-positive (ER+/AR+) tumours demonstrated better OS than ER-positive/AR-negative (ER+/AR-) tumours(p = 0.015). ER-negative/AR-positive (ER−/AR+) tumours (p = 0.014) had a worse DFS than ER-negative/AR-negative (ER−/AR-) tumours. Conclusions AR prevalence obtained was low. AR positivity was associated with positivity for ER and PR. On multivariate analysis, apart from TNM stage only ER/AR status were predictive of OS and DFS, with concordant expression of ER/AR demonstrating a better, early survival.

Background: Triple negative breast carcinoma (TNBC) and basal-like breast carcinoma (BLBC) are subtypes of breast carcinoma (BCa) that are associated with poor survival. Aims: To study the prevalence, clinicopathological profile and survival of TNBC among a Sri Lankan patient cohort and to determine the proportion and predictive histological features of BLBC among TNBCs. Study Setting and Design: A cohort of 221 women undergoing primary surgery for BCa at a tertiary-care center in Sri Lanka was studied. Materials and Methods: Clinicopathological and follow-up information were collected by patient interviews and review of slides and clinical records. Estrogen, progesterone, HER2 receptors, and basal markers (CK5/6, CK14, EGFR, 34βE12) were evaluated immunohistochemically. Statistical Analysis: Data was analyzed with Chi-square test, multinomial logistic regression, and Cox regression using SPSS20.0. Results: Fifty-three (24%) tumors were triple-negative (95%CI = 18.37%–29.63%). On multivariate analysis, young age (P = 0.002), high Nottingham grade (P = 0.005), moderate to severe tumor necrosis (P = 0.004), absent ductal carcinoma in situ (DCIS) (P = 0.04), reduced vascular density at tumor edge (P = 0.016) and distinct cell margins (P = 0.047) predicted TNBC over luminal subgroups, whereas reduced vascular density (P = 0.004) and low TNM stage (P = 0.011) distinguished TNBC and HER2. BLBC accounted for 45.28% (95%CI 32.66%–58.55%-24/53) of TNBC. The presence of extensive necrosis in TNBC correlated significantly with BLBC (P = 0.03). The survival among the TNBC subgroup did not differ significantly from other subgroups. Conclusion: Twenty four percent were TNBCs by immunohistochemical analysis, comparable to studies in the Indian subcontinent, however higher than the West. TNBC status correlated with younger age, high tumor grade, necrosis, absent DCIS, reduced vascular density at tumor edge, and distinct cell margins. The presence of moderate to extensive necrosis in TNBC was predictive of BLBC.

Introduction: Both the curative and preventive sectors of the health system provide services to leprosy patients in Sri Lanka. Identification of the needs and gaps of service delivery would help to redesign the leprosy control activities in the country. Objectives: To assess healthcare service provision to adult leprosy patients in Western Province Methods: A descriptive cross-sectional study was conducted in 12 hospital dermatology clinics and 22 medical officer of health (MOH) offices in the Western Province. The sample was selected through a stratified random sampling method. A pretested checklist was used as the study instrument. Data were gathered by observations, interviewing hospital and MOH office staff. Results: Overall service provision was satisfactory in all selected hospitals. All the hospitals' scores were above 75% indicating an overall satisfactory service provision in all categories of hospitals in the province. However, many deficiencies were identified in the service provision in individual hospitals in selected areas. In 2017, Colombo District had the highest number of leprosy cases (n=157). Case distribution in Western Province showed that Moratuwa (n=88), Negombo (n=31) and Beruwala (n=43) MOH areas had the highest number of cases in the Colombo, Gampaha and Kalutara Districts, respectively. Considering the maintenance of the registers and records of the 22 MOH offices surveyed, most (n=15; 68.2%) of the areas satisfactorily maintained their records. Contact tracing and health education were the main deficiencies identified. Conclusions & Recommendations: Service provision was satisfactory in dermatology clinics. Unsatisfactory record-keeping in some MOH areas was found, while delay in case investigations, poor health education and contact tracing coverage were found in many MOH areas. MOH areas with poor performances should be closely monitored by the supervising officers to ensure the quality of service provision.

Here the authors show in a large cohort of healthcare workers that one dose of the AZD1222 vaccine seroconverts 92.9% of vaccinees, irrespective of age and gender, and results in high antibody titers to wild-type SARS-CoV-2 but only low titers to the B.1.351 variant.

