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Diyatalawa, Sri Lanka

Kanitkar M.,Base Hospital | Ramamurthy H.R.,Military Hospital
Indian Journal of Pediatrics | Year: 2013

Bed wetting or nocturnal enuresis is a common problem among children. It is either monosymptomatic or may be associated with a voiding disorder. Many factors may contribute towards enuresis such as developmental delay, heredity, inappropriate nocturnal anti diuretic hormone secretion and reduced bladder capacity. Any child presenting with bed-wetting should be evaluated for any underlying bladder dysfunction before labeling as monosymptomatic enuresis. The evaluation consists of structured bowel and bladder history, detailed clinical examination, frequency volume record and appropriate investigations. The frequency volume diary is an indispensible component of evaluation and helps in establishing diagnosis and tailoring therapy. The treatment of monosymptomatic enuresis consists of positive psychological support, alarms and medication (desmopressin/ anticholinergics/ imiprammine). Children with features of underlying bladder dysfunction, anatomical anomalies and neurological disorders should be referred to a pediatrician without delay. The outcome of therapy is usually rewarding but varies, depending on the underlying etiology, motivation, compliance and family support. The cure rates with alarms are better than with desmopressin in monosymptomatic enuresis. Timely and appropriate therapy yields better outcomes. Thus, a thorough, scientific and evidence based approach is essential in children presenting with bed-wetting. © 2013 Dr. K C Chaudhuri Foundation.

Ranawaka R.R.,Base Hospital
The Ceylon medical journal | Year: 2014

OBJECTIVES: The objectives were to assess the demographical pattern, clinical presentation and therapeutic response in a cohort of patients with alopecia areata (AA) in Sri Lanka.METHODS: Hospital-based observational study of 290 adults aged 18 years or above.RESULTS: Alopecia areata was commoner in men (M:F=1.3:1). Age of onset was between 20-35 years (median 31 years) in 61%. Those with juvenile-onset AA (≤ 17 years, n=5) showed severe disease with many relapses and resistance to therapy. Late-onset AA (<50 years, n=12) was commoner among females and had mild disease activity. Alopecia areata was the commonest clinical type (93.7%), followed by alopecia universalis (n=10), ophiasis pattern (n=3), alopecia totalis (n=3), and reverse ophiasis pattern (n=1). Mild disease (>10% scalp area) was the commonest (82%). Alopecia was total, universal or extensive (>10% scalp area) in 18%. Sites involved were scalp (71%), beard only (20.5%) and multiple sites (8.7%). Nail changes were associated with severe disease. Associated autoimmune diseases were vitiligo 6 (2%), thyroid disease 5 (1.7%) and rheumatoid arthritis 1 (0.3%). Atopy (21%) was not associated with younger age of onset or severity of disease. Patients with a family history among first degree relatives had earlier onset of disease. Most (61%) were cured after 1-2 intralesional steroid injections. Oral dexamethasone mini pulse with or without topical 5% minoxidil lotion for 12 months or more were used in 28%.CONCLUSIONS: In Sri Lanka AA is a disease of the young. Extensive disease, juvenile onset, and associated nail changes were poor prognostic factors.

Kathpalia S.K.,Base Hospital
Medical Journal Armed Forces India | Year: 2016

Background: Prior to legalization of abortion, induced abortions were performed in an illegal manner and that resulted in many complications hence abortion was legalized in India in 1971 and the number of induced abortions has been gradually increasing since then. One way of preventing abortions is to provide family planning services to these abortion seekers so that same is not repeated. The study was performed to find out the acceptance of contraception after abortion. Methods: A prospective study was performed over a period of five years from 2010 to 2014. The study group included all the cases reporting for abortion. A proforma was filled in detail to find out the type of contraception being used before pregnancy and acceptance of contraception after abortion. The existing facilities were also evaluated. Results: 1228 abortions were performed over a period of five years. 94.5% of abortions were during the first trimester. 39.9% had not used any contraceptive before, contraceptives used were natural and barrier which had high failure. Themain indication for seeking abortion was failure of contraception and completion of family. 39.6% of patients accepted sterilization as a method of contraception. The existing post abortion family planning services are inadequate. Conclusion: Post abortion period is one which is important to prevent subsequent abortions and family planning services after abortion need to be strengthened. © 2015 Published by Elsevier B.V. on behalf of Director General, Armed Forces Medical Services.

Cooray T.C.M.G.P.G.,Base Hospital
Sri Lankan Journal of Anaesthesiology | Year: 2011

Preoperative anaesthetistic visit is an essential component in the present day management of anaesthesia. This not only allows the anaesthetic risk assessment of the patient but also gives an opportunity to optimise the patient. We seldom consider the patient's views on this visit by the anaesthetist. The aim of this audit was to get an understanding of the patients outlook towards these visits. The audit was carried out in three hundred patients using a questionnaire 86.6% responded. 90% of them had benefited from the preoperative visit by the anaesthetist. Only 16.5% were satisfied with the time the anaesthetist spent with them. This was mainly with the patients under going major surgery. Only 27.3% patients were satisfied with the explanation of the anaesthetic procedure. 5% of the patients were not satisfied with the opportunity given for them to express their views. 6.5% of the patients became more anxious after the anaesthetist's visit.

Apte C.V.,Oman Medical College | Tomar R.K.S.,Medical Depot | Sharma C.D.,Base Hospital
Medical Journal Armed Forces India | Year: 2015

Background: There is uncertainty whether acclimatized low-landers who return to high altitude after a sojourn at low altitude have a higher incidence of pulmonary edema than during the first exposure to high altitude. Methods: Thiswas a prospective cohort study consisting of men ascending to 3400mby road (N = 1003) or by air (N = 4178). The study compared the incidence of high altitude pulmonary edema during first exposure vs the incidence during re-exposure in each of these cohorts. Results: Pulmonary edema occurred in 13 of the 4178 entries by air (Incidence: 0.31%, 95% CI: 0.18%e0.53%). The incidence during first exposure was 0.18% (0.05%e0.66%) and 0.36% (0.2%e0.64%) during re-exposure (Fisher Exact Test for differences in the incidence (two-tailed) p = 0.534). The relative risk for the re-exposure cohort was 1.95 (95% CI, 0.43%e8.80%). Pulmonary edema occurred in 3 of the 1003 road entrants (Incidence: 0.30%, 95% CI: 0.08%e0.95%). All three cases occurred in the re-exposure cohort. Conclusion: The large overlap of confidence intervals between incidence during first exposure and re-exposure; the nature of the confidence interval of the relative risk; and the result of the Fisher exact test, all suggest that this difference in incidence could have occurred purely by chance. We did not find evidence for a significantly higher incidence of HAPE during re-entry to HA after a sojourn in the plains. © 2013, Armed Forces Medical Services (AFMS). All rights reserved.

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