Knowledge, and practices on sexual and reproductive health among youth trainees attached to youth training centers in Sri Lanka.

BACKGROUND: Sexual and reproductive health is a major concern among adolescents and youth in Sri Lanka. The study was carried out to assess the knowledge, and practices of the youth trainees attached to youth training institutes in Sri Lanka. METHODOLOGY: A descriptive, cross-sectional study was carried out among randomly selected 425 youth trainees attached to youth training centers in Sri Lanka using a pre-tested self-administered questionnaire. Statistical analysis was conducted using SPSS-21. Categorical variables were presented as numbers and percentages. A comparison of categorical variables was conducted using the Chi-Square test and Fisher's exact test as applicable. The bivariate logistic regression model was used to determine the independent association of the selected demographic factors with youth trainees' sexual and reproductive health knowledge. RESULTS: Study group consisted of 51.8% (n = 220) males and 48.2% (n = 205) females with a mean age of 18.6 years (SD = 1.8). Youth trainees' knowledge of the physiology of the reproductive tract was not at a satisfactory level, where Only 49% (n = 211) knew that nocturnal emission is normal in young men. The trainee's knowledge of contraception was also at a poor level. Only 47.5% (n = 202) had ever heard of condoms, and 13.2% (n = 56) knew about the emergency contraceptive pill. Nearly 8% (n = 33) of the youth had engaged in sexual intercourse at least once in their lifetime. Male gender (AOR = 2.3, p < 0.001), and age above 20 years (AOR = 1.9, P = 0.005) were positively associated with SRH knowledge. CONCLUSIONS AND RECOMMENDATIONS: Knowledge and practices on sexual and reproductive health among youth trainees were sub-standard. The study recommends strengthening sexual and reproductive health education at youth training centers.

A Fusion Algorithm for Saccade Eye Movement Enhancement With EOG and Lumped-Element Models.

Electrooculography (EOG) can be used to measure eye movements while the eyelids are open or closed and to assist in the diagnosis of certain eye diseases. However, challenges in biosignal acquisition and processing lead to limited accuracy, limited resolution (both temporal and spatial), as well as difficulties in reducing noise and detecting artifacts. Methods such as finite impulse response, wavelet transforms, and averaging filters have been used to denoise and enhance EOG measurements. However, these filters are not specifically designed to detect saccades, and so key features (e.g., saccade amplitude) can be over-filtered and distorted as a consequence of the filtering process. Here we present a model-based fusion technique to enhance saccade features within noisy and raw EOG signals. Specifically, we focus on Westheimer (WH) and linear reciprocal (LR) eye models with a Kalman filter. EOG signals were measured using OpenBCI's Cyton Board (at 250 Hz), and these measurements were compared with a state-of-the-art EyeLink 1000 (EL; 250 Hz) eye tracker. On average, the LR model-based KF produced a 47% improvement of measurement accuracy over the bandpass filters. Thus, we conclude that our LR model-based KF outperforms standard bandpass filtering techniques in reducing noise, eliminating artifacts, and restoring missing features of saccade signatures present within EOG signals.

Assessment of Prevalence, Associations ,Knowledge, and Practices about Diabetic Foot Disease in a Tertiary Care Hospital in Colombo, Sri Lanka.

BACKGROUND: One in five adults in Sri Lanka has either diabetes or prediabetes, and one-third of those with diabetes are undiagnosed. Diabetic foot is a debilitating condition affecting up to 50% of patients with both type 1 and type 2 diabetes. The risk of nontraumatic lower limb amputations is 15 times higher in diabetic patients when compared with nondiabetics. Patient education about correct foot care practices is the cornerstone of prevention of diabetic foot disease. OBJECTIVE: To assess the prevalence of diabetic foot disease, knowledge, and practices about diabetic foot care among diabetic patients. METHODS: 334 patients attending the diabetic clinic in Colombo South Teaching Hospital were recruited according to the inclusion and exclusion criteria. Data were collected using 3 questionnaires, and they were filled using the foot examination findings, patients' medical records, and direct interviewing of the patients. RESULTS: The mean age of the patients included in the study was 58.23 ± 10.65 years while the median duration of diabetes was 10.54 ± 7.32 years. 34.1% patients had peripheral neuropathy, and 29.5% had peripheral vascular disease. Diabetic foot disease according to the WHO definition was present only in 23 (6.9%) patients. There was a significant association between peripheral neuropathy and current or past foot ulcer which took more than 2 weeks to heal (p < 0.05). Knowledge about foot care was less among the studied population, and it was associated with poor foot care practices. Presence of diabetic foot and current or past foot ulcer which took more than 2 weeks to heal were significantly associated with the foot care knowledge and practices (p < 0.05). CONCLUSION: Improvement of patients' knowledge about foot care and their practices have a significant impact on the reduction of diabetic foot disease.