Introduction: Despite much research on chronic kidney disease of uncertain etiology (CKDu) in Sri Lanka and the Mesoamerican nephropathy, the etiology and pathogenesis of this disease remains elusive. The pathology has broadly been described as chronic tubulointerstitial nephritis and no specific signature lesions have been identified. Methods: A scoping review was conducted through MEDLINE and Google Scholar databases for peer-reviewed publications on biopsy studies related to CKDu – Sri Lanka and Mesoamerican nephropathy to develop a comparative and critical analysis of the renal pathology found in these patients. Results: Thirteen studies met the selection criteria. Interstitial fibrosis was the predominant lesion in all the studies. Tubulointerstitial and glomerular abnormalities showed a more variable distribution. No characteristic histopathological feature was reported other than a proximal tubular lysosomal inclusion body which was claimed to indicate a toxic etiology. Three main pathogenetic mechanisms were postulated: repeated acute insults leading to scarring, low-grade chronic insults leading to non-inflammatory fibrosis, and tubulointerstitial damage in combination with glomerular injury. The main limitations in the interpretation and comparative analysis of these studies were the heterogeneity in case selection and biopsy reporting. Conclusions: Although no characteristic histopathological feature could be found in CKDu–Sri Lanka or Mesoamerican nephropathy, there are noticeable differences between these two groups in the frequency and severity of the glomerular and tubulointerstitial changes which warrant more explorative studies preferably on kidneys in early stages of the disease. Future strategies should ensure that more uniform selection criteria and reporting methods are used.

Objective(s): The essential oil (EO) extracted from Cinnamomum verum leaves has been used as an antimicrobial agent for centuries. But its antifungal and antibiofilm efficacy is still not clearly studied. The objective of this research was to evaluate the in vitro antifungal and antibiofilm efficacy of C. verum leaf EO against C. albicans, C. tropicalis, and C. dubliniensis and the toxicity of EO using an in vitro model.Materials and Methods: The effect of EO vapor was evaluated using a microatmosphere technique. CLSI microdilution assay was employed in determining the Minimum Inhibitory (MIC) and Fungicidal Concentrations (MFC). Killing time was determined using a standard protocol. The effect of EO on established biofilms was quantified and visualized using XTT and Scanning Electron Microscopy (SEM), respectively. Post-exposure intracellular changes were visualized using Transmission Electron Microscopy (TEM). The toxicological assessment was carried out with the Human Keratinocyte cell line. The chemical composition of EO was evaluated using Gas Chromatography-Mass Spectrometry (GC-MS).Results: All test strains were susceptible to cinnamon oil vapor. EO exhibited MIC value 1.0 mg/ml and MFC value 2.0 mg/ml against test strains. The killing time of cinnamon oil was 6 hr. Minimum Biofilm Inhibitory Concentration (MBIC50) for established biofilms was Conclusion: C. verum EO is a potential alternative anti-candida agent with minimal toxicity on the human host.

Identification and quantification of environmental and socio-economic impact risks and effective monitoring of water projects are crucial for sustainable water resource management. Hence, the present study was conducted with the objectives of identifying potential environmental risks of different stages of the development of a new water supply scheme located in the wet zone of Sri Lanka, and categorizing identified impacts based on their significance. A rapid environmental assessment (REA) was followed to identify the upstream point source pollution and downstream water uses in the immediate catchment. Subsequently, a semi quantitative approach was conducted to screen the environmental, social, and economic risks concerning likelihood and sensitivity of the impact. Besides, an analysis of physico-chemical and biological parameters of water quality was conducted in the intake location. The semi quantitative method highlighted that low and medium risk with ecological impacts (50%), low risks towards sustainability of water source (75%), medium level constructional impacts (60%), and very high-level impacts at the operational stage were available (50%). A water quality monitoring program revealed that Escherichia coli count, total coliform bacterial count, and colour of the water were above the standard limits in the nearby freshwater source. In conclusion, a similar approach can be implemented worldwide as a reference to determine the potential socio-environmental consequences in water supply projects to minimize the adverse impacts. Through this study, sustainable mitigation measures were proposed accordingly to prevent the impacts and to strengthen the long-term viability of the new Rural Water Supply Scheme. HIGHLIGHTS The safety of drinking water is an ongoing concern within the world.; To reach the targets of safe drinking water, sanitation services should be strengthened.; Identifying potential environmental risks of new water supply projects is crucial for sustainable water resource management.; Rapid environmental assessment and semi quantitative approaches can be applied to screen the socio-economic and environmental risks of water sanitization projects.; Results revealed 50% of ecological, 60% constructional impacts, and 50% operational stage impacts.; Implementing a sustainable environment plan is vital to control environmental impacts.;

