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This case report describes how family conflict, and a lack of parental support for emotional expression, result in distress being expressed through cultural symbols in children, and how these very symbols can be utilized in therapy. In the current example, a 12-year-old girl presented to mental health services with altered behaviour and claims of being possessed by a demon for two months. There was a history of the parents being emotionally unavailable and frequent altercations with the paternal grandmother in whose house they currently lived. Even though possession states are not uncommon in adults presenting to mental health services, it is uncommon for children to present with persistent possession states for long periods of time. In this instance, the whole family was supported with an eclectic family therapy approach, using psychodynamic, Cognitive Behaviour Therapy, and Systemic ideas. This approach utilized the very same “demon” symbol the child presented with, and resulted in the child expressing her distress in a more adaptive way and getting back to her daily activities.

Our communities are changing, and we need to look at its impact on our children and adolescents. How families interact with their children and the attachment experiences thus created, are important factors that have an effect on child and adolescent development. The quality of these experiences are in turn influenced by broader community level factors. These need to be taken into consideration in the prevention of mental health issues and in managing psychiatric disorders. Both formal community level interventions, as well as informal promotion of positive community influences are needed.

IntroductionIt is well known that stigma is a key contributory factor for delayed help seeking in mental health issues. This in turn has led to poor outcomes amongst those who suffer from mental health issues. In Sri Lanka, large studies on stigma amongst adolescents are limited. AimsThis study aims to describe the attributes of stigma in relation to selected mental health issues amongst adolescents. MethodsThis is a descriptive cross-sectional study focusing on data collected from 1002 adolescents. The data was collected using a questionnaire based on the Children's Attribution Questionnaire (AQ-8-C). Case vignettes depicting depression with suicidal ideation, social phobia, psychosis and a physical health issue, namely diabetes, was used. ResultsThe study revealed that the likelihood of providing help was significantly higher with regards to mental health issues compared to diabetes (p Those with a personal or family history of mental health issues had a higher tendency of avoiding or being angered by such patients, or considering the person in the mental health vignette to be dangerous (p ConclusionsAdolescents in this cohort stated they were more likely to help in the case of a person with a mental health issue, compared to someone with diabetes. They were more likely to stay away from those with psychosis, compared to those with other mental health issues. Exposure to mental health issues did not appear to lower the stigma associated with these disorders.

Introduction: Primary Health Care is proven to be a highly effective and efficient way to address poor health and well-being. Despite its achievements Sri Lanka’s PHC System, specialized for preventive and curative actions, is increasingly under pressure due to chronic and non-communicable diseases. Developing the broad range of skills necessary for medical practice in the existing PHC settings should be achieved through continuous professional development. A distant learning programme through eLearning is a model solution to expand the existing boundaries for CPD. Methods: Sri Lanka Medical Association, Ministry of Health, Primary Healthcare System Strengthening Project and World Bank have collaboratively worked as key stakeholders to develop and implement a course for capacity building among the medical professionals. The first phase of the course was developed with 6 priority modules consisting of Ministry of Health approved content conjoined with digital material. Participants were provided with additional resources. The course was evaluated by assessing user involvement and users’ perception towards the course. The course reflected a positive involvement for majority of modules and a generally positive feedback despite the response rate being considerably low. Discussion: Vulnerabilities in the system could be identified including shortcomings of the system, instructors and learning material, and administration issues. Including diverse course materials, provision of incentives for participation, training resource persons and other recommendations may allow better distance learning experience with desired outcomes. Conclusion: Distance learning through an eLearning platform is an ideal way to address CPD in PHC through timely modules, appropriate learning material, user friendly interface, efficient evaluation methods, and an effective system improving procedure. This course has enabled medical professional to develop their insights in PHC, however the shortcomings should not be neglected.

