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President's Column

Contents

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Dear all,

I am happy to report that the final verdict on the 126th Anniversary Scientific Medical Con-gress is most encouraging. The participants in 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-phar-ma 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 plan-ning some out-station and provincial meetings as well as the Foundation Sessions with the Anuradhapura Clinical Society from the 23rd to the 25th of October 2013. Please await further 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 interested.

We will have the Medical Dance on the 7th of December 2013 and the Annual General Meet-ing on the 14th of December 2013. Please be kind enough to keep these dates free.

With the warmest of personal regards.

Page No.

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1

August 2013 Volume 06 Issue 08

SLMANEWSTHE OFFICIAL NEWSPAPER OF THE SRI LANKA MEDICAL ASSOCIATION

Notice Bord 02

SLMA wins the Inaugural SLMA-SLCOG Cricket Match 02

SLMA Pre Congress Workshops 03

Building Key Competencies of Field Health 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

Dr B J C PereraPresident,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 - [email protected]

August, 2013 SLMANEWS

2

Notice Board

The 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, Cha-meera Akurugoda, Rajiv Niramalas-ingham, Lahiru Senanayake, Shehan Aziz, S. Partheepan, Jalitha Liyanage,

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 vic-tory. 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.

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.

SLMA wins the Inaugural SLMA-SLCOG Cricket Match

The match summary

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 : Joint Clinical Meeting with RuhunaClinical Society

13th of December 2013 : Annual Clinical Sessions of Avissawella Clinical Society in collaboration with the Sri Lanka Medical Association

14th of December 2013 : Annual General Meeting of SLMA

The SLMA team

SLMANEWS August, 2013

3

PRE CONGRESS WORKSHOP ON EARLY INTERVETION IN CHILDREN WITH DISABILITIES

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

SLMA PRE CONGRESS WORKSHOPSPRE CONGRESS WORKSHOP ON INCULCATING ERGONOMICS IN THE

SRI LANKAN SETTINGS

PRE CONGRESS WORKSHOP ON CANCER GENETICS – DIAGNOSTICS,

PROGNOSTICATION AND PHARMACOGENOMICS

PRE CONGRESS WORKSHOP ON “COMMUNICATION SKILLS FOR DOCTORS”

PRE CONGRESS WORKSHOP ON IMPROVING THE QUALITY OF JOURNALS

PRE CONGRESS WORKSHOP ON SPORTS MEDICINE


4

SLMANEWS

Contd. on page 06

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

The Expert committee on Wom-en’s Health of the Sri Lanka Medical Association organized

a pre congress workshop for the 2013 Annual Sri Lanka Medical As-sociation 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 Lec-turer in Clinical Psychology, Faculty of Medicine, University of Colombo), Ms. Chrishara Paranavithana (Clini-cal psychologist, Visiting Lecturer, Faculty of Medical Sciences, Uni-versity of Sri Jayewardenepura), Dr. Deepika Attygalle (Health & Nutrition Specialist, UNICEF) and Dr. Enoka

Wickramesinghe (Registrar in Com-munity Medicine, Faculty of Medicine, University of Colombo). The work-shop was sponsored by UNICEF.

The chairperson of the Expert com-mittee on Women’s Health, Dr. Nalika Gunawardena, welcomed the gather-ing 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 “Tech-niques 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 ‘tra-ditional intelligence’ which is not suf-ficient to ensure success and wellbe-ing in one’s personal and professional life. This was followed by a detailed description of the components of emotional intelligence which are: Be-ing aware of one’s emotional status, ability to manage ones emotions, abil-ity 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 experi-ence 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 realiza-tion makes the person understand that s/he does not have to necessar-ily 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

lecture discussion by Dr. Deepika Attygalle on “Promoting parents’ role in Early Childhood Care and Devel-opment”.

She initiated the lecture with a justification of why the parents’ role in Early Childhood Care and De-velopment (ECCD) was necessary, which was that all newborns begin an extraordinary journey, from newborns to becoming energetic young children ready for school.

Building Key Competencies of Field Health Staff to Promote Family Wellbeing

Dr. Piyanjali de Zoysa

Dr. Nalika Gunawardena

Dr.Sampatha Goonawardena

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However, globally over 200 million children under 5 years fail to achieve their full developmental potential due to challenges such as under nutri-tion, 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 opportu-nity 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 com-ponents 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 adult-hood which also includes integrating health, nutrition and intellectual stimu-lation (psychosocial),good parenting, providing opportunities for explora-tion and active learning as well as providing the social and emotional care. She explained that such nurtur-ing 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 commu-nity. 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 “empow-ering parents to protect children”. The overall presentation had a focus in discussing parenting styles, neuro-psychological, psychosocial develop-ment 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

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 strate-gies 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 de-velopmental 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 pro-tect children from being abused were discussed at length.