The spatial presentation of mechanical information is a key parameter for cell behavior. We have developed a method of polymerization control in which the differential diffusion distance of unreacted cross-linker and monomer into a prepolymerized hydrogel sink results in a tunable stiffness gradient at the cell-matrix interface. This simple, low-cost, robust method was used to produce polyacrylamide hydrogels with stiffness gradients of 0.5, 1.7, 2.9, 4.5, 6.8, and 8.2 kPa/mm, spanning the in vivo physiological and pathological mechanical landscape. Importantly, three of these gradients were found to be nondurotactic for human adipose-derived stem cells (hASCs), allowing the presentation of a continuous range of stiffnesses in a single well without the confounding effect of differential cell migration. Using these nondurotactic gradient gels, stiffness-dependent hASC morphology, migration, and differentiation were studied. Finally, the mechanosensitive proteins YAP, Lamin A/C, Lamin B, MRTF-A, and MRTF-B were analyzed on these gradients, providing higher-resolution data on stiffness-dependent expression and localization.

Rupture of an infectious intracranial aneurysm causing subarachnoid haemorrhage is a rare complication of infective endocarditis. We report a case of subarachnoid haemorrhage that occurred as a late complication, in an infective endocarditis patient, on the 30th day of successful treatment, which is an extremely rare occurrence. He was a mainline drug addict with a history of rheumatic valvular heart disease.

Introduction: Sensorineural hearing loss (SNHL) is a prevalent sensory deficit presenting commonly as age-related hearing loss. Other forms of SNHL include noise-induced and sudden SNHL. Recent evidence has pointed to oxidative stress as a common pathogenic pathway in most subtypes of acquired SNHL. MicroRNAs (miRNAs) are small non-coding RNA sequences that suppress target mRNA expression and affect downstream processes. Many studies have shown that miRNAs are integral biomolecules in hypoxia-adaptive responses. They also promote apoptosis in response to oxidative stress resulting in SNHL. Our hypothesis is that miRNAs are involved in the pathophysiological responses to hypoxia and oxidative stress that result in SNHL. This study reviews the evidence for hypoxia-adaptive miRNAs (hypoxamiRs) in different types of acquired SNHL and focuses on miRNAs involved in hypoxia driven SNHL.Methods: Electronic bibliographic databases PubMed, Ovid MEDLINE, Ovid EMBASE, and Web of Science Core Collection were searched independently by two investigators for articles published in English from the inception of individual databases to the end of July 2020. The text word or medical subject heading searches of all fields, titles, abstracts, or subject headings depending on the database were undertaken with combinations of the words “microRNAs”, “hypoxia”, “hypoxamiRs”, “oxidative stress”, “ischemia” and “hearing loss”. The reference lists of studies meeting the inclusion criteria were searched to identify additional relevant studies. The inclusion criteria included relevant clinical studies with human subjects, animals, and in vitro experiments. The risk of bias was assessed using the Cochrane risk of bias assessment tool for human studies and the Systematic Review Center for Laboratory animal Experimentation (SYRCLE) a risk of bias assessment tool for animal model and in vitro studies.Results: A total of 15 primary articles were selected for full text screening after excluding duplicates, reviews, retracted articles, and articles not published in English. All nine articles meeting the study inclusion criteria were from animal or in vitro model studies and were assessed to be at low risk of bias. miRNAs miR-34a and miR-29b were reported to be involved in SNHL in inner ear cell models exposed to oxidative stress. Signaling pathways Sirtuin 1/peroxisome proliferator-activated receptor gamma coactivator-1-alpha (SIRT1/PGC-1α), SIRT1/p53, and SIRT1/hypoxia-inducible factor 1-alpha (HIF-1α) were identified as underlying pathways involved in acquired SNHL.Conclusion: There is evidence that miR-34a and -29b are involved in hypoxia-driven and other causes of oxidative stress-related acquired SNHL. Further studies are required to determine if these findings are clinically applicable.