Asteroseismology is the science that deals with the oscillations in the stars with the goal of understanding the stellar structure. In this study, photometric data of Kepler mission have been used for the asteroseismic study of Delta Scuti type pulsating stars. The light curve analysis of three Delta Scuti stars observed by Kepler mission is presented. The pulsation frequencies were determined by applying a discrete Fourier transformation with the pre-whitening process. The short cadence light curve of Kepler target KIC 9700322 revealed dominant radial fundamental frequency at 9.792 ± 0.002 d-1 and 1st overtone frequency at 12.569 ± 0.002 d-1 accompanied by a large number of frequency multiples. Non-radial frequencies of mode l = 2 quintuplet were detected with the frequency spacing of 0.134 d-1 and it provided a rotation period of the star as 6.19 days, which was detected as the peak of 0.159 d-1 in frequency spectra. Using the fundamental period, a value for relative density of the star was estimated as 0.10 ± 0.04 relative to the sun. Furthermore, the full dataset of KIC 11754974 was subjected to frequency analysis and the radial fundamental pulsation frequency and its 1st overtone were detected at 16.3451 ± 0.0002 d-1 and 21.3997 ± 0.0002 d-1, respectively. l = 2 frequency quintuplet was detected with a frequency spacing of 0.22 d-1 and determined the rotation period and relative density of the star as 3.83 days and 0.29 ± 0.01 respectively. KIC 9845907 was identified as a purely radial pulsator. The fundamental pulsation frequency was recovered as 17.597 ± 0.002 d-1 with two other dominant modes of overtones at 22.850 ± 0.002 d-1 and 28.210 ± 0.002 d-1. The relative density of the star was determined as 0.34 ± 0.06.

Introduction: Histopathology examination is a common and recommended practice among all types of autopsy practitioners; there are few scientific outlooks guidelines or protocols about the number of samples that need to be obtained at autopsy for the histopathology examination. The aim of this study was to evaluate the value of taking multiple samples from the same kidney at autopsy examination. Methodology: A cross-sectional descriptive prospective study was carried out among 108 post mortem reports and histopathology samples at the department of forensic medicine of Base Hospital Panadura and District General Hospital Kalutara and Kegalle. All autopsies with available microscopic samples of kidney irrespective of the cause of death were used for the study. The data collection process was carried out from November 2019 to February 2020 and the ethical clearance was obtained prior to the data collection. Results: Data from the 108 post mortem reports were obtained. The studied sample consists of 69% (n=74) of males and 31% (n=34) females. With regard to the age distribution, the majority of 40% (n=43) cases belonged to the 51-70 age category. 69% (n=74) samples were collected from the left kidney while remaining 31% (n=34) from the right. Considering the macroscopic appearance of the kidney, cortical thickness reduction was noted among 34% (n=37) samples followed by granular contracted kidney of 31% (n=33). In the microscopic findings, the different numbers of pathologies were identified in both samples. However, the 1st sample had a higher frequency of histopathological findings than sample 2 and no significant difference in identification pathologies between 1st sample and 2nd samples were determined (p= 0.784>0.05.) Conclusion: Taking two samples from same kidney during the autopsy does not suggest statistical difference. However, where the resources are available it is suggested that taking two samples is beneficial.

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Tandem solar cells have been researched to enhance the performance of the second generation (II-VI) thin-film solar cells. In this study, we have developed an efficient tandem solar cell model by optimizing the thickness of the (II-VI) layers and by introducing Mg doped ZnO as the window material for the top cell. The tandem solar cell model consists of a top cell, n-MZO/p-CdTe and a bottom cell, n-CdS/p-Cu(In, Ga)Se2 (CIGS). The parameters of the computational model, such as thicknesses of n-CdS, p-CIGS. p- CdTe has been varied to improve the efficiency of the tandem solar cell and compared with the previous researched single junction thin-film solar cells. All the numerical experiments were conducted under one sun illumination condition with AM 1.5 G solar spectrum by using the Analysis of Microelectronic and Photonic Structures simulation software (AMPS-1D) and Solar Cell Capacitance Simulator (SCAPS 1-D) software. The observed open circuit voltage was 1.413 V and the efficiency wa sincreased to 28.84% and this is a huge improvement compared to the reported recorded best research cell values of 0.8 V and 24.2% respectively for single junction solar cell.

