Browsing by Author "Kalubowila, K.V.U."

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Are alanine transaminase (ALT) levels useful to screen for Non-alcoholic Fatty Liver Disease (NAFLD) in the community?
(Sri Lanka Medical Association, 2009) Niriella, M.A.; Dassanayake, A.S.; Kalubowila, K.V.U.; Rajindrajith, S.; de Silva, A.P.; Wickremasinghe, A.R.; Kato, N.; Makaya, M.; de Silva, H.J.
BACKGROUND: The value of ALT in screening for NAFLD is controversial. Furthermore, the upper limit of normal (ULN) ALT is defined for western populations but not Asian populations. Objectives: To establish ULN ALT for an urban adult Sri Lankan population, and assess its value in screening for NAFLD in that community. METHODS: This was part of a community based study on non-communicable diseases - the Ragama Health Study. 35-64y adults were selected using stratified random sampling. They were screened by structured interview and liver ultrasound, and 10ml venous blood .was obtained. "Normal" adults were defined as those not using potentially hepatotoxic drugs, drinking alcohol within safe limits, HBsAg and anti-HCV negative, and no fatty liver on ultrasound. NAFLD was diagnosed on established ultrasound criteria, .safe alcohol consumption and being HBsAg and anti-HCV negative. The 95th percentile of ALT was taken as the ULN for this population. RESULTS: 3012 subjects participated in the study. Those with NAFLD (n=930) and "normals" (n=1716) were matched for age and sex. ULN ALT (U/l) was significantly higher in normal males than females (68 vs. 53; p<0.001, Student's t-test). ALT was significantly higher in NAFLD than normals (p<0.001). However, ALT>ULN had a sensitivity [positive predictive value (PPV)] of only 14.5% (58%) for males and 11.5% (60%) for females with NAFLD. When ULN ALT cut offs for western populations (males 30 IU/1, females 19 IU/1) were used, although sensitivity considerably increased, the PPV to detect NAFLD decreased.further [sensitivity (PPV): males 79.4% (42%); females 94.6% (41%)]. CONCLUSIONS: Although ALT was significantly higher in NAFLD than in normal adults, it does not seem a useful test to screen for NAFLD in the community.
Is a six hour fast after a rice meal sufficient before upper gastrointestinal endoscopy?
(Sri Lanka Medical Association, 2009) de Silva, A.P.; Niriella, M.A.; Perera, N.J.A.H.D.; Aryasingha, J.V.S.; Kalubowila, K.V.U.; Manchnayake, M.M.J.H.; Dassanayake, A.S.; Pathmeswaran, A.; de Silva, H.J.
BACKGROUND: Rice is the staple diet in many Asian countries. Current endoscopic guidelines advise a 6 hour fast for solids and a 4 hours fast for liquids before the procedure. These guidelines focus on a western type diet. AIMS: To determine if a six hour fast for rice is sufficient prior to upper gastrointestinal endoscopy. (UGIE). METHODS: In a pilot study using real time ultrasound scanning we found that the time taken for complete gastric emptying after a standard rice meal was 10 hours. After informed consent, 133 patients referred for UGIE without alarm symptoms, were randomised into two groups in preparation for UGIE: fasting 6 hours after a rice meal (R6) or fasting 10 hours after a rice meal (RIO). All meals contained dhal and an egg, and were isocaloric. Endoscopic vision was graded as poor, average or. Good. The endoscopist was not aware of the type of preparation. RESULTS: RIO - vision poor in 1 (1.4%), average in 3 (4.3%), good in 66 (94.3%). R6 - vision poor in 13 (20.6%), average in 10 (15.9%), good in 40 (63.5%). The observed difference of percentages among the two groups for endoscopic vision was significant (Pearson Chi-Square; P<0.001). CONCLUSION: Fasting for 6 hours after a rice based meal seems inadequate for UGIE. Fasting for 10 hours significantly improves endoscopic vision. Current guidelines need to be re-evaluated for the Asian setting.
Is Acanthosis Nigricans a useful clinical screening test for non-alcoholic fatty liver disease(NAFLD) in resource poor settings
(Elsevier, 2009) Niriella, M.A.; Dassanayake, A.S.; Kalubowila, K.V.U.; de Silva, A.P.; Wickremasinghe, A.R.; Kato, N.; Makaya, M.; de Silva, H.J.
BACKGROUND: Acanthosis nigricans (AN) is an easily detectable papillomatosis and hyperkeratosis of the skin associated with insulin resistance. Insulin resistance is widely accepted as the underlying cause of Non- Alcoholic Fatty Liver Disease (NAFLD). Ultrasonography is the currently accepted tool to screen for NAFLD in the community, but is expensive and needs expertise. OBJECTIVES: To investigate whether AN would be an useful screening test for NAFLD in an adult Sri Lankan population. METHODS: This study was part of a community based investigation −Ragama Health Study (RHS). The study population consisted of 35−64 year old adults, selected using stratified random sampling. Consenting adults were screened by a structured interview, clinical examination, liver ultrasound and collection of 10 ml venous blood. NAFLD was diagnosed based on established ultrasound criteria for fatty liver, safe alcohol consumption and absence of serum markers for Hepatitis B and C. AN was identified by the presence of dark, thick, velvety skin in the neck, body folds and creases. Results: 3012 subjects participated in the study. AN was present significantly more frequently among NAFLD patients than normal individuals in both males (37.9% vs. 4.8%, p <0.001) and females (39.8% vs. 5.8%,p<0.001). The sensitivity, specificity, and positive predictive value of AN for NAFLD was 37.9%, 95.2%, 78.0% for males and 39.8%, 94.2%, and 81.3% for females respectively. CONCLUSION: AN is significantly more common in NAFLD than normal individuals. Although AN has a high specificity, it is not an useful test to screen for NAFLD in the community.
The prone 12 o'clock position reduces Heal intubation time during colonoscopy compared to the left lateral 6 o'clock (standard) position
(Sri Lanka Medical Association, 2010) de Silva, A.P.; Kumarasena, R.S.; Keragala, B.S.D.P.; Kalubowila, K.V.U.; Niriella, M.A.; Dassanayake, A.S.; Pathmeswaran, A.; de Silva, H.J.
OBJECTIVES: Ileal intubation is the gold standard for evidence of a complete colonoscopy. However, despite evidence of clinical benefit, ileoscopy is not always attempted due to perceived technical difficulty. The aim of this study was to compare time taken for ileal intubation using a new position - the prone 12 o'clock position (PP) - with the standard method (left lateral 6 o'clock position-LLP).METHODS: We first performed a pilot study using fluoroscopy to determine the best patient position for the most direct (end-on) approach to the ileo-caecal valve. The prone 12 o'clock position appeared to be the best position. We then randomized consecutive patients having colonoscopy, aged 18-80 years and who were not pregnant, to undergo ileoscopy in the standard position or the prone 12 o'clock position. RESULTS: Colonoscopy was performed on 150 patients [82 females, mean (SD) age 53 (16) years]. 75 patients were randomized for ileal intubation in the PP and 75 patients in the LLP. Overall, the ileum was successfully intubated in 145 (96%) patients [74 (98.7%) in the PP and 71 (94.7%) in the LLP]. The mean (SD) ileal intubation time was 26.4 (63) seconds in the PP and 96.9 (112) seconds in the LLP (p0.000l; Student t-test). The ileum was abnormal in 11 (7.5%) patients: 6 in the PP group and 5 in toe LLP group. CONCLUSIONS: During colonoscopy, the prone 12 o'clock position gives a more direct approach to the ileo-caecal valve and reduces ileal intubation time when compared to the standard left lateral 6 o'clock position.