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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Is hyperkalaemia associated with the development of heart blocks in patients with acute yellow oleander poisoning?(Sri Lanka Medical Association, 2023) Eriyawa, W.M.A.B.W.; Jayamanne, S.F.; Lokunarangoda, N.; Francis, G.R.; andakumari, G.V.N.; Jayawardane, P.INTRODUCTION: Yellow oleander (Thevetia peruviana) contains cardiac glycosides which result in arrhythmias, heart blocks and electrolyte imbalances. OBJECTIVES: The objective of the study was to find whether the development of hyperkalaemia within the first 24 hours of admission predicts the development of heart blocks. METHODS: A prospective cohort study was carried out at Teaching Hospital Batticaloa, Sri Lanka, from 1st July 2022 to 28th February 2023 among patients admitted with acute yellow oleander poisoning. Patients were recruited if any of the following signs were present: bradycardia (<60bpm), systolic blood pressure <80mmHg, nausea, vomiting, abdominal pain, diarrhoea, xanthopsia, within 2 hours of admission. Serum potassium level was assessed at recruitment and 6 hourly, serial electrocardiograms were done at recruitment and 4 hourly, for 24 hours. The association between hyperkalemia (serum potassium >5.5mmol/L) and the development of heart blocks were calculated using the chi-squared test. Ethical Clearance was granted by the Ethics Review Committee of the Faculty of Medical Sciences, University of Sri Jayewardenepura. RESULTS: Among 120 consenting symptomatic patients recruited, 26.67%(n=32) patients developed hyperkalemia while 7.5%(n=9), 10.0%(n=12) and 3.33%(n=4) patients developed 1st, 2nd, and 3rd degree heart blocks respectively. Temporary cardiac pacing (TCP) was done in 9.16%(n=11) patients and 2.5%(n=3) died due to cardiac arrest. Hyperkalemia within 24 hours of admission was associated with the development of heart block (X2(1, N=120)=12.9689, p=0.0003). CONCLUSION: Patients who developed hyperkalemia within 24 hours of admission following acute yellow oleander poisoning should be closely monitored for the development of heart blocks and managed at centres where facilities for TCP are available.Item Should ‘Drug Related Problems’ remain unnoticed among patients with chronic kidney disease of uncertain aetiology?(Sri Lanka Medical Association, 2023) Wickramasinghe, N.D.D.; Lynch, C.B.; Coombes, J.; Jayamanne, S.F.; de Silva, S.T.INTRODUCTION: Chronic kidney disease of uncertain aetiology (CKDu) is a major public health concern in Sri Lanka. CKDu patients often consume 10-12 drugs per day, which can result in drug-related problems (DRPs). However, emerging economies such as Sri Lanka have few safeguards in place to detect and report DRPs. OBJECTIVES: The objective of this study was to introduce clinic-based pharmacy services to detect, address and report DRPs that occurred in CKDu out-patients. METHODS: A randomized controlled clinical trial was conducted in pre-dialysis CKDu stages 4 and 5 patients at outpatient renal clinics in Teaching Hospital, Anuradhapura, Sri Lanka. DRPs were identified in both groups at baseline. The control group received usual clinic care while the intervention group received medication counseling by a clinic-based pharmacist. DRPs were identified in both groups after 12 months. RESULTS: At baseline, there were 123 and 126 patients in the control and intervention groups, respectively. 133 and 147 DRPs were identified from 80 and 79 patients in the control and intervention groups, respectively. The median number of DRPs per patient was 1 (1-2) (p=0.458) for both groups. After 12 months, there were 101 and 98 patients in the control and intervention groups, respectively. 137 and 59 DRPs were identified from 57 and 33 patients in the control and intervention groups, respectively. The median number of DRPs per patient was 2 (1-3) and 1 (1-2) (p=0.029) in control and intervention groups, respectively. CONCLUSION: A “clinic-based pharmacist” counselling is a beneficial additional service for identifying and addressing DRPs occurring in patients with CKDu.Item Changes in biochemical markers of outcomes in haemodialysis patients following a clinical pharmacy intervention.