Browsing by Author "Kalubowila, U."

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Alanine Transaminase (ALT) levels in normal adult Sri Lankans
(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2009) Niriella, M.A.; Dassanayake, A.S.; Kalubowila, K.; Kalubowila, U.; de Silva, A.P.; Wickremasinghe, A.R.; Kato, N.; Makaya, M.; de Silva, H.J.
BACKGROUND : Alanine transaminase (ALT) levels are widely used in screening for liver disease.The upper limit of normal (ULN) of ALT (males 30 IU/l, females 19 IU/l) have been definedfor western populations. Normal levels have not been established for Asian populations. OBJECTIVES: To establish levels of ALT for a normal, 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, liver ultrasound and collection of 10 ml venous blood. The “normal” population was defined as those not using potentially hepatotoxic drugs, safe alcohol consumption (14 units/week for males, 7 units/week for females), absence of fatty liver, and being HBsAg and anti-HCVab negative. ALT levels were estimated by a kit using the Bergmeyer method. The 95th percentile of the ALT levels was taken as the ULN. RESULTS: 3012 subjects participated in the study. The ALT level (U/l) among 831 normal males (mean 36, median 30, SD 20, ULN 68) was significantly higher than that of the 885 normal females (mean 29, median 25, SD 13, ULN 53) (p<0.001,Student's t-test ). CONCLUSION: The ULN for ALT levels of a “normal” Sri Lankan population was higher than observed in western populations. The levels were higher in males. ULN for ALT may need to be redefined for different population groups.
Bleeding from oesophageal ulceration induced by endoscopic variceal ligation for primary prophylaxis
(British Medical Assosiation, 2010) Kumarasena, R.S.; Niriella, M.A.; Kalubowila, U.; de Silva, A.P.; Dassanayake, A.S.; de Silva, H.J.
Comment on : García-Pagán JC et al Spanish Variceal Bleeding Study Group.(Gut. 2009; 58(8):1144-50.) No Abstract Available
Epidemiology of non- alcoholic fatty liver disease (NAFLD) in an urban Sri Lankan population
(Sri Lanka Medical Association, 2008) Dassanayake, A.S.; Rajindrajith, S.; Kasturiratne, A.; Kalubowila, U.; de Silva, A.P.; Mizoue, T.; Makaya, M.; de Silva, H.J.
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is increasing in the Asia-Pacific region. NAFLD can progress from simple steatosis, through steatohepatitis to advanced hepatic fibrosis, cirrhosis and hepatoma. Its prevalence in Sri Lanka is not known. Objective: To investigate community prevalence and risk factors associated with NAFLD among adults in an urban Sri Lankan population. DESIGN, SETTING AND METHODS: The sample consisted of 2985 randomly selected subjects, 35-65 years old, resident in the Ragama Medical Officer of Health area. NAFLD was diagnosed on ultrasound criteria (presence of 2 out of 3: increased hepatic echogenicity compared to spleen or kidney, blurring of hepatic vasculature, deep attenuation of ultrasound signal), and when alcohol intake was <14 units/week for males and <7 units/week for females. Anthropometric and blood pressure (BP) measurements were made; fasting blood glucose, lipid profile and serum alanine transaminase (ALT) were estimated (normal cutoff values were based on revised ATP III criteria of metabolic syndrome for Asians). RESULTS: 974(35%) individuals had NAFLD [mean age 52.8 years (SD 7.3), 605 (62.1%) females]. On multivariate analysis, central obesity (BMI>25kg/m2 and/or waist circumference >90cm for males, >80cm females), elevated fasting plasma glucose (>100mg/dl), elevated diastolic BP (>85mmHg), elevated plasma triglycerides (>150mg/dl), elevated ALT (>twice the upper limit of normal), and low high density lipoprotein cholesterol (<40mg/dl for men, <50mg/dl for women) were significantly associated with NAFLD. CONCLUSIONS: The prevalence of NAFLD among adults in this urban Sri Lankan community is as high as in western populations. NAFLD is associated with factors that constitute the metabolic syndrome.
Epidemiology of Non-Alcoholic Fatty Liver Disease (NAFLD) among adults in an urban Sri Lankan community
(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2008) Dassanayake, A.S.; Rajindrajith, S.; Kasturiratne, A.; Kalubowila, U.; de Silva, A.P.; Mizoue, T.; Makaya, M.; de Silva, H.J.
