Childhood allergic diseases across geographical regions of Kandy and Anuradhapura districts of Sri Lanka; where do the rates stand among other regions: experience from Global asthma network Phase 1 study.

BACKGROUND: Asthma, allergic rhinitis and eczema have been identified as the most prevalent childhood allergic diseases. However, the prevalence of these allergic diseases can vary in different regions within a country and in the world. METHODS: The objective of the study was to estimate the prevalence of asthma, allergic rhinitis and eczema in schoolchildren in the Kandy and Anuradhapura districts of Sri Lanka. This was a multicentre cross sectional study carried out among children of age 6-7 years and 13-14 years attending state schools fulfilling the entry criteria of the Global Asthma Network Phase 1 study methodology. RESULTS: A total of 3673 children of 6-7 years and 4658 children of 13-14 years were recruited. The prevalence of current asthma, allergic rhinitis and eczema were 12% (CI 10.44-13.75), 15.7% (CI 13.94-17.64) and 9.7% (CI 8.30-11.31) among 6-7 years age group and 15.3% (CI 13.66-17.09), 30.5% (CI 28.86-32.74) and 7.3% (CI 6.15-8.65) respectively among the 13-14 age group in Kandy district. The reported prevalence rates of the disease conditions were 9.9% (CI 8.72-11.22), 10.1% (CI 8.90-11.44) and 5.9% (CI 4.98-6.98) among 6-7 years age group and 14.9% (CI 13.67-16.22), 22.5% (CI 21.04-24.03) and 1.8% (CI 1.38-2.34) in the 13-14 years age group in Anuradhapura district. When comparing these prevalence rates, there is relatively a higher prevalence of childhood allergic diseases in Kandy district. This difference is statistically significant in all three allergic disease conditions (P < 0.001). CONCLUSION: Prevalence of allergic diseases in Anuradhapura is closer to reported data in the previous studies. There is relatively higher prevalence of childhood allergic diseases among children in Kandy district.

Isolated unilateral temporalis muscle hypertrophy in a child: a case report with literature review.

BACKGROUND: Temporalis muscle hypertrophy is a rare entity of masticatory muscle hypertrophy. All types of masticatory muscle hypertrophies have been documented of which temporalis muscle hypertrophy is one. Temporalis muscle hypertrophy is most commonly bilateral and usually associated with other types of masticatory muscles hypertrophy such as masseter or pterygoid hypertrophy. However, isolated unilateral temporalis muscle hypertrophy is extremely rare and only 9 cases have been reported to date in English literature since 1990 with only two patients less than 18 years. There is no exact etiology identified and the diagnosis is made by muscle biopsy combined with imaging study to exclude other possibilities. Age at presentation is ranges from 15 to 65 years with involvement of both sexes. We report the youngest child who is a seven year old girl with right side isolated unilateral temporalis muscle hypertrophy. CASE PRESENTATION: In this patient, we discuss the youngest child with isolated unilateral temporalis muscle hypertrophy and literature review to date. The patient is a seven year old female presenting with painless swelling of the right temporalis muscle. There had no features of inflammation, trauma, neoplasm or history of parafunctions such as bruxism. The child was not complaining significantly headache or visual disturbances as well. She had undergone radiological assessment with ultrasound scan and contrast MRI. The diagnosis was confirmed by muscle biopsy which shows normal muscle architecture. She was managed conservatively with regular follow up. CONCLUSION: Isolated unilateral temporalis muscle hypertrophy is extremely rare in children. However this case raises the importance of considering alternative diagnoses despite the condition being rare in the pediatric population.

Clinical Features and Transmission Pattern of Hepatitis A: An Experience from a Hepatitis A Outbreak Caused by Two Cocirculating Genotypes in Sri Lanka.

Sri Lanka is one of the intermediate-endemic areas for hepatitis A virus (HAV), and concerns exist about the increasing HAV-susceptible population. In fact, Sri Lanka recorded a large hepatitis outbreak, possibly hepatitis A, around the end of the Sri Lankan war. It included more than 14,000 patients consisting of local residents, internally displaced personnel, and military personnel in the main combat zone. The outbreak had slowed down by October 2009; however, acute viral hepatitis continued to occur sequentially among military personnel. We obtained clinical information and serum samples from 222 patients with acute hepatitis who visited the Military Hospital Anuradhapura between January and September 2010. Samples were subjected to laboratory testing including HAV-immunoglobulin M and genotyping. Most patients (98.2%) were confirmed as having hepatitis A belonging to two subgenotypes: IA and IIIA. We did not observe any differences in clinical or biochemical features among patients with subgenotypes IA and IIIA except for pale stools and upper abdominal discomfort. During the investigation period, we observed a serial outbreak caused by identical HAV strains with an interval in line with that of typical HAV incubation periods. Most patients in the first outbreak were found in the training center, and patients in the second outbreak were found in multiple places where soldiers were assigned after the training center. These findings indicate that a strain of HAV diffused from one place to another along with movement of infected persons among the HAV-susceptible population. HAV vaccination for high-risk groups, such as young soldiers, is necessary.

Angelman syndrome presenting with a rare seizure type in a patient with 15q11.2 deletion: a case report.

INTRODUCTION: Angelman syndrome, a neurodevelopmental genetic disorder associated with abnormalities in chromosome15q11-q13, is inherited from the mother. Epilepsy is seen in 85 % of children with Angelman syndrome within the first 3 years of life and is often severe and difficult to control. CASE PRESENTATION: We report a case of a baby boy who presented at 13 months of age with a history of acute gastroenteritis and marked gross motor and speech developmental delay. He was found to have a microdeletion of the chromosome 15q11.2 region confirming the diagnosis of Angelman syndrome. He was the first child born to healthy, unrelated Sinhalese parents. The child had generalized extensor spasms involving both upper limbs and the head beginning at the age of 9 months, and he developed flexor and extensor spasms at the age of 13 months. His facial appearance was characteristic of Angelman syndrome. His electroencephalographic pattern did not correspond to any other of the patterns previously described in patients with Angelman syndrome. He had extensor and flexor spasms, which are rarely described in patients with Angelman syndrome. These symptoms responded to a combination of valproic acid and clonazepam. CONCLUSIONS: Angelman syndrome due to a microdeletion of the chromosome 15q11.2 region is often not diagnosed in infancy. Extensor and flexor spasms are not typically described seizure types in Angelman syndrome, and our patient's seizures responded well to a combination of valproic acid and clonazepam. Clinicians should suspect other possible seizure types in patients with Angelman syndrome and should treat the patient appropriately.