Background From 2008-2015, several female murders were reported from Sabaragamuwa, Sri Lanka. The motive of most killings was not obvious and the attacks were targeted against isolated, elderly females. This study was conducted to analyze the medico-legal aspects of those female murders. Methods Data of females who had been killed under similar circumstances in Kahawatta, Ratnapura were collected from July 2008 to Dec 2015. Results There were 17 female murders. Ten dead bodies were left at the scene and remaining seven were moved. The cause of deaths had been cut injuries to the head (n=12) and blunt force trauma to the head (n=2), ligature strangulation (n=2) and manual strangulation (n=1). There were three double murders. The first double murder and Case 15 and 16 were due to personal enmities. Suspect arrested in 2010 was a paraphilic and claimed for 3 murders with no DNA matches. Suspect arrested in 2015, was responsible for six murders and DNA of three identical post-coital samples matched with his DNA. Features such as “two or more” “independent”, “planned” murders committed at ‘separate locations’ for ‘personal gratification’ by the same individual/s, separated by a “cooling-off” period were found in most murders. Conclusions The three special features found in this series were some attempting to mimic serial killings, some appearing to be copycat murders and in other instances appearing to be an alibi created by the suspects who were in the custody. This is the first ever reported instance of two or more serial killers operated in the same area in the same duration.

Catatonia is a syndrome involving abnormalities of movements and position, manifesting as excessive and purposeless motor activity or immobility. Even though this condition is well described in adults, catatonia has been less identified and studied in children and adolescents. Early identification of catatonia can lead to better treatment outcomes in this population. In this case report, we discuss the case of a boy aged 12 years and 11 months, who presented with catatonia, and who was later diagnosed as having early onset schizophrenia.

Background and Objectives Health related quality of life of children encompasses the clinical status and the perception of health. The aim of the study was to adapt and validate TAPQOL health related quality of life instrument for children in the age group of 3 to 4 years in Sri Lanka. Methods English TAPQOL was adapted to Sinhala language using modified Delphi technique. A community based cross-sectional descriptive study was conducted among 492 children in the age range of 3 to 4 years in Colombo district. Multistage cluster sampling method was used to select children. Mothers of children were interviewed using a structured questionnaire which included the adapted tool. Factor extraction, reliability and discriminant validity were tested in the analysis. Results Response rate was 94.9% (n=467). In the factor extraction, 44 items were extracted and arranged to 12 subscales. Subscales represented different dimensions of health. All subscales had less than 2% of missing values indicating high acceptability. Cronbach’s alpha was more than 0.7 in eleven subscales. High correlations were observed for test-retest reliability for responses 2 weeks apart. The instrument showed satisfactory discriminant validity with preterm born children obtaining low scores in eleven subscales compared to term born group. Conclusions and recommendations TAPQOL questionnaire could be used in the community setting for preschool aged children to assess health related quality of life.