BackgroundThe worst SARS-CoV-2 outbreak in Sri Lanka was due to the two Sri Lankan delta sub-lineages AY.28 and AY.104. We proceeded to further characterize the mutations and clinical disease severity of these two sub-lineages.Methods705 delta SARS-CoV-2 genomes sequenced by our laboratory from mid-May to November 2021 using Illumina and Oxford Nanopore were included in the analysis. The clinical disease severity of 440/705 individuals were further analyzed to determine if infection with either AY.28 or AY.104 was associated with more severe disease. Sub-genomic RNA (sg-RNA) expression was analyzed using periscope.ResultsAY.28 was the dominant variant throughout the outbreak, accounting for 67.7% of infections during the peak of the outbreak. AY.28 had three lineage defining mutations in the spike protein: A222V (92.80%), A701S (88.06%), and A1078S (92.04%) and seven in the ORF1a: R24C, K634N, P1640L, A2994V, A3209V, V3718A, and T3750I. AY.104 was characterized by the high prevalence of T95I (90.81%) and T572L (65.01%) mutations in the spike protein and by the absence of P1640L (94.28%) in ORF1a with the presence of A1918V (98.58%) mutation. The mean sgRNA expression levels of ORF6 in AY.28 were significantly higher compared to AY.104 (p < 0.0001) and B.1.617.2 (p < 0.01). Also, ORF3a showed significantly higher sgRNA expression in AY.28 compared to AY.104 (p < 0.0001). There was no difference in the clinical disease severity or duration of hospitalization in individuals infected with these sub lineages.ConclusionsTherefore, AY.28 and AY.104 appear to have a fitness advantage over the parental delta variant (B.1.617.2), while AY.28 also had a higher expression of sg-RNA compared to other sub-lineages. The clinical implications of these should be further investigated.

Abstract Background To determine the kinetics and persistence of immune responses following the Sinopharm/BBIBP‐CorV, we investigated immune responses in a cohort of Sri Lankan individuals. Methods SARS‐CoV‐2 specific total antibodies were measured in 20–39 years (n = 61), 40–59 years (n = 120) and those >60 years of age (n = 22) by enzyme‐linked immunosorbent assay, 12 weeks after the second dose of the vaccine. Angiotensin‐converting enzyme 2 (ACE2) receptor blocking antibodies (ACE2R‐Ab), antibodies to the receptor‐binding domain (RBD) of the ancestral virus (WT) and variants of concern, were measured in a sub cohort. T cell responses and memory B cell responses were assessed by ELISpot assays. Results A total of 193/203 (95.07%) of individuals had detectable SARS‐CoV‐2 specific total antibodies, while 67/110 (60.9%) had ACE2R‐Ab. A total of 14.3%–16.7% individuals in the 20–39 age groups had detectable antibodies to the RBD of the WT and variants of concern, while the positivity rates of those ≥60 years of age was

The COVID-19 pandemic caused by SARS-CoV-2 is associated with a lower fatality rate than its SARS and MERS counterparts. However, the rapid evolution of SARS-CoV-2 has given rise to multiple variants with varying pathogenicity and transmissibility, such as the Delta and Omicron variants. Individuals with advanced age or underlying comorbidities, including hypertension, diabetes and cardiovascular diseases, are at a higher risk of increased disease severity. Hence, this has resulted in an urgent need for the development of better therapeutic and preventive approaches. This review describes the origin and evolution of human coronaviruses, particularly SARS-CoV-2 and its variants as well as sub-variants. Risk factors that contribute to disease severity and the implications of co-infections are also considered. In addition, various antiviral strategies against COVID-19, including novel and repurposed antiviral drugs targeting viral and host proteins, as well as immunotherapeutic strategies, are discussed. We critically evaluate strategies of current and emerging vaccines against SARS-CoV-2 and their efficacy, including immune evasion by new variants and sub-variants. The impact of SARS-CoV-2 evolution on COVID-19 diagnostic testing is also examined. Collectively, global research and public health authorities, along with all sectors of society, need to better prepare against upcoming variants and future coronavirus outbreaks.

