Introduction: Chromoblastomycosis is a chronic disfiguring fungal infection of the subcutaneous tissue found mainly in the socio-economically marginalized population in the tropical and sub-tropical regions, characterized by the presence of sclerotic cells. This study was done with the aim of identifying the antifungal sensitivity patterns of the causative agents of chromoblastomycosis in Sri Lanka from 1992 to 2019.Methodology: Study was done on the stored isolates received from patients with chromoblastomycosis since 1992 to 2019, to the Mycology Reference Laboratory of Medical Research Institute, Colombo. Isolates were revived by subculture on Potato dextrose agar. Identification was done phenotypically. Antifungal sensitivity testing was performed by E test method. Available demographic and clinical data were analysed.Results: Of the 74 isolates, 71 (96%) were caused by Fonsecaea pedrosoi. Mean MIC for the antifungals tested were lowest for posaconazole 0.015 μg/ml followed by itraconazole 0.225 μg/ml, and voriconazole 0.768 μg/ml while amphotericin B demonstrated complete resistance with mean MIC of 30.591 μg/ml. No statistically significant differences were noted on the antifungal sensitivity of the isolates from 1992 to 2004 and 2005 to 2019.Conclusions: Fonsecaea pedrosoi was the commonest causative agent causing chromoblastomycosis in the studied population. Posaconazole demonstrated the lowest MIC values for the tested isolates followed by itraconazole and voriconazole. Amphotericin B demonstrated very high MIC values which were likely to result in clinical failure upon treatment. MIC values demonstrated minimal fluctuations throughout the tested time.

Background: Antimicrobial resistance (AMR) is a signifi-cant global health issue in the 21st century, posing a serious threat to human health.Objectives: This study was to determine the burden and predictors of AMR and multidrug resistance (MDR) among bacterial pathogens isolated from specimens submitted to the diagnostic laboratory of a hospital in Sri Lanka.Methodology: This retrospective study used laboratory records of 1,204 clinical specimens submitted for bacterial culture submitted to the diagnostic laboratory of Neville Fernando Teaching Hospital in Sri Lanka for bacterial culture and sensitivity testing between October 2021 and May 2024. Records from specimens positive for Enterobacteriaceae, Staphylococcus aureus, or Pseudomonas spp. isolates were included for analysis.Results: Number of samples which yielded Gram negative Enterobacterales was 758 (62.95%). Of these 499 (65.83%) were ESBL and 59 (7.78%) were carba-penemase producers. Among the 214 participants, Staphylococcus aureus was isolated from 206 (96.26%) participants. This included 74 (35.92%) participants who were colonized with Methicillin Resistant Staphylococcus aureus (MRSA) isolates and Methicillin Sensitive Staphylococcus aureus (MSSA) 132 (64.07%). Among Pseudomonas spp. isolates, 29.48% were resistant to one or more aminoglycosides, 29.48% were resistant to a fluoroquinolone and only 8.54% were resistant to carbapenems.Conclusion: This study shows that there is a high level of microbial resistance in Sri Lanka. The high levels of extended-spectrum cephalosporin resistance and multi-drug resistance (MDR) among Enterobacterales observed in this study are of concern. However, the relatively low levels of methicillin-resistant Staphylococcus aureus (MRSA) and MDR S. aureus, as well as the very low levels of carbapenem resistance among Pseudomonas spp. isolates, are encouraging.

Background: Colorectal carcinoma (CRC) accounts for substantial cancer morbidity and mortality worldwide. Our study was designed to assess the contributions of dietary and lifestyle factors on the risk of developing CRC.Methods: A case-control study was conducted over a five-year period at the National Hospital of Sri Lanka. Data was collected via an interviewer administered, structured, pre-tested questionnaire on 200 histologically confirmed CRC cases and 200 age and gender-matched controls. Multivariate analyses were done to identify associations.Results: The median age was 58 years in the CRC group and 54 years in the control group, while the male:female ratio was 1.50 and 1.49 respectively. On multivariate analysis the consumption of six or more cups of brown tea per day [Odds Ratio (OR) = 2.98 (95% CI 1.47-6.05), p=0.003] was independently associated with CRC. Beef consumption also showed significant association with risk of CRC [OR = 1.76 (95% CI 1.12-2.78), p=0.015]. Green tea was not found to be associated with CRC. There were no associations with body weight, work-sleep pattern, smoking or the consumption of alcohol, mutton, pork, fruits or coffee.Conclusions: The consumption of six or more cups of brown tea per day or beef was associated with an increased risk of developing CRC.