(Ceylon College of Physicians, 2021) Kalpani, A.G.S.; Mohamed, F.; Hough, J.E.; de Silva, D.N.N.; Chandrasena, W.M.H.N.M.; Jayamanne, S.F.Introduction and Objectives Common complications of End-Stage Renal Disease (ESRD) include cardiovascular disease, diabetes, anaemia and mineral and bone disease. Achieving an optimum level of biochemical markers of outcomes is crucial in managing ESRD. This study was conducted to assess the changes in selected biochemical parameters following a clinical pharmacy intervention (CPI) in this population. Method A randomized controlled trial was conducted at outpatient haemodialysis units in North Central Province, Sri Lanka. Serum phosphate, serum calcium, haemoglobin, lipid profile, eGFR and 'adequacy of dialysis* (AoD) (determined by urea reduction ratio (URR); calculated based on pre-post blood urea nitrogen measurements and Kt/V measurements) were measured in patients at baseline (BL) and after one year (PI). The Intervention Group (IG), n=143 patients received comprehensive pharmaceutical care by the clinical pharmacist on four consecutive occasions at recruitment, and 2, 6 and 10 months after recruitment. While the Control Group (CG), n=140, received standard care. Results At the baseline, there was no significant difference in the biochemical markers of outcomes between the two groups and AoD was within the acceptable range. However, there was a significant improvement in the mean serum phosphate levels (IG 4.04±1.19 vs CG 5.00±1.67, p<0.0001), mean serum calcium levels (IG 8.90±1.35 vs CG 7.11±2.07, p<0.0001), and mean haemoglobin levels (IG 10.5±1.25 vs CG 9.4±1.87, p<0.0001) in the IG compared to the CG at the end of one year. However, eGFR, lipid profiles did not change significantly (p>0.05). AoD was within the acceptable range in both groups at baseline and post intervention and did not change significantly (p>0.05) Conclusions Improvement in the selected biochemical markers of outcomes resulting from CPI suggests better patient management outcomes in the ESRD population.Item Opportunities for optimization of drug therapy and characterization of drug-related problems in ckd/ckdu patients undergoing hemodialysis in Sri Lanka(Ceylon College of Physicians, 2021) Kalpani, A.G.S.; Mohamed, F.; Hough, J.E.; de Silva, D.N.N.; Jayamanne, S.F.Introduction and objectives Drug-related problems (DRPs) in ESRD patients undergoing haemodialysis have not been investigated in Sri Lanka. The present study was conducted to identify and characterize the potential drug-related problems and identify opportunities to optimize drug therapy in ESRD patients undergoing haemodialysis. Method As part of RCT at ambulatory hemodialysis (HD) units of Teaching Hospital Anuradhapura (THA) and District General Hospital (DGH) Polonnaruwa, randomly selected ESRD patients undergoing hemodialysis were recruited for the study. DRPs were identified by reviewing the clinic drug charts, patient clinic records and structured interviews with patients or caregivers to identify the patients* actual drug-taking behaviour. Identified DRPs were categorized using a PCNE classification system V.08. Results A total of 1350 drug related problems were identified in 283 ambulatory HD patients during the study period. Patients were taking an average of 10.64 drugs and had 4.77 DRPs. Unnecessary drug treatment (30.3%), effect of the drug treatment not optimal (29.9%) followed by untreated symptom or indication (24.5%) were the most prevalent DRP categories according to the PCNE classification system. The major cause for the identified DRPs was a prescriber related (50.22%) followed by patient related (30.0%) and dispensing related (16.9%) causes in ESRD patients undergoing HD. Conclusions ESRD patients undergoing HD had a large number of medications which increases the risk of potential DRPs. Significant opportunities exist for pharmacists' input to improve the quality use of medicines by identifying and resolving the DRPs in ESRD patients undergoing haemodialysis in the current Sri Lankan government hospital setting as part of multidisciplinary teamItem Evaluating spatiotemporal dynamics of snakebite in Sri Lanka: Monthly incidence mapping from a national representative survey sample(Public Library of Science, 2021) Ediriweera, D.S.