Experimental fluid dynamics characterization of a novel micropump-mixer.

The application of lab-on-a-chip systems to biomedical engineering and medical biology is rapidly growing. Reciprocating micropumps show significant promise as automated bio-fluid handling systems and as active reagent-to-sample mixers. Here, we describe a thorough fluid dynamic analysis of an active micro-pump-mixer designed for applications of preclinical blood analysis and clinical diagnostics in hematology. Using high-speed flow visualization and micro-particle image velocimetry measurements, a parametric study is performed to investigate the fluid dynamics of six discrete modes of micropump operation. With this approach, we identify an actuation regime that results in optimal sample flow rates while concomitantly maximizing reagent-to-sample mixing.

Comparative study on larvicidal activity of green synthesized silver nanoparticles and Annona glabra (Annonaceae) aqueous extract to control Aedes aegypti and Aedes albopictus (Diptera: Culicidae).

The present study reports mosquito larvicidal potential of green synthesized silver nanoparticles by using Annona glabra leaves (An-AgNPs). Synthesized An-AgNPs were characterized by Ultraviolet-Visible spectroscopy (UV-VIS), Scanning Electron Microscopy (SEM), Dynamic Light Scattering (DLS) technique and Fourier transform infrared spectroscopy (FTIR). Colur change from pale yellow to brick red of the plant extract and AgNO3 solution indicated the formation of An-AgNPs initially. Surface Plasmon Resonance (SPR) band at 435 nm in the UV-Vis confirmed the formation of An-AgNPs. SEM images showed that An-AgNPs were spherical in shape. FTIR proved that An-AgNPs were functionalized with biomolecules in A. glabra leaves. Based on DLS analysis the average size range of synthesized An-AgNPs was determine to be 10-100 nm and 100-1000 nm. Third instar larvae of dengue vector mosquitoes, Aedes aegypti and Aedes albopictus were subjected to larvicidal bioassays in a range of concentrations of An-AgNPs and A. glabra crude aqueous leaf extract (2-10 mg/L). An-AgNPs exhibited very high larvicidal activity against dengue vector mosquito larvae; LC50 value for Ae. aegypti at 24 h exposure to An-AgNPs (Plant extract: AgNO3 1 : 10) 5.29 mg/L; An-AgNPs (Plant extract: AgNO3 2 : 10) 2.43 mg/L while LC50 value for Ae. albopictus at 24 h exposure to An-AgNPs (Plant extract: AgNO31:10) 3.02 mg/L; An-AgNPs (Plant extract: AgNO3 2:10) 2.51 mg/L. LC50 values obtained for A. glabra leaf extract tested against Ae. aegypti and Ae. albopictus are 5.94 mg/L and 5.00 mg/L respectively at 24-hour exposure. This study further revealed that Ae. albopictus is more susceptible than to Ae. aegypti to a given concentration of An-AgNPs and to crude aqueous leaf extract of A. glabra. Larvicidal effect of An-AgNPs is superior to the crude aqueous leaf extract of A. glabra. An-AgNPs is a potent larvicide for dengue vector control.

A patient with extensive cerebral calcification due to pseudohypoparathyroidism: a case report.

