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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Rare case of self-limiting haemolysis associated with Dengue fever in a Sri Lankan female - case report(Royal Society of Medicine,London, 2022) Luke, W.; Lohithalingam, P.; Jayamanne, S.F.A 61-year old female with dengue haemorrhagic fever developed anaemia and rising transaminase levels on the 6th day of illness. She was found to have haemolysis with a negative direct antiglobulin test (DAT), and no red cell fragmentation. She recovered with supportive care. Haemolysis with associated Haemolytic uraemic syndrome (HUS), Disseminated intravascular coagulation (DIC) and cold Auto-immune haemolytic anaemia (AIHA) is reported previously; DAT negative haemolytic anaemia associated with dengue fever has not. This case suggests a need for further studies on other immune mechanisms that can lead to haemolysis with dengue fever.Item Pharmacist counselling: A new practice for improving out-patient management of diabetes in Sri Lanka(Sri Lanka Medical Association, 2018) Mamunuwa, A.M.G.N.; Coombes, J.; Lynch, C. B.; de Silva, A.; Wickramasinghe, N.D.D.; Jayamanne, S.F.INTRODUCTION AND OBJECTIVES: Our study assessed the effectiveness of pharmacist counselling on outpatient management of diabetes. Though this is new to Sri Lanka, many countries include this practice to achieve target treatment outcomes of patients with diabetes.METHODS: 800 participants with diabetes attending outpatient clinics of two Sri Lankan hospitals were assigned either intervention group (IG) or control group (CG). IG received pharmacist counseling for four consecutive monthly visits in addition to standard care. CG received standard care only Glycaemic control was assessed using Glycosylated haemoglobin (HbAlc) post-intervention Adherence and patient-knowledge were assessed using questionnaires at baseline and post-intervention. RESULTS: A Wilcoxon signed-rank test showed that the 4-month intervention made a statistically significant improvement in adherence in the IG. The IG had median adherence score of 5 out of 8 (IQR 6-3 3) at baseline which increased to 7 (IQR 8-6) post-intervention There was no significant change in adherence in the CG.The IG had median HbAlc of7.2% (IQR 1.5%) post-intervention whereas CG had median of7.7% (IQR 1.95%). This difference was statistically significant.The IG had a median score of 36. l 5% (IQR 48% - 24.07%) for the medication related knowledge domain which increased to 65% (IQR 76.4% - 50.4%) post-intervention (P value< 0 001). The CG did not have a significant change in the same at baseline and post-intervention (P = 0 15). CONCLUSION: Pharmacist counselling improved medication adherence, glycaemic control and patients' knowledge. Thus, it can effectively be used for improving the outpatient management of diabetes in Sri Lanka.Item Evaluating temporal patterns of snakebite in Sri Lanka: The potential for higher snakebite burdens with climate change(Sri Lanka Medical Association, 2018) Ediriweera, D.S.; Diggle, P.J.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Jayamanne, S.F.; Isbister, J.K.; Dawson, A.; Lalloo, D.G.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: Snakebite is a neglected tropical disease that has been overlooked by healthcare decision makers in many countries. Previous studies have reported seasonal variation in hospital admission rates due to snakebites in endemic countries including Sri Lanka, but seasonal patterns have not been investigated in detail. METHODS: A national community-based survey was conducted during the period of August 2012 to June 2013. The survey used a multistage cluster design, sampled 165,665 individuals living in 44,136 households and recorded all recalled snakebite events that had occurred during the preceding year Log-linear models were fitted to describe the expected number of snakebites occurring in each month taking into account seasonal trends and weather conditions, and addressing the effects of variation in survey effort during the study and due to recall bias amongst survey respondents RESULTS: Snakebite events showed a clear seasonal variation. Typically, snakebite incidence was highest during November to December followed by March to May and August, but this varied between years due to variations in relative humidity, which is also a risk-factor. Low relative humidity levels was associated with high snakebite incidence. If current climate change projections are correct, this could lead to an increase