Background: Burnout is well known mental health problem that can be found in many occupational settings. Due to the potential for concentrating known antecedents, the military context is particularly susceptible to burnout. Sri Lanka Army is the main focal asset in national security, resilience in disaster or any other national threat as the defender of the nation. Due to recent reforms, there is an increased risk that the Sri Lanka Army to experience known correlates of burnout. For the development of policies to enhance the mental health of the army community, it is essential to determine the influential power of those elements.Method: A nested case-control study was carried out. Cases and controls were selected from a cohort of 1692 army soldiers that had been previously chosen to investigate the prevalence of burnout. The validated MBI-GS (Sinhala version), the brief COPE, and the structured questionnaire on correlates of burnout were all included in the self-administered questionnaire for data collection. Cases and controls were defined using the findings of the criteria validity evaluation of MBI-GS (Sinhala version); 386 cases and 766 controls were selected as per the desired case-control ratio of 1:2. After doing a bivariate analysis for dichotomous variables and an independent t test for continuous variables, a binary logistic regression was carried out to determine the antecedents.Results: Altogether 29 factors were identified as significant correlates of burnout through bivariate analysis and t tests, out of those only 14 factors were confirmed through logistic regression. Age of 30 years or below, no additional income, no saved money, have bed ridden dependent, having transport difficulties, past history of psychiatric treatment, family history of psychiatry, frustration about life, being a daily smoker, and practicing dysfunctional coping strategies were identified as risk factors. Whereas satisfied on children support, received special training relevant to current tasks, able to get leave timely and practicing problem focused coping strategies were identified as protective factors.Conclusion: Identified antecedents should consider at policy making of the organization. Early attention and proper action is strongly recommended.

Background: Purpura fulminans (PF) is a term used to describe a heterogeneous group of disorders characterized by rapidly progressive purpuric lesions that develop into extensive areas of skin necrosis and peripheral gangrene [1]. Purpura fulminans is known to be associated with many infections, such as menin-gococcal, staphylococcal, and streptococcal infections. There are very few reports of this entity with spotted fever group rickettsioses and scrub typhus in Sri Lanka.Case presentation: A 33-year-old female with intellectual disability since childhood presented with an acute febrile illness for seven days. She also had severe arthralgia, conjunctival suffusion, and a widespread “fern-leaf pattern” necrotic skin rash involving both upper limbs and lower limbs, sparing the face and trunk. She had a very high antibody titer against Rickettsia Conorii antigen, confirming the diagnosis of SFG rickettsioses, and recovered completely with anti-rickettsial therapy.Conclusion: Clinicians should consider rickettsial infection as one of the differential diagnoses in a patient presenting with acute febrile illness with patchy necrotic skin lesions which would help in early diagnosis and initiating appropriate treatment, thus preventing a deleterious outcome.

Introduction: Pregnancy and lactation-associated osteoporosis (PLO) is a rare condition affecting women during the late pregnancy and early postpartum period. PLO is manifested with multiple fragility fractures mainly involving the spine with the height loss.Case presentation: We report a 31-year-old lady presenting with severe lower back pain during early post-partum period after her second pregnancy. She reported history of similar back pain after delivery of first baby 2 years back. Vertebral imaging revealed multiple com-pressive fractures (Th9, L1 and L2). There was evident height loss of 7 cm compared to her pre-pregnancy height. Bone mineral density (BMD) assessment with the DXA scan revealed severe osteoporosis. She denied the family history of osteoporosis. Biochemical assess-ment showed normal levels of calcium, phosphorus, vitamin D and alkaline phosphatase. Secondary causes of osteoporosis were excluded. She was explained about the diagnosis and advised on cessation of breast-feeding, proper contraception, and lifestyle modifications. Calcium carbonate and vitamin D supplements were started with adequate pain relief. On 6 months follow-up, she had significant improvement in back pain, and she didn't have new fractures on repeat imaging. Repeat DXA scan showed significant improvement in the lumbar spine BMD. She is awaiting reassessment in 1 year.Conclusion: The possibility of PLO should be considered during the evaluation of osteoporosis in women during late pregnancy and lactation, but exclusion of secondary causes is important before making the diagnosis. Appropriate supportive measures should be initiated to improve the quality of life and prevent further fractures.