BACKGROUND: Pseudohypoparathyroidism(PHP) is a heterogeneous group of disorders due to impaired activation of c AMP dependant pathways following binding of parathyroid hormone (PTH) to its receptor. In PHP end organ resistance to PTH results in hypocalcaemia, hyperphosphataemia and high PTH levels. CASE PRESENTATION: A 59 year old male presented with a history of progressive impairment of speech and unsteadiness of gait for 1 week and acute onset altered behavior for 1 day and one episode of generalized seizure. His muscle power was grade four according to MRC (medical research council) scale in all limbs and Chovstek's and Trousseau's signs were positive. Urgent non contrast computed tomography scan of the brain revealed extensive bilateral cerebral and cerebellar calcifications. A markedly low ionized calcium level of 0.5 mmol/l, an elevated phosphate level of 9.5 mg/dl (reference range: 2.7-4.5 mg/dl) and an elevated intact PTH of 76.3 pg/l were noted. His renal functions were normal. His hypocalcemia was accentuated by the presence of hypomagnesaemia. His 25 hydroxy vitamin D level was only marginally low which could not account for severe hypocalcaemia. A diagnosis of pseudohypoparathyroidism without phenotypic defects, was made due to hypocalcaemia and increased parathyroid hormone levels with cerebral calcifications. The patient was treated initially with parenteral calcium which was later converted to oral calcium supplements. His coexisting Vitamin D deficiency was corrected with 1αcholecalciferol escalating doses. His hypomagnesaemia was corrected with magnesium sulphate parenteral infusions initially and later with oral preparations. With treatment there was a significant clinical and biochemical response. CONCLUSION: Pseudohypoparathyroidism can present for the first time in elderly resulting in extensive cerebral calcifications. Identification and early correction of the deficit will result in both symptomatic and biochemical response.

Doxycycline Usage for Prevention of Leptospirosis among Farmers and Reasons for Failure to Use Chemoprophylaxis: A Descriptive Study from Southern Sri Lanka.

BACKGROUND: Leptospirosis causes substantial morbidity and mortality in Sri Lanka. Health authorities have implemented a chemoprophylaxis programme for prevention of disease for farmers who are at a high risk of leptospirosis. Only 39% of general population is aware of chemoprophylaxis. Awareness on chemoprophylaxis and its usage among the risk population and the reasons for non-usage was uncertain. Our aim was to assess the chemoprophylaxis usage for prevention of leptospirosis among farmers and reasons for failure to use such preventive strategy. METHODS: Cross-sectional descriptive study was conducted on farmers in community setting in Galle District. Multi-stage cluster sampling method was used. Out of the seventeen "Ministry of Health" (MOH) divisions within the Galle district, nine divisions were randomly selected and, subsequently, two subdivisions ("Public Health Midwife" divisions) were randomly selected from each MOH division. From each PHM division (total of 18), a cluster who does farming as the main source of income was selected. From these farmers, details on demographics, knowledge on leptospirosis and knowledge and practice on chemoprophylaxis usage were obtained through an interviewer administered open-ended questionnaire. From those who have not properly taken chemoprophylaxis, the reasons for non-usage were explored by semistructured interviews. RESULTS: We recruited 319 (77%-males) farmers to the study. Eighteen (5.6%) have already had leptospirosis. Majority (86.8%) of farmers were aware that doxycycline can be used to prevent the disease occurrence. Only 31% knew about correct recommendations of chemoprophylaxis usage adopted by the national guidelines. Only 28.5% (91) used doxycycline prophylaxis. Out of those, only 60 farmers (65.9%) continued the prophylaxis throughout the contact and followed national recommendations. Themes responsible for non-usage were elicited such as lack of awareness of chemoprophylaxis usage, false sense of security from the disease by perceived "immunity" due to prolong exposure or due to low prevalence of disease, lack of motivation, lack of availability of medication, and fear of side effects. CONCLUSIONS: Awareness of leptospirosis is better among farmers compared to the general population. Usage of chemoprophylaxis among farmers was highly inadequate. Individual and health system related hypotheses and myths exist for non-usage of chemoprophylaxis. Thus, an urgent concerted campaign aimed at increasing awareness within the target group through education and making medicines effectively distributed is essential for better prevention of the disease.

A Geometrical Approach to Human Saccade Simulation.

Modeling and simulation of human eye movement have a wide range of applications in many domains. Various attempts have been made to model and simulate eye movements in a physically accurate manner. All the existing models show limitations and problems in simulating secondary and tertiary eye movements. Recent investigation of pulley models (passive and active hypotheses) in representing human eye motion has recognized mathematical complexity in modeling eye behavior. Sophisticated techniques of modeling are required to investigate eye movements. This paper presents a procedure for eye movement simulation through geometrical modeling (an OpenSim script with its recent MATLAB binding) for binocular vision. First order neural dynamics with Millard's muscle model are used to actuate six Extra Ocular Muscles (EOMs). Pulse-step inputs are used to generate the muscle forces around the eye globe. The implemented model is successful in simulating horizontal and vertical movements of the human eye with respect to the prescribed activation. The developed technique is evaluated using responses from lumped parameter models and EOG recordings.

