SLMA wins the Inaugural
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SLMANEWS
Contents
THE OFFICIAL NEWSPAPER OF THE SRI LANKA MEDICAL ASSOCIATION
August 2013 Volume 06 Issue 08
President's Column Dear all,
Page No. Notice Bord
02
SLMA wins the Inaugural SLMA-SLCOG Cricket Match
02
the 126th Anniversary Scientific Medical Con-
SLMA Pre Congress Workshops
03
gress is most encouraging. The participants in
Building Key Competencies of Field Health
I am happy to report that the final verdict on
all events organised have been kind enough to convey their appreciation of the content and facilities provided. The sponsorship secured, mainly from the corporate sector and non-pharma sources helped a great deal in organising the entire event. Of course, as in other years, the pharma industry participants too were pillars of strength for us and they helped a great deal by rallying round us. The success of the Congress was due to the untiring efforts of the members of the Steering Committee. They are the best that I could ever have hoped for and I wish to congratulate them on the fruits of their labour. We just could not have done it without them. In the second half of our tenure we are planning some out-station and provincial meetings as well as the Foundation Sessions with the
Staff to Promote Family Wellbeing
04
Letter to the Editor
12
126th Anniversary Scientific Medical Congress
16 - 17
Influenza : the current outbreak
18
Banquet
22
Our Advertisers GlaxoSmithKline Pharmaceuticals. Edlocate Pvt Ltd Nation Lanka Finance PLC Future Automobiles (pvt) ltd. A.Baurs & Co. (Pvt.)Ltd. Associated Motorways (Private) Limited State Pharmaceuticals Corporation of Sri Lanka George Steuart Health. Pan Asia Banking Corporation PLC Guardian Acuity Asset Management Limited
Anuradhapura Clinical Society from the 23rd to
Hongkong and Shanghai Banking Corporation Limited
the 25th of October 2013. Please await further
C M Condos (Pvt) Ltd.
details on all these events, mainly through our e-mail communication portal. We have also advertised for the 3rd Speech Craft Programme which will start in the near future, provided of course that sufficient numbers of participants are
Astron Ltd. Tokyo Cement Company (Lanka) Plc. Asiri Surgical Hospital. LOLC PLC Emerchemie NB (Ceylon) Ltd. GlaxoSmithKline Pharmaceuticals.
interested. We will have the Medical Dance on the 7th of December 2013 and the Annual General Meeting on the 14th of December 2013. Please be kind enough to keep these dates free. With the warmest of personal regards. Dr B J C Perera President, Sri Lanka Medical Association, No.06, Wijerama Mawatha, Colombo 07, Sri Lanka
Official Newsletter of The Sri Lanka Medical Association. Tele : 0094 - 112 -693324 E mail - slma@eureka.lk Publishing and printing assistance by
This Source (Pvt.) Ltd etc., 236/14-2, Vijaya Kumaranathunga Mawatha, Kirulapone, Colombo 05, Sri Lanka Tele: +94-112-854954 marketing@thissource.com
1
Notice Board
August, 2013
SLMANEWS
Upcoming events October 2013 :
Joint Clinical Meeting with Batticaloa Medical Association (Confirmed date will be notified later)
23rd to 25th October 2013
Foundation Sessions of Sri Lanka Medical Association with Annual Academic Sessions of Anuradhapura Clinical Society
November 2013 :
Joint Clinical Meeting with Jaffna Medical Association (Confirmed date will be notified later)
20- 21st of November 2013
:
: 13th of December 2013 14th of December 2013
:
Joint Clinical Meeting with RuhunaClinical Society Annual Clinical Sessions of Avissawella Clinical Society in collaboration with the Sri Lanka Medical Association Annual General Meeting of SLMA
SLMA wins the Inaugural SLMA-SLCOG Cricket Match
T
he inaugural cricket match between the Sri Lanka Medical Association (SLMA) and Sri Lanka College of Obstetricians and Gynecologists (SLCOG) was held on Tuesday 20th August 2013 at the Department of Health Grounds, Castle Street , Colombo 08. This 25 over friendly cricket match was organized by SLCOG. Doctors Indika Karunathilake, Chameera Akurugoda, Rajiv Niramalasingham, Lahiru Senanayake, Shehan Aziz, S. Partheepan, Jalitha Liyanage,
The SLMA team
Shritharan Ganeshamurthi, Sankalpa Marasinghe and Supun De Silva represented SLMA. The SLMA and SLCOG teams were captained by Dr.
