Miller Fisher syndrome (MFS) is an immune mediated neuropathy commonly triggered by an infection. It is considered as a variant of Guillain-Barre syndrome. Although bilateral ophthalmoplegia is the commonest ocular involvement in MFS, there are reported cases of unilateral ophthalmoplegia. MFS has a benign course and treatment is not required in majority of cases unless there is a lifethreatening complication.We report an unusual case of MFS, presented with isolated right sided oculomotor nerve palsy with pupillary involvement, ataxia and areflexia. Patient was treated with intravenous immunoglobulin (IVIG) achieving a remarkable recovery by five days of treatment. We believe this is a treatment effect rather than the natural course of her illness. Although it is rare, MFS should be included in the differential diagnosis of unilateral 3 rd nerve palsy with pupillary involvement, especially when associated with ataxia or areflexia. Having a low threshold to initiate IVIG in MFS may accelerate the recovery with a positive impact on patient's functional status.

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Rhino-orbital-cerebral mucormycosis is an invasive disease caused by fungi. Diabetes mellitus and solid organ transplantation are known risk factors, while it is increasingly recognized in patients with COVID-19 although the exact causal relationship is unknown. Early diagnosis and treatment with liposomal amphotericin B with surgical debridement carries a better outcome in these patients.We present a case of extensive rhino-orbital-cerebral mucormycosis involving the paranasal sinuses, left orbit, cavernous sinus, middle cranial fossa with abscess formation in the left middle cerebellar peduncle in a 46-year-old kidney transplant recipient with concomitant COVID-19 infection.

AimsOur objective was to study the psychological morbidity and associated risk factors among antenatal and postnatal patients referred for the psychiatric assessment at University Psychiatry Unit of National Hospital of Sri Lanka.MethodAll the Clinic records of perinatal referrals from 1st January 2019 to 31st December 2019 were assessed. Sociodemographic details, delivery details, health of the newborn, past and present psychiatry illness related details were obtained using a questionnaire. Data were analysed using SPSS.ResultTotal of 161 perinatal referrals were studied. Mean age of the mothers were 28.7 years (SD = 6.60). About 18 (11.8%) were not legally married, partner passed away or estranged. Above Ordinary level education was having 34.5% of participants. Majority were postnatal mothers (61.5%). Some mothers (32.3%) have reported the pregnancy was unexpected whilst 20(32.3%) and 49(30.8%) have experienced delivery complications and neonatal illnesses respectively. Past mental illnesses were found among 31(20.7%) of mothers. Out of whole perinatal referrals maternity blues (28.9%) was the commonest current psychiatry diagnosis. Among antenatal mothers, adjustment disorder (28.8%) and depressive disorder (17.3%) were the commonest. Schizophrenia, Schizophreniform disorder and bipolar illness were found among 8(5%), 6(3.7%) and 3(1.9%) mothers respectively. Major psychoactive substance use disorder was found among 4 (2.5%) mothers. Presence of pregnancy related complications were significantly associated with postpartum metal illnesses(p = 0.008).ConclusionCommonest perinatal mental illness was the maternity blues. Depressive disorder was the commonest major mental illness and neonatal complications were associated with psychological morbidity in postnatal mothers.

Introduction:The transition from undergraduate student to independent practitioner for medical graduates is a challenging one. This paper describes a multi-faceted training model-the "Good Intern Programme (GIP)"-that aims to provide such training for newly qualified doctors (pre-interns, PI) in Sri Lanka. Methods: The development and implementation of the GIP included the following: focus group discussions to understand the requirements; a needs assessment including identification of the main stressors; a 10-day practical Tamil language-training programme; a 4-day acute care skills training (ACST) program; and a 4-day Good Medical Practice (GMP) workshop based on the system building blocks of the WHO. Results: 980 PIs participated in the needs assessment; 383 (39.1%) stated that the first half of their internship was more stressful than the second (p<0.003). Amongst the 866 PI who registered for the GIP, 783 (90.4%) considered knowledge of medical administrative matters to be of importance to doctors. Hospital based clinical training, conducted in 28 hospitals island-wide, was attended by 278 PI; a statistically significant increase for all surveyed skills was demonstrated. The feedback for the GMP workshop, attended by 796 PI, was broadly positive with the session on "essential skills for interns" receiving the highest positive rating for relevance. Conclusion:The GIP provides a comprehensive opportunity to facilitate the transition of medical graduates in Sri Lanka using a multimodal, integrated and sustainable platform. This national program may have applicability beyond Sri Lanka.