Corrigendum to "Metastatic Renal Cell Carcinoma Presenting as Prolonged Pyrexia and Stauffer's Syndrome: Can a Routine Ultrasound Scan Fail to Detect a Renal Cell Carcinoma?"

[This corrects the article DOI: 10.1155/2018/4215041.].

Metastatic Renal Cell Carcinoma Presenting as Prolonged Pyrexia and Stauffer's Syndrome: Can a Routine Ultrasound Scan Fail to Detect a Renal Cell Carcinoma?

Background: Prolonged pyrexia and weight loss are recognised paraneoplastic manifestations of renal cell carcinoma (RCC). Stauffer's syndrome is a rarely described paraneoplastic manifestation, which is described early in the course of RCC. We report a patient who presented with unresolving fever with multiple pulmonary opacities with biochemical evidence of hepatic choleastasis and was later diagnosed to have metastatic RCC with Stauffer's syndrome. Case Presentation: We report a 54-year-old female who was investigated for a poorly resolving fever and recent weight loss for two months. During her course of illness, she developed bilateral multiple opacifications in the chest radiograph with negative pyogenic, mycobacterial microbiological studies. Despite intravenous antibiotics, her fever continued. She was found to have elevated alkaline phosphatase and gamma-glutamyl transferase and she underwent imaging with ultrasound scan of abdomen twice, which did not reveal demonstrable abnormalities. Later, contrast CT of abdomen and chest was performed and detected a renal cell carcinoma of the right upper pole of the kidney with multiple lung metastases, which was concluded as a metastatic RCC with paraneoplastic Stauffer's syndrome. Conclusion: Prolonged pyrexia with loss of weight and Stauffer's syndrome could be features to suggest renal cell carcinoma in the absence of positive microbiological studies. Isoechoic RCC could be missed in routine ultrasonography. When a RCC is suspected in the setting of a pyrexia of unknown origin, ultrasound with doppler or a contrast CT should be requested to aid diagnosis.

Cerebral vasculitis and lateral rectus palsy - two rare central nervous system complications of dengue fever: two case reports and review of the literature.

BACKGROUND: Dengue fever is a common mosquito-borne viral illness with a clinical spectrum ranging from a simple febrile illness to potentially life-threatening complications such as dengue hemorrhagic fever and dengue shock syndrome. Dengue infection can affect many organs, including the central nervous system. The neurological manifestations reported in dengue infections are meningitis, encephalitis, stroke, acute disseminated encephalomyelitis, and Guillain-Barré syndrome. CASE PRESENTATION: We report the cases of two interesting patients with confirmed dengue infection who presented with complications of possible central nervous system vasculitis and cranial nerve palsy. The first patient was a 53-year-old previously healthy Singhalese woman who developed acute-onset slurring of speech and ataxia with altered sensorium 1 day after recovery from a critical period of dengue hemorrhagic fever. Subsequent investigations revealed evidence of encephalopathy with brainstem ischemic infarctions. Her clinical picture was compatible with central nervous system vasculitis. She was treated successfully with intravenous steroids and had a full functional recovery. The second patient was a middle-aged Singhalese woman who had otherwise uncomplicated dengue infection. She developed binocular diplopia on day 4 of fever. An ocular examination revealed a convergent squint in the left eye with lateral rectus palsy but no other neurological manifestation. CONCLUSIONS: Central nervous system vasculitis due to dengue infection is a very rare phenomenon, and to the best of our knowledge, only one case of central nervous system vasculitis has been reported to date, in a patient of pediatric age. Cranial nerve palsy related to dengue infection is also rare, and only a few cases of isolated abducens nerve palsy have been reported to date. The two cases described in this report illustrate the rare but important central nervous system manifestations of dengue fever and support the fact that the central nervous system is one of the important systems that can be affected in patients with dengue infection.

Timely delivery of hip fracture care: a Middlemore Hospital audit.

