S. N. Thiyahiny, M. G. Sathiadas, R. Surenthirakumaran, S. Layanthini
Aim of the study was to evaluate prescription of antibiotics among paediatric outpatients at Teaching Hospital-Jaffna. It was a cross sectional descriptive study carried out among the paediatric outpatients in July and August 2014. A data extraction form was developed based on WHO data collection forms and was used to collect the data. Nine drug use indicators which include modified core and complementary WHO drug use indicators and indicators developed by the investigators were used to evaluate antibiotic prescription. Descriptive statistics were used for data analysis. Out of 1181 prescriptions of paediatric outpatients, 825 (69.9%) had antibiotics. Average number of antibiotics per prescription was 0.7. Percentage of antibiotics prescribed by generic name, from essential medicine list and for common conditions were 97%, 100% and 91.4% respectively. Percentage of prescriptions with the documentation of reason for prescribing an antibiotic was 97%. Only 3.4% antibiotic prescriptions were complete. Percentage of drug cost spent on antibiotics was 33.2% and average antibiotic cost per encounter was 54.34 Sri Lankan rupees. The most frequently prescribed antibiotic group was penicillins (53.3%). The most common indication for antibiotics was respiratory tract infection (70.3%). Majority of the antibiotics (74%) were prescribed in paediatric dosage form. Good prescribing practice was observed for prescribing in generic name, prescribing the antibiotic from essential medicines list, prescribing for common conditions, documentation of reason for prescribing and prescription of paediatric dosage forms. The completeness of antibiotic prescriptions was poor and needs special attention to improve. The drug use indicators are useful tools to evaluate the antibiotic prescriptions in a setting as well as among different settings.
{"title":"Prescription of antibiotics among paediatric outpatients at Teaching Hospital-Jaffna","authors":"S. N. Thiyahiny, M. G. Sathiadas, R. Surenthirakumaran, S. Layanthini","doi":"10.4038/JMJ.V31I1.59","DOIUrl":"https://doi.org/10.4038/JMJ.V31I1.59","url":null,"abstract":"Aim of the study was to evaluate prescription of antibiotics among paediatric outpatients at Teaching Hospital-Jaffna. It was a cross sectional descriptive study carried out among the paediatric outpatients in July and August 2014. A data extraction form was developed based on WHO data collection forms and was used to collect the data. Nine drug use indicators which include modified core and complementary WHO drug use indicators and indicators developed by the investigators were used to evaluate antibiotic prescription. Descriptive statistics were used for data analysis. Out of 1181 prescriptions of paediatric outpatients, 825 (69.9%) had antibiotics. Average number of antibiotics per prescription was 0.7. Percentage of antibiotics prescribed by generic name, from essential medicine list and for common conditions were 97%, 100% and 91.4% respectively. Percentage of prescriptions with the documentation of reason for prescribing an antibiotic was 97%. Only 3.4% antibiotic prescriptions were complete. Percentage of drug cost spent on antibiotics was 33.2% and average antibiotic cost per encounter was 54.34 Sri Lankan rupees. The most frequently prescribed antibiotic group was penicillins (53.3%). The most common indication for antibiotics was respiratory tract infection (70.3%). Majority of the antibiotics (74%) were prescribed in paediatric dosage form. Good prescribing practice was observed for prescribing in generic name, prescribing the antibiotic from essential medicines list, prescribing for common conditions, documentation of reason for prescribing and prescription of paediatric dosage forms. The completeness of antibiotic prescriptions was poor and needs special attention to improve. The drug use indicators are useful tools to evaluate the antibiotic prescriptions in a setting as well as among different settings.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126987098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Idiopathic hypereosinophilic Syndrome (HES) is a rare disorder, and a diagnosis of exclusion of primary and secondary HES. Symptoms develop insidiously and hyper eosinophilia is often detected incidentally. It involves skin, liver, lung, gastro intestinal system, blood, bone marrow and central nervous system. This case study describes about a patient diagnosed as Idiopathic hypereosinophilic Syndrome with bone marrow, lung and liver involvement, who was treated successfully with steroids.