Dr. Enoka Wickremesignhe’s lec-ture on “enhancing good parenting” was an eye opener to all in the medi-cal professional. She introduced the topic of parenting as the role played by the parents or caregivers, to facili-

tate the child’s physical, psychoso-cial 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, adoles-cents, youth and adults are increas-ingly 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 chil-dren having increase vulnerability for future non communicable diseases, obesity, psychiatric illnesses including behavioural and emotional disorders, substance abuse, suicidal behav-iours, 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.

Building Key ...Contd. from page 4

Contd. on page 08

Ms. Chrishara Paranavithana

Dr. Deepika Attygalle


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 wellbe-ing 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 em-phasized 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 under-lined 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, medi-cine 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 develop-ment skills are entire different aspect

of parenting which are well addressed in the current Child Health Develop-ment Record of which primary health-care staff is familiar with.

The workshop concluded with the concluding remarks and from Dr.Sriyani Ranasinghe, Deputy Direc-tor, Field Services of the National Institute of Health Sciences, Kalutara.

Building Key ...Contd. from page 4

8

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

Dr. Enoka WickremesignheDr.Sriyani Ranasinghe

10


12

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 intro-duced 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) follow-ing 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 amal-gam 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 en-quiries regarding the illicit use of Hg. I then came across both local and overseas issues that lead to seri-ous 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. How-ever he had encountered instances of complete damage to gold jewel-lery when thermometer Hg had spilt due to breakages and most surpris-ingly Hg in hair sprays had damaged ear studs made of gold.

The information on the interna-tional 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 environ-mental pollution. He forwarded the following reports from USA and Asia which indicate the seriousness of the problem.

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.

Lesley Sloss October 2012 Mercury emis-sions 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 978-92-9029-453-5.)

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 oppor-tunity 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 correc-tive steps.

Re: Mercury PollutionLetter to the Editor

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

Course fee : Rs. 1000/= per participant

(Tea and lunch would be provided)

Contact details : Phone - 0112693324 (Ms. Nirmala)

e-mail - [email protected]

Date : Saturday, 14th September 2013

Time : 8.30 am to 1.30 pm

Venue : Lionel Memorial Auditorium, SLMA.

Closing date for registration : 9th September 2013

Resource person : Dr. Nalika Gunawardena

Faculty of Medicine, University of Colombo

16


126th Anniversary Scientific Medical Congress

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” Opposing team

Symposium on cardiovascular risk assessment

Symposium on respiratory medicine

It was hard to select the best poster….

Ergonomic applications in healthcare settings and for health-care professionals.

Symposium on leprosy : The neglected disease Dermatology for family physicians

Keynote address- Clinical governance to improve safety and quality in healthcare

Guest lecture- Utilising the win-dow periods in care for child-hood disabilities: The impact

Professor N.D.W Lionel memorial ration

“Paradigm shift in osteoporosis management: Diagnostic to intervention threshold” by Professor S. Lekamwasam

Innovative approaches in clinical teaching

Stroke- Neuro rehabilitation

Breakfast session-Coping with stress

Dr S.C Paul memorial oration

“Development of paediatric oncology in Sri Lanka as a speciality: Illustrated by improvement in the outcome of childhood acute lym-phoblastic leukaemia” by Dr Damayanthi Peiris

SLMANEWS

17

August, 2013

126th Anniversary Scientific Medical Congress

Professor N.D.W Lionel memorial ration

“Paradigm shift in osteoporosis management: Diagnostic to intervention threshold” by Professor S. Lekamwasam

Stroke- Neuro rehabilitation

“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

Dr S.C Paul memorial oration

“Development of paediatric oncology in Sri Lanka as a speciality: Illustrated by improvement in the outcome of childhood acute lym-phoblastic leukaemia” by Dr Damayanthi Peiris


18

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 con-ducted through FluID. Influenza virus is an Orthomyxo virus which has seg-mented (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 (clas-sified based on AA sequence of glyco-proteins: 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 Pro-gramme since 2004. Epidemiology Unit under Ministry of Health and DAPH under Ministry of Livestock Develop-ment are co-partners. MRI and VRI are laboratory counterparts.

Influenza surveillance in humans has

2 components. Patients are selected on standard surveillance case definitions. Institutions report weekly to Epidemiol-ogy 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.

