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Introduction:Gloriosa superba is a flowering plant that contains colchicine. Deliberate self-poisoning with this plant in Sri Lanka is common and potentially fatal. The objective of this study was to describe the epidemiology, toxicokinetics and selected biomarkers in these patients. Materials and methods: The study consisted of three parts; epidemiologic and outcome data (n = 297), concentrations and toxicokinetics (n = 72), evaluation of urinary and serum biomarkers (n = 45). Plasma colchicine levels were measured by high-performance liquid chromatography (HPLC). We also measured serum biomarkers: creatinine (sCr), cystatin C (sCysC) and creatine kinase (CK), and urinary biomarkers: creatinine, kidney injury molecule-1 (KIM – 1), clusterin, albumin, beta-2-microglobulin (β2M), cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), osteopontin (OPN) and trefoil factor 3 (TFF3). Results: The case fatality was 10% (29/297), and death was much more common in older patients. Median concentrations of colchicine were higher in those over 65 [median 4.7 ng/mL (IQR: 1.7–6.6) vs. 1.2 (IQR: 0.2–2.7) for those <35]. Admission colchicine concentrations were highly correlated with a fatal outcome [median 7.8 ng/ml (IQR: 5.8–18.7) vs 1.2 (0–2.3) in survivors]. The area under the receiver operating characteristic curve (AUC-ROC) for uncorrected admission colchicine level was highly predictive of a fatal outcome, and this improved even further with two methods we developed to correct for the expected change with time. The best method had an AUC-ROC of 0.98 (95%CI 0.94–1.00) in predicting death, with 100% sensitivity and 96% specificity at the best cut-point. Discussion: Fatal outcomes and high concentrations were both much more common in the elderly following poisoning with Gloriosa superba. Our findings are consistent with kinetic data after medicinal colchicine ingestion. Conclusions:Gloriosa superba self-poisoning causes significant mortality. High concentration of colchicine is highly predictive of a fatal outcome. Ingestion of Gloriosa superba caused only mild acute kidney injury (AKI) and rhabdomyolysis. [ABSTRACT FROM AUTHOR]

Background: Substituted urea herbicide is widely used in the agricultural industry and is accessible to most people around the globe. Accidental or deliberate poisoning is an anticipated complication of these agrochemical products. Case presentation: We present a 15-year-old girl following deliberate self-ingestion of substituted urea herbicide (Diuron). She was diagnosed with Diuron induced methemoglobinemia and treated with intravenous methylene blue. Later she developed hemolytic anemia and needed 3 units of blood transfusions. Her haemolysis was thought to be due to methylene blue with concomitant Glucose-6-phosphate dehydrogenase (G6PD) deficiency as no other possible cause was found for haemolysis. But on follow-up visits, G6PD deficiency was excluded by the screening test and enzyme level assay. Conclusion: Heamolytic anemia is a possible rare complication that should be anticipated in patients presented with a significant amount of substituted urea herbicide poisoning. Studies have found the possibility of reactive oxygen species accumulation in cells leading to oxidative damage. But we were unable to find any reported cases of haemolysis in humans. We postulate that the inhibition of NADPH production like G6PD deficiency may be the key mechanism that causes haemolysis in humans by creating an acquired G6PD deficiency status in red blood cells. However, further studies are needed to identify the exact mechanism of hemolysis in humans. [ABSTRACT FROM AUTHOR]

Background & Objective: Hyponatremia is a frequently found complication of stroke. However, its impact on stroke outcome is poorly understood. Hence, the purpose of this study was to determine the outcome of strokes in association with hyponatremia. Methods: This was a prospective cohort study conducted at a tertiary referral center in Sri Lanka. The study subjects consisted of 246 patients with confirmed stroke. Patient characteristics, mortality, length of hospital stay and functional outcome by Modified Rankin Scale (MRS) score were assessed to evaluate the effect of hyponatremia (<131mmol/l) on stroke. Early mortality was defined as the total number of deaths occurred by 70 days. The "not favorable" MRS score was defined from 4 to 6. Results: Out of 246 patients, 47 patients (19.1%) developed hyponatremia (95% confidence interval (CI): 14.39, 24.58). The mean day of development of hyponatremia was 1.81days (SD=1.73). Hyponatremia was associated with early mortality (OR=2.08; 95% CI: 1.05, 4.1; P=0.034), increased length of hospital stay (ß=2.37; 95% CI: 1.51, 3.23; P= <0.001) and "not favourable" functional outcome at discharge (OR=2.59; 95% CI: 1.33, 5.05; P=0.005). Kaplan Meier survival curve analysis showed better chance of survival in non-hyponatremic group compared to hyponatremic group (P =0.02). Conclusion: Hyponatremia is associated with early mortality, increased length of hospital stay and unfavorable functional outcome at discharge following stroke. Early detection and correction of hyponatremia may improve stroke outcome. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy of continuous infusion of hydrocortisone with or without chlorpheniramine bolus against early adverse reactions to polyspecific antivenom., Design and Setting: Prospective, double-blind, randomised, placebo-controlled trial at General Hospital, Anuradhapura, Sri Lanka., Subjects: 52 patients with snake envenoming were randomised to receive infusion of hydrocortisone (Group A), hydrocortisone with chlorpheniramine bolus (Group B) or placebo (Group C) during the administration of antivenom., Intervention: Hydrocortisone 1000 mg in 300 mL of normal saline infusion was started 5 min before and continued for 30 min after antivenom. Chlorpheniramine 10 mg intravenous bolus dose was given 5 min after commencement of antivenom., Main Outcome Measures: Occurrence and severity of adverse reactions to antivenom., Results: Adverse reactions were observed in 80% (12/15) of Group A, 52% (11/21) of Group B, and 81% (13/16) of Group C. Reactions were mild or moderate except in two patients. A significant reduction in the number of adverse reactions was seen in Group B compared with the placebo group (difference, 29 percentage points; 95% CI, 0.2 to 58 percentage points). There was no significant difference between Group A and the placebo group., Conclusion: Prophylaxis with a parallel hydrocortisone infusion alone is ineffective in reducing the occurrence of acute adverse reaction to antivenom serum, but combining it with chlorpheniramine seems efficacious.