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Jayamanne, S.F.; Murray, K.; Iwamura, T.; Isbister, G.; Dawson, A.; Lalloo, D.G.; de Silva, H.J.; Diggle, P.J.BACKGROUND: Snakebite incidence shows both spatial and temporal variation. However, no study has evaluated spatiotemporal patterns of snakebites across a country or region in detail. We used a nationally representative population sample to evaluate spatiotemporal patterns of snakebite in Sri Lanka. METHODOLOGY: We conducted a community-based cross-sectional survey representing all nine provinces of Sri Lanka. We interviewed 165 665 people (0.8% of the national population), and snakebite events reported by the respondents were recorded. Sri Lanka is an agricultural country; its central, southern and western parts receive rain mainly from Southwest monsoon (May to September) and northern and eastern parts receive rain mainly from Northeast monsoon (November to February). We developed spatiotemporal models using multivariate Poisson process modelling to explain monthly snakebite and envenoming incidences in the country. These models were developed at the provincial level to explain local spatiotemporal patterns. PRINCIPAL FINDINGS: Snakebites and envenomings showed clear spatiotemporal patterns. Snakebite hotspots were found in North-Central, North-West, South-West and Eastern Sri Lanka. They exhibited biannual seasonal patterns except in South-Western inlands, which showed triannual seasonality. Envenoming hotspots were confined to North-Central, East and South-West parts of the country. Hotspots in North-Central regions showed triannual seasonal patterns and South-West regions had annual patterns. Hotspots remained persistent throughout the year in Eastern regions. The overall monthly snakebite and envenoming incidences in Sri Lanka were 39 (95%CI: 38-40) and 19 (95%CI: 13-30) per 100 000, respectively, translating into 110 000 (95%CI: 107 500-112 500) snakebites and 45 000 (95%CI: 32 000-73 000) envenomings in a calendar year. CONCLUSIONS/SIGNIFICANCE: This study provides information on community-based monthly incidence of snakebites and envenomings over the whole country. Thus, it provides useful insights into healthcare decision-making, such as, prioritizing locations to establish specialized centres for snakebite management and allocating resources based on risk assessments which take into account both location and season.Item Opportunities for pharmacists to optimise quality use of medicines in a Sri Lankan hospital: An observational, prospective, cohort study(Wiley-Blackwell, 2017) Perera, D.M.P.; Coombes, J.A.; Shanika, L.G.T.; Dawson, A.; Lynch, C.; Mohamed, F.; Kalupahana, N.; de Silva, H.A.; Jayamanne, S.F.; Peters, N.B.; Myers, B.; Coombes, I.D.BACKGROUND: Quality use of medicines (QUM) has been identified as a priority in Sri Lanka. Aim: To identify opportunities to optimise QUM, and evaluate medication appropriateness and medication information exchanged with patients and carers on discharge in a Sri Lankan tertiary care hospital. METHODS: An observational, prospective, cohort study of patients systematically sampled from two medical wards. A research pharmacist determined their pre-admission medication regimen via interview at time of discharge. Issues of poor adherence and discrepancies between the pre- and post-admission medication regimens were recorded. Drug-related problems were categorised into opportunities to optimise drug therapy. The appropriateness of discharge medications was evaluated using a validated tool. The patient or carer was interviewed after discharge regarding the quality of medicine information exchanged in hospital. RESULTS: The 578 recruited patients were taking 1756 medications prior to admission, and 657 (37.4%) of these medications were not continued during admission. Opportunities to optimise drug therapy were identified on 1496 occasions during admission (median, 2.0 opportunities/patient), 215 opportunities, (14.4%) were resolved spontaneously by the medical team prior to discharge. The median score for appropriateness of medications on discharge was 1.5 per patient (interquartile range, 0.0–3.5). Of 427 patients surveyed after discharge, 52% recalled being asked about their medications on admission to hospital, 75% about previous adverse medication reactions and 39% recalled being informed about changes to their medications on discharge. CONCLUSION: Significant opportunities exist for pharmacists to enhance quality use of medicines for patients in the current hospitalbased healthcare system in Sri Lanka. © 2017 The Society of Hospital Pharmacists of Australia.Item Adjusting for spatial variation when assessing individual-level risk: A case-study in the epidemiology of snake-bite in Sri Lanka(Public Library of Science, 2019) Ediriweera, D.S.