Carotidynia or Transient Perivascular Inflammation of the Carotid Artery (TIPIC) syndrome is a rare cause of atypical neck pain. Exact aetiopathogenesis of this clinical entity is poorly understood. A 43-year-old female presented with progressively increasing right side neck pain of 3 days duration associated with focal tenderness over the right carotid pulse corresponding to the level of upper border of thyroid cartilage. Her inflammatory markers were not elevated. An ultrasound scan revealed increased echogenicity surrounding the distal common carotid artery, obliteration of the perivascular tissue planes with preserved doppler flow pattern. MRI showed soft tissue thickening around the distal common carotid artery, carotid bulb and proximal external carotid artery on right side of the neck corresponding to sonographic findings with gadolinium enhancement. A diagnosis of TIPIC syndrome was made and she was started on celecoxib. Pain completely subsided within 2 weeks. In conclusion, TIPIC syndrome is a rare differential diagnosis of neck pain. It is caused by a transient perivascular inflammation of the carotid artery. A high degree of suspicion is necessary for the diagnosis. Imaging is the gold standard investigation for the diagnosis of TIPIC syndrome. It is a self-limiting pathology and often responds rapidly to nonsteroidal anti-inflammatory drugs.

Introduction: Cajal like cells (CLCs) in the upper urinary tract have an ability to generate coordinated spontaneous action potentials and are hypothesized to help propel urine from renal pelvis into the ureter. The objective of this review was to describe the variations in the density and distribution of CLCs associated with ureteropelvic junction obstruction (UPJO).Materials and Methods: Studies comparing the density and distribution of CLCs in the human upper urinary tract in patients with UPJO and healthy controls were included in this systematic review. We searched online electronic databases; Ovid MEDLINE, Scopus, PubMed and Cochrane reviews for the studies published before October 31, 2020. A meta-analysis was conducted to compare the density of CLCs at the ureteropelvic junction (UPJ) in patients with UPJO and matched controls.Results: We included 20 and seven studies in the qualitative and quantitative synthesis, respectively. In majority (55%) CLCs were located between the muscle layers of the upper urinary tract. The CLC density in the UPJ gradually increased with aging in both healthy subjects and patients with UPJO. The pooled analysis revealed that the density of CLCs at the UPJ was significantly low in patients with UPJO compared to the controls (SMD = −3.00, 95% CI = −3.89 to −2.11, p < 0.01).Conclusions: The reduction in CLC density at the UPJ in patients with UPJO suggests a contribution from CLCs in the pathogenesis of UPJO. Since age positively correlates with CLC density, it is imperative to carefully match age when conducting case control studies comparing the CLC density and distribution.Protocol Registration Number: CRD42020219882.

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Forensic Age Estimation (FAE) in living is required in many civil and criminal circumstances where documentary proof of age is unavailable. In Sri Lanka, 16-21 age range has many statutory age limits. Though international guidelines recommend CT scanning of medial clavicular epiphyses for forensic age estimations within this age range, Sri Lanka does not have any population-specific reference standards for this modality.The objective of this study was to describe the pattern of medial clavicular epiphyseal fusion among Sri Lankans aged 15-30 years.Chest, neck and pulmonary angiography CT scans of patients between 15-30 years performed in two tertiary hospitals were reported independently by two radiologists using the five-stage classification for medial clavicular ossification by Schmeling et al. (2004). Interobserver reliability was assessed using Cohen's Kappa coefficient. A preliminary descriptive analysis of the first 46 cases was done using SPSS. There were 25 males and 21 females. Majority (80%) were 18 years and above. The oldest with stage 1 was 16 years. The youngest for stages 2 and 3 were both 17 years. Stages 4 and 5 were seen in 67% of cases and none were below 20 years. This trend was similar to previously published studies.From the preliminary results, it appears that only stages 4 and 5 can be used reliably to determine if a person is >18 years. Stages 2 and 3 are likely to indicate that the person is >16 years. Clavicular epiphyseal fusion shows good potential to be a reliable FAE method in Sri Lanka.

Objective To study antibiotic usage pattern in acute respiratory infections (ARI) in children. Design A descriptive cross-sectional study.

IntroductionAnatomical variations of the lung lobes and fissures have implications in diagnostic radiology and thoracic procedures. The prevalence of these variations is not reported in Sri Lanka. MethodsA cross-sectional study was conducted on cadavers to assess the morphological variations of lung lobes and fissures. The presence and absence of lung lobes and fissures were reported in addition to describing the completeness of the major lung fissures. ResultsA total of 24 lungs in 12 cadavers were studied. Inferior accessory fissures were noted in one right and one left lung of two independent cadavers. Two cadavers had no horizontal fissures, and one left lung had an incomplete oblique fissure posteriorly. Azygos lobe was not observed in this study sample. ConclusionsThe morphology of lung lobes and fissures demonstrate a notable variability, on par with previous reports. Further studies with a large sample size in our population are necessary for generalizable results.

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