Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Estimates of disease burden due to snakebite in Sri Lankan hospitals(Sri Lanka Medical Association, 2003) Kasturiratne, A.; Pathmeswaran, A.; Fonseka, M.M.D.; Lalloo, D.G.; Brooker, S.; de Silva, H.J.INTRODUCTION: There have been no country-wide studies or estimates of disease burden due to snakebite in Sri Lankan hospitals. OBJECTIVES: To assess disease burden due to snakebite and estimate relative frequency of the biting species in hospitals situated in different parts of the country. METHODS: Hospital morbidity and mortality data on snakebite was obtained for each administrative district. Sri Lanka was divided into 5 zones based on climate and available data on snake habitat (Zone 1-wet zone altitude <900m; Z2-intermediate zone; Z3-dry zone, Z4-wet zone altitude >900m; Z5-northern and north-western dry zone). Administrative districts were allocated to zones based on their geographical location and population using geographical information systems technology. Hospital morbidity and mortality data were collated for the 5 zones. A survey among physicians (37 physicians in 42 hospitals covering the 5 zones) was used (Delphi technique) to estimate the proportion of snakebites by different species and requirement of hospital resources, in each zone. Results: There was a clear difference in incidence of hospital admissions due to snakebite in the different zones (Z3-3.5 and Z4-0.4 per 1000 population). The distribution of bites by individual species also varied between zones (deadly venomous species Z3-85%, Z2-45%), moderately venomous and mildly-venomous species Z4-100%, Zl-70%). These trends corresponded to estimates of requirements for AVS and other hospital facilities (in 2000, Z3-86100 vials of AVS, 7380 Intensive care unit patient-days; Zl-26400 vials of AVS, 2640ICU patient-days). CONCLUSIONS: Incidence of hospital admissions due to snakebite and estimates of relative medical importance of different snake species show geographic variation within the country. This is reflected in estimates of requirements for facilities. Zoning based on environmental information rather than on political boundaries could lead to better distribution of health care resources for management of snakebite in hospitals situated in different parts of the country.Item 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.Item Estimates of disease burden due to land-snake bite in Sri Lankan hospitals(SEAMEO Regional Tropical Medicine and Public Health Project, 2005) Kasturiratne, A.; Pathmeswaran, A.; Fonseka, M.M.D.; Lalloo, D.G.; Brooker, S.; de Silva, H.J.Snake bite is a common cause of hospital admission in Sri Lanka. Despite this, there have been no countrywide studies or national estimates of disease burden due to snake bites in Sri Lankan hospitals. We assessed the disease burden due to snake bite in our hospitals and estimated the frequency of admissions due to bites by different snake species. Sri Lanka was divided into four zones based on climate and topography. Hospital morbidity and mortality data, which are available on an administrative district basis, were collated for the four zones. A survey of opinion among specialist physicians (the Delphi technique) was used to estimate the proportion of bites by different species, and requirements for anti-venom (AV) and intensive care facilities for management of snake bites in hospitals in each of the four zones. A study of hospital admissions due to snake bites in seven selected hospitals was also performed to validate the opinion survey. There was a clear difference in the incidence of hospital admissions due to snake bites in the different zones. Estimates of hospital admissions due to bites by different species also varied considerably between zones. These trends corresponded to estimates of requirements of AV and other supportive health care. Health care planning using data based on environmental information, rather than merely on political boundaries, could lead to targeted distribution of AV and intensive care requirements to manage snake bites.Item 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 AvailableItem Anti-venom for snake bite in Sri Lanka(Sri Lanka Medical Association, 2002) de Silva, H.J.; Fonseka, M.M.D.; Gunatilake, S.B.; Sellahewa, K.H.; Kularatne, S.A.M.No Abstract AvailableItem Safety of subcutaneous adrenaline as prophylaxis against acute adverse reactions to anti-venom serum in snakebite(Sri Lanka Medical Association, 2002) Dassanayake, A.S.; Karunanayake, P.; Kasturiratne, K.T.A.A.; Fonseka, M.M.D.; Wijesiriwardena, B.; Gunatilake, S.B.; de Silva, H.J.OBJECTIVES: To study the safety of low dose subcutaneous adrenaline given as prophylaxis against acute adverse reactions to anti-venom serum(AVS) in patients bitten by snakes. METHODS: Patients admitted with snakebite envenoming who satisfied inclusion criteria were given 0.25 ml of 1:1000 adrenaline subcutaneously immediately before administration of AVS. They were observed for adverse effects, and pulse and blood pressure (BP) were monitored. RESULTS: 51 patients [35 males, mean age 34.8 years (SD 14)] were included in the study. Adverse reactions to AVS occurred in 15 (29.4%) patients. There was one death from suspected cerebral haemorrhage, and 3 (5.9%) patients developed small haematomas at the subcutaneous injection site. There were no significant changes in mean pulse or BP following administration of subcutaneous adrenaline. CONCLUSIONS: Low dose subcutaneous adrenaline did not cause significant changes in pulse rate or BP. Although the death was unlikely to be directly related to subcutaneous adrenaline, we suggest further studies on the safety of this prophylactic treatment before its routine use.Item 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.Item Lack of myocardial damage following Sri Lankan Russell's viper and hump-nosed viper bites(Sri Lanka Medical Association, 1999) Seneviratne, S.L.; Gunatilake, S.B.; Fonseka, M.M.D.; Adhikari, A.A.D.N.W.; de Silva, H.J.INTRODUCTION: Cardiac effects following the bite of Burmese Russell's vipers and European vipers are well known. The question whether envenomation caused by Sri Lankan viper bites results in myocardial damage remains largely unanswered. The aim of this prospective study was to investigate whether myocardial damage occurs after Sri Lankan viper bites, using a highly specific and sensitive marker, troponin T. METHODS: 45 patients admitted after a definite viper bite [Russell's viper (RV), n = 13, hump-nosed viper (HNV), n = 32] were studied with regard to cardiac symptoms, ECG changes, and troponin T levels. There were no admissions with bites of other types of Sri Lankan vipers during the study period. RESULTS: Cardiac symptoms were present in a number of patients following the bite. Two patients had transient ECG changes. However, troponin T levels were not elevated in any of them. COMMENT: Myocardial damage does not seem to be an important feature of Sri Lankan Russell's and hump-nosed viper bites. This may be because of venom heterogeneity in vipers, that is based on their geographical distribution.