Indika Karunathilake and Prof. Deepal Weerasekara, respectively. The SLMA registered a comprehensive 71 run victory. The highlight of the match was an entertaining power-packed innings by Dr. Rajiv Nirmalasingham who scored 50 runs in 30 balls. The spirited reply of SLCOG was led by Prof. Deepal Weerasekara and Dr. Chandika Wasalathilaka, before falling to a skillful display of seam bowling by Dr, Chameera Akurugoda.
The match summary
2
Dr. B.J.C. Perera, President, SLMA, Prof. Hemantha Senanayake, President, SLCOG, Dr. Samanmali Sumanasena, Secretary, SLMA, graced the occasion. The match was followed by fellowship which strengthened the bond between members of SLMA and SLCOG.
SLMANEWS
SLMA PRE CONGRESS WORKSHOPS
PRE CONGRESS WORKSHOP ON EARLY INTERVETION IN CHILDREN WITH DISABILITIES
August, 2013
PRE CONGRESS WORKSHOP ON INCULCATING ERGONOMICS IN THE SRI LANKAN SETTINGS
PRE CONGRESS WORKSHOP ON “COMMUNICATION SKILLS FOR DOCTORS”
PRE CONGRESS WORKSHOP ON CANCER GENETICS – DIAGNOSTICS, PROGNOSTICATION AND PHARMACOGENOMICS
PRE CONGRESS WORKSHOP ON IMPROVING THE QUALITY OF JOURNALS
PRE CONGRESS WORKSHOP ON SPORTS MEDICINE
PRE CONGRESS WORKSHOP ON BUILDING EFFECTIVE TEAMS IN DIABETES CARE IN SRI LANKA: AN EVIDENCE BASED APPROACH
PRE CONGRESS WORKSHOP ON HEALTHCARE QUALITY AND SAFETY
3
SLMANEWS
August, 2013
Building Key Competencies of Field Health Staff to Promote Family Wellbeing Dr.Shamini Prathapan, Secretary, Expert Committee on Women’s Health, SLMA Dr. Nalika Gunawardena, Chairperson, Expert Committee on Women’s Health, SLMA Dr.Sampatha Goonawardena, Member of the Expert Committee on Women’s Health, SLMA
T
he Expert committee on Women’s Health of the Sri Lanka Medical Association organized a pre congress workshop for the 2013 Annual Sri Lanka Medical Association session, titled “Building Key Competencies of Field Health Staff to Promote Family Wellbeing”. It was held in the auditorium of the National Institute of Health Sciences, Kalutara on the 4th of July 2013. It was well attended with more than 175 field health staff attending from the region. The panel of speakers were Dr. Piyanjali De Zoysa (Senior Lecturer in Clinical Psychology, Faculty of Medicine, University of Colombo), Ms. Chrishara Paranavithana (Clinical psychologist, Visiting Lecturer, Faculty of Medical Sciences, University of Sri Jayewardenepura), Dr. Deepika Attygalle (Health & Nutrition Specialist, UNICEF) and Dr. Enoka
Dr. Nalika Gunawardena
4
Wickramesinghe (Registrar in Community Medicine, Faculty of Medicine, University of Colombo). The workshop was sponsored by UNICEF. The chairperson of the Expert committee on Women’s Health, Dr. Nalika Gunawardena, welcomed the gathering and chaired the symposium. Dr.Sampatha Goonawardena compered the workshop with active discussions in between the lectures. Dr. Piyanjali de Zoysa then initiated the workshop on a lecture on “Techniques to Enhance the Psychosocial Wellbeing of the Family”. She began her lecture by describing emotional intelligence, which is a composite of five characteristics as opposed to ‘traditional intelligence’ which is not sufficient to ensure success and wellbeing in one’s personal and professional life. This was followed by a detailed description of the components of emotional intelligence which are: Being aware of one’s emotional status, ability to manage ones emotions, ability to muster motivation and to strive ahead, ability to be empathic towards and having effective social skills. Dr. Zoysa also stressed that emotional intelligence need to be cultivated. The untrained mind ‘pushes’ ones’ mind to the past, present or future. By being in the present moment, on the other hand, one realizes through experience that thoughts are generated, they stay on and that they vanish; that thoughts are transitory; that most thoughts may not be an accurate representation of reality. This realization makes the person understand that s/he does not have to necessarily react to these thought and thus his behavior, which is a reflection of his thoughts, start changing to be more in accord with reality. Such a person reports a greater sense of wellbeing in his/her life. This was followed by an inspiring
Dr. Piyanjali de Zoysa
Dr.Sampatha Goonawardena
lecture discussion by Dr. Deepika Attygalle on “Promoting parents’ role in Early Childhood Care and Development”. She initiated the lecture with a justification of why the parents’ role in Early Childhood Care and Development (ECCD) was necessary, which was that all newborns begin an extraordinary journey, from newborns to becoming energetic young children ready for school. Contd. on page 06
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SLMANEWS
August, 2013 Contd. from page 4
Building Key ...