in the annual snakebite of burden of 35,086 (95% CI: 4 202 a€" 69,232) during the next 25 to 50 years. CONCLUSION: Snakebite in Sri Lanka shows seasonal variation Additionally, more snakebites can be expected during periods of lower than expected humidity. Global climate change is likely to increase the incidence of snakebite in Sri Lanka.Item The role of pharmacist counselling in the control of diabetes(Sri Lanka Medical Association, 2017) Mamunuwa, A.M.V.G.N.; Jayamanne, S.F.; Coombes, J.; de Silva, A.; Lynch, C.B.; Wickramasinghe, N.D.D.INTRODUCTION & OBJECTIVES: Diabetes is a global health burden. Data in international literature prove the success of involving pharmacists to achieve glycaemic control. This is the first study in Sri Lanka on the impact of pharmacist counselling among outpatients with diabetes. The objective was to assess the impact of pharmacist counselling on glycaemic control of outpatients with diabetes. METHODS: A total of 400 consecutive patients with diabetes mellitus attending the outpatient diabetes clinics at Base Hospital, Dambadeniya, were randomized into either the intervention group (IG) or the control group (CG). IG received pharmacist counselling (verbal and written) for four consecutive monthly visits in addition to the standard care at the clinic, while the CG received standard care only. Glycaemic control was assessed for both groups with HbA1c measured at the end of the four monthly visits.RESULTS: Mean age of participants was 57.14±10.15 years and 67.5% were females. Non parametric tests were performed as data did not follow the normal distribution. On analysis of HbA1c data, the IG had a median of 7.2% (IQR: 8.2%-6.5%) whereas the CG had a median of 7.7% (IQR: 8.8%-6.9%). The IG patients had statistically lower HbA1c levels compared to the CG patients, according to the Mann-Whitney U test (p<0.05). HbA1c levels <8.00% indicate good/fair glycaemic control. 73.9% of the IG, but only 58% of the CG subjects had levels <8.00%. However, 9.1% of the IG and 10% of the CG had very poor glycaemic control (HbA1c level >10.00%). CONCLUSION: Pharmacist counselling in the outpatient clinics can improve the glycaemic control of patients with diabetes.Item Development of a Snakebite risk map for Sri Lanka(Sri Lanka Medical Association, 2016) Ediriweera, D.S.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Wijayawickrama, B.A.; Jayamanne, S.F.; Isbister, G.K.; Dawson, A.; Giorgi, E.; Diggle, P.J.; Lalloo, D.G.; de Silva, H.J.INTRODUCTION: Snakebite is a public health problem in Sri Lanka and about 37,000 patients are treated in government hospitals annually. At present, health care resources which are required to manage snakebite are distributed based on the administrative boundaries, rather than based on scientific risk assessment. OBJECTIVES: The aim of the study is to develop a snakebite risk map for Sri Lanka. METHOD: Epidemiological data was obtained from a community-based island-wide survey. The sample was distributed equally among the nine provinces. 165,665 participants (0.8%of the country’s population) living in 1118 Grama Niladhari divisions were surveyed. Generalized linear and generalized additive models were used for exploratory data analysis. Model-based geostatistics was used to determine the geographical distribution of snakebites. Monte Carlo maximum likelihood method was used to obtain parameter estimates and plug-in spatial predictions were obtained. Probability contour maps (PCM) were developed to demonstrate the spatial variation in the probability that local incidence does or does not exceed national snakebite incidence. RESULTS: Individual point estimate snakebite incidence map and PCM were developed to demonstrate the national incidence of snakebite in Sri Lanka. Snakebite hotspots and cold spots were identified in relation to the national snakebite incidence rate. Risk maps showed a within-country spatial variation in snakebites. CONCLUSIONS: The developed risk maps provide useful information for healthcare decision makers to allocate resources to manage snakebite in Sri Lanka.Item Patterns of acute poisoning with pesticides in the paediatric age group(Springer, 2017) Dayasiri, K.C.; Jayamanne, S.F.; Jayasinghe, C.Y.BACKGROUND: Pesticides are identified as one of the dangerous poisons globally in children and are associated with increased short- and long-term morbidity. Pesticide poisoning is the most common method of self-poisoning among adults in rural Sri Lanka, and the clinical management is associated with