C.E. de Silva

Yellow oleander poisoning in Sri Lanka: outcome in a secondary care hospital

Cardiac toxicity after self-poisoning from ingestion of yellow oleander seeds is common in Sri Lanka. We studied all patients with yellow oleander poisoning (YOP) admitted to a secondary care hospital in north central Sri Lanka from May to August 1999, with the objective of determining the outcome of management using currently available treatment. Patients with bradyarrhythmias were treated with intravenous boluses of atropine and intravenous infusions of isoprenaline. Temporary cardiac pacing was done for those not responding to drug therapy. During the study period 168 patients with YOP were admitted to the hospital (male:female=55:113). There were six deaths (2.4%), four had third-degree heart block and two died of undetermined causes. They died soon after delayed admission to the hospital before any definitive treatment could be instituted. Of the remaining 162 patients, 90 (55.6%) patients required treatment, and 80 were treated with only atropine and/or isoprenaline while 10 required cardiac pacing in addition. Twenty-five (14.8%) patients had arrhythmias that were considered life threatening (second-degree heart block type II, third-degree heart block and nodal bradycardia). All patients who were treated made a complete recovery. Only a small proportion of patients (17%) admitted with YOP developed life-threatening cardiac arrhythmias. Treatment with atropine and isoprenaline was safe and adequate in most cases.

Twin pregnancy chorionicity determination in a tertiary care setting

Ultrasound determination of chorionicity is most reliable before 14 weeks and subsequently reduces in accuracy with advancing gestation. The aim of this study was to evaluate the accuracy of chorionicity determination in a birth cohort of twin pregnancies. Antenatal ultrasound determination of chorionicity in twin pregnancy was undertaken at suboptimal period of gestation in over twothirds of twin pregnancies. Even in the first trimester of pregnancy, the accuracy of chorionicity determination was lower than previously reported.