However, globally over 200 million children under 5 years fail to achieve their full developmental potential due to challenges such as under nutrition, poor health, environment and lack of opportunities for learning and responsive care. She stressed that therefore vital that society contributes to ensure for every child the opportunity to achieve his or her full potential, which means that it is a responsibility of the adult population. The lecture continued with the definition and components of ECCD, which is “all the essential support a young child need to survive and thrive in life, as well as the support a family and community need to promote children’s holistic development”. She explained that the period of human development from conception to 8 years of age is now recognized as a period essential to healthy happy and productive adulthood which also includes integrating health, nutrition and intellectual stimulation (psychosocial),good parenting, providing opportunities for exploration and active learning as well as providing the social and emotional care. She explained that such nurturing would help a child to realize his or her optimal human potential, and would thus play an active role in his/ her family and later in the community. The lecture was concluded with the emphasis that due to the above mentioned importance the ECCD has been placed internationally in the Convention on the Rights of the Child. This was followed by Ms. Chrishara Paranavithana’s lecture on “empowering parents to protect children”. The overall presentation had a focus in discussing parenting styles, neuropsychological, psychosocial development in childhood and had a main emphasis on aspects pertaining to child abuse. In relation to parenting, the presentation discussed about the impact of divergent parenting styles on children’s behaviors ( behavioral manifestations of children), main
6
types of child –parent relationships, how to foster positive parenting, monitoring to reduce risks, a model to solve common problems together with children, and understanding the psychological changes in children as they pass many stages. The evidence based facts on impacts of divergent forms of parenting styles and strategies to be used by parents in dealing with children particularly to reduce risks were also explored. Another prominent part of the presentation was the discussions on psychosocial developmental stages of children, cognitive, neuropsychological developmental aspects and in detail describing the dimensions of child abuse, impacts, identification and assessment of child abuse taking into consideration the holistic phenomena. Particularly, the neuropsychological manifestations and impacts of abuse and mechanisms to prevent and protect children from being abused were discussed at length. Dr. Enoka Wickremesignhe’s lecture on “enhancing good parenting” was an eye opener to all in the medical professional. She introduced the topic of parenting as the role played by the parents or caregivers, to facili-
Dr. Deepika Attygalle
Ms. Chrishara Paranavithana
tate the child’s physical, psychosocial and personality development by providing necessary care, guidance, and adequate stimulation with a safe environment in line with accepted social norms. However in recent years, she stressed that the children, adolescents, youth and adults are increasingly engaged in violence, crime and social conflicts which result in grave adversities to the individuals, society and the country as a whole, for which poor parenting has been identified as a major modifiable determinant of these psychosocial issues. She also pointed out that due to poor parenting the levels of child abuse and neglect are on the rise, with emphasis on children having increase vulnerability for future non communicable diseases, obesity, psychiatric illnesses including behavioural and emotional disorders, substance abuse, suicidal behaviours, increase teenage pregnancy risk, and poor academic achievement leading to economic deprivation. She justified the need for the workshop that it is a timely need and we as professionals should come up with measures to enhance and promote proper parenting practices among the parents and the future parents. Contd. on page 08
SLMANEWS
August, 2013 Contd. from page 4