INTRODUCTION: New Zealand (NZ) hospitals lack a centralised audit process to evaluate hip fracture care whereas UK hospitals audit hip fracture care in relation to best practice guidelines. This study sought to evaluate multiple factors in hip fracture care at Middlemore Hospital (MMH). Comparisons were made with an audit from MMH in 2008 and a multicentre UK audit. METHOD: A retrospective audit of patients with hip fractures was carried out at MMH between January and June 2012. RESULTS: 120 patient charts were reviewed. In 2012, 14.2% of patients were admitted from ED within the guideline recommended period of four hours compared to 5.6% of patients in 2008. 72.5% received operative management within the guideline suggested period of 48 hours in comparison to 51% in 2008. Lack of available theatre space accounted for 51% of delays in 2008. CONCLUSION: There have been considerable improvements to timely delivery of hip fracture care at MMH between 2008 and 2012. However, there are ongoing delays to ward admission and operative management at our institution resulting in care that falls beyond the times recommended by international guidelines. The lack of available theatre space remains a major cause of delayed surgery. We advocate the development of a multicentre audit in NZ hospitals.

Twin pregnancy chorionicity determination in a tertiary care setting.

Ultrasound determination of chorionicity is most reliable before 14 weeks and subsequently reduces in accuracy with advancing gestation. The aim of this study was to evaluate the accuracy of chorionicity determination in a birth cohort of twin pregnancies. Antenatal ultrasound determination of chorionicity in twin pregnancy was undertaken at suboptimal period of gestation in over twothirds of twin pregnancies. Even in the first trimester of pregnancy, the accuracy of chorionicity determination was lower than previously reported.

Yellow oleander poisoning in Sri Lanka: outcome in a secondary care hospital.

Cardiac toxicity after self-poisoning from ingestion of yellow oleander seeds is common in Sri Lanka. We studied all patients with yellow oleander poisoning (YOP) admitted to a secondary care hospital in north central Sri Lanka from May to August 1999, with the objective of determining the outcome of management using currently available treatment. Patients with bradyarrhythmias were treated with intravenous boluses of atropine and intravenous infusions of isoprenaline. Temporary cardiac pacing was done for those not responding to drug therapy. During the study period 168 patients with YOP were admitted to the hospital (male:female = 55:113). There were six deaths (2.4%), four had third-degree heart block and two died of undetermined causes. They died soon after delayed admission to the hospital before any definitive treatment could be instituted. Of the remaining 162 patients, 90 (55.6%) patients required treatment, and 80 were treated with only atropine and/or isoprenaline while 10 required cardiac pacing in addition. Twenty-five (14.8%) patients had arrhythmias that were considered life threatening (second-degree heart block type II, third-degree heart block and nodal bradycardia). All patients who were treated made a complete recovery. Only a small proportion of patients (17%) admitted with YOP developed life-threatening cardiac arrhythmias. Treatment with atropine and isoprenaline was safe and adequate in most cases.

Low dose subcutaneous adrenaline to prevent acute adverse reactions to antivenom serum in people bitten by snakes: randomised, placebo controlled trial.

OBJECTIVE: To assess the efficacy and safety of low dose adrenaline injected subcutaneously to prevent acute adverse reactions to polyspecific antivenom serum in patients admitted to hospital after snake bite. DESIGN: Prospective, double blind, randomised, placebo controlled trial. SETTING: District general hospital in Sri Lanka. SUBJECTS: 105 patients with signs of envenomation after snake bite, randomised to receive either adrenaline (cases) or placebo (controls) immediately before infusion of antivenom serum. INTERVENTIONS: Adrenaline 0.25 ml (1:1000). MAIN OUTCOME MEASURES: Development of acute adverse reactions to serum and side effects attributable to adrenaline. RESULTS: 56 patients (cases) received adrenaline and 49 (controls) received placebo as pretreatment. Six (11%) adrenaline patients and 21 (43%) control patients developed acute adverse reactions to antivenom serum (P=0.0002). Significant reductions in acute adverse reactions to serum were also seen in the adrenaline patients for each category of mild, moderate, and severe reactions. There were no significant adverse effects attributable to adrenaline. CONCLUSIONS: Use of 0.25 ml of 1:1000 adrenaline given subcutaneously immediately before administration of antivenom serum to patients with envenomation after snake bite reduces the incidence of acute adverse reactions to serum.