Objectives Although new-born screening (NBS) for classical congenital adrenal hyperplasia (C-CAH) has been available for decades, it is not widely implemented. We assessed the usefulness of introducing NBS for C-CAH, by analyzing presenting status of infants with C-CAH, over the past two decades, in Sri Lanka. Methods This retrospective clinic-based study, from the largest tertiary children’s hospital in Sri Lanka, analyzed initial presenting features of children with C-CAH from 1999 to 2018, in the absence of NBS for CAH, and included gender-based comparisons. Results Features suggestive of impending adrenal-crisis were seen at initial presentation in >80 % (dehydration 70%, hyponatremia 65%, hyperkalemia 47%, vomiting 45%, hypoglycemia 22%, collapse 20%). Hyperpigmentation was seen in 78%, and consanguinity in 27%. There were fewer affected males (n = 12) compared to females (n = 28). Most girls (96%) had virilized genitalia, and 16 faced uncertainty about gender at birth. Median age at diagnosis was 20 days. More than 70% of children had SW-CAH (males = 9 and females = 20). There were fewer males with SW-CAH, and all had features of impending adrenal crisis, including severe hyponatremia in 50%, while 62% of girls also developed hyponatremia and 33% had hyperkalemia, prior to treatment. Treatment of SW-CAH was initiated at a median age of 30 days in boys, and 10 days of age in girls. Conclusion Many boys and girls with C-CAH from Sri Lanka presented late with impending adrenal crisis. Males were diagnosed later, and some possibly succumbed to C-CAH undiagnosed. These findings support including CAH in NBS programs to avert preventable childhood morbidity and mortality.

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SummaryUltrasound determination of chorionicity is most reliable before 14 weeks and subsequently reduces in accuracy with advancing gestation. The aim of this study was to evaluate the accuracy of chorionicity determination in a birth cohort of twin pregnancies. Antenatal ultrasound determination of chorionicity in twin pregnancy was undertaken at suboptimal period of gestation in over twothirds of twin pregnancies. Even in the first trimester of pregnancy, the accuracy of chorionicity determination was lower than previously reported.

Introduction : Non-communicable diseases (NCD) are emerging in all ages, with cardio-metabolic diseases being a leading cause of morbidity and mortality.OBJECTIVE: To determine the prevalence of cardio-metabolic risk among medical students of a selected Faculty of Medicine in Colombo.METHOD: A cross-sectional study was conducted among medical students (volunteered from all 5 batches) of the selected faculty. Data was collected using a self-administered questionnaire. Anthropometry and body composition were assessed. Blood pressure was measured and after a 12-hour-overnight-fast, blood was drawn for fasting blood glucose (FBG), lipid profile and two-hour oral glucose tolerance test.RESULTS: Final sample included 188 students (males=66). Mean (SD) age was 23.1yrs (1.7) and mean BMI 22.0 kg/m 2 (3.4). Prevalence of overweight was 35.1% (95%CI 28.3-41.9), obesity 5.9% (95%CI 2.5-9.3) and central obesity 16.9% (95%CI 11.5-22.3). 25.8% of males and 46.7% of females had abnormally high percentage body fat. Impaired FBG and impaired glucose tolerance were seen in 13.8% and 1.1% respectively. 25.4%, 12.2%, 31.6%, 5.3% had hypercholesterolemia, high LDL, low HDL and hypertriglyceridemia respectively. Consumption of alcohol was seen in 9%, low physical activity in 39.5%, sedentary life in 58%, low consumption of vegetables in 83.4% and low consumption of fruits in 86%. Males had higher rate of overweight/obesity (p=0.02), abnormal W/Height ratio (p=0.04), hypertriglyceridemia (p=0.06) while females had higher abnormal fat mass (p=0.005) and W/Hip ratio (p=0.000).CONCLUSIONS: Medical students (young adults) have high prevalence of cardio-metabolic risk, highlighting the importance of routine screening, proper health education and behaviour modification for these future doctors who should be role models of health.