Building Key ... Transmitting this knowledge and skills to the community is the duty of the Primary Healthcare staff at the grass root level and hence, it is essential to empower the primary healthcare providers on family wellbeing strategies. Dr. Wickremasinghe identified the key domains of parenting, which are providing physical and emotional care, intellectual stimulation and language development, behaviour control, and providing safety and security to the child. She also emphasized that when talking of good parenting it is important to understand the conation or how each child reacts to situations because, each child is different at different ages, and from one another. In addition, it was underlined that there is no golden formula for proper parenting but certain basic ground rules need to be understood. Among the types of care explained, Physical care includes providing healthy diet, clothing, shelter, medicine and other physical needs for the wellbeing of the child, emotional care would be extending unconditional love, being responsive to the needs of the child, spending quality time
with the child, proper communication, and encouragement and socializing of the child. These practices would help to enhance the child’s sense of security and attachment to the parents, which will further improve the psychosocial wellbeing of the child. She further explained that intellectual stimulation and language development skills are entire different aspect
of parenting which are well addressed in the current Child Health Development Record of which primary healthcare staff is familiar with. The workshop concluded with the concluding remarks and from Dr.Sriyani Ranasinghe, Deputy Director, Field Services of the National Institute of Health Sciences, Kalutara.
Dr.Sriyani Ranasinghe
Dr. Enoka Wickremesignhe
SEMINAR ON CAREER GUIDANCE FOR JUNIOR MEDICAL OFFICERS – 2013 Objective: To assist junior doctors to choose their career Date
:
Sunday 15th September 2013
Time
:
8 am to 1 pm
Venue
:
Lionel Memorial Auditorium, No. 6, Wijerama Mw., Colombo 07
Registration :
On or before Friday 06th September 2013
(Admission will be on first come first served basis, as only a limited number can be accommodated). The registration fee is Rs. 500/= per participant Please contact SLMA office for further details Tel no: 011- 2693324
8
10
SLMANEWS
Letter to the Editor
August, 2013
Re: Mercury Pollution
I
was most interested in the recent article in the SLMAnews (April 2013, Volume 06, Issue 04, p. 10) regarding the above subject as from my days as a medical student I have been peripherally in contact with the subject.
It all started when we were introduced to Mercury poisoning as 4th year medical students in 1969 during the Neurology appointment with that eminent and pioneer Neurologist the late Dr. George Rathnavale. He compelled and encouraged us to read on “Hatters’ Shakes” (amongst many other interesting topics) following which he showed us two cases of acute Hg poisoning. It was a very unique situation as the two patients were nationals from Thailand who we were told had been brought to work on the “Ranweta” around the Sri Maha Bodhiya at Anuradhapura. It appears that they made an amalgam of gold with mercury, applied the paste on the metal frame and then evaporated the mercury using blow torches. For some reason they had not used the protective gear and hence the clinical effects. The new “Ranweta” was formally completed on 11th August 1969. Recently while serving as an examiner for a PhD thesis on clinical
effects of heavy metals I made enquiries regarding the illicit use of Hg. I then came across both local and overseas issues that lead to serious Hg poisoning. On questioning a friend who is a prominent Jeweler in Sri Lanka I was informed by him that although he had not encountered any instances of illicit use of Hg in the industry it may be happening during the processing of gold. However he had encountered instances of complete damage to gold jewellery when thermometer Hg had spilt due to breakages and most surprisingly Hg in hair sprays had damaged ear studs made of gold. The information on the international scene was forwarded to me by my son whose PhD thesis was on the elimination of Hg from coal. Coal samples from almost all countries worldwide contain Hg and burning unprocessed coal causes environmental pollution. He forwarded the following reports from USA and Asia which indicate the seriousness of the problem.
Lesley Sloss October 2012 Mercury emissions in India and South East Asia. CCC 208, ISBN 978-92-9029-528-0.) Lesley Sloss June 2008 Economics of Mercury Control. CCC 134, ISBN 97892-9029-453-5.)