BACKGROUND - Non-alcoholic fatty liver disease (NAFLD) is increasing in the Asia-Pacific region.NAFLD can progress from simple steatosis, through steatohepatitis to advanced hepatic fibrosis, cirrhosis and hepatoma. Its prevalence in Sri Lanka is not known. OBJECTIVE: To investigate community prevalence and risk factors associated with NAFLD among adults in an urban Sri Lankan population. DESIGN, SETTING AND METHODS: The sample consisted of 2985 randomly selected subjects, 35-65 years old, resident in the Ragama Medical Officer of Health area. NAFLD was diagnosed on ultrasound criteria (presence of 2 out of 3: increased hepatic echogenicity compared to spleen or kidney, blurring of hepatic vasculature, deep attenuation of ultrasound signal), when alcohol intake was <14 units/week for males and <7 units/week for females. Anthropometric and blood pressure (BP) measurements were made; fasting blood glucose and insulin, lipid profile and serum alanine transaminase (ALT) were estimated (normal cutoff values were based on revised ATP III criteria of metabolic syndrome for Asians). RESULTS: 974 (35%) individuals had NAFLD [mean age 52.8 years (SD 7.3), 605 (62.1%) females]. On multivariate analysis, male sex, presence of acanthosis nigricans, central obesity (BMI>25kg/m2 and/or waist circumference >90cm for males, >80cm females), elevated fasting plasma glucose (>100mg/dl),Insulin resistance(HOMA-IR>1), elevated diastolic BP (>85mmHg), elevated plasma triglycerides (>150mg/dl), elevated ALT (> twice the upper limit of normal), and low high density lipoprotein cholesterol (<40mg/dl for men, <50mg/dl for women) were significantly associated with NAFLD. CONCLUSIONS: The prevalence of NAFLD among adults in this urban Sri Lankan community is as high as in western populations. NAFLD is associated with factors that constitute the metabolic syndrome
Is a six hour fast after a rice meal sufficient before upper gastrointestinal endoscopy?
(Informa Healthcare, 2010) de Silva, A.P.; Niriella, M.A.; Perera, H.; Aryasingha, S.; Kalubowila, U.; Manchanayake, J.; Dassanayake, A.S.; Devanarayana, N.M.; Pathmeswaran, A.; de Silva, H.J.
OBJECTIVE: Rice is the staple diet in many Asian countries. Current endoscopic guidelines advice a 6 h fast for solids and a 4 h fast for liquids before the procedure. However, these guidelines focus on a Western type diet. The aim of the study was to determine if a 6 h fast for rice is sufficient prior to upper gastrointestinal endoscopy (UGIE). PATIENTS AND METHODS: After informed consent, 212 patients referred for UGIE, who had no alarm symptoms, were randomized into two groups in preparation for UGIE. Fasting 6 h after a rice meal (R6) or fasting 10 h after a rice meal (R10). All meals contained lentils and an egg, and were isocaloric. Endoscopic vision was graded as poor, average, or good. RESULTS: In the R10 group (n = 107) vision was poor in 2 (1.9%), average in 7 (6.5%), and good in 98 (91.6%). While in the R6 group (n = 105) vision was poor in 30 (28.6%), average in 19 (18.1%), good in 56 (53.3%). The observed difference of percentages among the two groups for endoscopic vision was significant (M-H Chi-Square for trend = 25.67; df = 1; p < 0.001). CONCLUSIONS: Fasting for 6 h after a rice based meal seems inadequate for UGIE. Fasting for 10 h significantly improves endoscopic vision. Current guidelines need to be re-evaluated for populations where rice is the staple diet.
Non-alcoholic fatty liver disease in a rural, physically active, low income population in Sri Lanka
(Biomed Central, 2011) Pinidiyapathirage, M.J.; Dassanayake, A.S.; Rajindrajith, S.; Kalubowila, U.; Kato, N.; Wickremasinghe, A.R.; de Silva, H.J.
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is recognized as a metabolic disorder largely seen in urbanized populations. The purpose of this study was to assess prevalence and risk factors for NAFLD in a rural, physically active, economically deprived population in Sri Lanka. METHODS: By visiting individual households in the community, 35-64 year old adults resident in two selected estates in the Nuwara Eliya District of Sri Lanka, were invited to participate in the study. Blood pressure and anthropometric measurements were made on all participants. Blood samples were obtained for the assay of fasting glucose, serum lipids, serum insulin and alanine aminotransferase. NAFLD was diagnosed on established ultrasound criteria for fatty liver in the absence of hepatitis B and C markers and high alcohol consumption. RESULTS: Of those invited, 403 (65%) participated in the study. Almost all participants were either Indian or Sri Lankan Tamils and 53% were females. Prevalence of NAFLD was 18% in this population. Twice as many males were diagnosed as having NAFLD compared to females. Male sex, high BMI, high waist circumference, high diastolic blood pressure and high plasma glucose levels were significant predictors of NAFLD. CONCLUSION: Nearly one in five people in this predominantly Indian Tamil, rural, physically active, economically deprived population had NAFLD. The condition was associated with constituent features of the metabolic syndrome. These results support studies reporting ethnic variations in disease susceptibility and suggest that genetic factors may also play a role in determining disease risk
Prevalence and risk factors for non-alcoholic fatty liver disease among adults in an urban Sri Lankan population
(Wiley-Blackwell, 2009) Dassanayake, A.S.; Kasturiratne, A.; Rajindrajith, S.; Kalubowila, U.; Chackrewarthy, S.; de Silva, A.P.; Makaya, M.; Mizoue, T.; Kato, N.; Wickremasinghe, A.R.; de Silva, H.J.
