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We aimed to describe anatomical landmarks to accurately locate the five nerves that are infiltrated to accomplish anaesthesia of the foot in an ankle block. Twenty-four formaldehyde-fixed cadaveric ankles were studied. Photographs of cross sections of the frozen legs, cut at a horizontal plane across the most prominent points of the medial and lateral malleoli, were analysed. The curvilinear distance from the most prominent point of the closest malleolus to each of the five cutaneous nerves and their depth from the skin surface were measured. Sural, tibial, deep peroneal, saphenous and medial dorsal cutaneous nerves were located 5.2 ± 1.3, 9.2 ± 2.4, 7.4 ± 1.9, 2.8 ± 1.1, 2.1 ± 0.6 mm deep to the skin surface. The curvilinear distances from the medial malleolus to the tibial, deep peroneal and saphenous nerves were 32.5 ± 8.9, 62.8 ± 11.1 and 24.4 ± 7.9 mm, respectively. The curvilinear distances from the lateral malleolus to the sural and medial dorsal cutaneous branches of superficial peroneal nerves were 27.9 ± 6.3 and 52.7 ± 7.3 mm, respectively. The deep peroneal nerve was found between the tendons of the extensor hallucis longus and the extensor digitorum longus in the majority of specimens, while the medial dorsal cutaneous nerve was almost exclusively found on the extensor digitorum longus tendon. The sural and tibial nerves were located around halfway between the most prominent point of the relevant malleolus and the posterior border of the Achilles tendon. In conclusion, this study describes easily identifiable, palpable bony and soft tissue landmarks that could be used to locate the nerves around the ankle. [ABSTRACT FROM AUTHOR]

Background: The use of inappropriately long needles for subcutaneous insulin injection increases the risk of inadvertent intramuscular injection. Aims: To estimate the inadvertent intramuscular injection risk at potential subcutaneous insulin injection sites and to identify the determinants of this risk in adults. Methods: A descriptive cross-sectional study was conducted on adult patients between the ages of 18 and 70 years who were admitted to the National Hospital of Sri Lanka. Skin-to-muscle distance and dermal thickness of potential insulin injection sites were measured using ultrasonography to estimate the intramuscular injection risk. Results: A total of 185 patients were included in the study. The estimated risk of inadvertent intramuscular injections with insulin needles of any length was considerably higher at the mid-arm and mid-thigh compared to the abdomen. The risk of inadvertent intramuscular injection was approximately 60% with 13-mm needles without a skin fold at the arm and thigh. The abovementioned risk was approximately halved when the needle length was 8 mm. We developed formulae to predict the skin-to-muscle distance with or without a raised skin fold based on assigned sex at birth and anthropometric parameters. Conclusions: There is a high inadvertent intramuscular injection risk with currently used needles (8 and 13 mm) with U-100 syringes in our population even with a raised skin fold. To minimize this risk, 13-mm needles should be avoided when injecting insulin subcutaneously especially to the limbs. Sex and anthropometric parameters can be used to predict the distance from skin to muscle surface; hence, the selection of needle length could be personalized based on the derived formulae. [ABSTRACT FROM AUTHOR]

Blue whales Balaenoptera musculus are the most abundant and widely distributed cetacean species in Sri Lankan waters. A vessel-based opportunistic line transect survey focusing on marine mammals was conducted in Sri Lankan waters between 24 June to 12 July 2018, while an ecosystem survey was performed by the R/V Dr. Fridtjof Nansen. The entire transect length was 2090 km within an area of 3895 km2. Overall, 72% (n = 57) of blue whale observations were group assemblages ranging between 1 and 5 individuals out of a total of 79 sightings. The largest aggregations of blue whales were recorded at the intersection of the submarine canyon off the coastline of Mirissa and busy shipping lanes between Dondra Head and Galle, where previous ship strikes were recorded. Overall, the average observed group size was 2.64 (CV, 12.34%; 95% CI, 2.07–3.38), the average group density was 0.0029 km−2 (CV, 35.96%; 95% CI, 0.00145–0.00610), and the total blue whale abundance within the survey area was 513 individuals (CV, 38.02%; 95% CI, 243–1083). These survey results fill vital knowledge gaps regarding the abundance and distribution of blue whales in Sri Lanka, which is essential for the establishment of management and conservation strategies. [ABSTRACT FROM AUTHOR]