Although Sri Lanka has not been included in the Asian report we are probably at a high risk. I also heard a recent BBC report on the serious Hg pollution in Peru due to illicit gold mining practices and had the opportunity to enquire about the situation in person when we made a family visit to Peru in May this year. I was informed of lakes in Peru where the Hg pollution is so severe that neither the water nor the fish can be used for human consumption. I complement the author Dr. Jayaindra Fernando and the editorial board of SLMAnews for highlighting this potential public health problem for Sri Lanka. I sincerely hope that some relevant and rational action would be taken to study this issue and introduce the necessary corrective steps.
References: United States Environment Protection Agency December 1997: Mercury Study Report to Congress. Volume 1, EPA-452/R-97-003 and Volume II, EPA-452/R-97-004.
Prof. Harshalal Rukka Seneviratne M.B.,B.S. (Ceylon), D.M. (by research) (Colombo), FRCOG (UK) SCOG (SL) Former Dean, Faculty of Medicine, University of Colombo.
A workshop on
Development and validation of Data Collection Tools for Clinicians Resource person
:
Dr. Nalika Gunawardena Faculty of Medicine, University of Colombo
Date
: Saturday, 14th September 2013
Course fee
:
Rs. 1000/= per participant
Time
: 8.30 am to 1.30 pm
(Tea and lunch would be provided)
Contact details
:
Phone - 0112693324 (Ms. Nirmala)
Venue : Lionel Memorial Auditorium, SLMA.
12
Closing date for registration :
e-mail - slma@eureka.lk
9th September 2013
SLMAN
August, 2013
126th Anniversary Scien
Dr. S Rramachandran memorial oration–“Chronic kidney disease of uncertain origin in Sri Lanka; The past, present and future” by Dr. Thilak Abeysekara
Breakfast session - Physical activity for doctors
Doctors debate- “Patient safety is the responsibility of the individual healthcare provider”
Dr S.C Paul memorial oration
“Development of paediatric oncology in Sri La Illustrated by improvement in the outcome of c phoblastic leukaemia” by Dr Damayanthi Peir
Opposing team
Breakfast session-Coping with stress Symposium on respiratory medicine
Symposium on cardiovascular risk assessment
Stroke- Neuro rehabilitation
It was hard to select the best poster….
Guest lecture- Utilising the window periods in care for childhood disabilities: The impact
Innovative approaches in clinical teaching
Ergonomic applications in healthcare settings and for healthcare professionals.
Keynote address- Clinical governance to improve safety and quality in healthcare
Professor N.D.W Lionel memorial ration Symposium on leprosy : The neglected disease
16
Dermatology for family physicians
“Paradigm shift in osteoporosis management: intervention threshold” by Professor S. Lekam
August, 2013
NEWS
ntific Medical Congress
anka as a speciality: childhood acute lymris
: Diagnostic to mwasam
“Sri Lanka clinical trials registry�- Pre luncheon session
Symposium on herbal medicine
Scaling up nutrition: Multisectoral approach
Providing services to survivors of gender based violence
Practical aspects of addressing harm from tobacco,alcohol and drug use
Familial adenomatous polyposis coli
17
SLMANEWS
August, 2013
Influenza : the current outbreak Summary of the symposium presentations on “Influenza” held on 22nd May 2013. The resource persons were, Dr. Paba Palihawadana, Chief Epidemiologist, Epidemiology Unit, Ministry of Health, Dr Jude Jayamaha, Consultant Virologist, National Influenza Centre, Medical Research Institute, Dr Priyankara Jayawardene, Resident Physician, Castle Street Hospital for Women, Colombo & Dr Ananda Wijewickrama, Infectious Diseases Physician, Infectious Diseases Hospital , Angoda
Influenza global surveillance Influenza has gained global health importance as a disease with pandemic potential. World Health Organization maintains continuous virological and epidemiological surveillance through Global Influenza Programme (GIP). Virological surveillance is conducted by GISRS (Global Influenza Response System) via Flunet. http://www.who.int/ influenza/gisrs_laboratory/flunet/en/ Epidemiological surveillance is conducted through FluID. Influenza virus is an Orthomyxo virus which has segmented (8) negative sense RNA and Haemagglutinin (H) and neuraminidase (N) surface antigens. There are 3 types - Influenza A, B, C (classified based on antigenically stable nucleo-protein). Influenza A has several sub types (classified based on AA sequence of glycoproteins: H - 16 types (H1 - H16), N - 9 types (N1 - N9) with 3 common human sub types - H1, H2, H3 / N1, N2.
