Eosinophilia-associated myopathies exhibit clinical and pathological heterogeneity. This is a man in his sixties who presented with fever accompanied by prodromal symptoms, as well as bilateral lower limb weakness and pain. There was evidence of peripheral eosinophilia, increased CPK levels, polyphasic muscle action potentials, and eosinophilic infiltration into the muscle with eosinophilic vasculitis present, without cutaneous or myofascial involvement. Serological and imaging studies were unremarkable, revealing no discernible secondary aetiology for eosinophilia or myositis. A diagnosis of idiopathic eosinophilic myositis accompanied by eosinophilic vasculitis was established. He received glucocorticoids and methotrexate, resulting in effective symptom relief.

Introduction: Blood and blood product transfusion is a standard practice in the clinical setting; however, transfusion-associated adverse events are a growing concern. This study is to evaluate the transfusion reactions occurring at a tertiary care hospital in Sri Lanka.Methods: This was a prospective audit, and data were collected from the transfusion reaction notification forms.Results: There were 144 reported transfusion reactions in the study period, and out of that, 121 reactions were due to red cell transfusions. The commonest symptom was urticaria, followed by fever. Management, only 65(45.14%) cases were managed appropriately.Conclusion: Transfusion Reactions are not always preventable; however, detection, management and prevention of transfusion reactions could be improved.

In Sri Lanka, liver transplantation is rarely performed for decompensated cirrhosis. Hepatic hydrothorax (HH) is a rare yet significant complication of decompensated cirrhosis, affecting approximately 5–10% of patients with portal hypertension. It results from ascitic fluid shifts through diaphragmatic defects, resulting in pleural effusions, mainly on the right side. HH is often refractory to standard diuretic therapy and poses considerable management challenges due to the lack of local consensus guidelines. This narrative review discusses the clinical complexities encountered in two patients with HH and highlights key management considerations, including the effective diuresis and mitigation of other associated complications along with meticulous fluid management strategies; yet ultimately emphasizing liver transplantation as the definitive treatment along with other possible therapeutic strategies.

Sexualised drug use (SDU) refers to the intentional consumption of psychoactive substances before or during sexual activity to enhance sexual experience, reduce inhibitions, or prolong sexual encounters. While extensively documented among men who have sex with men (MSM) in high-income countries, chemsex remains under-recognised and poorly documented in low- and middle-income countries (LMICs), including Sri Lanka. This editorial article provides a narrative overview of SDU and chemsex, synthesising global and regional evidence on associated human immunodeficiency virus (HIV) and sexually transmitted infection (STI) risks, and situating the issue within the Sri Lankan context. Sri Lanka’s youth are at a higher risk of HIV, with MSM disproportionately affected, alongside emerging patterns of synthetic drug use among young adults in urban and nightlife settings. The conjunction of substance use, sexual risk behaviour, stigma, and limited surveillance contributes to a largely hidden public health burden. A brief case illustration of two young men presenting for counselling and STI screening following exposure to a sexualised drug-use environment highlights how chemsex-related contexts can act as an entry point to high-risk sexual behaviour among previously inexperienced individuals. The editorial discusses why chemsex matters for public health, identifies vulnerable populations, and outlines prevention and response strategies, including harm reduction, integration into HIV/STI services, and community-based interventions. Recognising and addressing chemsex is timely and essential for strengthening HIV and STI prevention efforts in Sri Lanka.

Background: Antimicrobial resistance (AMR) poses a significant global health threat, particularly in low- and middle-income countries. Nurses, integral to antibiotic administration, may inadvertently contribute to AMR due to knowledge and practice gaps. In surgical settings, improper antibiotic use can exacerbate resistance. Antimicrobial stewardship (AMS) programs aim to optimize antibiotic use and mitigate AMR.Objectives: To assess surgical ward nurses' knowledge, attitudes, and self-reported practices regarding antibiotic administration, and to examine associations with professional experience, training, and demographics.Methodology: A descriptive cross-sectional study was conducted among 130 nurses in the surgical units of the National Hospital, Kandy. A validated self-administered questionnaire evaluated knowledge, attitudes, and practices related to antibiotic administration. Data analysis included descriptive statistics, Chi-square and Fisher's exact tests for categorical variables, and Kruskal-Wallis and Mann-Whitney tests for continuous variables.Results: Participants were predominantly female (80.8%), aged 30–40 years (53.8%), with diplomas (55.4%), and less than five years of experience (47.7%). Knowledge levels were moderate in 64.6% and poor in 18.5%. Notably, 16.9% believed antibiotics are effective against viral infections, and 32.3% did not recognize nausea/vomiting as signs of anaphylaxis. AMS awareness was moderate (60.8%). Practice gaps included correct IV drop rate calculation (61.5%) and cannula patency checks (60.0%). The mean practice score was 50.71 (SD 5.42), with 71.5% demonstrating good practices. Higher education correlated with better knowledge (p=0.003); attitudes and practices showed no significant demographic associations.Conclusions: Identified gaps in knowledge, AMS awareness, and antibiotic administration practices among nurses highlight the need for targeted education and training to enhance practices and combat AMR.