{"title":"Idiopathic Hypereosinophilic syndrome with multiorgan involvement","authors":"V. Nivethini, A. Hittarage, U. Dissanayake","doi":"10.4038/JMJ.V31I1.65","DOIUrl":"https://doi.org/10.4038/JMJ.V31I1.65","url":null,"abstract":"Idiopathic hypereosinophilic Syndrome (HES) is a rare disorder, and a diagnosis of exclusion of primary and secondary HES. Symptoms develop insidiously and hyper eosinophilia is often detected incidentally. It involves skin, liver, lung, gastro intestinal system, blood, bone marrow and central nervous system. This case study describes about a patient diagnosed as Idiopathic hypereosinophilic Syndrome with bone marrow, lung and liver involvement, who was treated successfully with steroids.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125122678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Varuni, S. Sivansuthan, G. Pratheepan, S. Gajanthan
Saw scaled viper is one of the venomous snakes in Sri Lanka. (1) It has different species worldwide. Bleeding manifestations and mortality are varying among them. There is no reported case on saw scaled bite related death in Sri Lanka. (1) Coagulopathy is the commonest manifestation. Here we are reporting the case report on Bradycardia following saw scaled viper bite for the first time. It has occurred after 72 hours and recovered with isoprenaline.
{"title":"A case report on Bradycardia: a rare manifestation of Saw scaled viper bite","authors":"K. Varuni, S. Sivansuthan, G. Pratheepan, S. Gajanthan","doi":"10.4038/JMJ.V31I1.66","DOIUrl":"https://doi.org/10.4038/JMJ.V31I1.66","url":null,"abstract":"Saw scaled viper is one of the venomous snakes in Sri Lanka. (1) It has different species worldwide. Bleeding manifestations and mortality are varying among them. There is no reported case on saw scaled bite related death in Sri Lanka. (1) Coagulopathy is the commonest manifestation. Here we are reporting the case report on Bradycardia following saw scaled viper bite for the first time. It has occurred after 72 hours and recovered with isoprenaline.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114797311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdominal cutaneous nerve entrapment syndrome is caused by entrapment of an intercostal nerve in a fibrous ring in the rectus abdominis muscle and causes neuropathic pain. It remains an overlooked cause of chronic abdominal wall pain. Carnett’s test is useful to make a diagnosis. An injection of local anaesthetic and corticosteroid combination relieves pain and it is both diagnostic and treatment. This review article describes its pathophysiology, clinical diagnosis and its management. The databases Medline, and Google Scholar were searched using the terms chronic abdominal pain in general, surgical and gynaecological practice. Database were merged and duplicates were removed. The aim of the review is to update the knowledge on this topic in day to day clinical practice.
{"title":"Abdominal cutaneous nerve entrapment syndrome (ACNES)","authors":"M. Thirukumar, H. Thambawita","doi":"10.4038/JMJ.V31I1.62","DOIUrl":"https://doi.org/10.4038/JMJ.V31I1.62","url":null,"abstract":"Abdominal cutaneous nerve entrapment syndrome is caused by entrapment of an intercostal nerve in a fibrous ring in the rectus abdominis muscle and causes neuropathic pain. It remains an overlooked cause of chronic abdominal wall pain. Carnett’s test is useful to make a diagnosis. An injection of local anaesthetic and corticosteroid combination relieves pain and it is both diagnostic and treatment. This review article describes its pathophysiology, clinical diagnosis and its management. The databases Medline, and Google Scholar were searched using the terms chronic abdominal pain in general, surgical and gynaecological practice. Database were merged and duplicates were removed. The aim of the review is to update the knowledge on this topic in day to day clinical practice.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126697866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 46 years old female found to be unconscious at home and brought by neighbours. On admission her GCS was 9. Airway was patent with normal breathing pattern. She tachycardic with low volume pulse and bloodpressure is 60/40mmHg. She was febrile on admission. During resuscitation she received fluid boluses up to 1.5 litres (30ml/kg) .Intravenous noradrenaline was commenced to maintain BP. On examination both lungs breath sounds were equal, vesicular breathing and there were occasional crepitations. There was an eschar on the abdominal wall.