National Influenza Surveillance Programme Sri Lanka This is conducted under National Avian/Pandemic Preparedness Programme since 2004. Epidemiology Unit under Ministry of Health and DAPH under Ministry of Livestock Development are co-partners. MRI and VRI are laboratory counterparts. Influenza surveillance in humans has
18
2 components. Patients are selected on standard surveillance case definitions. Institutions report weekly to Epidemiology Unit on the number of influenza like illness (ILI) visits to OPD & SARI admissions in wards and send up to 50 respiratory samples/month (6-7 weekly) each to National Influenza Centre (NIC) for laboratory confirmation.
seasonal flu’ viral strains since 2011. Trends in SARI Admissions (2011 – 2013)
1. Influenza-Like-Illness (ILI) - 19 sentinel hospitals An acute respiratory illness defined as • Measured temperature ≥ 380C , cough, onset within past 7 days
Trends in ILI Visits to OPD ( 2009 – 2013)
2. Severe Acute Respiratory tract Infections (SARI) - 4 sentinel sites are used An acute respiratory illness is defined as • A history of fever or measured temperature ≥ 380C , cough, onset within past 7 days which requires hospital admission
Influenza Percent Positivity – 2012 & 2013
Routine samples collection from backyard poultry, industrial poultry farms and from migratory birds and investigation of all bird die-offs are conducted by DAPH & VRI. In Sri Lanka two influenza peaks with high flu activity are observed within a year, which are reflected in both laboratory and epidemiological data. First peak in May-July and second larger peak in Oct-Dec and these peaks coincide with monsoon rains. Risk groups for severe disease are elderly, very young children, those with chronic illnesses, immunosuppressed persons and pregnant women.
Current Influenza Situation Unusually high seasonal influenza activity seen since March this year with all 3 currently circulating influenza virus strains (Influenza A (H1N1) pdm09, Influenza B and Influenza A (H3N2)) being responsiblewith a predominance of Influenza A (H1N1) pdm09 virus strain. Although some deaths including maternal deaths had been reported, no clustering of severe disease or deaths were observed. Influenza A(H1N1)pdm09 pandemic waves seen in 2009/2010. Influenza B, Influenza A(H3N2) and Influenza A(H1N1)pdm09 seen as circulating
Virological diagnosis and surveillance: Role of the National Influenza Centre(NIC) NIC has been designated by Ministries of Health and recognized by the WHO for the purpose of participating in the activities of the WHO Global Influenza Programme.
Collection and storage of specimens for laboratory diagnosis Respiratory specimens, including nasopharyngeal aspirate / swabs, oropharyngeal swabs, tracheal aspirates / broncho-alveolar lavage, lung biopsy, para-mortem biopsy (Tru Cut biopsy), are specimens in the diagnosis. Blood should not be sent.During storage avoid freeze-thaw and do not store at -20 oC as storage temperature of -70 oC or lower is required to retain viability of virus. During transport to NIC keep specimen in wet ice, or 4oC. Contd. on page 20
SLMANEWS
August, 2013 Contd. from page 18
Influenza... Guidance for laboratory diagno-
sis for confirmation of cases • Diagnostic samples should be collected on clinical judgment from hospitalised patients only. • All diagnostic samples should include a detailed clinical history indicating the justification for doing the investigation in the special request form developed by the NIC for this purpose. • Samples received would be screened at the NIC and those prioritized on the given clinical history would be processed depending on the availability of logistics.
