Browsing by Author "Jayamanne, S. F."

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Accidental and deliberate self-poisoning with medications and medication errors among children in rural Sri Lanka
(Hindawi Pub. Corp., 2020) Dayasiri, K.; Jayamanne, S. F.; Jayasinghe, C. Y.
ABSTRACT: Context. Pharmaceutical products are the leading cause accidental poisoning in middle- and high-income countries. Patterns of poisoning with medicinal drugs change across different geographic regions and over decades owing to variability in prescription practice, sociocultural factors, safe storage of medicines, and free availability of over the counter medications. Methods. This multicentre descriptive study was conducted over a seven-year period (February 2007 to January 2014) to assess patterns and trends of medicinal drug-related poisoning among children less than 12 years of age in thirty-six hospitals across rural Sri Lanka. Children with both accidental and deliberate medication poisonings and medication errors were recruited to the study. Data on poisoning events and medication errors were gathered via patient/parent interviews using multistructured questionnaires that assessed demographic factors, first aid measures, location and circumstances of poisoning, clinical management, and complications. In addition, focus group discussions were performed on all children and their families who had deliberate poisoning events and medication errors. Results and Conclusions. Among 1621 children presented with acute poisoning over seven years of age, 410 children had acute poisoning with medications. Male children (225, 54.9%) outnumbered female children. Paracetomol (137, 35.6%), salbutamol (55, 14.3%), and chlorpheniramine (35, 9.1%) were the most commonly poisoned medications. Prospective data at Anuradhapura teaching hospital (n = 112) revealed that unsafe first aid measures were practiced on 22 (19.6%) children. Although the majority of children remained asymptomatic (61, 54.5%), neurological symptoms (34, 67%) were predominantly seen in symptomatic children. The majority of poisonings took place within home premises (76, 67.9%). There were 16 reports of medication errors (14.2% of acute poisoning events) either due to erroneous administration by caregivers or erroneous issue of medicines by health workers. The current study did not observe mortality following medication poisonings. This study brings to light the burden of medicinal drug-related poisoning morbidity among children in rural Sri Lanka. Potentially, interventions such as community educational initiatives, written safety warnings, increased use of child resistant containers, and enforcement of laws to bring down accidental medication poisonings need to be implemented, and their effectiveness should be evaluated.
The effect of the Smart Glucose Manager (SGM) on glycosylated hemoglobin (HbAlc)
(Sri Lanka Medical Association, 2018) Dhanishka, L.; Gunawardena, K.C.; Jackson, R.; Jayamanne, S. F.; Kalpani, A. G. S.; Muthukuda, D. T.; Robinett, I.
INTRODUCTION AND OBJECTIVES: Smartphone use is growing rapidly in developing countries and mobile plications have begun to be utilized in the field of diabetes. Present study was conducted to evaluate the effectiveness of a newer mobile application, Smart Glucose Manager (SGM) in the management of diabetes mellitus. _ METHODS: A prospective randomized control trial was conducted at out-patient diabetes clinics of Sri Jayewardenepura General Hospital. Patients with HbAlc = 8.0% with access to smart phone were recruited and randomly assigned to two arms. Patients in both arms received standard care, the intervention arm received the mobile application, SGM. HbAlc levels were measured at baseline and every 3-months. RESULTS: The mean age of the study participants was 52±11 years. The improvement of mean HbAlc from baseline to 3-months follow-up, the intervention (baseline: 9.7%±1.3, follow-up: 8.2%±1.0, p =0.001) and control (baseline: 9.5%±1.6, follow-up: 8.2%±0.6, p=0.008) arms were not significantly different (p=0.98). However, a significant improvement in HbAlc was observed in the intervention arm from 3-months (8.3%±0.6) to 6-months (7.3%+_0.6), (p=0.005) compared with the control arm (8.2% at 3-months) (7.9%+_0.6-months), (p=0.16). Improvement of mean HbA1c was shown in both arms 3- months after the baseline clinic visit, but after 6-months, only the intervention arm continued to show statistically significant improvement of HbAlc(p=0.01). CONCLUSION: The improved glycemic control after 6 months in the intervention arm patients suggests increased patients compliance via the unique features of SGM. Further studies should be carried out to assess the long-term impact of SGM in diabetes patients.
