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Idiopathic granulomatous mastitis (IGM) is a debilitating, chronic, inflammatory condition of the breast. Several studies have emerged evaluating intralesional steroid (ILS) injection and topical steroid administration as a treatment for IGM. However, there is a dearth of international consensuses with regards to the management of IGM. Therefore, we have systematically reviewed the effectiveness of ILS in the management of IGM. A systematic search was conducted in PubMed and Cochrane Library databases, the Google Scholar website and by citation searching up to June 15th, 2023. Eight articles were selected and analyzed. A total of 397 IGM patients were included in the review. The mean patient age was 35.7 years, ranging from 23–62 years. The mean pre-treatment diameter of lesions was 27.5 mm. A total of 184 patients were treated with ILS. The mean complete clinical response time was 2.6 months. The overall complete response rate was 92.8%. Complications following ILS were minor, with hematoma, skin atrophy and hyperemia being commonly described, while avoiding the systemic side effects of oral steroid use, such as weight gain and hirsutism, which were the most commonly reported side effects with oral steroids. The recurrence rates in the ILS group (6.6%) appear to be lower than in the oral steroid group (25.8%) and surgery group (26.3%). ILS seem to show a favorable outcome in terms of complete response rate, complete clinical response time and has a lower recurrence rate and complication rate when compared to other intervention strategies. However, more comparative studies with standardized protocols are necessary to ascertain the optimum type, dosage and frequency of ILS regimens.

Paradigm shift is a significant modification of the core assumptions and methods of experimentation in a scientific discipline. The field of education, at all levels, has undergone tremendous change recently, precipitated by extraordinary demand for high quality and meaningful sustainable education at all levels across the globe. The national education system is segregated into five main categories: primary, junior secondary, senior secondary, collegiate (higher education) and tertiary. In Sri Lanka, basic and higher education levels are compulsory for students; however tertiary education is an optional level. Recent data show that just 20% of students who pass the GCE Advanced Level Test can be admitted into the government university system, leaving the remaining students with few options for higher education. The framework or for determining students' university choice based on their qualifications, talents, demand and supply characteristics, or their willingness to select an appropriate degree program is somewhat non-existent in Sri Lanka's existing educational system. To determine the steps that can be taken for a paradigm shift in higher education, this study aims to highlight the need for one in Sri Lankan post-secondary education while also proposing a relevant conceptual framework. The Marketing Mix Model for Higher Education, Hossler, Kotler and Fox, and the Integrated Complex Decision Model was the framework used to identify the demand pull and supply push factors affecting the university choice in Sri Lanka. Both qualitative and quantitative techniques were used. The study sample was drawn using stratified sampling technique and clustered into several sub-clusters such as state university, private university, technological campus and vocational Institute. Both descriptive and essential inferential statistics tools were used for the data analysis. This study identified the measures that can be used for a paradigm shift in the tertiary education.

Recently, many researchers have found that education systems in many nations are very comprehensive and competitive. They revealed that the primary goal of many universities is to increase the number of students' enrolment as much as possible. In students' perspective, they also consider different factors when they make their higher education decision. Therefore, this article aims to investigate the factors affecting for students' university choice and satisfaction. Relevant literature reviews explained in terms of four models which link to students' university choice process: economic model, sociological model, combined complex decision model and the marketing mixed model. Then, the study investigated the other main factors that are affecting to the university choice of students from empirical evidence. In terms of students' university satisfaction, this paper has described several models and other factors influencing on students' university satisfaction.

A study conducted from July 2019 to May 2022 at several hospitals in the Western Province, Sri Lanka, focused on dengue virus strains during the COVID-19 pandemic. Among 417 febrile patients, 47% were PCR-positive for dengue. Serotyping revealed DENV-1 (12.8%), DENV-2 (46.4%), DENV-3 (37.2%), and DENV-4 (3.6%). Sequencing identified two genotypically distinct variants of DENV-3 and two genotypically distinct variants of DENV-1, while DENV-2 showed a single genotype cluster. Notably, the study found concurrent circulation of two DENV-3 and two DENV-1 genotypes, along with DENV-2, during the pandemic in the area. This data suggests the presence of multiple dengue strains, including several DENV-1 and DENV-3 variants, without major epidemic outbreaks reported in the Western Province. Continuous monitoring and research are essential to understand the dynamics of these dengue strains in the context of the COVID-19 pandemic.

