BackgroundIncidence of Dengue infection is on the increase in Sri Lanka with it being associated with significant maternal and neonatal morbidity in pregnancy.Case presentationA 33-year-old pregnant woman at 38 weeks of gestation, presented with acute onset of fever, was later diagnosed with Dengue illness. Due to the emergence of warning symptoms and signs and rapidly dropping platelet count, the baby was delivered by urgent caesarian section. She went into the critical phase during the postoperative period and due to concealed bleeding, required blood transfusion. On the 5th day of life, the neonate was also diagnosed with possible dengue by vertical transmission and required blood and PLT transfusions for recovery.ConclusionsThis case report illustrates how a high index of suspicion, early diagnosis, close monitoring, timely intervention and critical consideration of physiological changes of pregnancy when interpreting clinical situation, led to achieving a successful outcome.

Introduction: Teenage pregnancies account for approximately 6.1% of total pregnancies in Sri Lanka. The objectives of the study were to assess obstetric and psychological outcomes and socioeconomic determinants of teenage pregnancy. Method: A cross-sectional descriptive study carried out on 182 pregnant teenagers for a period of seven months. The validated translation of the Edinburgh Postnatal Depression Scale (EPDS), questions on socioeconomic status and obstetric outcomes were recorded. Results: Teenage pregnancy rates for Singhalese, Tamil and Muslim were 87.4%, 8.2% and 4.4% respectively. The social support was adequate as 177(97%) were living with partners or parents. Unwanted pregnancies accounted for 13(7.1%) of teenage pregnancies at term. Outcomes were; birth weight 2.69 kg (2.57-2.81kg), pre-term labour 17(9.7%), hypertensive disorders 20(11.1%) and perinatal depression 30(16.5%). 75(42.9%) of pregnant teenagers were separated from one or both parents for more than six months in their childhood. There were no pregnant teenagers from upper social class, while 69(46.6%) were from middle and 79(53.4%) were from lower social class. Disruption to family structure and parental educational level of primary school less had 2.32 times and 2.78 times higher risk of perinatal depression in pregnant teenagers respectively. Conclusion: Teenage pregnancies in Sri Lanka are unique compared to other countries as they did not appear to be related to ethnicity and had good social support. Disruption to family structure and socioeconomic background of the parents were risk factors for adolescent pregnancy. Although the majority were wanted pregnancies there was a significant amount of unwanted pregnancies at term.

To assess the effectiveness of spray technique (aqueous based solution in a reusable sprayer) and conventional paint only technique in view of reducing abdominal wall bacteria and to assess the volume of povidone-iodine used in each technique and evaluate which technique is more cost-effective. Methodology The sample included 70 patients, who had elective Gynaecological surgeries at Teaching Hospital, Kandy (2014-2015). This was a non-randomized clinical trial. In all patients, half the abdomen was prepared using the conventional technique and the other half using the new spray technique. Prepreparation and post-preparation skin swabs were taken and cultured to assess the mixed bacterial colony counts. Two output variables were measured; percentage reduction of mixed bacterial colony counts between preoperative and postoperative cultures for the two methods separately and the volume of povidone-iodine used in each method.

Introduction: Oligohydramnios is an important sign of fetal jeopardy and amniotic fluid index (AFI) and single deepest vertical pocket (SDVP) have been used to detect it. Objective: To compare AFI vs. SDVP at term as a predictor of adverse perinatal outcomes. Methods: A prospective observational study was conducted in Teaching Hospital Kandy, Sri Lanka for eight months from July 2015 to March 2016. 448 Singleton pregnancies admitted after 37 completed weeks were included. AFI ≤ 5 cm and SDVP < 2 cm were the exposure variables, which were related to outcome variables. Results: Mean AFI was 11.35 cm (SD = 5.15) and Mean SDVP was 4.07 cm (SD = 1.88). AFI and SDVP values showed a significant positive correlation (r = 0.954; p < 0.001). A significant percentage with low AFI needed induction of labour (RR 2.14, 95% CI 1.85 -2.49). Low AFI was also a significant risk factor for not having an uneventful birth outcome (RR 2.682, 95% CI 1.082 -6.642). Low SDVP was a significant risk factor for induction of labour (RR 1.83, 95% CI 1.434 -2.334), operative delivery (RR 1.714, 95% CI 1.292 -2.280), meconium-stained liquor (RR 2.67, 95% CI 1.342 -5.308), and Apgar < 7 (RR 17.74,). SDVP had better predictability than AFI for adverse perinatal outcomes. Conclusion: AFI better predicted oligohydramnios and subsequent labour induction than SDVP. Low SDVP was a risk factor for adverse perinatal outcomes (such as induction of labour, meconium-stained liquor, operative delivery, 5-minute Apgar less < 7, admission to special care baby units or perinatal deaths). In predicting adverse perinatal events, a higher potential was noted in SDVP method than AFI method. To determine the most predictive cut-off values of SDVP and AFI for each perinatal outcome, an in-depth experimental analysis is required in future research.

Rheumatoid arthritis (RA) is a chronic disease that causes inflammatory synovitis. The treatment plan of RA includes reducing inflammation and improving the quality of life. Hence, understanding the role of Adenosine deaminase (ADA) and C-reactive protein helps for a better plan of treatment. The present study was undertaken to determine the serum ADA activity and CRP in RA patients and correlate with the severity of the progression of the disease. 25 patients diagnosed with RA as per 2010 ACR/EULAR criteria and 25 age and sex matched healthy controls were included in the study after informed consent. Blood samples were collected from all the subjects after an overnight fast, serum separated was analyzed immediately for Adenosine deaminase(ADA) activity measured using colorimetric method of Guisti and Galanti. Disease score, C-reactive protein, RA factor, ADA and ESR were significantly higher in cases when compared with controls. Significant positive correlation was present between the disease score and C-reactive protein, RA factor among cases. A positive correlation was observed between the disease score and ADA, but it was not statistically significant among cases.