Purpose: The purpose of this study is to compare the endothelial cell loss (ECL) in nanophthalmic eyes and age-matched controls undergoing cataract surgery by phacoemulsification and also to identify the risk factors influencing the endothelial cell density (ECD). This was a prospective comparative interventional case series. Methods: We enrolled 19 nanophthalmic eyes (study group) and 42 age-matched cataract controls (control group) undergoing phacoemulsification after meeting the inclusion criteria. Ocular parameters like best-corrected visual acuity, intraocular pressure, pachymetry, specular microscopy, and slit lamp findings were noted preoperatively and at month 1 and 3 postsurgery. All nanophthalmic eyes underwent cataract surgery with concomitant prophylactic posterior sclerostomy. Results: The median percentage endothelial loss in nanophthalmic eyes was 4.0 (IQR 0–23.5), 7.4 (IQR 1.0–-22.4) at 1 and 3 months postoperatively compared to 6.3 (IQR 1.7–14.1) and 6.4 (IQR 2.6–-12.1) in age controlled normal eyes (P = 0.94, P = 0.46, respectively). Linear regression analysis showed increasing age as the only variable influencing the percentage decrease in corneal ECD in the study group (P = 0.001). Nanophthalmic eyes with ACD 2.5 mm were significantly better postcataract surgery (P = 0.02 and P = 0.002, respectively). Conclusion: The percentage of ECL in nanophthalmic eyes undergoing phacoemulsification is equivalent to normal eyes. However, in the nanophthamic eyes with AC depth

Abstract Nail beautification is a widely applied gender independent practice. Excessive nail beautifications and nail-arts have a direct impact on the nail structure and can cause nail disorders. Therefore, the assessment of post-progressive nail-art effects on the nail is essential to maintain optimal nail health and to avoid any undesirable disorders. In this study, in vivo nails were examined in control stage, with a nail-art stage, and after removing the nail-art stage using a 1310 nm spectral-domain optical coherence tomography (SD-OCT) system. The acquired cross-sectional OCT images were analyzed by a laboratory customized signal processing algorithm to obtain scattered intensity profiling assessments that could reveal the effects of nail beautification on the nail plate. The formation and progression of cracks on the nail plate surface were detected as an effect of nail beautification after 72 h of nail-art removal. Changes in backscattered light intensity and nail plate thickness of control and art-removed nails were quantitatively compared. The results revealed the potential feasibility of the developed OCT-based inspection procedure to diagnose post-progressive nail-art effects on in vivo nail plate, which can be helpful to prevent nail plate damages during art removal through real-time monitoring of the boundary between the nail plate and nail-art. Besides nail-art effects, the developed method can also be used for the investigation of nail plate abnormalities by examining the inconsistency of internal and external nail plate structure, which can be diagnosed with both qualitative and quantitative assessments from a clinical perspective.

Our investigation of pleosporalean fungi performed from terrestrial habitats in provinces of Arezzo (Tuscany region), Forlì-Cesena and Ravenna (Emilia-Romagna region) in Italy. We yielded a novel species, Italica heraclei (Phaeosphaeriaceae), a novel host record of Pseudoophiobolus mathieui (Phaeosphaeriaceae) and the second Italian record of Phomatodes nebulosa (Didymellaceae). Species boundaries were defined using detailed morphological illustrations, comprehensive descriptions and multi-gene phylogeny of maximum likelihood (ML), maximum parsimony (MP) and Bayesian posterior probability (BYPP) analyses. Our findings expanded the knowledge on host and distribution ranges of the newly isolated pleosporalean taxa in Italy.

Introduction: Isolation of persons is a key strategy to prevent and control highly contagious diseases throughout the history worldwide and its importance had re-emerged due to COVID-19 pandemic. In Sri Lanka, like other countries, this isolation process is mainly governed by the law. The Quarantine and Prevention of Diseases Ordinance is the main law in this regard where the powers are mainly vested with health authorities. Objectives: To analyses the law of isolation and its legitimacy of practice in Sri Lanka Methods: A desk review of laws associated with isolation and quarantine in Sri Lanka was conducted and compared with the actual practice of implementation of these laws during COVID-19 epidemic. Results: Quarantine and Prevention of Diseases Ordinance of Sri Lanka and its regulations contain strong provisions on isolation of persons which are incorporated in to legal scenarios of disease locality, infected house/place, self-quarantine and observational hospital/place and linked to face mask and social distancing rules. However, these legal provisions are misused and not legitimately implemented by authorities. Conclusions and Recommendations: Quarantine and Prevention of Diseases Ordinance of Sri Lanka and its regulations can be used to prevent and control COVID-19 effectively as adequate and powerful provisions are available, especially in relevant to isolation of persons. However, the relevant law is often wrongly interpreted and imposed by authorities as well as non-authorities. Authorities and Authorized Officers need to be empowered on their powers and limitations to implement the law legitimately in order to achieve the maximum control and prevention of COVID-19 and other infectious diseases.

