Medicine

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Author: search.filters.author.de Silva, H.J.Subject: search.filters.subject.Retrospective Studies

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    Snakebite in children: a two year retrospective review of victims admitted to a tertiary care hospital in sri lanka
    (Sri Lanka College of Paediatricians, 2010) Jayasinghe, Y.C.; Kasturiratne, A.; Rajindrajith, S.; Samaraweera, S.A.S.G.; de Silva, H.J.
    INTRODUCTION: Snakebite is an incident which causes great parental concern and medical unease, and envenomation is always more serious in a child. OBJECTIVE: To determine the pattern and characteristics of snake bites in children admitted to a tertiary care hospital in Southwest Sri Lanka. DESIGN, SETTING AND METHOD: A retrospective descriptive study was conducted to collect data on circumstances of the bite, clinical manifestations and management of paediatric victims of snakebite. Patient records of children admitted to the paediatric wards of Colombo North Teaching Hospital, Ragama, from January 2008 to December 2009 were reviewed. RESULTS: Our study population comprised 41 children (1.6 per 1000 admissions). Malerfemale ratio was 23:18. Mean age was 6 (SD=3.46) years. The bites were definite in 4 subjects and circumstantial (fang marks, signs of local and systemic envenomation) in the others. Twenty five (61%) were between 5 to 12 years of age. Nine (22%) bites occurred indoors and 13 (31.7%) in the home garden. In 12 (29.3%) the place of bite was not documented. In 42% the bite took place between 4pm-8pm. The snake species was identified by carers in 19 (46%) and confirmed by a doctor in 16 (39%) by identifying the dead snake. Of the 16 snakes brought for identification., 8 were hump-nosed vipers, 2 were Russell vipers, one was a krait and the rest were non-venomous species. Definite puncture marks were seen in 17 (41.4%) and were on the lower limbs in 11 (26.8%) and on the upper limbs in 6 (14.6%). First aid was given to 12 (29%) of the victims and the median time taken to reach hospital was 30 minutes (range 10 minutes to 15 hours). Nephrotoxicity developed in 1 (2.4%) (Russell viper bite). Antivenom was required by only 4 children in whom Russell viper bite was either suspected or confirmed. Three children developed reactions to antivenom. There were no deaths. None required intensive care. The median stay in hospital was 1 day (range 1-5 days) with 35 (94.6%) children being discharged home within 2 days. CONCLUSIONS: Snakebite in children was mainly diagnosed on circumstantial evidence, and mostly occurred in and around their homes. The outcome was good in all patients probably because the hump-nosed viper or non-venomous snakes were the offenders in most cases in this study.
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    Snakebites in children - a five year retrospective review of victims admitted to two hospitals in Sri Lanka
    (Sri Lanka Medical Association, 2012) Jayasinghe, Y.C.; Kasturiratne, A.; Somaraweera, S.A.S.G.; de Silva, H.J.
    INTRODUCTION: Snakebite in children causes great parental concern and medical unease. AIMS: To determine characteristics of paediatric snakebite in two hospitals, in the wet zone (Colombo North Teaching Hospital (CNTH) and dry zone (Base Hospital Polonnaruwa-BHP). METHODS: A retrospective study collected data on snakebite by reviewing records of children admitted to CNTH and BHP from January 2007 to December 2011. RESULTS: There were 188 snakebite victims (CNTH 71, BHP 117).Similarities in the two cohorts were (CNTH and BHP -M:F=35:36and 64:53; mean age 6 years (SD3) and 7 years (SD3); definite bites 30(53.6%) and 39(37.5%); circumstantial evidence in 57(80.3%) and 84(71.8%);time of bite: between 4- 8pm 42.6% and 47.2%. Majority of confirmed bites were HNV (60%) in CNTH and Kraits (30.8%) in BHP. Differences in the cohorts were :place of bite: in and around the home, median time from bite to hospital, administration of first aid, antivenom use, intensive care, median (range) duration of hospitalization and deaths (CNTH vs BHP): 37(56.9%) and 29(27.6%),35 vs 102.5 minutes, 21.4% vs 1%, 5.6% vs 17.1%, 1.4% vs 5.1%, 1 (1-7) days vs 2 (1-13), 0 vs 3.4% (Krait bites). CONCLUSIONS: Snakebites occur in ambulatory children, diagnosed mainly on circumstantial evidence and occur in and around homes irrespective of geographic location. Clinical features and outcome depend on offending species and availability of resources.
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    Concomitant leptospirosis-hantavirus co-infection in acute patients hospitalized in Sri Lanka: implications for a potentially worldwide underestimated problem
    (Cambridge University Press, 2015) Sunil-Chandra, N.P.; Clement, J.; Maes, P.; de Silva, H.J.; Van Esbroeck, M.; Van Ranst, M.
    Two global (re-)emerging zoonoses, leptospirosis and hantavirus infections, are clinically indistinguishable. Thirty-one patients, hospitalized in Sri Lanka for acute severe leptospirosis, were after exclusion of other potentially involved pathogens, prospectively screened with IgM ELISA for both pathogens. Of these, nine (29·0%) were positive for leptospirosis only, one (3·2%) for hantavirus only, seven (22·5%) for both pathogens concomitantly, whereas 13 (41·9%) remained negative for both. Moreover, in a retrospective study of 23 former patients, serologically confirmed for past leptospirosis, six (26·0%) were also positive in two different IgG ELISA hantavirus formats. Surprisingly, European Puumala hantavirus (PUUV) results were constantly higher, although statistically not significantly different, than Asian Hantaan virus (HTNV), suggesting an unexplained cross-reaction, since PUUV is considered absent throughout Asia. Moreover, RT-PCR on all hantavirus IgM ELISA positives was negative. Concomitant leptospirosis-hantavirus infections are probably heavily underestimated worldwide, compromising epidemiological data, therapeutical decisions, and clinical outcome.
