Early management after self-poisoning with an organophosphorus or carbamate pesticide - a treatment protocol for junior doctors.
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Severe organophosphorus or carbamate pesticide poisoning is an important clinical problem in many countries of the world. Unfortunately, little clinical research has been performed and little evidence exists with which to determine best therapy. A cohort study of acute pesticide poisoned patients was established in Sri Lanka during 2002; so far, more than 2000 pesticide poisoned patients have been treated. A protocol for the early management of severely ill, unconscious organophosphorus/carbamate-poisoned patients was developed for use by newly qualified doctors. It concentrates on the early stabilisation of patients and the individualised administration of atropine. We present it here as a guide for junior doctors in rural parts of the developing world who see the majority of such patients and as a working model around which to base research to improve patient outcome. Improved management of pesticide poisoning will result in a reduced number of suicides globally. (+info)
Changing patterns of mitral stenosis in childhood and pregnancy in Sri Lanka.
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The findings in rheumatic mitral stenosis appear to have undergone changes, probably in association with improved socioeconomic conditions, in developing countries. The objective of this study was to assess such changes and to adapt strategies of management. The clinical and pathologic features, mortality rate, long-term functional class and restenosis rate in 168 children and 62 pregnant women who underwent closed transventricular mitral valvotomy in the first 14-year period (June 1964 to May 1978) were compared and correlated with those of 140 children and 106 pregnant women in the following 7-year period (June 1978 to May 1985). During the late period, there were attenuated severity of the disease, emergence of a mild pathologic type of valve involvement confined to the commissures (commissural band stenosis), decreased mortality (1.2%) and restenosis rates (p less than 0.001) and increased long-term improvement (p less than 0.001) during childhood. The best results of closed valvotomy were obtained in simple commissural and commissural band stenosis, the latter forming the predominant group in children and pregnant women in the late period (p less than 0.001). Poor results were observed in patients with the subtype of combined stenosis characterized by commissural rigidity, cuspal stenosis and chordal fusion, demonstrating the inapplicability of closed valvotomy. Closed valvotomy is safe in all stages of pregnancy, as evidenced by the zero mortality rate and rate (1.8%) of fetal death, and offers good long-term palliation. However, in pregnant women with pure mitral stenosis characterized by simple commissural or commissural band stenosis, balloon valvuloplasty is an acceptable alternative, especially in light of the risks associated with surgery. The choice of the procedure for the relief of stenosis is determined by the pathologic anatomy of the valve stenosis. (+info)
Maps of the Sri Lanka malaria situation preceding the tsunami and key aspects to be considered in the emergency phase and beyond.
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BACKGROUND: Following the tsunami, a detailed overview of the area specific transmission levels is essential in assessing the risk of malaria in Sri Lanka. Recent information on vector insecticide resistance, parasite drug resistance, and insights into the national policy for malaria diagnosis and treatment are important in assisting national and international agencies in their control efforts. METHODS: Monthly records over the period January 1995-October 2004 of confirmed malaria cases were used to perform an analysis of malaria distribution at district spatial resolution. Also, a focused review of published reports and routinely collected information was performed. RESULTS: The incidence of malaria was only 1 case per thousand population in the 10 months leading up to the disaster, in the districts with the highest transmission. CONCLUSION: Although relocated people may be more exposed to mosquito bites, and their capacity to handle diseases affected, the environmental changes caused by the tsunami are unlikely to enhance breeding of the principal vector, and, given the present low parasite reservoir, the likelihood of a malaria outbreak is low. However, close monitoring of the situation is necessary, especially as December-February is normally the peak transmission season. Despite some losses, the Sri Lanka public health system is capable of dealing with the possible threat of a malaria outbreak after the tsunami. The influx of foreign medical assistance, drugs, and insecticides may interfere with malaria surveillance, and the long term malaria control strategy of Sri Lanka, if not in accordance with government policy. (+info)
Awareness of oral cancer and precancer among patients attending a hospital in Sri Lanka.
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OBJECTIVE: To assess awareness about oral cancer and precancer among patients attending for dental treatment at a University Dental hospital. METHODS AND MATERIALS: A self-administered questionnaire was used to collect information from 410 randomly selected outpatients attended the Dental Hospital (teaching), Faculty of Dental Sciences, University of Peradeniya, Sri Lanka. The questionnaire included questions to ascertain information on socio-demographic parameters, awareness of oral cancer and precancer, habits of betel chewing, smoking and alcohol consumption. RESULTS: Ninety five percent of the respondents were aware of the possibility of occurrence of cancer in the mouth while only 44.9% (n=184) were aware about precancer. Of the 390 individuals who were aware of the existence of oral cancer, 80.7% were knowledgeable about the causal relationship between betel chewing habit and oral cancer. Forty-seven and 17 percent were aware of links with tobacco smoking and alcohol consumption, respectively. However, out of those who had knowledge of oral cancer, 18 % (n=69) were not knowledgeable about associations with habits. CONCLUSIONS: This survey revealed that the patients attending the hospital were well informed about oral cancer. However, awareness about precancer was relatively low. Knowledge about the causal relationships with tobacco smoking and use of alcohol was low compared to that for betel chewing. (+info)
Transitions in ancient inland freshwater resource management in Sri Lanka affect biota and human populations in and around coastal lagoons.