PCR is not done on all suspected patients, only for who have risk factors and has to be authorized by the clinician. It is very expensive: Real time PCR costs s 10,000/=
Laboratory Surveillance at NIC 1. Direct antigen test (DFT) 2. Molecular Techniques- Real time 3. Isolation of the virus- Cell culture (MDCK cell line) or Egg inoculation 4. Selectedisolates and atypical isolates sent to WHO CC for further characterization
it is highly infectious, it is usually self limiting. But can cause severe pneumonia and deaths. It transmits by droplet infection – coughing, sneezing (distance 4-5 feet). It also can spread by contaminated hands. The spread is limited to close contacts and don’t spread by cooked food. Virus is destroyed at 70 oC . The symptoms are similar to those of flu. The symptoms are fever, cough, sore throat, body aches, headache, fatigue and may have diarrhoea and vomiting.H1N1 is infectious from day 1 to day 7 and the incubation period up to 6-7 days. Cases are defined as follows. A suspected case: Influenza like illness (fever, cough, sore throat, shortness of breath), a probable case: a suspected case with positive test for influenza A but negative for seasonal subtypes or died following a clinically compatible illness, a confirmed case: a suspected case with confirmed H1N1 test. The preparedness should be at the OPD, wards, laboratory, ICU, the level of Health staff, community level. Risk factors are pregnancy, patients with COPD, IHD etc, older patients (>65 yrs), children below two years. In the ward isolation and hand hygiene is necessary and may need CPAP or IPPV and prolonged ventilation if admitted for ICU care .
Procedure
Processing time
IF staining
<24 hrs
RT-PCR
2 days 3 days (if inconclusive results)
Admission policy for OPD
Viral culture
5 -10 days
Admission criteria are as for acute bronchitis e.g. severe cough, SOB, persistent fever for more than 3 days. If symptoms are mild, there is no necessity for lab confirmation or anti-viral treatment. Advice them to rest at home, isolate themselves, droplet infection prevention methods, wash hands frequently, seek medical advice if cough is getting worse or developing SOB. Admission is needed for investigations, for empirical antiviral treatment and close monitoring .The tests are FBC – if viral counts, suspect H1N1;CXR PA – if cough is severe or if shortness of breath, nasopharyngeal aspirate (or swabs) – if H1N1 is suspected.
Common errors observed during collection and transport of specimens to the MRI • Leaking sample containers • Request form soaked/ wet • Not transported in ice • Melted ice with sample floating • Thick layer of plaster wrapped around • No history in request form • Non standard acronyms (Eg: THK)
Clinical aspect of influenza Swine flu is a type of influenza A virus, subtype of H1 N1.It can get transmitted between humans. Though
20
• Triage the Patients with fever & cough • Separate place in the OPD to examine the patients with flu like symptoms(Patients & staff are given
masks) • Arranging isolation units at each wards in gynaecology section • Direct admissions to isolation unit after contacting Resident Physician • Providing a mask to all patients with flu like illness Minimize unnecessary overcrowding and early discharge whenever possible
Management Guidelines • Admitting all patients with fever/ fever with symptoms • Do not miss Dengue & other infections • CRP/ FBC/ UFR/ Blood Cultures/ Dengue Ag/Influenza screen • If UTI or other infection treat and early discharge. If clinical picture suggestive of Influenza with fever • Start Tamiflu( Oseltamivir) and proceed with necessary Investigations • Oseltamivir 75 mg twice a day for 5 days. (for children according to the body weight). Syrup is available.Safe to use in pregnancy. • Patients with significant symptoms/patients ill enough to get admitted should be treated. Have a low threshold for patients with risk factors. • Prophylaxis is effective if given within 48 hours only. (but not 100% protective).The drug regime is Oseltemivir 75 mg daily for 10 days. Prophylaxis is not generally necessary because it is widespread • Special care for pregnant asthmatic patients • More close supervision/early delivery/ close monitoring at wards without ICU facility • Start on special IV Antibiotic regime if secondary bacterial infections • Symptomatic Rx to reduce secretions ( Chlorpheniramine, nasal drops) • Proper waste managements (infected tissues and other material) • Minimize nebulization (use separate mask & tubes) • Giving Metered Dose Inhalers/ volumatic spacers • Follow up of patients (Telephone calls) Compiled by Professor Jennifer Perera, Chairperson, Subcommittee on Communicable Diseases
SLMANEWS
August, 2013
Banquet
Vote of thanks by the Honorary Secretary
Happy birthday Dr J.B Peiris !
Toast to the President of the Democratic Socialist Republic of Sri Lanka and the Country
22