BackgroundClozapine is a second generation antipsychotic used to treat resistant schizophrenia and other psychotic illnesses. Leucopenia or agranulocytosis is a rare side effect of this drug. Pancytopenia is an extremely rare side effect of clozapine and literature review showed only one such case in where the pancytopenia developed several months after starting clozapine together with other antipsychotic drugs.Case presentationA 26-year-old Sri Lankan male was admitted with fever for 3 days. Apart from generalized body aches there were no other significant symptoms. His blood counts showed pancytopenia. He was being treated for a resistant schizophrenia and clozapine was started only 4 weeks before. Common causes for pancytopenia were excluded, and a diagnosis of clozapine induced pancytopenia was made. He was managed in the intensive care unit with broad spectrum antibiotics, antifungals and granulocyte colony stimulating factors. He made a complete recovery after 4 weeks.ConclusionThis is a rare and probably the first reported case of early onset clozapine induced pancytopenia complicated by severe sepsis recovering completely.

Information-seeking behavior and information utilization are two vital concepts that can be assessed to measure the usage of circulars and guidelines in organizations. Information accessibility and availability are two main components of information utilization. This descriptive cross-sectional study assesses the utilization, accessibility, and availability of circulars among senior and middle-level managers of the PDHS office in Western Province. Senior and middle-level managers constituted the study population. Quantitative method was utilized in achieving the objectives. Respondents were assessed through pre-validated questionnaires on the variables of information utilization and case scenario-basedmodel. Accordingly, it was identified that the awareness and capability of information utilization in their daily routines were high among senior and middle-level managers (over 3). The overall performance in the case scenarios was very low (average of 22). Although the most preferred mode of keeping information was the circular file, the majority were in the belief that an alternative method to improve availability and accessibility is useful in improving information utilization in decision-making.

Introduction: The cost of laboratory services has become a challenge for continuing free healthcare in developing countries like Sri Lanka. Objectives To undertake cost estimation and cost comparison of three selected laboratory investigations at different levels of healthcare institutions in the Western Province. Methodology: A descriptive cross-sectional study was carried out from May 2019 to July 2019. The analysis was based on secondary data collected from Lady Ridgeway Children's Hospital Colombo (LRH), Base Hospital Horana (BHH), and Divisional Hospital Bandaragama (DHB), during the study period. The cost analysis was performed using the step-down method. Result:s Total cost of FBC, CRP, and UFR tests were calculated, and compared among three hospitals. The total cost of FBC in the LRH, BHH, and DHB was Rs.301.16, Rs.255.19, and Rs.380.83 respectively. The total cost of CRP in those hospitals was Rs.264.46, Rs.237.70, and Rs.85.63 while the total cost of UFR was Rs.130.21, Rs.126.42, and Rs.81.83 respectively. Discussion: The highest cost of FBC as revealed by this study was in DHB. It comprised of a high equipment cost per test. Though the LRH possesses a high-tech hematology analyzer, the higher volume of investigations done makes the equipment cost less per test in the LRH. The cost of testing CRP, in the order of highest to lowest, was in the LRH, BHH, and DHB. The reason for the lowest cost of CRP in DHB can be attributable to the non-usage of reagents and less equipment cost due to manual handling. The cost of UFR was comparatively low in DHB. It can be due to the contribution of low salary cost and low cleaning service cost because of less human resource usage. ConclusionRecommendation: