BackgroundMigraine is a primary headache disorder, which cause significant disability in adolescence. This double blind, randomized clinical trial assessed the immediate effects of suction of paranasal sinus air during an acute migraine episode.MethodsA randomized, double blind study was conducted with 56 selected Sri Lankan school children of 16–19 years of age. Participants who met International Headache Society criteria for migraine (with or without aura) were included in the study. Subjects were randomly allocated into 2 groups where one group was subjected to three intermittent 10 sec paranasal air suctions with a ten sec suction free interval between two suctions for each nostril and the other group was subjected to placebo air suction (no paranasal air suction) in similar arrangement. Severity of headache and sub–orbital tenderness before and after suction were recorded using standard pain rating scale.ResultsAfter dropouts, treated and placebo groups consisted of 27 and 23 subjects respectively. The mean headache pain score drop in the treated group was significantly higher compared to that of the control group. Moreover, there was a difference in the treatment response between the types of headache (with or without aura). With respect to tenderness there was a statistically significant drop in the treated group compared to the control. In general, airflow rates in left and right nostrils were different in these subjects. However such difference was not seen in the tenderness on two sides. Nevertheless it was revealed that airflow rate has a slight negative correlation with the tenderness irrespective of the side.ConclusionSixty–second paranasal air suction can provide an immediate pain relief for acute migraine in adolescents. We did not assess pain outcomes beyond 60 s, but the initial responses suggests the need to further study the efficacy of paranasal suction in migraine. A further study is suggested to evaluate the acute effects, efficacy and side effects of paranasal air suction using follow up over a prolong period.Trial registrationSri Lanka Clinical Trials Registry SLCTR/2017/018, 29 Jun 2017. Retrospectively registered.

Febrile illnesses of infective aetiology are common causes of hospital admission in tropical countries. In Sri Lanka, the incidence of dengue infection has markedly increased during the last 15 years whilst infections such as leptospirosis and viral hepatitis A remain endemic. Most of the common infections share a common and non-specific symptomatology, making diagnosis at initial presentation difficult. Similarly co-infections can complicate the clinical course but may remain undetected unless a high index of suspicion is maintained especially during epidemics of one infection. We report two cases of co-infections, highlighting the importance of this possibility. Coexistence of dengue infection with hepatitis A in one patient and with leptospirosis in another patient resulted in an atypical and protracted course of illness with confusing clinical features in either case.

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Tuberculosis is known as the great masquerader for its ability to present atypically. We report a case of a young man presented with progressive tuberculous meningitis and subsequently developed paraplegia due to thoracic cord myelitis, where diagnosis was confirmed bacteriologically. We highlight the presence of acute gastric dilatation as a warning sign of thoracic cord involvement and the place for CSF examination and spinal imaging in arriving at a clinical diagnosis, as treatment needs to start without delay to avoid permanent sequelae. Patient showed a good response to a combined approach of anti-tuberculosis treatment, systemic steroids and intravenous immunoglobulin.

Background: Smoking, alcohol consumption, unhealthy diet and physical inactivity are behavioural risk factors of cardiovascular diseases. These risk factors can be easily changed or modified. Objective: The objective of this study was to estimate the prevalence of behavioural risk factors of cardiovascular diseases and identify their correlates. Methods: A descriptive cross-sectional study was conducted among adults aged between 30-60 years in Sabaragamuwa province, Sri Lanka. Three stage random sampling method was used to select the participants. WHO STEPS wise interviewer administered questionnaire was used to collect data. Chi square test was used to assess the associations between risk factors and their correlates. P value <0.05 was considered as statistically significant. Results: A total of 366 adults participated. Among males 28.4% and 34.3% were current smokers and alcohol users, respectively. Females neither smoked nor consumed alcohol. Only 16.9% of the participants met the WHO recommendations of fruit and vegetable consumption. Approximately two third were physically inactive (63.4%). Women were significantly physically inactive than men (p=<0.001). Men in younger age group smoked than men in older age group (p=0.012). Conclusion: Higher prevalence of behavioural risk factors reported in this study emphasizes the urgent need of adopting healthy lifestyle in this population.