{"title":"Rare presentation of Typhus Fever with multiorgan failure and Disseminated Intravascular Coagulation","authors":"S. Sathiaruban, S. Ghetheswaran","doi":"10.4038/JMJ.V31I1.68","DOIUrl":"https://doi.org/10.4038/JMJ.V31I1.68","url":null,"abstract":"A 46 years old female found to be unconscious at home and brought by neighbours. On admission her GCS was 9. Airway was patent with normal breathing pattern. She tachycardic with low volume pulse and bloodpressure is 60/40mmHg. She was febrile on admission. During resuscitation she received fluid boluses up to 1.5 litres (30ml/kg) .Intravenous noradrenaline was commenced to maintain BP. On examination both lungs breath sounds were equal, vesicular breathing and there were occasional crepitations. There was an eschar on the abdominal wall.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124522392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bronchiolitis is the commonest lower respiratory tract infection in infants needing hospital admission. It is caused by the virus mainly the respiratory syncytial virus. The infants typically present with initial upper respiratory symptoms such as rhinitis, nasal congestion and low grade fever which is followed by tachypnea recessions grunting apnoea and cyanosis in severe cases. Young age group, prematurity congenital heart diseases are the major risk factors for the severe disease. Diagnosis of bronchiolitis is mainly depended on clinical features. Clinical assessment of a child suspected with bronchiolitis should include clinical features to diagnoses the bronchiolitis and to assess the severity of the bronchiolitis. There is no definitive management for bronchiolitis. None of the drugs tried in the management of bronhiolitis have shown their efficacy in reducing the length of hospital stay, severity of the illness or improvement in the outcome. The main stay of management is supportive like minimum handling, supplementary oxygen, and care on fluid and nutrition and ventilator support whenever needed.
{"title":"Bronchiolitis in children","authors":"N. Umasankar","doi":"10.4038/JMJ.V31I1.61","DOIUrl":"https://doi.org/10.4038/JMJ.V31I1.61","url":null,"abstract":"Bronchiolitis is the commonest lower respiratory tract infection in infants needing hospital admission. It is caused by the virus mainly the respiratory syncytial virus. The infants typically present with initial upper respiratory symptoms such as rhinitis, nasal congestion and low grade fever which is followed by tachypnea recessions grunting apnoea and cyanosis in severe cases. Young age group, prematurity congenital heart diseases are the major risk factors for the severe disease. Diagnosis of bronchiolitis is mainly depended on clinical features. Clinical assessment of a child suspected with bronchiolitis should include clinical features to diagnoses the bronchiolitis and to assess the severity of the bronchiolitis. There is no definitive management for bronchiolitis. None of the drugs tried in the management of bronhiolitis have shown their efficacy in reducing the length of hospital stay, severity of the illness or improvement in the outcome. The main stay of management is supportive like minimum handling, supplementary oxygen, and care on fluid and nutrition and ventilator support whenever needed.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131400642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is unfortunate that over the last 65 years many factors have contributed to the sporadic publication of the Jaffna Medical Journal (JMJ). To sustain publication as a regular periodical, it is important to explore avenues to increase the number of submissions of high-quality manuscripts. One untapped source that could significantly enhance the number of submissions to JMJ are manuscripts arising from research undertaken by undergraduate students. To enable such students to produce high quality manuscripts from the work they carry out, students have to be adequately trained and mentored. We are of the view that if appropriate training is provided for undergraduates it will not only help JMJ in the short-term but also nurture the aspirations of future clinicians and researchers who have an interest in inquiry. Moreover, such an investment in student training and capacity building will ensure the future continuity of the Journal.