Introduction: Adenosquamous carcinoma (ASC) is a rare subtype of the conventional adenocarcinoma of the bile duct. The clinico-pathological characteristics of this entity are poorly understood partly due to its rarity. Case Summary: A 67-year-old ASA II male presented with obstructive jaundice subsequently complicated by cholangitis. CT abdomen showed dilatation of the intra and extrahepatic biliary tree. Endoscopic retrograde cholangiopancreatography revealed a stricture with a mucosal growth at the ampulla of Vater. He had a pancreaticoduodenectomy and the distal common bile duct tumour identified in the specimen was on histology an adenosquamous carcinoma (ASC) of the extrahepatic bile duct. Discussion: ASCs are considered to have more aggressive tumour biology compared to adenocarcinomas. The presence of a squamous component at the invasive front relates to its poor prognosis. Surgery is the curative option, but with a high propensity for early recurrence and distant metastases. The scarcity of reports on the clinicopathological course of ASC have resulted in a lack of standardised care pathways. Conclusion: A better understanding of the clinicopathological characteristics, biological behaviour and disease progression of ASC will aid therapeutic options and prognostication.

Summary: Background: Dexamethasone was the first intervention proven to reduce mortality in patients with COVID-19 being treated in hospital. We aimed to evaluate the adoption of corticosteroids in the treatment of COVID-19 in the UK after the RECOVERY trial publication on June 16, 2020, and to identify discrepancies in care. Methods: We did an audit of clinical implementation of corticosteroids in a prospective, observational, cohort study in 237 UK acute care hospitals between March 16, 2020, and April 14, 2021, restricted to patients aged 18 years or older with proven or high likelihood of COVID-19, who received supplementary oxygen. The primary outcome was administration of dexamethasone, prednisolone, hydrocortisone, or methylprednisolone. This study is registered with ISRCTN, ISRCTN66726260. Findings: Between June 17, 2020, and April 14, 2021, 47 795 (75·2%) of 63 525 of patients on supplementary oxygen received corticosteroids, higher among patients requiring critical care than in those who received ward care (11 185 [86·6%] of 12 909 vs 36 415 [72·4%] of 50 278). Patients 50 years or older were significantly less likely to receive corticosteroids than those younger than 50 years (adjusted odds ratio 0·79 [95% CI 0·70–0·89], p=0·0001, for 70–79 years; 0·52 [0·46–0·58], p80 years), independent of patient demographics and illness severity. 84 (54·2%) of 155 pregnant women received corticosteroids. Rates of corticosteroid administration increased from 27·5% in the week before June 16, 2020, to 75–80% in January, 2021. Interpretation: Implementation of corticosteroids into clinical practice in the UK for patients with COVID-19 has been successful, but not universal. Patients older than 70 years, independent of illness severity, chronic neurological disease, and dementia, were less likely to receive corticosteroids than those who were younger, as were pregnant women. This could reflect appropriate clinical decision making, but the possibility of inequitable access to life-saving care should be considered. Funding: UK National Institute for Health Research and UK Medical Research Council.

Urban tree canopies provide manifold benefits, such as: improved air quality, moderated temperatures, reduced storm water runoff, increased property value, reduced crime, improved visual aesthetics, and reduced health problems. Socioeconomically disadvantaged neighborhoods often have many fewer trees than other neighborhoods. This mixed methods case study explored approaches to expand the participatory process in tree stewardship with residents from a socioeconomically disadvantaged neighborhood in Washington, D.C. As a first step, we used semi-structured interviews to elicit residents’ experiences regarding nature and trees. We then built public-private partnerships to strategically convene multi-year tree planting efforts. We additionally performed targeted community outreach, developed a Tree Planting Challenge, and supported mural art to draw attention to the urban tree canopy. Ultimately, the mixed approaches resulted in more than 660 commitments to having free trees planted on properties in a matter of 12 months. We review these findings and discuss implications for future research into collective efficacy-building for a range of sustainability issues.

