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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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 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 Patterns and risk factors of acute poisoning among children in rural Sri Lanka(Sri Lanka Medical Association, 2014) Dayasiri, M.B.K.C.; Jayamanne, S.F.; Jayasinghe, Y.C.INTRODUCTION AND OBJECTIVES: This controlled prospective study identifies the patterns and risk factors of acute poisoning in the paediatric age group in rural Sri Lanka. METHODS: All children presenting with a history of acute poisoning to the paediatric units of Anuradhapura Teaching .Hospital were included. Age and gender matched controls without any identifiable chronic medical conditions were recruited from the same population over the same duration. Data were collected using clinicai interviews, focused group discussions, and Bed Head Ticket based records over a period of eighteen months from March 2012 to September 2013. RESULTS: Analysis was based on 307 children with acute poisoning and 250 controls. Sixty percent of children with acute poisoning were males and most were between 2-4 years (49%). Odds ratios were calculated for each of the 24 risk factors proposed and each was used to create a logistic regression model together with age and gender. Application of Chi Square test in this model revealed inadequate supervision by the parents as the commonest risk factor (p< 0.001, Cl=95%) associated with acute poisoning. Other risk factors which showed a significant association (p< 0.001, Cl=95%) included unsafe storage of household chemicals, unsafe storage of medicines, poor extended family support, presence of poisonous plants in the neighborhood and poor maternal education. CONCLUSIONS: Children become victims of acute poisoning mostly secondary to inadequate supervision, unsafe environment and unsafe storage of poisons. As these risk factors are significantly associated with poisoning, community education, safe storage and assurance of safe environment should be evaluated.