Melioidosis with a subdural collection - a case report.
(BioMed Central,London, 2019) Amarasena, H. L. P.; Silva, F. H. D. S.; Tilakaratna, P. M. Y. I.; Jayamanne, S. F.; Ranawaka, U. K.
BACKGROUND:Melioidosis is an infection caused by Burkholderia pseudomallei, which is more prevalent in the tropics and leads to significant morbidity and mortality. It characteristically produces widespread caseous lesions and abscesses, and can present with varied clinical manifestations. Melioidosis involving the central nervous system is uncommon. CASE PRESENTATION: A 42-year-old Sri Lankan male with type 2 diabetes presented with a febrile illness of 6 days with headache and constitutional symptoms. Clinical examination was unremarkable. Four days later, he developed focal seizures involving the left leg and numbness of the left side. Initial laboratory investigations were suggestive of a bacterial infection. Blood culture was reported as positive for a Pseudomonas species, which was resistant to gentamicin. Contrast enhanced CT and MRI scans of the brain showed a subdural collection in the right fronto-temporo-parietal region with possible abscess formation. Melioidosis antibody testing using indirect hemagglutination method was reactive with a titre more than 1/10,240. He was treated with intravenous meropenem and oral co-trimoxazole for 8 weeks (Intensive phase). The subdural collection was managed conservatively, and seizures were treated with oral antiepileptics. At 7 weeks, follow-up contrast enhanced MRI showed improvement of the subdural collection, and inflammatory markers had normalized. He was discharged after 8 weeks, and treated with oral co-trimoxazole and doxycycline for 6 months (eradication phase). At 6 months follow-up, the patient is asymptomatic. CONCLUSIONS: Cerebral melioidosis is an unusual presentation of melioidosis where the diagnosis can be easily missed. Knowledge of the protean manifestations of melioidosis is of paramount importance in order to detect and treat this potentially fatal infection appropriately, especially in tropical countries where the disease is endemic.
Patterns of acute poisoning among children in rural sri lanka
(Sri Lanka College of Paediatricians, 2015) Dayasiri, M.B.K.C.; Jayamanne, S. F.; Jayasinghe, Y. C.
OBJECTIVE:The study describes the patterns of demographic characteristics, poison related factors, clinical management and outcome following acute poisoning among children (9 months - 12 years) in rural Sri Lanka.METHOD:The current multi-centre study was hospital based and involved the two major hospitals (Anuradhapura and Polonnaruwa), and 34 peripheral hospitals of the North Central province of Sri Lanka (NCP). Total period covered by the study was seven years. Major part of data collections was carried out at Anuradhapura hospital prospectively for two years using interviewer administered questionnaire based assessments.RESULTS:Among 1621 children, boys (59%) outnumbered girls and most were of preschool age group. Majority belonged to the farming community. Commonest poison and type of poison were kerosene oil and household poisons respectively in most studies. Both male and female children ingested pesticides least. Most had unintentional poisoning and incidents mostly occurred within their own house premises. First aid measures were practised by one third of care givers and there were six incidents of aspiration pneumonia as detrimental effects of first aid measures and guardians were unaware of these effects in all cases. Commonest reasons for delayed presentation at emergency centre had been lack of concern by family members regarding the urgency of the situation and lack of knowledge regarding possible complications. Complications were observed in 12.5% and commonest was chemical pneumonitis.CONCLUSIONS: •The victims of acute poisoning in this muli-centre study were predominantly preschoolers, and male children were at a higher risk. • They were poisonined mostly unintentionally and within their own housing premises. •Kerosene oil was the commonest poison with its additional risks of aspiration pneumonia following hazadrous first aid measures by care givers.