Purpose: Surveillance of different SARS-CoV-2 variants of concern (VOCs) is a crucial aspect in control of the pandemic. Although sequencing is the gold-standard to detect VOCs, it is labor intensive and is costly. We compared a cost-effective real-time PCR assay that detects single nucleotide polymorphisms (SNPs) of VOCs, with next generation sequencing (NGS) in surveillance of VOCs. Methods & Materials: A total of 782 SARS CoV-2 PCR positive samples From May – August 2021 were screened using two variant RT-qPCR assays (Seegene Allplex™ SARS-CoV-2 Variant Assay I and II), which detects 7 SNPs in the spike protein assigning them to one of the VOCs. We compared the results of the variant RT-qPCR with Illumina (n=97) and Oxford Nanopore (n=53) platforms in a subset of samples (n=150). Sequences with > 25x coverage were used and assigned to a Pangolin lineage. Results: 516 samples amplified for N501Y and HV69/70 deletion of the spike protein were assigned as alpha (B.1.1.7). Two samples with spike K417N mutation along with N501Y and E484K were considered to be beta (B.1.351) and 175 samples which are only positive for spike L452R mutation were considered to be delta (B.1.617). 120/156 samples designated as alpha, 22/175 designated as delta and 2 samples designated as beta by RT-qPCR were sequenced either by Illumina or Oxford nanopore platforms. The sequencing results showed a 100% accuracy with the variant RT-qPCR for identification of VOCs. Conclusion: RT-qPCR that detected SNPs specific for VOCs, appear to be highly sensitive and specific in detection of VOCs and had a similar specificity of genomic sequencing. Therefore, this could be a rapid and less expensive method for surveillance of VOCs, in lower income countries. However, as it only detects specific SNPs, any emerging mutations of concern in these VOCs or newly emerging variants, will not be detected.

Abstract Objective To adapt the CEQ into Sri Lankan Sinhala cultural context and to determine the psychometric properties of CEQ. This would yield an opportunity to evaluate childbirth experience among Lankan population. Results Out of 390, 226 (57.9%) postnatal mothers completed the CEQ after 1 month postpartum. Face validity and content validity were demonstrated with all participants stating that CEQ was easy to understand and complete. For reliability, internal consistency was acceptable for the overall score (0.85) and for all four domains in CEQ (0.65, 0.80, 0.70, 0.83 for “own capacity”, “professional support”, “perceived safety” and “participation”, respectively). A weighted kappa of 0.61–0.80 for all 22 items in CEQ demonstrated a good test–retest reliability. This Sri Lankan version showed fit statistics in line with standard recommendations in exploratory factor analysis. Women with spontaneous onset of labour (except for “professional support” in women with spontaneous onset of labour) and women with a normal birth showed significantly higher CEQ scores. However, oxytocin augmentation could not yield a difference in CEQ scores.

Introduction: The most important and frequently occurring eye infections are conjunctivitis and corneal ulcers. Though the significance of Streptococcus pneumoniae in eye infections is well-known, identification of causative serotypes is important for comparison with serotypes causing invasive diseases. Objectives: To describe the spectrum and characteristics of bacterial pathogens associated with conjunctivitis and corneal ulcers with special reference to S. pneumoniae.Methods: A descriptive cross-sectional study was carried out from January to April 2008 in which samples were collected from patients above one month old with suspected conjunctivitis or corneal ulcers seen in the out-patients department and wards of the National Eye Hospital, Colombo, Sri Lanka. Both eye swabs (n=322) and corneal buttons (n=31) were cultured. Isolated bacteriawere identified as far as possible and antibiotic sensitivity testing done. S. pneumoniae isolates were stored in sheep blood agar slants at -70 ºC and serotyped. Results: There were 296 conjunctival swabs and 26 corneal swabs. From 296 conjunctival swabs 118 (39.8%) samples yielded no bacterial growth. There were 185 bacterial isolates from 159 significant positive samples. The most frequently isolated bacteria were coagulase negative Staphylococcus sp. (n=58: 31.4%), and second commonest was S. pneumoniae (n=33: 17.84%). From 57 samples from patients with corneal ulcers, 47 (82%) did not yield any bacterial growth. Sensitivity to chloramphenicol was high among Staphylococcus sp., S. pneumoniae, Haemophilus influenzae, Moraxella sp and coliforms. Among pneumococcal isolates serotyped, 19F was predominant. Conclusion: Coagulase negative staphylococci were predominantly isolated from eye swabs and corneal buttons, but the most significant frequent isolate was S. pneumoniae. Except Pseudomonas, >90% isolates were sensitive to chloramphenicol. The predominant pneumococcal serotype was 19F.