significant healthcare costs to the country. There is however little data published on acute pesticide poisoning among children in rural Sri Lanka. The current study aimed to comprehensively evaluate clinical profiles, harmful first aid measures, emergency clinical management, complications and outcomes related to acute pesticide poisoning among children in the rural community of Sri Lanka. METHODS: This multicenter study was conducted in the North Central Province of Sri Lanka involving all children with acute pesticide poisoning and who were between 9 months and 12 years of age. Data were collected over 7 years (2007-2014), and children from 36 hospitals were recruited. Data collection was carried out by pretested, multi-structured, interviewer-administered questionnaires to identify clinical profiles of children, harmful first aid measures, emergency clinical management, reasons for delayed management, complications and outcomes of pesticide poisoning events. RESULTS: Among 1621 children with acute poisoning, 9.5% (155) comprised children with acute pesticide poisoning. Male children outnumbered female children, and the majority of children were less than 5 years. Most common pesticides implicated in poisoning of children were organophosphates and carbamates. Gastrointestinal and neurological symptoms were predominant clinical features. Limited transport and lack of concern regarding urgency among caregivers were leading reasons for delayed management. Most common location for poisoning was cultivation lands. Harmful first aid measures were practiced in 32.4%. 7.1% had intentional pesticide poisoning. The case fatality rate of all pesticide poisonings in the study was 1.9%. 58.1% of patients were transferred between regional hospitals and teaching hospital. Cardiac and respiratory arrests, aspiration pneumonia and convulsions were among the reported complications. CONCLUSIONS: Acute pesticide poisoning in paediatric age group (<12 years) is a relatively uncommon yet significant cause of child health-related morbidity and mortality in rural Sri Lanka. Patterns of poisoning represent the pattern of pesticide use by the rural community. The practice of harmful first aid measures by caregivers and delay in attending the emergency department may negatively impact patient outcomes.Item Clinical management of agrochemical poisoning – promising outcome with evidence based practice(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Jayamanne, S.F.Pesticide self-poisoning is an important clinical problem in rural regions of the developing world, and kills an estimated 200 000 people every year. It is a major problem in countries like ours where highly toxic organophosphate pesticides and paraquat are available. Medical management is difficult, with case fatality more than 15%. In the early part of this century, little clinical research and evidence existed with which to determine best therapy. Research conducted in Sri Lanka over the last fifteen years has changed the overall management and outcomes. Our main concern is still organophosphates and carbamates. We still do not know how the core treatments—atropine, oximes, should best be given. However, consensus suggests that early resuscitation with atropine, oxygen, respiratory support, and fluids, improve oxygen delivery to tissues, and therefore the final outcome. The role of oximes is not completely clear. Small studies suggest benefit from new treatments such as clonidine, but much larger trials are needed. Gastric lavage could have a role but should only be undertaken once the patient is stable. Some pesticides might prove very difficult to treat with current therapies, such that bans on particular pesticides could be the only method to substantially reduce the case fatality and we have successfully achieved this.Item Community incidence of snakebite in the Amiradhapura district(Sri Lanka Medical Association, 2013) Kasturiratne, A.; Gunawardena, N.K.; Wijayawickrama, B.A.; Jayamanne, S.F.; Pathmeswaran, A.; Isbister, G.; Dawson, A.; de Silva, H.J.INTRODUCTION AND OBJECTIVES: The community incidence of snakebite in Sri Lanka is unknown. To investigate incidence of snakebite, we undertook a community study in the Anuradhapura district as part of an ongoing countrywide survey on snakebite. METHODS: The survey was designed to sample at least 1% of the population in each district Within the district, a Grama Niladhari (GN) division, was defined as a cluster for data collection. The number of clusters required to sample