BACKGROUND AND AIMS: Non-alcoholic fatty liver disease (NAFLD) is an emerging problem in the Asia-Pacific region. However, its prevalence and risk factors in Asian (especially South Asian) communities is poorly studied. In this study, the aim was to determine the community prevalence and risk factors for NAFLD among adults in an urban Sri Lankan population. METHODS: The study population consisted of 35-64-year-old adults, selected by stratified random sampling. NAFLD was diagnosed on established ultrasound criteria for fatty liver, safe alcohol consumption (< 14 units/week for men, < 7 units/week for females) and absence of hepatitis B and C markers. Blood pressure (BP) and anthropometric measurements were made, and fasting glucose, glycosylated hemoglobin, serum lipids, fasting serum insulin and serum alanine aminotransferase (ALT) were determined. RESULTS: Of the 2985 study participants, 974 (32.6%) had NAFLD (605 [62.1%] women, mean age 52.8 years [standard deviation, 7.3]). On multivariate analysis, obesity, acanthosis nigricans, insulin resistance, elevated diastolic BP, fasting plasma glucose, plasma triglycerides, and ALT twice the upper limit of the reference range or more were independently associated with NAFLD. CONCLUSION: The prevalence of NAFLD among adults in this urban Sri Lankan community is high and is strongly associated with constituent features of the metabolic syndrome.
Prevalence of Acanthosis Nigricans in an urban population in Sri Lanka and its utility to detect metabolic syndrome
(Biomed Central, 2011) Dassanayake, A.S.; Kasturiratne, A.; Niriella, M.A.; Kalubowila, U.; Rajindrajith, S.; de Silva, A.P.; Kato, N.; Wickremasinghe, A.R.; de Silva, H.J.
BACKGROUND: Insulin resistance (IR) plays a major role in the pathogenesis of metabolic syndrome. Acanthosis nigricans (AN) is an easily detectable skin condition that is strongly associated with IR. The aims of this study were, firstly, to investigate the prevalence of AN among adults in an urban Sri Lankan community and secondly, to describe its utility to detect metabolic syndrome. FINDINGS: In a community based investigation, 35-64 year adults who were selected using stratified random sampling, underwent interview, clinical examination, liver ultrasound scanning, and biochemical and serological tests. Metabolic syndrome was diagnosed on revised ATP III criteria for Asian populations. AN was identified by the presence of dark, thick, velvety skin in the neck.2957 subjects were included in this analysis. The prevalence of AN, metabolic syndrome and type 2 diabetes mellitus were 17.4%, 34.8% and 19.6%, respectively. There was a strong association between AN and metabolic syndrome. The sensitivity, specificity, positive predictive value and negative predictive value of AN to detect metabolic syndrome were 28.2%, 89.0%, 45.9% and 79.0% for males, and 29.2%, 88.4%, 65.6% and 62.3% for females, respectively. CONCLUSIONS: AN was common in our study population, and although it did not have a high enough sensitivity to be utilized as a screening test for metabolic syndrome, the presence of AN strongly predicts metabolic syndrome.
The Prone 12 o'clock position reduces ileal intubation time during colonoscopy compared to the left lateral 6 o'clock (standard) position
(BioMed Central, 2011) de Silva, A.P.; Kumarasena, R.S.; Keragala, S.D.P.; Kalubowila, U.; Niriella, M.A.; Dassanayake, A.S.; Pathmeswaran, A.; de Silva, H.J.
BACKGROUND: Ileal intubation is the gold standard for a complete colonoscopy. However, despite evidence of clinical benefit ileoscopy is not always attempted due to perceived technical difficulty. Our aim 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 performed a pilot study using fluoroscopy to determine the best patient position for ileal intubation. This was the prone 12 o'clock position. Patients were colonoscoped in the left lateral position and then randomized to ileal intubation in the 6 o'clock position(LL) or the 12 o'clock (PP) position. RESULTS: 202 consecutive patients were referred for colonoscopy. 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 median (Interquartile Range) ileal intubation time was 12 (10) seconds in the PP and 87 (82) seconds in the LLP (p < 0.0001; Mann-Whitney U test). The ileum was abnormal in 11 (7.5%) patients. CONCLUSIONS: During colonoscopy, the prone 12 o'clock position gives a more direct approach to the ileo-caecal valve and significantly reduces ileal intubation time. TRIAL REGISTRATION: Trial registry: Sri Lanka Clinical Trial Registry Clinical trial registry number: SLCTR/2009/002