Xanthogranulomatous inflammation is a rare form of chronic granulomatous inflammation. Bacterial infections, immunosuppression, chronic inflammatory conditions, luminal obstruction, endometriosis, leiomyoma, abnormal lipid metabolism, ineffective antibiotic therapy, ineffective clearance of bacteria by phagocytes and chronic irritation of the urachal remnant have been implicated in the pathogenesis. There are very few reported cases of xanthogranulomatous salpingitis and oophoritis. We present such a case in a 34-year-old female, with primary subfertility for eight years, endometriosis, uterine leiomyoma, type II diabetes mellitus and a history of surgery for endometriosis and fibroids and surgical wound infection, who presented with symptoms of intestinal obstruction. The patient underwent emergency laparotomy followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histology revealed xanthogranulomatous salpingitis and oophoritis. Chronic inflammation due to inadequate treatment of bacterial infection, coupled with pelvic endometriosis and uterine leiomyoma may have led to xanthogranulomatous salpingitis and oophoritis.

CONTEXT:Artificial reproductive techniques using seminal preparations with bacteria may cause pelvic inflammatory disease and its sequalae.AIMS:To assess efficacy of two sperm preparation techniques to clear bacteria and the effect of bacteriospermia on sperm recovery rates.SETTINGS AND DESIGN:A descriptive cross-sectional study was carried out among males of subfertile couples.SUBJECTS AND METHODS:Semen samples were randomly allocated into swim-up method (group S, n = 68) and density gradient method (group D, n = 50) for sperm preparation. Seminal fluid analysis and bacterial cultures were performed in each sample before and after sperm preparation.STATISTICAL ANALYSIS:McNemar's chi-squared test and independent samples t-test in SPSS version 16.0 were used.RESULTS:Organisms were found in 86 (72.88%) out of 118 samples, before sperm preparation; Streptococcus species (n = 40, 46.51% of which 14 were Group D Streptococcus species), Coagulase negative Staphylococcus species (n = 17, 19.76%), Staphylococcus aureus (n = 13, 15.11%), Coliform species (n = 11, 12.79% of which 09 were Escherichia coli) and Corynebacterium species (n = 5, 5.81%). There was a statistically significant reduction of culture positive samples in raw vs. processed samples; in group S, 49 (72.05%) vs. 16 (23.52%) and in group D, 37 (74%) vs. 18 (36%). In group S and D, mean (SD) recovery rates of culture positive vs. culture negative samples were 39.44% (SD-14.02) vs. 44.22% (SD-22.38), P = 0.39 and 52.50% (SD-37.16) vs. 49.58% (SD-40.32), P = 0.82 respectively.CONCLUSIONS:Both sperm preparation methods significantly reduced bacteria in semen, but total clearance was not achieved. Sperm recovery rate was not affected by bacteriospermia.

Introduction: European cultural norms have influenced physicians’ attire in Sri Lanka. The necktie is one such item of clothing which is worn to be recognized and respected as professionals. This study was carried out to assess the perceptions of doctors and patients towards male doctors wearing neckties while providing patient care. Methododology: A descriptive cross-sectional study was carried out at the National Hospital of Sri Lanka. An interviewer-administered questionnaire was used to collect data from doctors and patients. Results: The study included 105 doctors (57% males) and 333 patients (54% males). Mean ages of the doctors and patients were 37 years (95% C.I. 36-39) and 47 years (95% C.I. 45-49) respectively. Sixty-nine percent of the patients had completed secondary education or above. None of the patients were aware of the risk of spreading infections by wearing a necktie. Of the 41% of doctors who thought it was unnecessary to wear a necktie, 95% believed the necktie can spread infections. Ninety-five percent of patients believed doctors should wear neckties to be identified and respected and to maintain trustworthiness. Conclusions: None of the patients were aware of the possible risk of spreading infections by wearing a necktie, while most of the doctors who thought neckties were unnecessary also believed neckties can spread infections. Almost all patients thought that doctors should wear a necktie to be recognized and respected. Therefore, implementing a change in dress policy for doctors is a challenging task in Sri Lanka.

Dermatoses of pregnancy are common, but rarely affect the feto-maternal outcome. Prurigogestationis is a pregnancy specific dermatological condition, which resolves spontaneously in the puerperium. We report a rare case in which it led to permanent disfiguration of the skin by transformation in to prurigonodularis.

Backgrounds: Induction of labor is a common practice. In women with immature cervix, PGE2 is commonly used for pre-induction. We hypothesized that PGE2 1.5 mg may be equally effective to PGE2 3 mg in multiparous women for labor induction. The present effort was an attempt to compare the efficacy and effects of pre-induction cervical ripening with PGE2 3 mg vs. 1.5 mg in multi-parous mothers (2nd and 3rd Pregnancy) at 40 weeks. Methods: A double-blind randomized controlled trial was carried out at Castle Street Hospital for Women, Colombo, Sri Lanka. Study subjects consisted of women with singleton pregnancy (no cesarean history) admitted for delivery at 40 weeks of their 2 nd or 3rd pregnancy. PGE2 1.5 mg vs. 3 mg PGE2 vaginal tablet were used for treatment (n = 173) and control (n = 170) groups, respectively. Cervical ripening and maternal, fetal complications were observed. Unfavorable cervices were induced with the same PGE2 dose in the following day. Results: Study group, compared with the control group, achieved the same rate of favorable cervices in 1st and 2nd cycles (63.5% vs. 64%, respectively). Both groups showed the same rate of cervical dilatation achievement, and admissions to Special Care Baby Unit. Study group showed significantly less maternal complications (4% and 11%, respectively: p = 0.01). Conclusion: PGE2 of 1.5 mg is equally effective in achieving favorable cervices, adequate cervical dilatation with minimum maternal complications compared to the usual 3 mg dose in multiparous low-risk women.