Objective:To describe intensive care unit (ICU) facilities in Sri Lanka; to describe the pattern of admissions, case-mix and mortality; compare patient outcome against the various types of ICUs; and determine the adequacy and standards of training received by medical and nursing staff.Materials and Methods:Observational study of multidisciplinary (general) and adult speciality ICUs in government sector hospitals.Results:Hospitals studied had 1 ICU bed per 100 hospital beds. Each bed catered to 70-90 patients over a year. Death rates were comparable in each level of hospital/ICU despite differences in resource allocation. Fifty to 60% of patients had their original problems related to medicine, while only 35% - 45% were surgical. Thirty two percent of medical patients and 15% of surgical patients died. More than 90% of ICUs had a multi-monitor for each bed. Seventy seven percent of ICUs had one or more ventilators for each bed. Arterial blood gas (ABG) facilities were available in 83% of ICUs. There were serious inadequacies in the availability of facilities of 24 hour physiotherapy (available only in 36.7%), 24 hour in hospital Ultra Sonography (22.4%), electrolyte analyser in ICU (54.2%), haemodialysis / continuous renal replacement therapy (HD/CRRT) (41.7%), and Echocardiography. Medical Officers’ training was anaesthetics dominated as opposed to a multidisciplinary training. There was a severe shortage of critical care trained nurses.Conclusions:Only limited evolution has taken place in intensive care over the past 5 years. The reasons for higher death rates in medical patients should be investigated further. Moving towards a multidisciplinary approach for training and provision of care for ICU patients is recommended.

Background: Diabetes mellitus (DM) is the most common endocrine disorder and major global public health problem. Lack of adherence to antidiabetic medication has lead to suboptimal blood sugar control, treatment failure, accelerated development of complications and increased mortality, thus medication adherence plays an important role in disease control. Hence present study was taken to evaluate the treatment adherence and factors affecting non adherence among Type 2 diabetes mellitus patients.Methods: A cross sectional study carried out by Department of Pharmacology and Medicine, Hassan Institute of Medical Sciences, Hassan. Total 150 patients of type 2 diabetes were recruited after taking their informed consent. Adherence to treatment and factors associated with non adherence has been assessed during a personal interview with each patient using standardized questionnaire.Results: Adherence levels were 28%, 42% and 30% for high, medium and poor adherence respectively. The overall prevalence of non adherence among respondents was 30%. Among them 77.77% were males, 44.44% belonged to age group of 41-60 years, 40% illiterate, 60% employed, 51.11% of patients with smoking and alcoholic habits were not adherent to anti diabetic treatment. Other reasons contributing to non-adherence to treatment were forget fullness (86.66 %), inadequate knowledge about side effects (80%), unhappy clinical visits (71.11 %) and lack of assistance (48.88 %).Conclusions: Results showed that patients in the area of study were moderately adherent to anti-diabetic medications. This emphasizes the need for constant motivation and education at frequent intervals to ensure better adherence.

Background: Thrombocytopenia is the hallmark laboratory finding in dengue fever and leads to bleeding manifestations when reduced markedly. So, this causes panic amongst the patient and relatives about the possibility of severity and leading to various complications including bleeding tendencies. Platelet transfusion is the only definitive treatment and it is indicated only in severe cases with bleeding manifestations. Prophylactic platelet transfusion is not much useful unless it’s reduced below 10,000cells/cumm. Carica papaya leaf extract (CPLE) are believed to have some role in improving platelets and its role is unclear. Hence, this study is taken up to evaluate the role of CPLE in improving dengue thrombocytopenia.Methods: Total 500 patients were included in the study; out of which 380 were males and 120 were females. Patients of dengue fever with thrombocytopenia (Platelet count <1, 50,000 cells/cumm) matching inclusion criteria were included in the study. After the inclusion, patients were randomized into two groups. Study group and control group by simple randomization (even/odd method). The study group treated with CPLE 1100mg three times daily for five days along with symptomatic and supportive treatment. The control group was given only symptomatic and supportive treatment. The average platelet count, average duration of stay and transfusion requirement of platelets were compared using student ‘t’ test.Results: Increased platelet counts were noted early in the treated group than the controlled group. The average duration of hospital stay was 5.42±0.98 days in study group and 7.2±0.97 days in controlled group. The requirement of platelets is more in control group than study group and it was statistically significant.Conclusions: Carica papaya leaf extract tablets can be used in patients with dengue thrombocytopenia with clear advantages over control group.

Hidradenitis suppurativa (HS) can significantly impact quality of life. Reddit allows users with common interests, like HS, to form a community and share information. This has become increasingly important with pandemic-related social isolation. We administered a survey from May 2021– July 2021 to characterize HS patients’ use of Reddit and social media more broadly before and during the COVID-19 pandemic. An analysis of a popular HS support page on Reddit from January 2019– August 2021 was also conducted, analyzing subscribers over time. The rate of subscriber increase was higher before the pandemic. Of 42 patients contacted, 20 patients enrolled (90% female, mean age of 32.4 years) and 18 of the 20 fully completed the survey that was administered. Participants were stratified into two groups: online support group users (n=8) and non-users (n=12). There were no differences in sex, age, education level, antidepressant usage, and overall social media usage between these groups. However, there was a difference in Hurley staging, with over four times as many users reporting a Hurley III staging compared to non-users (p=0.003). Non-users ranked the following as desired features of a social media group more frequently than current users: bandaging/dressing boils, living with HS, medical advice from professionals, causes of HS, and diet (p=0.047, p=0.043, p=0.043, p=0.047, and p=0.013, respectively). This study demonstrates that online support group use is associated with HS of higher clinical severity. Based on the needs/expectations identified in this study, recommendations can be made to providers to help fill any lacunae in clinical care.

by their duration of effect, necessitating frequent redosing. We aim to develop a nanoparticle-based delivery system to extend BoNT release and characterize its release profile. METHODS:Botulinum toxin A (BoNTa) neuromodulators were encapsulated within polymeric nanoparticles (NPs) using a kinetically controlled microfluidic assembly method. Dynamic light scattering was used to measure particle size and uniformity. ELISA was used to quantify the protein release profile. RESULTS:Particle sizes were uniform with most particles centered at 100nm and nearly all particles between 50-200nm. A tunable release profile was achieved, in which BoNTa could be released linearly or with an initial bolus followed by sustained release at the desired rate. Reproducibility of NP performance was demonstrated in 3 independent trials. Our early in-vivo and mechanistic studies have demonstrated preservation of toxin bioactivity and extended therapeutic effect in a rat model. CONCLUSIONS:We developed a novel nanoparticle-based Botox formulation capable of providing long-acting release of neuromodulator with tunable kinetics at designated dosage. This sustained release delivery modality enables superior therapeutic outcomes with less frequent re-dosing.