Abstract Background The economic crisis in Sri Lanka worsened food insecurity, with millions facing moderate-to-severe food shortages. This study evaluates the effectiveness of cash transfers combined with mobile health education in enhancing dietary diversity and food security among Sri Lankan households during the crisis. Methods This quasi-experimental single-group pre-post study involved 1040 eligible individuals selected through stratified random sampling from eligible households of Samurdhi beneficiaries and smallholder farmers. The intervention included a cash transfer of LKR 22,500 and weekly nutrition awareness messages via WhatsApp and SMS complemented by a one-time awareness session. Dietary diversity and food security were assessed using standard validated tools such as the Diet Quality Questionnaire and Food Security Questionnaire. Results Food insecurity decreased significantly from 89.3% (n = 681) in the pre-test to 76.9% (n = 533) in the post-test, with a 12.4% reduction (95% CI, 8.57 to 16.24, p

Abstract Gestational Diabetes Mellitus (GDM) is associated with adverse maternal and perinatal outcomes and increased risk of developing diabetes in later life. Sri Lanka adopted universal GDM screening at two time points in pregnancy (before 12 weeks and between 24 and 28 weeks) in 2014 and its utilization has not been assessed. This study assessed the utilization of GDM screening services and associated factors among antenatal mothers in Southern Sri Lanka. A cross-sectional study was carried out in a consecutive sample of 420 postpartum mothers who delivered at three major hospitals in Sri Lanka. Data were collected on socio-demographics, pregnancy, availability and utilization of screening services and logistics using an interviewer-administered questionnaire and a data record sheet. Data was analysed using SPSS software. Chi-square test and binary logistic regression was used to assess the association between variables. The coverage of first and second screening tests were 91.4% and 94.5% and timeliness were 72.4% and 59.5%, respectively. The median period of amenorrhoea at the first and second screening were 10.0 (inter-quartile range: 2.5) weeks and 28.0 (inter-quartile range: 1.5) weeks. A higher utilization was associated with higher income (OR = 3.4, 95% CI: 1.1–10.5) and planned pregnancy (OR = 4.9, 95% CI: 2.2–10.7) for the first screening test. Primiparity (OR = 0.3, 95% CI: 0.1–0.9) and proximity of the nearest laboratory (OR = 3.5, 95% CI: 1.0–12.0) were positively associated with the second screening test. The timeliness of both screening tests was associated with planned pregnancy (OR = 2.1, 95% CI: 1.1-4.0 and OR = 2.3, 95% CI: 1.1–4.5) and being non-employed during the pregnancy (OR = 2.5, 95% CI: 1.4–4.3 and OR = 2.3, 95% CI: 1.3–4.1). A high utilization of GDM screening was observed. Timeliness should be ensured through improved availability and accessibility of screening facilities.

Abstract Background Early Childhood Caries (ECC) is a highly prevalent disease among preschoolers in Sri Lanka, with stagnated prevalence over the decades. Therefore, it is important to determine the socio-behavioural associations of ECC among preschoolers to reduce the country’s ECC burden. Methods A cross-sectional study with a multistage cluster sampling technique was used to select 3 to 4 year-old preschoolers/mothers dyads in Gampaha district in 2019. Preschoolers who completed third birthday and had not completed fifth birthday on the day of data collection were selected. The dependent variable was the presence (dmft ≥ 1) or absence (dmft = 0) of ECC. Independent variables were sex, monthly family income, mother’s educational and occupational status, child’s birth order, family type, frequency of consumption of sweets and sweetened drinks, time of sweet consumption during the last 24 h, toothbrushing frequency, supervision of toothbrushing, dental visit, and maternal dental caries. A pre-tested validated questionnaire was used. Multiple logistic regression analysis was used. Results Total of 1038 preschoolers were selected. There were 529 females (51.0%) and 509 males (49.0%). The prevalence of ECC was 56.3% (95% CI: 53.1–59.3). Consuming sweets between meals had a higher odds ratio than consuming sweets after main meals (OR = 1.72, 95% CI:1.25–2.35), consumption of sweets every day had a higher odds ratio than consumption of sweets several times a week or less (OR = 2.89, 95% CI: 2.02–4.13), consumption of sweetened drinks every day had a higher odds ratio than consumption of sweetened drinks several times a week or less (OR = 1.73, 95% CI: 1.07–2.79), and the presence of maternal caries had a higher odds ratio than the absence of maternal caries (OR = 1.74, 95% CI: 1.12–2.69). The use of adult fluoridated toothpaste than not using adult fluoridated toothpaste (OR = 0.64, 95% CI:0.48–0.85), tooth brushing twice per day than not brushing twice per day (OR = 0.67, 95% CI:0.51–0.89), and supervised toothbrushing than unsupervised toothbrushing (OR = 0.61, 95% CI: 0.41–0.93) was negatively associated with ECC. Conclusions ECC is highly associated with sweet consumption and oral hygiene behaviours among preschoolers in Gampaha District. Interventions should focus on the oral health behaviours of preschoolers to reduce ECC burden.

