Browsing by Author "Keragala, B.S.D.P."

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Liver dysfunction and its outcome in patients with dengue infection
(Sri Lanka Medical Association, 2010) Kumarasena, R.S.; de Silva, A.P.; Keragala, B.S.D.P.; Premaratna, B.A.H.R.; Premawardhena, A.P.; Jayamanna, S.F.; de Silva, H.J.; de Silva, S.T.
OBJECTIVES: To determine the frequency and severity of liver dysfunction due to dengue infection among hospitalised patients. METHOD: A retrospective, descriptive study was done at University Medical Unit, Colombo North Teaching Hospital. Records of all serologically confirmed dengue (IgM antibody positive) patients admitted from 1/1/09-31/1/10 were analysed. Results of blood tests, imaging and serology were noted. A diagnosis of acute liver failure was made in patients with an INR >1.5 together with hepatic encephalopathy. Patients on hepatotoxic drugs, alcohol abusers and patients with known chronic liver diseases (total 14 patients) were excluded from the analysis. RESULTS: Of 328 patients (58.5% female), aged 14-68 years (mean 38) with confirmed dengue, 169 (51.5%) had dengue fever, 147 (34.2%) dengue haemorrhagic fever (grade 1 and 2) and 47 (14.3%) dengue shock syndrome. 257 (78.4%) had elevated hepatic transaminases of whom 153 (46.6%) had minimal elevation (<3 times upper limit) and 38 (11.6%) had >1000 IU/1. Of those with elevated transaminases, 94% had AST: ALT >1. Thirteen (3.9%) with transaminases >1000 IU /I developed acute liver failure of whom 2 died. In 3 patients of whom 1 died, ischaemic liver injury (prolonged shock followed by rapid rise in ALT>AST) probably accounted for abnormal transaminases. Presence of nausea or vomiting at the time of AST/ALT>1000 was the only independent risk factor for development of acute liver failure (pO.OOl) on multivariate analysis. CONCLUSION: Abnormal liver function was common among hospitalised dengue patients. Liver failure was uncommon, and nausea or vomiting at the time of AST/ALT>1000 predicted its development.
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.
The Utility of the ALT: AST ratio as an early screening test for dengue fever
(Sri Lanka Medical Association, 2010) de Silva, A.P.; Keragala, B.S.D.P.; Kasturiratne, A.; Kumarasena, R.S.; Dassanayake, A.S.; Premaratna, R.; Dassanayake, K.M.M.P.; de Silva, H.J.
OBJECTIVES: Early diagnosis of dengue infection is important to reduce morbidity and mortality. The widely used antibody test becomes positive only after the fifth day of fever, and viral diagnosis by PCR is expensive and not widely available. Liver transaminases are commonly elevated in dengue, and the aspartate aminotransferase: alanine aminotransferase (AST: ALT) ratio is >1. This study was done to determine the utility of the AST/ALT ratio >1 as a test to detect dengue infection early. Methods: We recruited all patients aged 18 to 65 years who were not pregnant, with fever less than three days admitted to hospital from September 2009 to January 2010 during the current dengue epidemic. In addition to routine invetigations and management, all patients had liver transaminases (AST and ALT) measured on day 3, and dengue IgM antibody on day five of the illness. Statistical analysis was performed using SPSS 16. RESULTS: 117 patients [65 males; mean age 32 years (SD =14.7)] were recruited. 83/117 (70.9%) were confirmed as dengue infection. AST: ALT >1 was significantly more common in dengue compared to other short duration fevers (75/83 vs 13/34, pO.OOl; Chi squared test). AST: ALT ratio >1 on day 3 had a sensitivity of 90.4% and specificity of 61.8% to detect dengue. The positive predictive value and negative predictive value of the ratio were 85.2% and 72.4% respectively. CONCLUSIONS: AST/ALT ratio seems a useful test to differentiate dengue fever from other short duration febrile illnesses in an epidemic setting.