Peer-assisted learning (PAL) is described in the literature and is generally initiated with faculty assistance. The PAL process described here, called Kuppi classes, is exclusively organized and run by the students of the medical school of the University of Ruhuna. To explore students' experiences with Kuppi classes as a learning process. A phenomenological research method with focus group discussions and in-depth interviews for data collection was used. Selection of students for the study ensured representation of genders, academic years of study, both Kuppi tutors and tutees, and both those who did and did not pass the prior examination in the medical school on the first attempt. According to tutee and tutors, Kuppi was developed as a parallel process to fill in gaps in students' understanding and better explain unclear aspects of the formal curriculum. Within the Kuppi, students successfully use informality, familiarity and social bonds with one another to acquire the knowledge required for their examinations. This student-initiated PAL process appears to be succeeding for the students of our school. Some of their experiences may be helpful in implementing a PAL process or even improving the formal teaching processes in medical schools with similar academic, social and cultural environments. The need for a second, student-led curriculum should alert faculty to shortcomings in the formal curriculum and classes.

: Over the past few years, a recalcitrant dermatophytosis has been observed on the Indian subcontinent, including Sri Lanka, which has caused a major public health issue in the region. An emerging species, Trichophyton indotineae, first described as Trichophyton mentagrophytes ITS genotype VIII, is thought to be responsible for this fast-spreading, mostly terbinafine-resistant dermatophytosis. Recalcitrant dermatophytosis is a challenge to dermatologists, and knowing the causative species and antifungal sensitivity in the earlier stage of management would be invaluable. We report a case series of patients with dermatophytosis caused by T. indotineae in Sri Lanka. This is the first detection of this highly terbinafine-resistant strain in Sri Lanka, and existence of this species should be taken seriously by dermatologists and healthcare policymakers for better management of tinea infections and antifungal stewardship in the country.

The ability to predict candidaemia gives a significant advantage to the clinician by enabling pre-emptive treatment to reduce mortality. To identify the prevalence, risk factors, and to validate candida colonization index (CI), candida score (CS) to reliably predict the development of candidaemia in the identified study sample. Cross sectional analytical study of consecutive admissions fulfilling inclusion criteria to intensive care units (ICUs) of Teaching Hospital Karapitiya from 1st December 2015 to 30th March 2016. Candida colonization of non-blood body sites was measured by culture on admission and repeated every 3rd day until discharge from ICU, death or development of candidaemia. CI, corrected CI (CCI), and CS were calculated for the study patients. Candida colonization was found in 100 (65.7%) patients out of 152 patients screened. The presence of sepsis, gastro-intestinal infection or surgery, central venous line colonization, higher density of rectal, oral and urine colonization was significantly different among the infected and non-infected groups. Change of species of colonizing candida was also a significant new risk factor found in the study. All the indices and scores had excellent sensitivity and negative predictive values. However none of the scores had good specificity except for CCI, which was 94%. A combination of CI, CCI and CS formulated for the study sample could reliably predict candidaemia.

Introduction: Chromoblastomycosis is a chronic disfiguring fungal infection of the subcutaneous tissue found mainly in the socio-economically marginalized population in the tropical and sub-tropical regions, characterized by the presence of sclerotic cells. This study was done with the aim of identifying the antifungal sensitivity patterns of the causative agents of chromoblastomycosis in Sri Lanka from 1992 to 2019.Methodology: Study was done on the stored isolates received from patients with chromoblastomycosis since 1992 to 2019, to the Mycology Reference Laboratory of Medical Research Institute, Colombo. Isolates were revived by subculture on Potato dextrose agar. Identification was done phenotypically. Antifungal sensitivity testing was performed by E test method. Available demographic and clinical data were analysed.Results: Of the 74 isolates, 71 (96%) were caused by Fonsecaea pedrosoi. Mean MIC for the antifungals tested were lowest for posaconazole 0.015 μg/ml followed by itraconazole 0.225 μg/ml, and voriconazole 0.768 μg/ml while amphotericin B demonstrated complete resistance with mean MIC of 30.591 μg/ml. No statistically significant differences were noted on the antifungal sensitivity of the isolates from 1992 to 2004 and 2005 to 2019.Conclusions: Fonsecaea pedrosoi was the commonest causative agent causing chromoblastomycosis in the studied population. Posaconazole demonstrated the lowest MIC values for the tested isolates followed by itraconazole and voriconazole. Amphotericin B demonstrated very high MIC values which were likely to result in clinical failure upon treatment. MIC values demonstrated minimal fluctuations throughout the tested time.

Background: Treatment resistance in tinea corporis has emerged recently, resulting in unresponsive infections. Objectives: To assess the resistance of recalcitrant dermatophytoses on glabrous skin and to understand the situation in Sri Lanka. Methods: A descriptive, observational, cross-sectional study was conducted involving nine hospitals representing all nine provinces in Sri Lanka over 6 months, starting from June 2019. All patients with dermatophyte infections in the glabrous skin were included. Sociodemographic characteristics, symptoms and prior treatment were collected. Antifungal sensitivity testing was done by a method adopted from EUCAST E.DEF 9.3 (2015). Quality control was done to ensure the accuracy of results. Results: The study included 127 isolates of dermatophytes for testing antifungal sensitivity. Trichophyton mentagrophytes comprised the majority, with 79 isolates, while there were 48 isolates of T. rubrum. The mean minimum inhibitory concentration (50th percentile; MIC50) of terbinafine was 0.064 g mL–1 for T. mentagrophytes. A significant number of isolates (8 of 32, 25%) had an MIC higher than the epidemiological cutoff of 0.125 g mL–1 set by EUCAST for terbinafine, indicating a higher likelihood of clinical failure. The MIC50 for itraconazole was 0.25 g mL–1. Considering the epidemiological cutoff of 0.25 g mL–1 for T. mentagrophytes, 33 of 79 (42%) isolates tested for itraconazole were higher. Conclusions: Itraconazole may need to be used in the treatment, with close monitoring of the response of the patients.