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Jayamanne, S.F.; Murray, K.; Iwamura, T.; Lalloo, D.G.; de Silva, H.J.; Diggle, P.J.BACKGROUND:Health outcomes and causality are usually assessed with individual level sociodemographic variables. Studies that consider only individual-level variables can suffer from residual confounding. This can result in individual variables that are unrelated to risk behaving as proxies for uncaptured information. There is a scarcity of literature on risk factors for snakebite. In this study, we evaluate the individual-level risk factors of snakebite in Sri Lanka and highlight the impact of spatial confounding on determining the individual-level risk effects.METHODS:Data was obtained from the National Snakebite Survey of Sri Lanka. This was an Island-wide community-based survey. The survey sampled 165,665 individuals from all 25 districts of the country. We used generalized linear models to identify individual-level factors that contribute to an individual's risk of experiencing a snakebite event. We fitted separate models to assess risk factors with and without considering spatial variation in snakebite incidence in the country.RESULTS:Both spatially adjusted and non-adjusted models revealed that middle-aged people, males, field workers and individuals with low level of education have high risk of snakebites. The model without spatial adjustment showed an interaction between ethnicity and income levels. When the model included a spatial adjustment for the overall snakebite incidence, this interaction disappeared and income level appeared as an independent risk factor. Both models showed similar effect sizes for gender and age. HEmployment and education showed lower effect sizes in the spatially adjusted model.CONCLUSIONS:Both individual-level characteristics and local snakebite incidence are important to determine snakebite risk at a given location. Individual level variables could act as proxies for underling residual spatial variation when environmental information is not considered. This can lead to misinterpretation of risk factors and biased estimates of effect sizes. Both individual-level and environmental variables are important in assessing causality in epidemiological studies.Item Patterns and outcome of acute poisoning among children in rural Sri Lanka(BioMed Central, 2018) Dayasiri, M.B.K.C.; Jayamanne, S.F.; Jayasinghe, C.Y.BACKGROUND: The burden of poisoning among children is largely underexplored in rural Sri Lanka. This 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: This hospital based multi-center study included Anuradhapura Teaching hospital, Polonnaruwa District General hospital, and 34 regional hospitals within Regional Director of Health Services in North Central province of Sri Lanka. The study assessed clinical profiles, poison related factors, clinical management, complications, harmful first aid practices, reasons for delayed management, complications and outcomes following acute poisoning over 7 years. RESULTS: Among 1621 children with acute poisoning, the majority were in preschool age group. Household chemicals were accountable for 489 acute poisonings (30.2%). The most common poison was kerosene oil, followed by paracetamol. Most events occurred within their own domestic premises. Potentially harmful first aid measures were practiced by approximately one third of care givers. Reasons for delayed presentation at emergency center included 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 the most common complication was chemical pneumonitis. CONCLUSIONS: Children with acute poisoing in rural Sri Lanka were predominantly preschoolers. They are poisonined mostly within their own housing premises. Kerosene oil, in addition to being the most common poison, had additional risks of aspiration pneumonia following potentially hazadrous first aid measures practised by the care givers. Complications though rare were potentially preventable by community education and awareness on timely attention to seek medical care, and avoidance of harmful first aid practices. