Browsing by Author "Perera, G.A.M.H.E."

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Anti-tuberculosis drug inducd hepatitis:a Sri Lankan experience
(Sri Lanka Medical Association, 2006) Senaratne, W.V.; Pinidiyapathirage, M.J.; Perera, G.A.M.H.E.; Wickremasinghe, A.R.
OBJECTIVE: To assess the incidence of anti-tuberculosis (TB) drug induced hepatitis (AIH) in Sri Lankan patients, determine risk factors of AIH, and to address management options in AIH. DESIGN: A prospective study. SETTING: Chest Hospital, Welisara, Sri Lanka, from April 2001 to April 2002. PATIENTS: Seven hundred and eighty three patients with a confirmed diagnosis of TB and resident in the Colombo and Gampaha districts who presented to Chest Hospital, Welisara, Sri Lanka. METHODS: WHO recommended treatment was commenced in all cases. AIH was diagnosed when patients complained of decreased appetite with nausea or vomiting and elevated serum bilirubin (SB; >1.1 mg/dL) or elevated serum alanine transferase (ALT; > 3 times upper limit of normal).RESULTS: Of 783 enrolled patients, 74 (9.5%) developed AIH, the majority (58%) developing AIH within the first 2 weeks of the intensive phase of treatment. AIH was more common among patients over 60 years (p = 0.018), who developed pulmonary TB (p = 0.028), and in patients weighing 33-55 kg (p = 0.004). Age, weight and rifampicin overdosage were significant predictors of AIH. Of the 74 AIH patients, standard treatment was restarted in 60, treatment modified in six, two defaulted and six died. CONCLUSIONS: The incidence of AIH in Sri Lanka is 9.5% in treated patients. AIH was associated with age, low body weight and rifampicin over dosage.
Anti-tuberculous drug induced hepatitis in Sri Lankan patients
(Sri Lanka Medical Association, 2007) Senaratne, W.V.; Pinidiyapathirage, M.J.; Perera, G.A.M.H.E.; Wickremasinghe, A.R.
OBJECTIVE: To determine the incidence and risk factors of anti-TB drug induced hepatitis (AIH) in Sri Lankan patients and to address management options. DESIGN, SETTING AND METHODS: 783 patients with a confirmed diagnosis of TB who presented to a unit at Chest Hospital, Welisara from April 2001 to April 2002 were recruited for a follow up study. WHO category 1 for new and category 2 for re-treatment cases was commenced using single drug formulations. Doses were based on three weight bands. AIH was diagnosed when patients complained of decreased appetite, nausea/vomiting and elevated serum biliru&n (SB) l.lmg/dl or elevated serum alanine transferase (ALT) 3 times upper limit of normal (ULN). Results: 74 patients (9.5%) out of 783 enrolled patients developed AIH; the majority (58%) developing AIH within the first two weeks of the intensive phase of treatment. AIH was commoner among patients over 60 years (p=0.018), with pulmonary TB (p=0.028) and weighing 33-35 kg (p=0.004). Using regression analysis, age, weight and rifampicin overdosage were significant predictors of AIH. Of the 74 AIH patients, standard treatment was restarted in 60 and treatment was modified in six; two defaulted and six died. Conclusions: Incidence of AIH among Sri Lankan patients is 9.5%. They develop symptoms of hepatitis when ALT levels rise to three times the ULN lowering the threshold for diagnosis of AIH. Old age, 33-55 kg weight band and rifampicin over dosage are risk factors for AIH. Majority (81%) of AIH patients could be restarted on standard treatment.
Defaulter rate and predictors of defaulting of patients on anti-tuberculosis treatment
(Sri Lanka Medical Association, 2006) Pinidiyapathirage, M.J.; Senaratne, W.V.; Perera, G.A.M.H.E.; Wickremasinghe, A.R.
OBJECTIVE: To determine the defaulter rate and risk factors of defaulting of patients on anti- tuberculosis treatment. METHODS: All consenting patients with a confirmed diagnosis of tuberculosis admitted to a unit at Chest Hospital, Welisara were recruited from April 2001 to April 2002 for follow up. Personal and follow up data were recorded in a pre-tested questionnaire and data sheet respectively. A defaulter was defined as a patient who interrupted treatment for more than two consecutive months before the end of the course of treatment. RESULTS: Of the 892 patients recruited, 770 were new cases and 122 were relapses. Defaulter rate was 10.3%(95%CI:8.3%-12.6%) and 30.3% (95% CI:22.7%-38.1%) among new cases and re-treatment cases respectively in the intensive phase of treatment and 10.9 % (95% CI:8.7%-13.3%) and 16.5% (95% CI: 9.7- 25.5) respectively in the continuation phase. 90% of new cases and 94% of re-treatment cases were sputum positive at diagnosis. Altogether 205 (22.9%) defaulted treatment (95% CI: 20.3%-25.8%). Age, sex, occupational status, family income, regular alcohol consumption, current smoking and substance abuse were independently significantly associated (p<0.05) with defaulting. Defaulters were significantly different (p<0.05) from compliers with regard to the site of the lesion, being in new or re-treatment category (type), acid-fast bacilli in sputum and extent of lung involvement. Using logistic regression analysis, a regular smoker (OR=1.9), a smear positive defaulter (OR=2.4) and a patient having involvement of more than 3 zones of the lung on chest x-ray examination (OR=0.5) was more likely to default as compared to a patient who did not smoke regularly, a smear positive patient who had relapsed after taking the full course of treatment and a patient with less lung involvement, respectively. Of the occupational categories, skilled and unskilled labourers were most likely to default (OR=2.03) followed by sales personnel (OR=2.00) as compared to those unemployed or home-bound. Conclusions: A high defaulter rate of 23% was observed among the study participants. Smoking status, occupation, type of patient, and extent of lung involvement are predictors of defaulting.