25th Anniversary International Scientific Conference-2016
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Plenaries, Symposia and free papers presented at the 25th Anniversary International Scientific Conference, held on 6-8th April 2016, Faculty of Medicine, University of Kelaniya to celebrate the Silver Jubilee Anniversary of Faculty of Medicine
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Item Randomized controlled trial of a brief intervention for delayed psychological effects in snake bite victims(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Wijesinghe, C.A.Snake bite results in delayed psychological morbidity and negative psycho-social impact. However, psychological support is rarely provided to victims. The aim of this study was to assess the effectiveness of a brief intervention which can be provided by non-specialist doctors, and aimed at reducing psychological morbidity following snake bite envenoming. In a single blind, randomized controlled trial, 225 snake bite victims with systemic envenoming were randomized into three arms. One arm received no intervention (Group A, n=68); the second received psychological first aid and psychoeducation at discharge from hospital (Group B, n = 65); while the third received psychological first aid and psychoeducation at discharge and a second intervention one month later (Group C, n = 69). All patients were assessed six months after hospital discharge for the presence of psychological symptoms and level of functioning. A statistically significant decreasing trend in the proportion of patients positive for psychiatric symptoms of depression and anxiety was observed at six month follow up, from Group A through Group B to Group C, mainly due to a decreasing trend for symptoms of anxiety. There was also significant decreasing trend in the overall prevalence of disability from Group A through Group B to Group C, predominantly in relation to disability in family life and social life.Item Safe snake antivenom(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) de Silva, H.A.Snakebite is a WHO-listed neglected tropical disease. Bites result in an estimated 421 000 envenomings and 20 000 deaths globally each year, although the incidence may be as high as 1 800 000 envenomings and 94 000 deaths. Antivenom is the mainstay of treatment of snakebite envenoming. However, adverse reactions to poor quality snake antivenom that is available are common in many parts of the world, particularly South Asia, where snakebite is prevalent is a major problem. Both acute (anaphylactic or pyrogenic) and delayed (serum sickness type) reactions occur. Acute reactions are usually mild but severe systemic anaphylaxis may develop, often within an hour or so of exposure to antivenom. Serum sickness after antivenom has a delayed onset between 5 and 14 days after its administration. Ultimately, the prevention of reactions will depend mainly on improving the quality of antivenom. Until these overdue improvements take place, doctors will have to depend on pharmacological prophylaxis, where the search for the best prophylactic agent is still on-going, as well as careful observation of patients receiving antivenom in preparation for prompt management of acute as well as delayed reactions when they occur.Item Community incidence of snake bite in Sri Lanka(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Pathmeswaran, A.There are few studies on community incidence of snake bite. There are no national level data. We undertook a community-based country-wide survey on snake bite in Sri Lanka. The survey was designed to sample 1% of the population of Sri Lanka. A Grama Niladhari (GN) division was defined as a cluster for data collection. 125 clusters were allocated to each province. The clusters were selected using simple random sampling and in each cluster, 40 households were sampled consecutively from a random starting point. Population based incidence rates of snake bite were then constructed. 1,125 GN divisions with 43,827 households and a population of 164,746 (0.81% of country’s population) were surveyed. 694 snakebites and 317 significant envenoming (local tissue necrosis and systemic envenoming) were reported within the past 12 months. The crude overall community incidence of snake bites and significant envenoming were 421 and 192 per 100,000 population, respectively. There was wide variation within districts, the worst affected being Mullaitivu, Anuradhapura, Batticaloa and Polonnaruwa, all mainly agricultural areas in the Dry Zone of the country. It is concluded that Sri Lanka has a high community incidence of snake bite and envenoming, with marked geographical variation within the country.Item The Global Challenge of Snakebite: where are we in 2016?(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Lalloo, D.OBJECTIVE: To understand the ongoing challenges to improving outcomes following snakebite around the world. The existing state of our knowledge about the epidemiology and management of snakebite around the world will be reviewed, including identifying the major contributions made to the literature by Sri Lankan researchers. The future research agenda and the inherent challenges in achieving improved outcomes will be highlighted and discussed.