Browsing by Author "de Silva, C.E."

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Envenoming due to snake bite during pregnancy
(Oxford University Press, 2002) Seneviratne, S.L.; de Silva, C.E.; Fonseka, M.M.D.; Pathmeswaran, A.; Gunatilake, S.B.; de Silva, H.J.
No Abstract Available
Low dose subcutaneous adrenaline to prevent acute adverse reactions to antivenom serum in people bitten by snakes: randomised, placebo controlled trial
(British Medical Association, 1999) Premawardhena, A.P.; de Silva, C.E.; Fonseka, M.M.D.; Gunatilake, S.B.; de Silva, H.J.
OBJECTIVE: To assess the efficacy and safety of low dose adrenaline injected subcutaneously to prevent acute adverse reactions to polyspecific antivenom serum in patients admitted to hospital after snake bite. DESIGN: Prospective, double blind, randomised, placebo controlled trial. SETTING: District general hospital in Sri Lanka. SUBJECTS: 105 patients with signs of envenomation after snake bite, randomised to receive either adrenaline (cases) or placebo (controls) immediately before infusion of antivenom serum. INTERVENTIONS: Adrenaline 0.25 ml (1:1000). MAIN OUTCOME MEASURES: Development of acute adverse reactions to serum and side effects attributable to adrenaline. RESULTS: 56 patients (cases) received adrenaline and 49 (controls) received placebo as pretreatment. Six (11percent) adrenaline patients and 21 (43 percent) control patients developed acute adverse reactions to antivenom serum (P=0.0002). Significant reductions in acute adverse reactions to serum were also seen in the adrenaline patients for each category of mild, moderate, and severe reactions. There were no significant adverse effects attributable to adrenaline. CONCLUSIONS: Use of 0.25 ml of 1:1000 adrenaline given subcutaneously immediately before administration of antivenom serum to patients with envenomation after snake bite reduces the incidence of acute adverse reactions to serum.
Low dose subcutaneous adrenaline to prevent acute adverse reactions to antivenom serum in snake bite patients
(Sri Lanka Medical Association, 1999) Premawardhena, A.P.; de Silva, C.E.; Fonseka, M.M.D.; de Silva, H.J.
OBJECTIVE: To test efficacy and safety of low dose adrenaline as pretreatment for prevention of such reactions to AVS in patients with snake bite envenoming. METHODS: A prospective, randomized, double-blind, placebo .controlled trial was conducted at Base Hospital, Polonnaruwa. Patients with snake bite envenoming, who were recruited for the study, received 0.25ml of 1:1000 adrenaline (cases) or placebo (controls) subcutaneously as the only pretreatment immediately prior to full dose (10 vials) AVS infusion. Results: Of 196 patients admitted to hospital with snake bite envenoming who required AVS, 105 were recruited for the study. The other 91 had one or more exclusion criteria: treatment started in peripheral hosp'ital-72; age <12 or >70years-G; history of atopy-2, wheezing-3, hypertension -3, IHD-2; too ill to get consent-3.56 cases received adrenaline and 49 controls received placebo. The two groups were similar for age, gender, species of offending snake, degree of envenomation, proportion receiving first aid, and delay in hospital admission. Six (10.7%) cases and 21 (42.8%) controls developed acute adverse reactions to AVS, RR 0.25, Cl 0.11 - 0-57, p=0.0002. Significant reductions in acute adverse reactions to AVS were also found after grading them as mild, moderate and severe. There were no adverse effects attributable to adrenaline. CONCLUSIONS: 0.25ml of 1:1000 adrenaline injected subcutaneojjsly immediately prior to AVS infusions in patients with envenomation following snake bite significantly reduces the rate of acute adverse reactions to antivenom. The use of adrenaline in this manner is safe.
Outcome of envenomation due to snake bite during pregnancy
(Sri Lanka Medical Association, 2001) Seneviratne, S.L.; de Silva, C.E.; Fonseka, M.M.D.; Gunatilake, S.B.; de Silva, H.J.
Abstract available
Outcome of management of yellow oleander poisoning in a Base Hospital setting
(Sri Lanka Medical Association, 2001) Seneviratne, S.L.; de Silva, C.E.; Fonseka, M.M.D.; Gunatilake, S.B.; de Silva, H.J.
Abstract Available
Post mortem findings in yellow oleander poisoning
(Sri Lanka Medical Association, 2001) Seneviratne, S.L.; de Silva, C.E.; Fonseka, M.M.D.; Gunatilake, S.B.; de Silva, H.J.
INTRODUCTION: Death from yellow oleander poisoning (YOP) is mainly due to cardiac toxicity caused by its effect on the conducting system leading to bradyarrhythmias. Whether other organ systems are involved in YOP is not clear. No post-mortem studies of death due to YOP have been documented. OBJECTIVE: To study post-mortem (PM) abnormalities following YOP. METHODS: Post-mortems were performed on patients with YOP who died after admission to Base Hospital, Polonnaruwa (BHP), over a 20 month period from January 1998 to August 1999. Written consent was obtained from relatives for the PM examination. RESULTS: Thirty seven PMs were performed during the study period. There were 21 males and the age range was from 13 to 70 years. Twenty three patients died within 24 hours of admission while ten and two died on the 2" and 3rd days respectively. Two patients died after 72 hours of hospital stay. Almost all subjects (35) had myocardial and pericardial haemorrhages. Congested kidneys were found in 24 (64.8%) while nine had a congested liver. Cerebral oedema was found in 16(43.2%). No abnormalities were found in the lungs and other intra- abdominal organs. CONCLUSION: Deaths occur early in fatal YOP. Myocardial and pericardial haemorrhages were seen in almost all PMs and could have resulted from cardio-pulmonary resuscitation, at least in some patients. PM abnormalities seen in kidneys and brain were probably secondary to hypoperfusion following cardiac arrhythmias. YOP does not seem to cause direct damage to organ systems other than the heart. Further work needs to be done to determine the effects of YOP on the cardiac conducting tissue.
Yellow oleander poisoning in Sri Lanka: outcome in a secondary care hospital
(SAGE Publishing, 2002) Fonseka, M.M.D.; Seneviratne, S.L.; de Silva, C.E.; Gunatilake, S.B.; de Silva, H.J.
Cardiac toxicity after self-poisoning from ingestion of yellow oleander seeds is common in Sri Lanka. We studied all patients with yellow oleanderpoisoning (YOP) admitted to a secondary care hospital in north central Sri Lanka from May to August 1999, with the objective of determining theoutcome of management using currently available treatment. Patients with bradyarrhythmias were treated with intravenous boluses of atropine and intravenous infusions of isoprenaline. Temporary cardiac pacing was done for those not responding to drug therapy. During the study period 168 patients with YOP were admitted to the hospital (male:female = 55:113). There were six deaths (2.4%), four had third-degree heart block and two died of undetermined causes. They died soon after delayed admission to the hospital before any definitive treatment could be instituted. Of the remaining 162 patients, 90 (55.6%) patients required treatment, and 80 were treated with only atropine and/or isoprenaline while 10 required cardiac pacing in addition. Twenty-five (14.8%) patients had arrhythmias that were considered life threatening (second-degree heart block type II, third-degree heart block and nodal bradycardia). All patients who were treated made a complete recovery. Only a small proportion of patients (17%) admitted with YOP developed life-threatening cardiac arrhythmias. Treatment with atropine and isoprenaline was safe and adequate in most cases