Peripheral blood smear findings may be helpful in differentiating leptospirosis from other common acute febrile illnesses.

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Early recognition of impending outbreaks followed by rapid response is the mainstay of controlling a communicable disease. Acquiring the ability for collection of complete data island wide in a timely manner and analysis of such data, timely dissemination of analysed data as well as guidelines on appropriate interventions will no doubt strengthen the Epidemiology Unit's (EU's) capacity to implement disease prevention and control activities more efficiently and effectively. Insight to the current communicable disease surveillance process reviled five issues which lead to delayed response to epidemics, which are 1) delays in data collection, 2) delays and limitations in data analysis, 3) delays in decision making, 4) delays in proactive measures and 5) delays in information dissemination. The concept of Nivārana came to life in order to strengthen the communicable disease surveillance by addressing the identified issues using Information and Communication Technology (ICT). Nivārana is a communicable disease surveillance and analysis system, focused on swift data collection, efficient data processing and rapid information dissemination in order to control and prevent communicable diseases by implementing rapid response to epidemics. Swift information dissemination is identified as the key to implement rapid response. People, process and technology were identified as the main aspects in the design, development and implantation. User understanding acquired by the pre-development survey and the established design consideration provided the ground for the design. System is developed as a web based system having data collection, data analysis, reporting and information dissemination as the core modules. Thorough analysis highlighted Java Technologies as the most appropriate for Nivārana implantation. The developed system is to be piloted in the Western Province in Sri Lanka shortly. Nivārana is conceptualised on the basis of "prevention is better than cure" and is used to translate information to swift public health action to minimise the burden of communicable diseases in Sri Lanka thereby preventing ill health and suffering in the community and conserving much needed resources.

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In this paper, the authors present work that was carried out to develop an m-learning extension to a Moodle based VLE at the University of Colombo School of Computing (UCSC) and its initial evaluation. They believed this new development could bring a value added service to learners and describe how mobile browsing, mobile applications and Short Message Service (SMS) were used to access learning resources and activities to interact with other users who were facilitating or following on-line courses. However, in their investigation, the authors discovered that m-learning cannot be promoted as a value added service for the current e-Learning based framework. Learners do not receive a significant benefit compared to the cost they incur to interact with the learning service. Both pedagogy and technical infrastructure must be considered together, not as an extension of existing services but to provide a new learning service for m-learning.

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Background:The critical phase of dengue carries a high risk of bleeding. Associations of coagulation test parameters and the risk of bleeding in the critical phase is unclear.This study examines the association of rotational thromboelastometry (ROTEM delta and ROTEM platelet) with bleeding risk of patients with dengue in the critical phase.Methods: A total of 105 patients with confirmed dengue in the critical phase were recruited, with two subsequent prospective time point analyses of ROTEM parameters and platelet count within 24 and 48 hours from the onset of the critical phase.Conventional coagulation tests were performed only at the initial time point.Results: Twenty of 105 patients developed bleeding after onset of the critical phase.Within the first 24 hours of critical-phase onset, platelet count, coagulation tests, and ROTEM delta were unable to differentiate patients with bleeding manifestations from those without (P < .05). Area under the curve of thrombin receptor activating peptide-6 assay of ROTEM platelet (TRAPTEM) discriminated patients with bleeding manifestations from those without, at a cutoff value of <12.5 Ω*min at a sensitivity and specificity of 73.7%, and 60.2%. In patients who developed bleeding, the maximum lysis of extrinsic pathway of ROTEM was significantly lower in patients with severe bleeding compared to those with mild to moderate bleeding. (4.3 ± 3.4% vs 9.4 ± 7.5%; P = .01). Conclusion:An association with bleeding manifestations and TRAPTEM suggest a potential role for defective platelet aggregation in the pathogenesis of bleeding in the critical phase of dengue.

Introduction Hereditary hemochromatosis is an inherited disorder of iron metabolism, characterized by excessive iron deposition in major organs of the body, leading to multi-organ dysfunction. It is a genetically heterogeneous disease caused by mutations in one or more different genes, the most common being mutations in the HFE gene. HFE hereditary hemochromatosis is mostly found in Europeans and is almost always a result of two mutations: C282Y and H63D. The H63D mutation is not as penetrant as the C282Y mutation, but there are rare reported cases of hereditary hemochromatosis with homozygous H63D genotype. While the C282Y mutation is primarily confined to persons of Northern European origin, the H63D mutation is spread worldwide. Other types of hereditary hemochromatosis are rare and broadly defined as non- HFE hereditary hemochromatosis and include mutations in the hemojuvelin gene, hepcidin ( HAMP gene), transferrin receptor 2 gene, and ferroportin gene. Hereditary hemochromatosis is commonly found in populations of European origin; in contrast, it is rare and less well understood in Asia. It can be masked by the presence of concurrent iron deficiency or secondary iron overload in thalassemias. Case presentation We report the case of a 42-year-old Sri Lankan man investigated for fatigue during a brief upper respiratory tract infection and found to have high liver transaminases and high serum ferritin, which persisted even after complete resolution of the infection. Homozygosity for H63D mutation in the HFE gene was detected. Liver enzymes, serum ferritin, and transferrin saturation normalized following venesections. Conclusion This case adds to the literature on the importance of being vigilant and investigating patients suspected for iron overload, including genetic studies for hereditary hemochromatosis, even though it is a rare clinical entity in Asians.