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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty

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Author: search.filters.author.Gunatilake, S.B.End date: 1999

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    Coagulopathy and fibrinolysis following the bite of a hump-nosed viper (Hypnale hypnale)
    (Oxford University Press, 1996) Premawardena, A.P.; Seneviratne, S.L.; Jayanthi, S.; Gunatilake, S.B.; de Silva, H.J.
    No abstract available
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    Stroke subtypes in Sri Lanka
    (Sri Lanka Medical Association, 1997) Gunatilake, S.B.; Premawardhena, A.
    AIM: Data on stroke subtypes in Sri Lanka are limited. This is due to the unavailability of brain imaging facilities in most government hospitals in the country. In two leading private hospitals in Colombo, a high proportion of stroke patients are subjected to computerised tomography (CT) scanning. Therefore it was decide to study the stroke patients admitted to these two hospitals to determine the stroke subtypes METHODS: A prospective study of 103 consecutive first -ever stroke patients who were under the eare of the first author during the period 15lhMay 1995 lo30th August 1996 were studied. Diagnosis of stroke was made according to the WI10 definition. Transient ischaemic attacks (TIA) were not included in the study. The pathological subtype was confirmed by CT scan in 99 patients RESULTS: The age of the patients ranged from 37 to 94 years (mean 65y). 87 patients were over the age of 50 years. The proportion of pathological subtypes confirmed by CT scanning was cerebral infarction (CI) 74%, intracerebral haemorrhage (ICH) 19% and subarachnoid haemorrhage (SAII) 6%. Of the 74 infarcts 31 (23%) were cortical, 30 (22%) were lacunar, 12(9%) were cerebellar and brains tern and 1 (0.7%) was a border zone infarct, In-hospilal mortality was 19% for all strokes: 14% for infarcts and 35% for haemorrhages. Mortality was lowest in (he lacunar stroke group (3%). In the cortical infarct group the mortality was 16%, in the ICH group 22% and in the SAM group 50%. CONCLUSION: Direct comparisons with stroke subtypes seen in other countries are not possible due to differences in methodology. In developed countries in the West cerebral infarcs account for about 80% of alI first-ever strokes and of these 13 to 21% are lacunar strokes. Countries in the East like Japan and Hongkong have reported higher proportion of haemorrhages; 27% of first-ever strokes in Hong Kong. In Sri Lanka The proportion of stroke subtypes seem to be intermediate between these countries from die west and east. Lacunar .stroke .seem to be commoner in Sri Lanka than in other countries. These differences may be because of differences in risk factors prevalent in our country.
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    Sympathy towards patients
    (Royal College of Physicians of London, 1999) Seneviratne, S.L.; Gunatilake, S.B.; Dassanayake, D.; Adhikari, A.; de Silva, H.J.
    No abstract available
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    Serum cholesterol concentrations in parasuicide
    (Sri Lanka Medical Association, 1999) Seneviratne, S.L.; Warnasooriya, W.M.P.; Gunatilake, S.B.; Fonseka, M.M.D.; Gunawardena, M.K.R.; de Silva, H.J.
    OBJECTIVE: To evaluate whether people who have committed parasuicide have low serum cholesterol concentrations. METHOD: All subjects admitted to the University Medical Unit, Ragama after parasuicide from 1.3.96 to 31.1.97 were matched for age, sex, presence of diabetes and arterial hypertension, substance abuse, body mass index and socioeconomic status with controls. Venous blood samples for cholesterol estimation were collected from parasuicides within 24 hours of admission. RESULTS: Analysis was done on 168 parasuicide patients [males 74; mean age for males 24 years (SD 6.2), females 19 years (SD 3.3)] and 168 matched controls. Of the parasuicide subjects, 33 had a psychiatric illness and 135 were considered to have impulsive personalities. The serum cholesterol level in parasuicide patients was not significantly different from that in controls. CONCLUSIONS: This study, the first from a developing country, did not show an association between low serum cholesterol concentrations and parasuicide.
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    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.
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    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.
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    A Family with alkaptonuria showing quasidominant inheritance
    (Sri Lanka Medical Association, 1999) de Silva, A.P.; Seneviratne, S.L.; Gunatilake, S.B.; Fonseka, M.M.D.; Jayasekera, R.; de Silva, H.J.
    No Abstract Available
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    Diagnosis and management of tuberculous meningitis
    (State Pharmaceuticals Corporation, 1998) Gunatilake, S.B.
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    Two cases of Creutzfeld-Jakob disease
    (Sri Lanka Medical Association, 1998) Gunatilake, S.B.; de Silva, A.P.; Jayamanne, S.F.; de Silva, H.J.
    No Abstract Available
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    Driving and epilepsy in Sri Lanka
    (Elsevier-W.B. Saunders, 1998) Seneviratne, S.L.; Gunatilake, S.B.; Adhikari, A.A.D.N.W.; de Silva, H.J.
    Regulations regarding driving for patients with epilepsy vary from country to country. They are well implemented in developed countries, but this is not the case in countries such as Sri Lanka. The aims of this study were to study characteristics of a cohort of patients with epilepsy who were driving or riding a vehicle at present, and study the attitudes of a representative sample of doctors, patients with epilepsy and the general population regarding aspects of driving by patients with epilepsy. Patients with epilepsy attending the medical clinics at the Colombo North General Hospital, Ragama, who were driving, were given a questionnaire and interviewed in order to assess their seizure characteristics. Another questionnaire was administered to epileptic patients visiting the clinics, a sample from the general population (relatives visiting in-patients at the University Medical Unit selected randomly), doctors working at the General Hospital in Ragama and the Base Hospital in Negombo, and general practitioners in the Gampaha district, where these two hospitals are situated, which was designed to assess their views regarding driving by persons with epilepsy. Of the patients with epilepsy interviewed 24.8% were presently driving a vehicle, of them 51% were riding a motorcycle. The attitudes of the general public and patients to driving by epileptic patients were at opposite ends of the spectrum; 97% of the general public being opposed to driving by persons with epilepsy, while epileptics themselves being of the view that the rules should be lax. Doctors thought that there should be some regulations against driving by epileptic patients. These facts must be considered when setting implementable regulations regarding driving by epileptics in developing countries.
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