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The increasing anthropogenic pressure on natural environments results in impacts that affect tropical forest areas and their biodiversity. Adverse impacts on terrestrial and oceanic environments often compound in the intertidal area, where mangrove forest ecosystems thrive. In tropical coastal areas of many developing countries where people depend on wood and other mangrove forest products and services, forest degradation leads to socioeconomic problems. At the same time, increasing freshwater needs in these areas are expected to cause additional problems. On the basis of remote sensing and ground truthing complemented by colonial archival material from the Dutch East India Company (1602-1800), we report that changes to the historic system of inland freshwater management have increased dramatically in recent times. Hydrological changes, such as interbasin transfers, have resulted in a qualitative ecological and socioeconomic degradation in three coastal lagoons in southern Sri Lanka. Variations in river hydrology have caused changes in the areas suitable as mangrove habitat and, thus, have resulted in an altered distribution. However, increases in mangrove area can mask the degradation of the site in terms of floristic composition, significance of the species, and biodiversity (this effect is termed "cryptic ecological degradation"). It is important that such changes be carefully monitored to ensure biological and socioeconomic sustainability. (+info)
Medical needs of tsunami disaster refugee camps.
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BACKGROUND AND OBJECTIVES: In response to the massive tsunami disaster in South Asia, two Korean medical relief teams provided emergency medical care in the southern coastal area of Sri Lanka. Their findings are reported here to provide a realistic picture of medical needs created by the tsunami disaster and to enable a better-prepared medical response to future disasters of this type. METHODS: All victims of the tsunami in the area of operation of the two medical relief teams were encouraged to receive medical care. Care provided to each victim was documented in individual medical records. All medical records were reviewed and classified by age, gender, and diagnosis. RESULTS: A total of 4,710 people were treated by the two Korean medical relief teams for 9 days of operation in southern Sri Lanka. Respiratory problems were common, but diarrhea was diagnosed in an average of only 4.3 patients per day. Minor skin trauma and wound infection in the extremities were frequent as long as 3 weeks after the disaster. The proportion of skin trauma in relation to total trauma decreased as days elapsed from the disaster. CONCLUSIONS: Because of the provision of adequate quantities of potable water, the likelihood of waterborne diarrhea was low. Acute respiratory problems and chronic problems were prevalent in tsunami refugee camps. Despite concerted international relief efforts, inadequate treatment of minor skin trauma and skin infections was evident. (+info)
Risk factors for acute pesticide poisoning in Sri Lanka.
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This report describes the characteristics of patients with acute pesticide poisoning in a rural area of Sri Lanka and, for intentional self-poisoning cases, explores the relative importance of the different determinants. Data were collected for 239 acute pesticide-poisoning cases, which were admitted to two rural hospitals in Sri Lanka. Sociodemographic characteristics, negative life events and agricultural practices of the intentional self-poisoning cases were compared with a control group. Most cases occurred among young adults and the large majority (84%) was because of intentional self-poisoning. Case fatality was 18% with extremely high case fatality for poisoning with the insecticide endosulfan and the herbicide paraquat. Cases were generally younger than controls, of lower educational status and were more often unemployed. No agricultural risk factors were found but a family history of pesticide poisoning and having ended an emotional relationship in the past year was clearly associated with intentional self-poisoning. The presence of mental disorders could only be assessed for a subsample of the cases and controls and this showed that alcohol dependence was a risk factor. This study shows that acute pesticide poisoning in Sri Lanka is determined by a combination of sociodemographic and psychological factors. Suggestions are given for interventions that could control the morbidity and mortality due to acute pesticide poisoning in developing countries. (+info)
How effective were mangroves as a defence against the recent tsunami?
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Whether or not mangroves function as buffers against tsunamis is the subject of in-depth research, the importance of which has been neglected or underestimated before the recent killer tsunami struck. Our preliminary post-tsunami surveys of Sri Lankan mangrove sites with different degrees of degradation indicate that human activity exacerbated the damage inflicted on the coastal zone by the tsunami. (+info)