Background Simultaneous development of thyroid storm and diabetic ketoacidosis (DKA) is a rare condition. The review aims to summarise its clinical presentation, investigation findings and treatment options. Methods Databases and reference lists of the selected articles were searched for case reports in English which describe concurrent presentation of thyroid storm and diabetic ketoacidosis. CARE guidelines were used for the quality assessment of the selected articles. Results Twenty-six cases from twenty-one articles were selected out of 198 search results. Western Pacific, and American regions contributed to 77% of the cases. Females were most affected (88%). Features of Graves’ disease like hyperthermia and tachycardia, gastrointestinal and neuro-psychiatric disturbances were the common clinical presentations. In most of the cases, previous diagnosis of diabetes mellitus preceded that of Graves’ disease (46%). Among patients having their drug compliance reported, all had poor compliance to their routine anti-thyroid (9/9) and anti-diabetic (2/2) agents. Moreover, in all cases where HbA 1C (7/7) and T4 (16/16) were measured, the results were elevated and where TSH (17/17) was measured, the results were low. The recommended treatment for DKA and thyroid storm was used in most cases and methimazole was the thionamide of choice in the latest four cases reported. All cases survived except four (15%). Conclusions Concurrent presentation of thyroid storm and diabetic ketoacidosis is rare but life-threatening. Therefore, efforts should be made to maximise patient compliance to anti-thyroid and anti-diabetic agents in treating such patients. Electronic supplementary material The online version of this article (10.1186/s12902-019-0374-3) contains supplementary material, which is available to authorized users.

Purpose: Authenticity of organic tea has been questioned recently due to some evidence of contaminated organic tea in the market. Although producers' compliance with organic standards (OS) is a necessity to ensure the safety of organic tea and consumers' trust, the lack of empirical studies has become a timely need to understand the authenticity of organic tea production systems. Therefore, this study attempts to investigate the certifi ed organic tea (COT) farmers' compliance behaviour with OS using a study in Sri Lanka. Research Method: A cross-sectional fi eld survey was conducted among 77 small-scale COT farmers inthe Central and Uva provinces. These farmers were accessed through two coordinating organizations. Data was collected using interviews, structured questionnaires and observations and analyzed using descriptive statistics.Findings: Results show that higher profi ts and benefi ts from certifi cate holders are the main reasons to select COT farming than conventional tea farming. Generally, farmers perceive high discouragement violating OS and have mixed attitudes on diff erent aspects of organic farming. Farmers' compliance behaviour towards OS is not perfect and vary among OS due to various reasons, i.e. expected loss by being noncompliant, group farming, availability of support services, fi nancial ability and awareness about hazardous contaminants. Eff ective quality assurance system and hazardous free neighbourhood potentially facilitate the farmers' compliance behaviour. However, the unavailability of support services, lack of fi nancial capacities, and farmers' unawareness of contaminants during handling seem to hinder the compliance.Originality: Understanding the fi rst step of COT production is novel and provide insights to implement needful actions by those who are concerned and responsible for the authenticity of COT production.

In Sri Lankan universities, lecturers

This study aimed at investigating Sri Lankan small-scale Certified organic (CO) farmers’ awareness on their adopted organic standards, the third-party certification body, internal control system, Fairtrade certification, and conditions of contracts with coordinating organizations. A cross sectional survey was conducted among a randomly selected sample of 202 CO farmers who were linked with five coordinating organizations. Primary data was collected using a structured questionnaire along with key informant discussions and field observations. Data were analyzed using descriptive statistics to generate simple summaries and tendencies. According to the results, CO farmers are organized as farmer organizations that were initiated as out-grower groups of coordinating organizations. All CO farmers were unaware of the adopted organic standard. The majority were unaware of the third-party certification body (83%), and the internal control system (81.7%). This perhaps due to their exclusion in managing certification related aspects. Thus, showed submissive decision-making behavior. However, many of them were aware of Fairtrade certification (56.4%) as it provides a wide spectrum of additional benefits covering production, marketing, and farmers’ welfare. Farmers were also aware of their contracts (verbal or written) with coordinating firms (62.2%) but hardly conscious of their conditions. In some contracts, conditions were unfairly distributed among stakeholders. Therefore, the study recommends enhancing small-scale farmers knowledge not only the production aspects but also certification, quality assurance, administration, and marketing as well. Meanwhile, mediating the partnership among stakeholders by a government body is also recommended to avoid power abuses among stakeholders.

No abstract