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12887-018-1246-0) contains supplementary material, which is available to authorized users.Item Kerosene Oil Poisoning among Children in Rural Sri Lanka(Hindawi Pub. Corp., 2017) Dayasiri, M.B.K.C.; Jayamanne, S.F.; Jayasinghe, C.Y.INTRODUCTION: Kerosene oil poisoning is one of common presentations to emergency departments among children in rural territories of developing countries. This study aimed to describe clinical manifestations, reasons for delayed presentations, harmful first aid practices, complications, and risk factors related to kerosene oil poisoning among children in rural Sri Lanka. METHODS: This multicenter study was conducted in North-Central province of Sri Lanka involving all in-patient children with acute kerosene oil poisoning. Data were collected over seven years from thirty-six hospitals in the province. Data collection was done by pretested, multistructured questionnaires and a qualitative study. RESULTS: Male children accounted for 189 (60.4%) while 283 (93%) children were below five years. The majority of parents belonged to farming community. Most children ingested kerosene oil in home kitchen. Mortality rate was 0.3%. Lack of transport facilities and financial resources were common reasons for delayed management. Hospital transfer rate was 65.5%. Thirty percent of caregivers practiced harmful first aid measures. Commonest complication was chemical pneumonitis. Strongest risk factors for kerosene oil poisoning were unsafe storage, inadequate supervision, and inadequate house space. CONCLUSIONS: Effect of safe storage and community education in reducing the burden of kerosene oil poisoning should be evaluated. Since many risk factors interact to bring about the event of poisoning in a child, holistic approaches to community education in rural settings are recommended.Item Health seeking behavior following snakebites in Sri Lanka: Results of an island wide community based survey(Public Library of Science, 2017) Ediriweera, D.S.; Kasturiratne, A.; Pathmeswaran, A.; Gunawardena, N.K.; Jayamanne, S.F.; Lalloo, D.G.; de Silva, H.J.INTRODUCTION: Sri Lanka has a population of 21 million and about 80,000 snakebites occur annually. However, there are limited data on health seeking behavior following bites. We investigated the effects of snakebite and envenoming on health seeking behavior in Sri Lanka. METHODS: In a community-based island-wide survey conducted in Sri Lanka 44,136 households were sampled using a multistage cluster sampling method. An individual who reported experiencing a snakebite within the preceding 12 months was considered a case. An interviewer-administered questionnaire was used to obtain details of the bite and health seeking behavior among cases. RESULTS: Among 165,665 individuals surveyed, there were 695 snakebite victims. 682 (98.1%) had sought health care after the bite; 381 (54.8%) sought allopathic treatment and 301 (43.3%) sought traditional treatment. 323 (46.5%) had evidence of probable envenoming, among them 227 (70.3%) sought allopathic treatment, 94 (29.1%) sought traditional treatment and 2 did not seek treatment. There was wide geographic variation in the proportion of seeking allopathic treatment from <20% in the Western province to > 90% in the Northern province. Multiple logistic regression analysis showed that seeking allopathic treatment was independently associated with being systemically envenomed (Odds Ratio = 1.99, 95% CI: 1.36-2.90, P < 0.001), distance to the healthcare facility (OR = 1.13 per kilometer, 95% CI: 1.09 to 1.17, P < 0.001), time duration from the bite (OR = 0.49 per day, 95% CI: 0.29-0.74, P = 0.002), and the local incidence of envenoming (OR = 1.31 for each 50 per 100,000, 95% CI: 1.19-1.46, P < 0.001) and snakebite (OR = 0.90 for each 50 per 100,000, 95% CI: 0.85-0.94, P < 0.001) in the relevant geographic area. CONCLUSIONS: In Sri Lanka, both allopathic and traditional treatments are sought following snakebite. The presence of probable envenoming was a major contribution to seeking allopathic treatment.