{"title":"The Jaffna Medical Journal as a forum for undergraduate research","authors":"S. Ketheesan, R. Natkunam, N. Ketheesan","doi":"10.4038/JMJ.V31I1.63","DOIUrl":"https://doi.org/10.4038/JMJ.V31I1.63","url":null,"abstract":"It is unfortunate that over the last 65 years many factors have contributed to the sporadic publication of the Jaffna Medical Journal (JMJ). To sustain publication as a regular periodical, it is important to explore avenues to increase the number of submissions of high-quality manuscripts. One untapped source that could significantly enhance the number of submissions to JMJ are manuscripts arising from research undertaken by undergraduate students. To enable such students to produce high quality manuscripts from the work they carry out, students have to be adequately trained and mentored. We are of the view that if appropriate training is provided for undergraduates it will not only help JMJ in the short-term but also nurture the aspirations of future clinicians and researchers who have an interest in inquiry. Moreover, such an investment in student training and capacity building will ensure the future continuity of the Journal.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"70 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132330398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clinical governance","authors":"M. G. Sathiadas","doi":"10.4038/jmj.v30i2.16","DOIUrl":"https://doi.org/10.4038/jmj.v30i2.16","url":null,"abstract":"","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"55 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120988202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recurrent meningitis in children is potentially life threatening, causing long term morbidities and psychological trauma to the patient through the repeated hospital admission and multiple invasive investigations. Immune deficiency and bacterial migration along congenital or acquired pathways connecting CSF pathways to external surfaces are the two important aetiologies which should be taken into consideration1. We report a case of a boy who presented with recurrent meningitis due to defect in the anterior cranial fossa ethmoidal air cells.
{"title":"Child with recurrent meningitis: Encephalocele causing anterior cranial fossa defect with CSF rhinorrhoea","authors":"V. Mayoorathy, S. Doluweera","doi":"10.4038/jmj.v30i2.26","DOIUrl":"https://doi.org/10.4038/jmj.v30i2.26","url":null,"abstract":"Recurrent meningitis in children is potentially life threatening, causing long term morbidities and psychological trauma to the patient through the repeated hospital admission and multiple invasive investigations. Immune deficiency and bacterial migration along congenital or acquired pathways connecting CSF pathways to external surfaces are the two important aetiologies which should be taken into consideration1. We report a case of a boy who presented with recurrent meningitis due to defect in the anterior cranial fossa ethmoidal air cells.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"43 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114106628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fanconi anemia (FA) is an inherited bone marrow failure syndrome characterized by pancytopenia, physical abnormalities and predisposition to malignancy. It is due to DNA repair defect results in genomic instability. Diagnosis is done by chromosomal fragility test which is high sensitive and low specific test. In this case report, a nine year old girl was accidentally identified with bicytopenia during febrile illness with reactive bone marrow initially. It was followed by pancytopenia with hypocellular marrow. She was diagnosed as FA with classic physical findings of cafe au lait spots, microcephaly, torticollis, hypocellular bone marrow, positive mitomycin-C stress cytogenetic test and high HbF.
{"title":"A child with fanconi anaemia","authors":"A. Puvana, M. G. Sathiadas","doi":"10.4038/JMJ.V30I2.28","DOIUrl":"https://doi.org/10.4038/JMJ.V30I2.28","url":null,"abstract":"Fanconi anemia (FA) is an inherited bone marrow failure syndrome characterized by pancytopenia, physical abnormalities and predisposition to malignancy. It is due to DNA repair defect results in genomic instability. Diagnosis is done by chromosomal fragility test which is high sensitive and low specific test. In this case report, a nine year old girl was accidentally identified with bicytopenia during febrile illness with reactive bone marrow initially. It was followed by pancytopenia with hypocellular marrow. She was diagnosed as FA with classic physical findings of cafe au lait spots, microcephaly, torticollis, hypocellular bone marrow, positive mitomycin-C stress cytogenetic test and high HbF.","PeriodicalId":280534,"journal":{"name":"Jaffna Medical Journal","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117205622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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