Conference Papers
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This collection contains abstracts of conference papers, presented at local and international conferences by the staff of the Faculty of Medicine
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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.