Abstract Objective This quasi-experimental study aimed to describe the outcome of a social skills intervention for adolescents with depression followed up at an outpatient Child and Adolescent Psychiatry Unit. Twenty adolescents with depression attending a tertiary care facility in Colombo, Sri Lanka were recruited, who participated in two social skills training programmes (6 months apart), in addition to pharmacological treatment. Outcome of the programme was measured by a self-administered questionnaire that assessed perceived changes in social skills, before and after the intervention. Wilcoxon Signed Rank test was used to determine the statistical significance of improvement in social skills. Results The sample consisted of 80% (n = 16) female adolescents. Median scores (inter-quartile range) for social skills before and after the first social skills programme were 31.5 (21.0–36.0) and 33.0 (28.25–40.25) respectively, indicating a significant improvement in social skills following intervention (p = 0.011, r = 0.57). A similar improvement was observed after the second programme (n = 10), reporting higher median scores for social skills after intervention (29.5 vs. 37.5, p = 0.005, r = 0.89). A significant improvement was also observed in perceived ability to cope with depressive thoughts after intervention (p = 0.032), indicating that social skills training can be a useful adjunct to pharmacological interventions, in the management of depression in adolescents.

Abstract Urinary tract infections (UTIs) pose a substantial burden on global healthcare systems. When unraveling the complex pathophysiology of UTIs, bladder models are used to understand complex and multifaceted interactions between different components within the system. This review aimed to bridge the gap between in vitro and in vivo experimental bladder models towards UTI research. We reviewed clinical, animal, and analytical studies and patents from 1959 to the end of 2023. Both in vivo and in vitro models offer unique benefits and drawbacks in understanding UTIs. In vitro models provide controlled environments for studying specific aspects of UTI biology and testing potential treatments, while in vivo models offer insights into how UTIs manifest and progress within living organisms. Thus, both types of models are leading to the development of more effective diagnostic tools and therapeutic interventions against UTIs. Moreover, advanced methodologies involving three-dimensional bladder organoids have also been used to study bladder biology, model bladder-related disorders, and explore new treatments for bladder cancers, UTIs, and urinary incontinence. Narrowing the distance between fundamental scientific research and practical medical applications, these pioneering models hold the key to unlocking new avenues for the development of personalized diagnostics, precision medicine, and ultimately, the alleviation of UTI-related morbidity worldwide.

Abstract Women with a history of Gestational diabetes mellitus (GDM) have a high risk of developing Type 2 diabetes mellitus (T2DM) in their future life. Lifestyle interventions are known to reduce this progression. The success of a lifestyle intervention mainly depends on its feasibility. Therefore, this study aimed to evaluate the feasibility of a lifestyle intervention programme aimed to attenuate the development of T2DM in mothers with a history of GDM. This qualitative phenomenological study was carried out in selected Medical offices of Health (MOH) areas in Sri Lanka. Postpartum mothers with a history of GDM who have undergone a comprehensive, supervised lifestyle intervention program for 1 year, their family members, and public health midwives (PHM) were recruited for this study. Focus group discussions (FGD) were carried out with mothers and PHM while In-depth interviews (IDI) were conducted with family members. Framework analysis was used for the analysis of data. A total of 94 participants (45 mothers, 40 healthcare workers, and 9 family members) participated in FGDs and IDIs to provide feedback regarding the lifestyle intervention. Sixteen sub-themes emerged under the following four domains; (1) Feelings and experiences about the lifestyle intervention programme for postpartum mothers with a history of GDM (2) Facilitating factors (3) Barriers to implementation and (4) Suggestions for improvement. Spouse support and continued follow-up were major facilitating factors. The negative influence of healthcare workers was identified as a major barrier to appropriate implementation. All participants suggested introducing continuing education programmes to healthcare workers to update their knowledge. The spouse’s support and follow-ups played a pivotal role in terms of the success of the programme. Enhancing awareness of the healthcare workers is also essential to enhance the effectiveness of the programme. It is imperative to introduce a formal intervention programme for the postpartum management of mothers with a history of GDM. It is recommended that the GDM mothers should be followed up in the postpartum period and this should be included in the national postpartum care guidelines.