Introduction Incidental thyroid lesions are diagnosed with increased frequency by sophisticated imaging techniques; however, Sri Lanka lacks data on the prevalence of incidental thyroid pathology. The objective of this study was to determine the prevalence of incidental thyroid pathology in Sri Lanka. Methodology Consecutive autopsies of which the death was due to undiagnosed acute diseases or trauma, conducted at the Institute of Forensic Medicine and Toxicology, Colombo, from 2014-2016 were included. Informed written consent and a brief history were obtained from next of kin. Gross examination and microscopic examination of grossly normal and adequately sampled abnormal thyroid tissue was done by a histopathologist. Results Data was obtained from 248, including 174(70.2%) males and 74(29.8%) females of which eight were excluded due to unavailability of the thyroid. The mean age was 52.6 years (SD=16.9). None had a history of thyroid disease. One had a family history of thyroid carcinoma. At least one pathology was seen in 136/240(56.7%): papillary microcarcinoma (PMC) in 25(10.4%), colloid nodules in 72(30%), hyperplastic nodules in 6(2.5%), chronic autoimmune thyroiditis (CAT) in 52(21.7%). PMC was equally prevalent in males (10.5%) and females(10%) with no association with age (p>0.05). CAT was diffuse in 31(12.9%) and focal in 21(8.8%). Prevalence of CAT among females (63.4%, 33/52) was significantly higher than males (36.6%- 19/52)(p Discussion and Conclusion The commonest pathology found was colloid nodules. The prevalence of undiagnosed papillary microcarcinoma and chronic autoimmune thyroiditis was considerably high. Similar to other studies, prevalence of chronic autoimmune thyroiditis was significantly higher in females than males. Prevalence of papillary microcarcinoma falls in between the lowest, 0.01% in USA and highest, 35.6% in Finland, reported in literature.

Introduction Prevalence of incidental pathological lesions in pituitary, adrenals, pancreas and ovaries is not well known in the Sri Lankan setting. This study aims to determine the prevalence of incidental pathological lesions in these organs. Methodology A prospective study of consecutive autopsies of males and females who died of undiagnosed acute diseases and accidents during the 2014-2016 period was done after obtaining informed written consent from next of kin. Deaths due to endocrine related diseases except diabetes mellitus and putrefied bodies were excluded. A brief history was obtained using an interviewer administered questionnaire. The entire pituitary, three sections each from head, body and tail of the pancreas, one section each from adrenals and ovaries and at least one section from all grossly abnormal lesions in the studied organs were examined histologically by a histopathologist. Results Two hundred and forty eight autopsies were studied including 174(70.16%) males and 74(29.83%) females. Pituitary micro-adenoma and fibrosis with calcification were present in 2(0.8%) and 1(0.4%) cases respectively. Increase in fat infiltration in the pancreas was present in 35(14.9%) cases and fibrosis in 12(5.1%). Four (1.6%) had adrenal nodular hyperplasia and 2(0.8%) had granulomatous inflammation with caseous necrosis with no previous clinical history of tuberculosis. Of the autopsies of the 74 deceased females, 16(21.6%) had multiple cystic follicles and 2(2.7%) had haemorrhagic cysts. Conclusion The prevalence of incidental tumours in pituitary, adrenals, pancreas and ovaries were very low. However, non neoplastic pathological conditions were more commonly encountered.

Background Role of child care providers in changing eating habits and food consumption among preschool children is often highlighted. Objectives This study described knowledge, attitudes and practices on child feeding and factors associated with knowledge and attitudes among child care providers of preschools in Nuwaraeliya district. Methods Cross sectional descriptive study was conducted in three divisional secretariat areas in Nuwaraeliya district in a sample of 427 preschool teachers who are working in child care centres for more than 1 year. Results Response rate for the self-administered questionnaire was 82.1% (n=344). Mean total knowledge score was 5.49 (SD 1.9) and 52.6% (n=181) scored more than 50% of the total score. Positive attitudes toward child feeding were reported as 63.7% (n=219). Statistically significant associations for both knowledge score and attitude level were observed with ethnicity (p=0.001), level of education (p=0.001), minimal duration of basic training (p=0.008 and p=0.001), type of in-service nutrition training programme attended (p=0.0001 and p=0.009) and the sector of employment of the child care provider (p=0.0001 and p=0.003). Participation of care providers during feeding of children was 83.3% (n= 283). Almost 59% (n=223) incorporated nutrition messages into routine teaching. Conclusion Standard basic training and well organized in-service training are some of the modifiable factors in improving the knowledge and attitudes on child feeding among preschool teachers.