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    Prevalence of inflammatory bowel disease in two districts of Sri Lanka: a hospital based survey
    (BioMed Central, 2010) Niriella, M.A.; de Silva, A.P.; Dayaratne, A.H.G.K.; Ariyasinghe, M.H.A.D.P.; Navarathne, M.M.N.; Peiris, R.S.K.; Samarasekara, D.; Satarasinghe, R.L.; Rajindrajith, S.; Dassanayake, A.S.; Wickremasinghe, A.R.; de Silva, H.J.
    BACKGROUND: Inflammatory bowel disease (IBD) is being increasingly diagnosed in Asia. However there are few epidemiological data from the region. METHODS: To determine prevalence and clinical characteristics of IBD, a hospital-based survey was performed in the Colombo and Gampaha districts (combined population 4.5 million) in Sri Lanka. Patients with established ulcerative colitis (UC) and Crohn's disease (CD), who were permanent residents of these adjoining districts, were recruited from hospital registries and out-patient clinics. Clinical information was obtained from medical records and patient interviews. RESULTS: There were 295 cases of IBD (UC = 240, CD = 55), of which 34 (UC = 30, CD = 4) were newly diagnosed during the study year. The prevalence rate for UC was 5.3/100,000 (95% CI 5.0-5.6/100,000), and CD was 1.2/100,000 (95% CI 1.0-1.4/100,000). The incidence rates were 0.69/100,000 (95% CI 0.44-0.94/100,000) for UC and 0.09/100,000 (95% CI 0.002-0.18/100,000) for CD. Female:male ratios were 1.5 for UC and 1.0 for CD. Mean age at diagnosis was (males and females) 36.6 and 38.1y for UC and 33.4 and 36.2y for CD. Among UC patients, 51.1% had proctitis and at presentation 58.4% had mild disease. 80% of CD patients had only large bowel involvement. Few patients had undergone surgery. CONCLUSIONS: The prevalence of IBD in this population was low compared to Western populations, but similar to some in Asia. There was a female preponderance for UC. UC was mainly mild, distal or left-sided, while CD mainly involved the large bowel.
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    Yellow oleander poisoning in Sri Lanka: outcome in a secondary care hospital
    (SAGE Publishing, 2002) Fonseka, M.M.D.; Seneviratne, S.L.; de Silva, C.E.; Gunatilake, S.B.; de Silva, H.J.
    Cardiac toxicity after self-poisoning from ingestion of yellow oleander seeds is common in Sri Lanka. We studied all patients with yellow oleanderpoisoning (YOP) admitted to a secondary care hospital in north central Sri Lanka from May to August 1999, with the objective of determining theoutcome of management using currently available treatment. Patients with bradyarrhythmias were treated with intravenous boluses of atropine and intravenous infusions of isoprenaline. Temporary cardiac pacing was done for those not responding to drug therapy. During the study period 168 patients with YOP were admitted to the hospital (male:female = 55:113). There were six deaths (2.4%), four had third-degree heart block and two died of undetermined causes. They died soon after delayed admission to the hospital before any definitive treatment could be instituted. Of the remaining 162 patients, 90 (55.6%) patients required treatment, and 80 were treated with only atropine and/or isoprenaline while 10 required cardiac pacing in addition. Twenty-five (14.8%) patients had arrhythmias that were considered life threatening (second-degree heart block type II, third-degree heart block and nodal bradycardia). All patients who were treated made a complete recovery. Only a small proportion of patients (17%) admitted with YOP developed life-threatening cardiac arrhythmias. Treatment with atropine and isoprenaline was safe and adequate in most cases
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    Suicide in Sri Lanka: Points to ponder
    (Sri Lanka Medical Association, 2000) de Silva, H.J.; Kasturiaratchi, N.; Seneviratne, S.L.; Senaratne, D.C.; Molagoda, A.; Ellawala, N.S.
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    Viral hepatitis complicating pregnancy--a five year hospital based retrospective study
    (Sri Lanka Medical Association, 1993) de Silva, H.J.; Jayawardena, J.; Pethiyagoda, A.U.; Pethiyagoda, C.J.B.; Sirisena, J.L.
    Limited data are available on viral hepatitis (VH) complicating pregnancy from Sri Lanka. We retrospectively studied all pregnant and non-pregnant women of child bearing age, who were admitted with VH to the Teaching Hospital Peradeniya between January 1987 and December 1991. During this period, there were 187 cases of icteric VH among non-pregnant women of child bearing age, but only 10 cases among pregnant women (hospital incidence of 0.35 cases of VH per 1000 pregnancy related admissions). Two of the 10 (case fatality 20%) pregnant women died of causes related to VH compared with only 3 of the 187 (1.6%) non-pregnant women (p < 0.001), giving a relative risk of death due to VH in pregnant women of 12.5 (95% confidence limits 1.8-85.6). The perinatal case fatality rate due to VH was 20%. VH complicating pregnancy does not appear to be a common cause of hospital admission, but pregnancy makes death due to VH more likely. VH complicating pregnancy also results in a high perinatal mortality
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