at least 1 % of the population was first determined, and clusters were then selected using simple random sampling. In each selected cluster 40 households were sampled consecutively from a random starting point. Population estimates of snakebite were constructed for the district. RESULTS: The Anuradhapura district has a total of 694 GN divisions, and 84 were surveyed. This included 3357 households and a population of 13,428 (1.6% of the district's population). Eightysix snakebites were reported within the last 12 months. Extrapolating this to the district (mid-year population=855,373), the estimated snakebites in Anuradhapura district was 5478. The crude community incidence of snakebite in the Anuradhapura district was 640.5 per 100, 000 population. CONCLUSIONS: The incidence of snakebite in the community is high in the Anuradhapura district, with one in 156 persons bitten annually.Item Acute poisoning in the paediatric age group in North-Central province of Sri Lanka(Sri Lanka Medical Association, 2013) Dayasiri, M.B.K.C.; Jayamanne, S.F.; Jayasinghe, Y.C.INTRODUCTION AND OBJECTIVES: There is little data on poisoning in the paediatric age group in the North Central Province (NCP) of Sri Lanka. Objective of this study was to identify characteristics, risk factors and outcome of poisoning in the paediatric age group in the NCP. METHODS: All children presenting with either accidental or deliberate poisoning, to all paediatric casualty units at the Anuradhapura and Polonnaruwa Teaching Hospitals, over a period of 8 months from March 2012 were studied. Information was obtained from clinical interviews, focus group discussions, clinical observation and clinical records. RESULTS: Of the 167 children, 53% were male and 91% were below six years of age. Parents were agricultural workers in 25% and 51% had been educated up to GCE O' Level. Poisoning was mainly accidental (97%). Commonest poison was kerosene oil (24.9%). Reasons for delay in seeking medical help included lack of transport (14%), poor knowledge (12%), lack of awareness regarding urgency (12%) and financial constraints (8%). Complications included acute liver injury (4.2%), chemical pneumonitis (3.6%), and convulsions (1.8%). There were no deaths. Inadequate supervision by parents 87.5%, improper storage of household chemicals 52% and medicines 40% were common risk factors. CONCLUSIONS: Acute poisoning in children mostly occurred due to inadequate supervision by parents and improper storage of chemicals and medicines. Community education and safe storage of chemicals and medicines will reduce the incidence of poisoning in the paediatric age group.Item A case series of duplication errors due to brand name confusion - experience from a Sri Lankan teaching hospital(Sri lanka Medical Association, 2015) Mamunuwa, A.M.V.G.N.; Jayamanne, S.F.; Coombes, J.; Lynch, C.B.; Perera, D.M.P.; Pathiraja, V.M.; Shanika, L.G.T.; Mohamed, F.; Dawson, A.H.INTRODUCTION AND OBJECTIVES: Confusion with drug names has been identified as a leading cause of medication errors. The majority of these errors result from look-alike or sound-alike drugs. This case series aims to provide examples of duplication errors due to brand confusion where there are no similarities in the names. METHOD: Information for this case series was extracted from a database prospectively collected from Colombo North Teaching Hospital as part of a study conducted to evaluate the impact of the addition of a clinical pharmacist to the standard inpatient care. RESULTS: Of 800 patients reviewed during the study period of 7 months, clinical pharmacist identified 8 cases of duplication errors due to prescribing both generic and brand names of the same drug, but with no similarities in names. Cases identified include a duplication of frusemide caused by the lack of awareness that 'Amifru' {a combination of frusemide and amiloride) contains frusemide. Similarly, a patient was prescribed 'H. Pylori Kit' plus the three individual drugs included in the 'Kif prescribed using their generic names. A patient was found to be taking two different brands of carbidopa plus levodopa not knowing the two contained the same drugs. CONCLUSION: Brand confusion does not necessarily arise from look-alike or sound-alike drug names. It can be due to numerous brands of generic ingredients and lack of awareness of drug names among the patients. Employing trained clinical pharmacists in the wards, educating patients on discharge drugs and appropriate labeling of medicines may prevent these errors.