Sexual assaults that have shown an alarming rise are a serious public health problem with hazardous socioeconomic and health related consequences. International studies have shown that young girls from poor socioeconomic and low educational level are at highest risk. Though we experience the same in Sri Lanka only few studies are available in the literature. The study objectives were to determine the socio-demographic factors and medico-legal aspects such as type of act, relationship to the assailant, place of the incident, economic group, time of the incident and examination in cases of sexual assault. The study was conducted on sexually abused individuals who reported to hospitals in Central and Sabaragamuwa provinces for medico-legal examination during the period between April 2007 and June 2012. Data was collected using a questionnaire by specialists and trainees in Forensic Medicine, maintaining professional standards. Data was analyzed using Microsoft Excel software. Among 282 sexually assaulted victims, 96% were females. 81% were less than 18 years of age and among them, 43% were in 12-16 years age group. 71.13% were from school going population. 71.63% were from low socioeconomic group. 96% knew the assailant and 36% were boyfriends. 34% occurred in victim’s house. 56% claimed vaginal penetration. 6% were examined within 24 hours of the incident and 52% after 1 week. In our study, most victims are young, school going females belonging to low socioeconomic group. In majority of assaults, assailant was a known person and it has occurred in a place known to the victim. Common allegation was vaginal intercourse. There was a considerable delay in time between the incident and examination which would have led to the destruction of very important medical evidence. According to this study, young school children and low socioeconomic group cannot be excluded in formulating effective preventive programs against sexual violence. Sri Lanka Journal of Forensic Medicine, Science & Law Vol.6(1): 12-20 (2015)

The value of Mg therapy for patients with tetanus, which minimizes heavy sedation and paralysis in keeping with the goals of modern intensive care, is discussed. A protocol for magnesium therapy is given.

In the recent past krill (Sinhala: kooni) has been widely considered for its nutritional value. However almost all the pastnutritional studies on krill have been based on temperate species. Literature related to biochemical composition of tropical species are few. In Sri Lanka no work has been reported on krill. Therefore in the present study, it was aimed to investigate the proximate composition, fatty acid profiles and mineral contents of three dried krill varieties commercially available in Sri Lanka. They included a sun-dried Sri Lankan krill product, a boiled and sundried krill variety imported from Indonesia and a freeze-dried variety imported from India. Based on the observable characteristics, these products most probably belong to the genera Stylocheironand/or Nematoscelis. Crude protein contributed upto54.6 – 71.6% of the dry matter. Crude fat content varied between 4.5 – 9.2% of the dry weight. The ash content was found to range from 22.0 – 40.7%on dry weight basis. GC/MS analysis of fatty acids revealed higher levels of polyunsaturated fatty acids (43.1 – 53.1%) for the three krill varieties. Predominating n-3 PUFAs fatty acids were eicosapenteinoic acid (EPA, C 20:5) and docosahexaenoic acid (DHA, C22:6). Linoleic (C18:2 n-6) and arachidonic (C20:4 n-6) acids were present as main n-6 PUFAs.Palmitic acid (C16:0) and palmitoleic acid (C16:1 n-7) were the main saturated and monounsaturated fatty acids, respectively. The calculated atherogenic and thrombogenic index values varied between 0.80 - 2.49 and 0.17 – 0.61 respectively. The mineral element analysis revealed values which ranged from 361.0 – 483.6 mg/100g, 522.3– 684.3mg/100g, 90.5 – 164.8 mg/100g and 503.8 – 776.0 mg/100g, for Na, Mg, K and Ca, respectively. Fe (3.5 – 6.5 mg/100g) and Zn (4.1 – 10.9 mg/100g) were detected as the major trace elements. Fluoride contents recorded in this study (23.2 – 63 ppm w/w) were much lower than those reported for krill in earlier studies. Overall, this study demonstrated that dried krill has promising nutritional value, due to its favourable biochemical composition, and deserve further exploitation to increase utilization. KYWORDS: Krill, proximate composition, fatty acid profile, mineral composition, fluoride level

Journal of the College of Community Physicians of Sri Lanka Volume 16, No. 02, December 2011 31-37 DOI: http://dx.doi.org/10.4038/jccpsl.v16i2.4578