A comparison of changes in venous lactate and haematocrit during fluid resuscitation of dengue haemorrhagic fever.

BACKGROUND: Judicious fluid resuscitation and stringent monitoring of clinical parameters improve the outcome of dengue haemorrhagic fever (DHF). The usefulness of serum lactate to monitor adequate fluid therapy has not been adequately explored. METHODS: An observational study was conducted in Sri Lanka, recruiting 162 DHF patients within 12 h of diagnosis of the critical phase. Venous lactate level was measured at each time of performing haematocrit (HCT), using a prevalidated handheld lactate analyser. RESULTS: The median venous lactate level was 1.3 (range 0.3-6) mmol/L in the study population and 154 (95.2%) patients had median lactate levels of <2 mmol/L. The HCT values in the study participants ranged from 28 to 62, with a median value of 43. There was no statistically significant correlation between the lactate and HCT values obtained at the same time. A significant reduction in venous lactate was not observed following the administration of fluid boluses. The expected reduction in HCT was seen following the administration of dextran and crystalloid/dextran combination. The maximum recorded lactate level positively correlated with the duration of hospital stay. CONCLUSIONS: This study concludes that venous lactate is not an appropriate parameter with which to monitor the response to fluid therapy in uncomplicated DHF.

'Modified STOPP-START criteria for Sri Lanka'; translating to a resource limited healthcare setting by Delphi consensus.

BACKGROUND: 'Screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START)' criteria is a useful tool to assess the appropriateness of medicines among older adults. However, the original STOPP/START criteria developed in the West, may not be directly applicable to resource limited healthcare settings like Sri Lanka. Hence, we aimed to modify STOPP/START criteria (Version 2) to suit Sri Lanka. METHOD: Two investigators (a clinical pharmacologist and a pharmacist) reviewed and flagged criteria that were unfeasible to Sri Lanka based on their previous research experiences on using STOPP/START version 1. A Delphi consensus methodology was conducted among six experts, including geriatricians, clinical pharmacologists, physicians and a pharmacist, to review and assess each criterion (including the ones flagged by the researchers) for suitability to Sri Lanka. RESULTS: Two Delphi validation rounds were conducted. A final meeting was held with the participation of all experts to resolve disagreements and to establish 100% consensus. The expert panel agreed on a list of 105 criteria, including 70 STOPP and 35 START criteria, indicating an 8% reduction in criteria compared to the original version. Modifications included complete removal (n = 11), re-wording (n = 25), splitting (n = 1) of original criteria and adding a new criterion (n = 1). Main reasons for modifications were unavailability of some medicines in the country, unavailability or inaccessibility of specific clinical information required for assessment of criteria, and adherence to treatment guidelines commonly used in the country. CONCLUSION: A list of 'Modified STOPP/START criteria for Sri Lanka' was developed. These criteria are currently being validated through a multi-centre study.

Lower urinary tract symptoms; an undetected cause for morbidity in adults.

INTRODUCTION: Lower urinary tract symptoms (LUTS) have been recognised as a cause of distress among adult men and women. In view of the increasing elderly population in Sri Lanka, the number of individuals with LUTS is likely to increase. OBJECTIVES: To determine the prevalence and severity of LUTS in a community sample of older men and women residing in an urban area. DESIGN: Cross-sectional descriptive study. SETTING: Field practice area of National Institute of Health Sciences, Kalutara. METHODS: Households were selected using probability proportionate to the size (PPS) method. 985 adult men and women (above 40 years of age) were interviewed by Public Health Midwives regarding LUTS using an interviewer-administered questionnaire. The questions were adapted from ICSmale questionnaire and the Bristol Female Lower Urinary Tract questionnaire. RESULTS: 209 (47%) men and 338 (62.6%) women reported at least one urinary symptom. In men, urgency, nocturia, dysuria and frequency were the most prevalent symptoms with stress incontinence being the least prevalent. Majority of the symptoms showed an increase in prevalence with age. In women, dysuria, stress incontinence, urgency and frequency were the most prevalent symptoms. Hesitancy, intermittency, and stress and urge incontinence were the most bothersome symptoms among men, and urge and stress incontinence among women. CONCLUSIONS: Prevalence of LUTS was high in our study population.