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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 Spatiotemporal distribution of cutaneous leishmaniasis in Sri Lanka and future case burden estimates(Public Library of Science, 2021) Karunaweera, N.D.; Senanayake, S.; Ginige, S.; Silva, H.; Manamperi, N.; Samaranayake, N.; Dewasurendra, R.; Karunanayake, P.; Gamage, D.; de Silva, N.; Senarath, U.; Zhou, G.BACKGROUND: Leishmaniasis is a neglected tropical vector-borne disease, which is on the rise in Sri Lanka. Spatiotemporal and risk factor analyses are useful for understanding transmission dynamics, spatial clustering and predicting future disease distribution and trends to facilitate effective infection control. METHODS: The nationwide clinically confirmed cutaneous leishmaniasis and climatic data were collected from 2001 to 2019. Hierarchical clustering and spatiotemporal cross-correlation analysis were used to measure the region-wide and local (between neighboring districts) synchrony of transmission. A mixed spatiotemporal regression-autoregression model was built to study the effects of climatic, neighboring-district dispersal, and infection carryover variables on leishmaniasis dynamics and spatial distribution. Same model without climatic variables was used to predict the future distribution and trends of leishmaniasis cases in Sri Lanka. RESULTS: A total of 19,361 clinically confirmed leishmaniasis cases have been reported in Sri Lanka from 2001-2019. There were three phases identified: low-transmission phase (2001-2010), parasite population buildup phase (2011-2017), and outbreak phase (2018-2019). Spatially, the districts were divided into three groups based on similarity in temporal dynamics. The global mean correlation among district incidence dynamics was 0.30 (95% CI 0.25-0.35), and the localized mean correlation between neighboring districts was 0.58 (95% CI 0.42-0.73). Risk analysis for the seven districts with the highest incidence rates indicated that precipitation, neighboring-district effect, and infection carryover effect exhibited significant correlation with district-level incidence dynamics. Model-predicted incidence dynamics and case distribution matched well with observed results, except for the outbreak in 2018. The model-predicted 2020 case number is about 5,400 cases, with intensified transmission and expansion of high-transmission area. The predicted case number will be 9115 in 2022 and 19212 in 2025. CONCLUSIONS: The drastic upsurge in leishmaniasis cases in Sri Lanka in the last few year was unprecedented and it was strongly linked to precipitation, high burden of localized infections and inter-district dispersal. Targeted interventions are urgently needed to arrest an uncontrollable disease spread.Item Safety of low dose subcutaneous adrenaline used as prophylaxis against acute reactions to anti-venom serum (AVS) in patients bitten by snakes(Sri Lanka Medical Association, 2002) Dassanayake, A.S.; Karunanayake, P.; Kasturiratne, K.T.A.A.; Fonseka, M.M.D.; Wijesiriwardena, B.; Gunatilake, S.B.; de Silva, H.J.INTRODUCTION: Low dose subcutaneous adrenaline significantly reduces acute adverse reactions to AVS in patients envenomed following snake bite. OBJECTIVES: To further study the safety of low dose subcutaneous adrenaline. METHODS: We prospectively studied patients with snake bite envenoming in two units of the Colombo North Teaching Hospital, Ragama, from April 2000 to October 2001. Patients who satisfied inclusion criteria were given 0.25ml 1:1000 adrenaline subcutaneously immediately before administration of AVS. They were observed for adverse effects, and pulse and blood pressure (BP) were recorded before and at frequent intervals for one hour after giving adrenaline. In patients who developed reactions to AVS, subsequent pulse and BP measurements were not included for analysis. Results: 51 patients [M:F=35:16; mean age 34.8yrs (SD 14)] were included in the study. No significant changes in mean pulse rate or BP were observed following administration of subcutaneous adrenaline. Adverse reactions to AVS occurred in 15 (29.4%) patients. There were 4 (7.8%) other complications: one (2%) death due to suspected intracerebral haemorr-hage in a 65yr old man who also had coagulopathy, and developed an adverse reaction to AVS which required treatment with adrenaline; 3 (5.9%) patients, who also had coagulopathy, developed small haematomas at the subcutaneous injection site. CONCLUSIONS: Low dose subcutaneous adrenaline did not cause significant changes in pulse rate or BP. The 3 small haematomas could be directly attributed to the injection. Although the death is unlikely to be directly related to subcutaneous adrenaline, we suggest further studies on the safety of this prophylactic treatment before recommending its routine use.Item Safety of subcutaneous adrenaline as prophylaxis against acute adverse reactions to anti-venom serum in snakebite(Sri Lanka Medical Association, 2002) Dassanayake, A.S.; Karunanayake, P.; Kasturiratne, K.T.A.A.; Fonseka, M.M.D.; Wijesiriwardena, B.; Gunatilake, S.B.; de Silva, H.J.OBJECTIVES: To study the safety of low dose subcutaneous adrenaline given as prophylaxis against acute adverse reactions to anti-venom serum(AVS) in patients bitten by snakes. METHODS: Patients admitted with snakebite envenoming who satisfied inclusion criteria were given 0.25 ml of 1:1000 adrenaline subcutaneously immediately before administration of AVS. They were observed for adverse effects, and pulse and blood pressure (BP) were monitored. RESULTS: 51 patients [35 males, mean age 34.8 years (SD 14)] were included in the study. Adverse reactions to AVS occurred in 15 (29.4%) patients. There was one death from suspected cerebral haemorrhage, and 3 (5.9%) patients developed small haematomas at the subcutaneous injection site. There were no significant changes in mean pulse or BP following administration of subcutaneous adrenaline. CONCLUSIONS: Low dose subcutaneous adrenaline did not cause significant changes in pulse rate or BP. Although the death was unlikely to be directly related to subcutaneous adrenaline, we suggest further studies on the safety of this prophylactic treatment before its routine use.