Objective To audit the process of stroke care. Design Retrospective case record evaluation using an audit package designed by the Royal College of Physicians of London.

Tuberculous meningitis in adults: a prospective study at a tertiary referral centre in Sri Lanka S A C U Gunawardhana, S C Somaratne, M A H Fernando, P S Gunaratne(Index words: tuberculous meningitis, clinical presentation, magnetic resonance imaging, Sri Lanka) AbstractIntroduction Central nervous system tuberculosis is the most severe form of extrapulmonary TB and it is associated with a substantial morbidity and mortality.Objectives To describe the demographic profile, clinical features, laboratory and imaging results of a cohort of adult patients with TBM (Tuberculous meningitis).Methods This study encompasses a prospective analysis of all adult cases of TBM diagnosed from 1st January 2010 to 31st December 2011 in the Neurology unit 2, National Hospital of Sri Lanka. Consensus case defini-

Introduction: Oral cancer is the commonest cancer among Sri Lankan males for decades.Objectives: To describe the sex difference in site specific cancers in oral cavity and to analyse the incidence trends according to sex, sites and age category of oral cancer in Sri Lanka between 2005 and 2019 Methods: Data on oral cancers were obtained from National Cancer Registry, Sri Lanka (NCR-SL) from 2005 to 2019. Sex difference for lip, tongue and mouth cancers were analysed. Analysis was performed with Joinpoint Trend Analysis Software on age standardized incidence rate (ASR) to examine the trends in sites, sex and age group categories over a 15-year period.Results: Data ofa total of31 919 oral cancer patients (males: 24 982; 78.3%; females: 6937; 21.7%) were analysed.All three site specific sub types showed a higher incidence in males than females. ASR has increased over the 15-year period in both sexes. The proportional increase in incidence was higher for males (1.9-fold increase with ASR; 9.8 to 18.9, average annual percentage change (AAPC) of5.4; 95% CI: 4.1, 6.7) than females (1.55-fold increase with ASR; 2.9 to 4.5,AAPC of3.l; 95% CI: 1.8, 4.5; p<0.001 fortrend). A statistically significant increasing trend was detected in all three types according to anatomical sites and in both sexes with a higher proportional increase in lip cancers (AAPC ofl0.5; 95%CI: 5.9, 15.3 in males;AAPC of6.9; 95%CI: 1.5, 12.6 in females;p<0.05 fortrend).An increasing trend in ASR was detected for all age categories. The rate was higher in less than 40 years age groups in both sexes (AAPC of 6.5; 95%CI: 3.3, 9.8 in males;AAPC of7.8; 95%CI: 3.4, 12.4 infemales;p<0.05 for trend). Conclusions & Recommendations:The incidence of oral cancer in Sri Lanka has shown an increasing trend with a greater propor t ional rise in males. It showed a higher incidence in males than females in all three subtypes. Structured prevention, screening and early detection programmes have to be planned to reduce the burden of oral cancer in Sri Lanka.

Background: Exclusive breastfeeding (BF) up to six months is recommended in Sri Lanka because it is known to be the best food for the infants and it provides vast benefits to the mother as well. Since exclusive BF rates decline with the advancing age of the baby, it is quite obvious that mothers face difficulties in BF.Objective: To describe the factors associated with difficulties in BF in mothers with neonates attending selected lactation management centres in the Colombo district. 2 . A study in the United States found a 25% increase in mortality among non-breast fed infants 3 . A study in Sri Lanka showed about 16% incidence of breast and nipple abnormalities in primigravida women and around 92% of them exclusively breast fed with support 4 . A study in a rural area in Sri Lanka found that 32% of the babies less than 3 months of age were on formula milk, and that difficulty in BF was a significant factor in starting formula feeding 5 . Method

Introduction: Dengue is an arboviral infection, transmitted from person to person via mosquito vectors. Dengue transmission is affected by rainfall, temperature, humidity and wind speed. These climate variables are changing as a result of anthropogenic climate change, and it is expected that this will affect the incidence of dengue. This scoping review explored the impacts on dengue transmission of variation in these climate variables in 12 Asian countries located in South- and South-East Asia regions. Methods: The protocol developed by the Joanna Briggs Institute was followed for this scoping review. Articles were found using the PubMed, Scopus, and Embase databases, as well as grey literature. Studies conducted in India, Bangladesh, Bhutan, the Democratic Republic of Korea, Indonesia, Maldives, Myanmar, Nepal, Thailand, Sri Lanka, and Timor Leste and published in English between 2002 and 2022 were included. An extensive literature search was conducted in February and March, 2022. A modified checklist designed for assessing the quality of ecological studies was used to assess the quality. Following quality assessment, ninety articles were included in the review. Results: The initial search yielded 1912 articles. After the duplicates were removed, 983 were identified as potentially relevant. Following the exclusion of 729 articles by two reviewers, 254 articles were subjected to full text screening. Thereafter, 90 articles were selected for the review that strictly met the inclusion criteria. Although the results were mixed, we found that dengue transmission decreases in temperature extremes. Dengue transmission increases with heavy rainfall, with a 1- 3-month lag. Humidity was also found to be related to dengue transmission. Other factors found to be associated with dengue transmission include the hours of sunshine and wind speed. Conclusion: There is a complex relationship between changing climate parameters and dengue incidence in Asia. This reflects the complex ecology of vector-borne diseases and suggests that the impact of changes in climate variables on dengue transmission may vary according to local climate and other factors.