Introduction: Emergency airway management (EAM) in paediatrics demands a high level of preparedness, particularly in resource-limited settings. This study audited the preparedness of paediatric healthcare staff for EAM and evaluated the impact of a simulation-based intervention.Methods: A prospective audit was conducted using an unannounced drill with a low-fidelity manikin to assess equipment, drug availability, patient preparation, protocol adherence, and team role allocation. A re-audit was carried out following a structured training session.Results: Functional equipment availability increased from 40% to 80% (Z = –3.357, p = 0.001), while drug availability improved with the introduction of fentanyl but without statistical significance (Z = –1.000, p = 0.317). Patient preparation rose from 60% to 100% (N = 5, p = 0.500), protocol adherence improved from 41.2% to 82.4% (N = 17, p = 0.016), and team role allocation increased from 42.9% to 85.7% (N = 7, p = 0.250).Conclusion: Overall, simulation-based training significantly enhanced paediatric EAM preparedness, particularly in equipment functionality and procedural adherence, highlighting its effectiveness as a low-cost educational tool to improve patient safety and readiness for paediatric airway emergencies.

Background: The motivation for a medical student to choose medicine as a career is manifold, and it is overall due to the pursuit of success.Objective: To understand what medical undergraduate students perceive as success and the factors they consider essential to achieving success.Methods: The required sample size based on a population of 450 students with a confidence level of 95%, margin of error of 4%, and response distribution of 50%, is 258. We employed a cross-sectional study design, surveying 268 clinical year students (Years 3, 4, and 5) using a pre-validated questionnaire. Students were randomly selected. We rated their perception of success in life based on five common attributes and rated the six identified factors that they perceived as important in their road to success.Results: We had 260 respondents. Financial stability (29.9%), personal growth (24.6%), and work-life balance (23.5%) were the most valued indicators of success. No statistically significant differences were found across gender, year of study, or ethnicity, indicating consistent perceptions across different groups. In examining the factors for success, strong family relationships (Mean=6.41, SD=0.918) and good health (Mean=6.08, SD=1.070) received the highest ratings. Good time management, economic stability, health, and study habits showed statistically significant variability between the groups. The least important was good teaching-learning methods.Conclusion: These findings highlight the importance of personal well-being and socio-economic stability in shaping both academic outcomes and the broader definitions of success, suggesting that interventions should focus on enhancing time management, health, and financial literacy.

Intestinal obstruction is a common surgical emergency. Internal hernias are rare with broad ligament hernias representing an exceptionally rare subset, especially in patients with virgin abdomen. 43 years old previously well female presented with small bowel obstruction. Imaging indicated bowel obstruction without an obvious cause. Diagnostic Laparotomy revealed an internal hernia through a left broad ligament defect. As the incarcerated bowel was viable it was reduced successfully without post-operative complications. Although rare, broad ligament internal hernias should be considered in females with virgin abdomen presenting with bowel obstruction. Prompt diagnosis and management are crucial to prevent morbidity.

No abstract available

Background: The point of care blood gas measurements are designed to aid immediate patient management right at their bedside. Objective: This study aimed to determine the association of parameters-hemoglobin, hematocrit, sodium, potassium levels obtained with blood gas device versus central laboratory analyzer and to evaluate their co-relation in different ranges of pH, age groups and gender. Methodology: This cross sectional study was carried out for six months in emergency treatment unit (ETU), National Hospital of Sri Lanka, Colombo. In recruited patients, venous blood samples were obtained at the admission for both measurements of central laboratory and blood gas analysis.Results: A total of 440 patients were included, of them 49.8% was male. Mean age 56.9 years (SD 22.33). Mean values of sodium, potassium, hemoglobin, hematocrit in blood gas analysis were 137.15(range 97.6-162), 3.99(1.9-7.4), 12.55(5.9-19.2), 35.65(40-58) respectively. In contrast, the laboratory values for the same parameters were 137(98-163), 4.09(1.99-7.0), 12.24(5.66-19.0), 35.94(19.5-56.9). There was a significant difference between the laboratory and blood gas hematocrit values (p=0.04), however mean values were closely lined. Subgroup analysis in gender, values were not statistically significant except hemoglobin levels (p=0.02). Further subgroup analysis among age and pH groups did not show significant difference.Conclusion: The critical decision can be made by trusting sodium, potassium and hemoglobin values obtained from blood gas analysis. The hematocrit values need to review once laboratory results are available before making a critical decision.