Background: The clinical presentation of hypopituitarism varies from asymptomatic to circulatory compromise. The late diagnosis may cause significant mortality and morbidity. There is scant data on the clinical profile.Method: A cross-sectional descriptive analysis was carried out on diagnosed children with hypopituitarism at the endocrinology unit of Lady Ridgeway Hospital for Children, Sri Lanka, from 2013-2021. The presence and progression of pituitary hormonal deficiency were ascertained.Results: Out of the total 94 children with hypopituitarism, 52 had congenital hypopituitarism with a median presenting age of 5.86 years (IQR 3-9). Short stature was the commonest presentation (59.6%). Multiple pituitary hormone deficiency (MPHD) was seen in 27 (51.91%). MPHD was associated with the presence of postnatal risk factors (OR 2.036, 95% CI 1.94-3.786) and MRI Imaging abnormalities in hypothalamic-pituitary morphogenesis (OR 1.768, 95% CI 1.087-2.874). 90.4% with GHD, 46.2% with ACTH deficiency, and 40.4% with TSH deficiency had the mean age of presentation 6.54 years, 6.11 years, and 5.56 years respectively. Of the children above 13 years, 57% showed hypogonadism. Hypoplastic anterior pituitary (40.4%) was the commonest MRI abnormality. Out of the 42 children with brain tumours, 25 (59.52%) had craniopharyngioma, and 13 (31%) had Medulloblastoma, while MPHD was seen in 32 (76.2%). Hormone deficiency at the presentation was seen in 57.1%.Conclusion: Comprehensive evaluation and periodic screening are mandatory for the timely diagnosis of MPHD.

Sri Lanka has a legacy of religious and cultural practices promoting health, and its rulers have been responsive to health needs of the populace. The healthcare milieu that prevailed in the pre-colonial and colonial periods favorably influenced the evolution of maternal health in the last 75 years. Since independence, maternal health in the country improved in many dimensions and directions, in the backdrop of multiple sociodemographic changes and geopolitical fluxes, while far-reaching advances in the medico-technological and communication fields were taking place at global level.By 1948, maternal health services were extensive with maternity hospitals, midwifery training school and functional health units in place. The establishment of a cadre of government-trained midwives instead of training traditional birth attendants (TBAs) was a key policy decision that brought long-term dividends. The WHO supported training primary health care workers even before opening their country office in 1952. In the early days, obstetricians relied mostly on their skills to conduct dexterous maneuvers with the generous use of rotational forceps rather than resorting to abdominal deliveries.The Family Planning Association was founded in 1953, which introduced family planning services to the country till the government took over the subject in 1958. A rigorous campaign (punchi pawla raththaran), promoting sterilization was conducted for population control in 1974, which resulted in the total fertility rate coming down significantly.Maternal Death Surveillance and Response system (MDSR) was established in 1981 which has been recognized globally as a success and is being upscaled to a confidential Inquiry status. Commitment and untiring efforts of the Ministry of Health: Family Health Bureau, professional organizations, development partners including the WHO, have contributed for the achievements in the area of women’s health.

Though palliative care is an essential component in the continuum of cancer care, it is still at an evolving phase in Sri Lanka. To identify knowledge, attitude, self-perceived competencies in practicing palliative care and factors associated among medical officers in National Cancer Institute, Sri Lanka. Methods: A descriptive cross sectional study was conducted among doctors in National Cancer Institute in 2020/21 using self-administered questionnaire to assess knowledge, attitudes and self-perceived competencies on palliative care. Doctors worked less than 3 months and directly not involved in patient care were excluded. Scoring systems were used to assess knowledge, attitudes and self-perceived competencies. A descriptive analysis of data was done using SPSS 21 using median scores, frequencies and chi- square test. Ethical clearance was taken from the Ethical Review Committee, Faculty of Medicine, University of Colombo. Out of 120 doctors included in the study, 83 (69.3%) were females and 37 (30.7%) were males. Majority 101(84.2%) were Sinhalese. Sixty (60%) were 31-40 years. Eleven (9.2%) had training in service. Five (4.2%) had a percentage score for knowledge ≤50 while 57 (47.5%) had > 75. Only 3 (2.5%) had a percentage score for attitudes of 51-75 while 116 (96.7%) had > 75. For competency level 57 (47.5%) had percentage score ≤50 while 23 (19.2%) had > 75. Ethnicity, age, work experience, receiving undergraduate training were not significantly associated with knowledge, attitudes and practices (p > .05). Though level of knowledge and attitudes were high, self -perceived competencies were low which highlights the need of training in palliative care. Eg: undergraduate curricular and in-service.

Ceylon Medical Journal (CMJ) is a peer-reviewed, open access journal published quarterly by the Sri Lanka Medical Association in the last week of March, June, September and December each year. The mission of the CMJ is to promote the science and art of medicine and betterment of public health. The Journal publishes original papers and commentaries which have relevance to medicine and allied sciences. The CMJ is committed to maintaining and conforming to the editorial and ethical standards recommended by the International Committee of Medical Journal Editors.