Background: Breast cancer (BC) poses a significant public health concern as it is the most common cancer detected among women worldwide. Early detection and intervention are associated with better prognosis and survival. A primary reason for the rising mortality and morbidity in developing countries is the lack of patient education and practice early detection programs and presentation. Aims and Objectives: The main objective of this study is to evaluate the prevalence of delayed presentation and the factors lead to delay among BC patients in Sri Lanka. Materials and Methods: A descriptive cross-sectional study was conducted from January 01, 2023, to June 30, 2023 among women diagnosed with BC attending two selected state hospitals in Sri Lanka. All women with histological diagnosis of early, locally advanced, or metastatic BC attending for treatment were included and women with recurrent BC and concomitant other cancers were excluded. Presentation delay was defined as ≥3 months. The calculated sample size was 396. Results: About 47.5% of our study population (n=188) had a presentation delay of more than 3 months. The main reasons for the delay in presentation were, being unaware that BC is a major problem in Sri Lanka, difficulty in accessing healthcare, and not being able to find time due to family and social commitments. Women who had not been practicing self-breast examination had a significant association with presentation delay (OR=3.26, 95% CI - 0.090–0.362, P=0.001). The participants who were having a presentation delay were also more likely to be diagnosed with an advanced stage of cancer (OR=2.86, 95% CI - 2.573–3.153, P=0.000). Conclusion: Our study population depicts a good knowledge related to BC symptoms, risk factors, and early detection methods. However, very few are practicing them. There is also a significant delay of presentation due to various factors. Awareness and good practices would lead to early detection and diagnosis and improve overall survival.

Background: The shadowing house officer is an experiential learning activity that usually takes place within the final year clinical rotations of medical undergraduates. An exposure to a surgical intern is especially useful as the work extends to more practical aspects of ward work. Objective: We assessed the impact of the shadowing house officer experience during medical student clinical rotation on the surgical internship and to evaluate the challenges of the shadowing period. Methods: A descriptive cross-sectional survey was carried out among 108 surgical intern doctors in Sri Lanka via electronic media in 2023. Results: Our study population consisted of 108 interns, with a response rate of 43.2%. This study demonstrates that on average a final year medical student undergoes a 4-day shadowing period in surgery which was considered by a majority to help in smooth transition to internship. 56% had a clear understanding about learning outcomes and less than half has had an induction session prior to commencement of shadowing. Official documentation, routine ward work, team work and communication skills were meaningfully experienced during shadowing. The main criticisms were inadequate breaks leading to exhaustion and missing out on important teaching activities. Another major concern was shadowing close to the final examination. Conclusions: Surgical shadowing house officer is an authentic work experience that intern doctors consider as important component in orientating the role of an intern. Introduction of shadowing at an earlier stage would be more beneficial and provide a broader view about the clinical set up to undergraduates.

Abstract Background Unhealthy diet is a key risk factor for Non-Communicable Diseases (NCDs) that contribute to increased morbidity and premature mortality. With increased computer literacy and mobile phone penetration, there is a high opportunity for mobile application-based interventions. The current study was conducted to develop a mobile application to monitor dietary intake and to assess its acceptability and effectiveness in diet control compared to a similar paper-based intervention. A mobile application was developed based on research evidence and opinions of local experts. The mobile application was introduced to a selected group of office workers who were in preparation, action, and maintenance stages of the Trans Theoretical Model (TTM) and a paper-based intervention was used as the comparator. Socio-demographic data were collected through a self-administered questionnaire. Participants were followed up for three months for adherence. The effectiveness of interventions was assessed at the end of three months by comparing the progressive change in the stage of change and the change from unhealthy to healthy dietary intake between two groups as primary and secondary outcomes respectively. Results Among 123 office workers who participated in the study, 19.5% preferred the mobile intervention over the paper-based intervention. Younger, unmarried office workers and those who do not have children, had a higher acceptance for the mobile intervention (p