1. Influenza-Like-Illness (ILI) - 19 senti-nel hospitals

An acute respiratory illness defined as

•Measuredtemperature≥380C,cough,onset within past 7 days

2. Severe Acute Respiratory tract Infec-tions (SARI) - 4 sentinel sites are used

An acute respiratory illness is defined as

•Ahistoryoffeverormeasuredtempera-ture≥380C,cough,onsetwithinpast7days which requires hospital admission

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

seasonal flu’ viral strains since 2011.

Virological diagnosis and surveil-

lance: Role of the National Influ-

enza Centre(NIC)

NIC has been designated by Minis-tries of Health and recognized by the WHO for the purpose of participating in the activities of the WHO Global Influ-enza Programme.

Collection and storage of speci-

mens for laboratory diagnosis

Respiratory specimens, including nasopharyngeal aspirate / swabs, oro-pharyngeal 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.

Influenza : the current outbreak

Trends in ILI Visits to OPD ( 2009 – 2013)

Trends in SARI Admissions (2011 – 2013)

Influenza Percent Positivity – 2012 & 2013

Contd. on page 20


20

Guidance for laboratory diagno-

sis for confirmation of cases

•Diagnosticsamplesshouldbecollectedon clinical judgment from hospitalised patients only.

•Alldiagnosticsamplesshouldincludeadetailed clinical history indicating the justification for doing the investigation in the special request form developed by the NIC for this purpose.

•Samplesreceivedwouldbescreenedat 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 fac-tors and has to be authorized by the clinician. It is very expensive: Real time PCR costs s 10,000/=

Laboratory Surveillance at NIC1. 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 character-ization

Common errors observed during

collection and transport of speci-

mens to the MRI•Leakingsamplecontainers

•Requestformsoaked/wet

•Nottransportedinice

•Meltedicewithsamplefloating

•Thicklayerofplasterwrappedaround

•Nohistoryinrequestform

•Nonstandardacronyms(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

it is highly infectious, it is usually self limiting. But can cause severe pneumo-nia and deaths. It transmits by droplet infection – coughing, sneezing (dis-tance 4-5 feet). It also can spread by contaminated hands. The spread is lim-ited 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 nec-essary and may need CPAP or IPPV and prolonged ventilation if admitted for ICU care .

Admission policy for OPD

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 neces-sity for lab confirmation or anti-viral treatment. Advice them to rest at home, isolate themselves, droplet infection prevention methods, wash hands fre-quently, 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. •TriagethePatientswithfever&cough

•SeparateplaceintheOPDtoex-aminethepatientswithflulikesymptoms(Patients&staffaregiven

masks)

•Arrangingisolationunitsateachwardsin gynaecology section

•Directadmissionstoisolationunitaftercontacting Resident Physician

•Providingamasktoallpatientswithflulike illness

Minimize unnecessary overcrowding and early discharge whenever possible

Management Guidelines

•Admittingallpatientswithfever/feverwith symptoms

•DonotmissDengue&otherinfections

•CRP/FBC/UFR/BloodCultures/Den-gueAg/Influenzascreen

•IfUTIorotherinfectiontreatandearlydischarge.

If clinical picture suggestive of Influenza with fever•StartTamiflu(Oseltamivir)andproceed

with necessary Investigations

•Oseltamivir75mgtwiceadayfor5days. (for children according to the body weight). Syrup is available.Safe to use in pregnancy.

•Patientswithsignificantsymptoms/pa-tients ill enough to get admitted should be treated. Have a low threshold for patients with risk factors.

•Prophylaxisiseffectiveifgivenwithin48 hours only. (but not 100% protec-tive).The drug regime is Oseltemivir 75 mg daily for 10 days. Prophylaxis is not generally necessary because it is wide-spread

•Specialcareforpregnantasthmaticpatients

•Moreclosesupervision/earlydelivery/close monitoring at wards without ICU facility

•StartonspecialIVAntibioticregimeifsecondary bacterial infections

•SymptomaticRxtoreducesecretions(Chlorpheniramine, nasal drops)

•Properwastemanagements(infectedtissues and other material)

•Minimizenebulization(useseparatemask&tubes)

•GivingMeteredDoseInhalers/volumaticspacers

•Followupofpatients(Telephonecalls)

Compiled by Professor Jennifer Perera, Chairperson, Subcommittee on Commu-nicable Diseases

Influenza...Contd. from page 18

Procedure Processing timeIF staining <24 hrs

RT-PCR2 days3 days (if inconclusive results)

Viral culture 5 -10 days


22

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

Documents

SLMAnews 2013 08