Introduction: The art and science of selecting the correct medicine for different diseases is called therapeutics. For students of medicine to learn this, real patients are a need. Yet, there are ethical and safety issues when trainees use patients for learning purposes. If patients and diseases can be mimicked, this problem could be circumvented. High Fidelity Simulations (HFS) is the science and art of mimicking patients and diseases as close as possible to real life scenarios. Objective: To assess the student perception on the use of HFS to teach therapeutics in paediatrics and to assess the knowledge gain. Method: A group of final year medical students during their professorial paediatric appointment were given the scenarios on status epilepticus and acute severe asthma using HFS, designed to select the correct drugs, formulations, doses, routes of administration, checking and giving the drugs, looking for adverse reactions and managing accordingly. Pre-test and post-test questionnaires were administered to assess the student's knowledge gain. Their perception about the teaching session was assessed using a pre-tested anonymous selfadministered questionnaire in a five-point Likert scale. (1=strongly disagree, 5=strongly agree) Results: Students scored significantly higher in the post-knowledge assessment when compared with the pre-session knowledge assessment (p <0.001). Student perception about the HFS session scored 4 to 5 in the Likert scale. Students mentioned that HFS should be used more often in teaching therapeutics and further mentioned that it is better than small group discussions. Conclusions: Use of HFS in teaching therapeutics in paediatrics is well received by students. It is an effective method of knowledge gain in therapeutics for medical students.

Several neurological manifestations are recognized in dengue infection, but stroke is a rare complication. We report a case of ischemic stroke in a patient with dengue hemorrhagic fever. A 52-year-old previously healthy male presented with a history of fever for 2 days, and left-sided weakness and numbness of sudden onset. MRI scanning showed a right-sided thalamic lacunar infarct. Diagnosis of dengue fever was made based on leuco-thrombocytopenia, positive dengue nonstructural protein-1 (NS-1) antigen, and positive dengue IgM antibodies. Severity of limb weakness correlated with the critical phase of dengue hemorrhagic fever (DHF). He was discharged home with good recovery from neurological symptoms and disability. Strokes are rare in dengue, and are mainly hemorrhagic strokes related to thrombocytopenia. Ischemic stroke is even rarer. More evidence is needed for confirmation of dengue as a pathogenic mechanism of ischemic stroke.

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Introduction: Gentamicin is the first line antibiotic for early onset neonatal sepsis. Yet the problem with gentamicin is the low therapeutic index. It is known that high trough levels correlate with ototoxicity and nephrotoxicity while the peak levels decide the therapeutic effect. Once daily dose (ODD) and twice daily dose (TDD) schedules are practised in neonatal units in Sri Lanka. Objectives:To assess whether the ODD and TDD schedules of gentamicin used in neonates are effective in avoiding high serum trough levels and in achieving peak serum levels in the therapeutic range.Method: A prospective study was conducted from April to August 2017 in four neonatal units on term neonates less than one week old, in whom gentamicin was started (TDD regime= 2.5 mg/kg 12 hourly and ODD regime= 5mg /kg 24 hourly) during the study period. Trough and peak serum gentamicin levels (SGLs) were assessed before and after the third dose in the TDD regime and after the second dose in the ODD regime. Serum creatinine (SCr) was measured in all the neonates and neonates with high trough levels were referred for hearing assessment.Results: A total of 50 neonates of clinical maturity 37-41 weeks and birth weight 1.8-4.1 kg was included. High trough levels (>2 mg/dl) were seen in 48% of the TDD group and in 12% of the ODD group (p=0.005) Mean trough value in the ODD group was 1.15 mg/dl (SD 0.87) and in the TDD group was 2.14 mg/dl (SD 1.72). (T=-2.564, df=35, p = 0.015). Peak SGL in the therapeutic range (5-_________________________________________ The authors declare that there are no conflicts of interest Funding: University research grant for financial assistance. Open Access Article published under the Creative Commons Attribution CC-BY License 10 mg/dl) was seen in 92% of ODD regime and in 80% of the TDD regime. Mean peak values in the ODD and TDD regimes were 9.42 (SD 2.37) mg/dl and 7.12 (SD 2.18) mg/dl respectively (T= 3.56, df=48, p = 0.001). SCr and the hearing assessment were within normal limits in all neonates. Conclusions:The ODD gentamicin schedule of 5 mg/kg achieves a significantly higher peak serum gentamicin level and safer trough levels than the TDD schedule of 2.5 mg/kg. DOI: http://dx.doi.org/10.4038/sljch.v48i1.8647 (