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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty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 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.Item Low dose subcutaneous adrenaline to prevent acute adverse reactions to antivenom serum in people bitten by snakes: randomised, placebo controlled trial(British Medical Association, 1999) Premawardhena, A.P.; de Silva, C.E.; Fonseka, M.M.D.; Gunatilake, S.B.; de Silva, H.J.OBJECTIVE: To assess the efficacy and safety of low dose adrenaline injected subcutaneously to prevent acute adverse reactions to polyspecific antivenom serum in patients admitted to hospital after snake bite. DESIGN: Prospective, double blind, randomised, placebo controlled trial. SETTING: District general hospital in Sri Lanka. SUBJECTS: 105 patients with signs of envenomation after snake bite, randomised to receive either adrenaline (cases) or placebo (controls) immediately before infusion of antivenom serum. INTERVENTIONS: Adrenaline 0.25 ml (1:1000). MAIN OUTCOME MEASURES: Development of acute adverse reactions to serum and side effects attributable to adrenaline. RESULTS: 56 patients (cases) received adrenaline and 49 (controls) received placebo as pretreatment. Six (11percent) adrenaline patients and 21 (43 percent) control patients developed acute adverse reactions to antivenom serum (P=0.0002). Significant reductions in acute adverse reactions to serum were also seen in the adrenaline patients for each category of mild, moderate, and severe reactions. There were no significant adverse effects attributable to adrenaline. CONCLUSIONS: Use of 0.25 ml of 1:1000 adrenaline given subcutaneously immediately before administration of antivenom serum to patients with envenomation after snake bite reduces the incidence of acute adverse reactions to serum.Item Excessive fibrinolysis: the coagulopathy following Merrem's hump-nosed viper( Hypnale hypnale) bites(1998) Premawardhena, A.P.; Seneviratne, S.L.; Gunatilake, S.B.; de Silva, H.J.In 56 patients with proven hump-nosed viper (Hypnale hypnale) bites, 12 (21.4 percent) developed continued oozing of blood from the site of the bite and a prolonged clotting time. Further investigations showed low fibrinogen levels and increased fibrinogen degradation products in plamsa. The bleeding time, platelet count, prothrombin time, and partial thromboplastin time with kaolin were normal. The bite of this snake can be complicated with a coagulopathy in which excessive fibrinolysis seems to be the main abnormalityItem Coagulopathy and fibrinoloysis following the bite of a hump-nosed viper (Hypnale hypnale)(Oxford University Press, 1996) Premawardhena, A.P.; Seneviratne, S.L.; Gunatilake, S.B.; de Silva, H.J.No Abstract Available