BackgroundDespite the evidence for adverse pregnancy outcomes, non-alcoholic fatty liver disease (NAFLD) is not routinely addressed in early pregnancy. The Fatty Liver Index (FLI) has been proposed as a screening tool for NAFLD in the general population. We aim to develop mathematical models for predicting NAFLD in pregnancy and validate the FLI for first-trimester pregnant women.MethodsBiochemical and biophysical parameters were analysed in pregnant women with period of gestation <12 weeks was done among Rajarata Pregnancy Cohort, Sri Lanka. Fatty liver was graded as (FLG) 0, I or II by ultrasound scan. Binary logistic regression models were employed to identify the factors predicting FLG-II. Six FLIs were developed to predict FLG-II. Validity of the FLIs was compared using the receiver operating characteristic curves.ResultsThe study sample consisted of 632 pregnant women with a mean age of 28.8 years (SD: 5.8 years). Age (OR: 1.6, 95% CI 1.1 to 2.3), body mass index (OR: 1.7, 95% CI 1.1 to 2.5) and gamma-glutamyl transferase levels (OR: 2.1, 95% CI 1.5 to 3.0) were the independent predictors of FLG-II. While the model with liver enzymes provided the best prediction of NAFLD (both FLG I and II) (area under the curve [(AUC]): −0.734), the highest AUC (0.84) for predicting FLG-II was observed with the full model (model with all parameters). The proposed budget model (AUC >0.81) is the best model for screening fatty liver in community health setup.ConclusionFLIs could be used as screening tools for NAFLD based on resource availability in different settings. External validation of the FLI and further investigation of the proposed FLI as a predictor of adverse pregnancy outcomes are recommended.

Ketamine is one of the old anaesthetic agents which has regained popularity in analgesia, trauma, emergency medicine, neurology and psychiatry. Recently several cases were reported on ketamine induced seizures in otherwise healthy children despite its popularity in the treatment of refractory status epilepticus. We present an eight-year-old prematurely born healthy boy who developed two episodes of generalized tonic clonic seizures following administration of ketamine for a short ophthalmic procedure. This case and our comprehensive narrative review of literature on pro-and anti-epileptic effects of ketamine show that the debate continues and gaps on mechanism of action, etiology and risk factors for ketamine's epileptic activity remains. Due to the recent increase in its use further evaluation on ketamine's epileptic effects is warranted to ensure safe and effective use of ketamine.

Soil moisture is one of the major factors that determines volatilization of urea. In this study, we investigated the effect of soil moisture on urea volatilization from an Alfisol (Reddish Brown Earth soil). A bulk soil sample was collected from the research field of the Faculty of Agriculture, Rajarata University of Sri Lanka. A pot experiment was arranged under completely randomized design with four replicates per treatment. Soil moisture levels were maintained at 0 kPa (volumetric water content (VWC): 33%), 33 kPa (VWC: 16%), 44 kPa (VWC: 8%), and 54 kPa (VWC: 2%) as the treatments. A 50% overhead shade net was hung at 1.8 m aboveground covering the treatment pots. Urea was applied to each pot at a rate of 1,276.5 mg kg -1 and emitted NH3 was collected using the enclosure method. Soil NO 3 − -N, NH 4 + -N, pH, and EC were determined at six times at two-day intervals. The effect of soil moisture, time, and their interaction effect on NH3 volatilization was analyzed using repeated measure ANOVA with post-hoc Tukey HSD test for mean comparison. The NH3 volatilization significantly decreased with time (p < 0.05). Time and treatment interactions effect were significant for volatilized NH3 and other soil parameters measured except for soil NO 3 − -N (p < 0.05). A decreasing trend was observed for NH3 volatilization at 0 kPa, 33 kPa, 44 kPa & 54 kPa metric suctions as 6.3 g m -2 day -1 , 4.9 g m -2 day -1 , 4.7 g m -2 day -1, and 0.065 g m -2 day -1 respectively. Soil NH 4 + -N and EC fluctuated significantly among the treatments. Maintaining the soil moisture at 33 kPa during urea application is recommended for achieving high fertilizer use efficiency.