Browsing by Author "Perera, K.R."

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Incidence and risk factors for non-alcoholic fatty liver disease in an urban, adult Sri Lankan population – a community cohort follow-up study
(Sri Lanka Medical Association, 2016) Niriella, M.A.; Kasturiratne, A.; de Silva, S.T.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Piyarathna, T.A.C.L.; Vithiya, K.; Dassanayake, A.S.; de Silva, A.P.
INTRODUCTION: In 2007, we reported a 33% prevalence of non-alcoholic fatty liver disease (NAFLD) and its association with PNPLA3(rs738409) gene polymorphism in an urban, adult Sri Lankan population. OBJECTIVES: This study investigated incidence and risk factors for NAFLD after seven years follow-up. METHOD: The study population (42-71-year-olds, selected by age-stratified random sampling from the Ragama MOH area) was screened initially in 2007 and re-evaluated in 2014. On both occasions they were assessed by structured interview, anthropometric measurements, liver ultrasound, biochemical and serological tests. NAFLD was diagnosed on established ultrasound criteria, safe alcohol consumption and absence of hepatitis B/C markers. Non-NAFLD controls did not have any ultrasound criteria for NAFLD. An updated case-control genetic association study for 10 selected genetic variants and incident NAFLD was also performed. RESULTS: 2155/2985 (72.2%) of the original cohort attended follow-up [1244-women, 911-men; mean-age 59.2(SD, 7.7) years]. 1322 [839 women; mean-age 58.9 (SD, 7.6) years] had NAFLD. Out of 795 [466 women] who initially did not have NAFLD, 365 [226 women, mean-age 58.6(SD,7.9) years] had developed NAFLD after 7 years (annual incidence-6.6%). Increased waist circumference [p=0.001], BMI>23kg/m2 [p<0.001] and raised plasma triglycerides [p<0.05] independently predicted incident NAFLD. The updated genetic association study (1310 cases, 427 controls) showed borderline association with NAFLD at 2/10 candidate loci: PPP1R3B(rs4240624), PNPLA3(rs738409) (one-tailed p=0.044 and 0.033, respectively). CONCLUSIONS: In this community cohort follow-up study, the annual incidence of NAFLD was 6.6%. Incident NAFLD was associated with features of metabolic syndrome, and showed tendency of association with PNPLA3 and PPP1R3B gene polymorphisms.
Lean non-alcoholic fatty liver disease (Lean-NAFLD): characteristics and risk factors from a community cohort follow up study
(Sri Lanka Medical Association, 2016) Niriella, M.A.; de Silva, S.T.; Kasturiratne, A.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Piyaratna, T.A.C.L.; Vithiya, K.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is usually associated with obesity. However, some NAFLD patients are lean. We assessed the characteristics and risk factors for lean-NAFLD. METHOD: In a community cohort follow up study (initial screening-2007, re-evaluation-2014), NAFLD was established on USS criteria and exclusion of alcohol overuse and secondary causes. Lean (BMI <23 kg/m2) and non-lean (BMI ≥23 kg/m2) NAFLD were compared. The two groups were compared for differences in gender, diabetes, hypertension, hypertriglyceridemia, low-HDL, weight and waist circumference (WC) at baseline. They were also compared for differences in development of incident diabetes, hypertension, hypertriglyceridemia, low-HDL, and change in weight and WC. RESULTS: 678 (69.6%) individuals with NAFLD detected in 2007 presented for follow up in 2014. 78(11.5%) [males-32(41%); mean-age 53.7(SD-7.1) years] were lean and 600(88.5%) [males-191(31.8%); mean-age 52.3(SD-7.5) years] were non-lean. Hypertension (p=0.007) and a smaller WC (<90cm for males, <80cm for females) (p<0.001) were associated with lean-NAFLD. After 7 years, change in BMI was less (p=0.022) among lean-NAFLD. There were no differences in change in WC or incident metabolic co-morbidities. Of those who did not have NAFLD in 2007, 746 developed incident NAFLD in 2014; lean-NAFLD 193/746 (25.9%) [males-100(51.8%); mean age 59.6(SD-7.5)], non-lean-NAFLD 553/746 (74.1%) [males-201(36.3%); mean age 58.2(SD-7.7)]. On logistic regression analysis, presence of diabetes (p=0.002, OR 2.1) and raised WC (p=0.003, OR 1.7) were associated with incident lean-NAFLD. CONCLUSIONS: Among individuals with NAFLD, lean-NAFLD is associated with hypertension and smaller WC. In the community, diabetes and bigger WC predict incident lean-NAFLD.
Non-resolution of non-alcoholic fatty liver disease (NAFLD) among urban, adult Sri Lankans in the general population: A prospective, cohort follow-up study.
(Public Library of Science, 2019) Niriella, M.A.; Kasturiratne, A.; Beddage, T.; Ediriweera, D.S.; de Silva, S.T.; Perera, K.R.; Subasinghe, C.E.; Kodisinghe, S.K.; Piyaratna, T.C.; Rishikesawan, V.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.
BACKGROUND: There are few studies investigating the natural course of non-alcoholic fatty liver disease (NAFLD) in the community. We assessed resolution of NAFLD in a general population cohort of urban Sri Lankans adults. METHODS: Participants were selected by age-stratified random sampling from electoral lists. They were initially screened in 2007 and re-evaluated in 2014. On both occasions structured interview, anthropometric-measurements, liver ultrasonography, and biochemical/serological tests were performed. NAFLD was diagnosed on ultrasound criteria for fatty liver, safe-alcohol consumption (<14-units/week for men, <7-units/week for women) and absence of hepatitis B/C markers. Non-NAFLD was diagnosed on absence of any ultrasound criteria for fatty liver and safe-alcohol consumption. Resolution of NAFLD was defined as absence of ultrasound criteria for fatty liver. Changes in anthropometric indices [Weight, Body-Mass-Index (BMI), waist-circumference (WC), waist-hip ratio (WHR)], clinical [systolic blood pressure (SBP), diastolic blood pressure (DBP)] and biochemical measurements [Triglycerides (TG), High Density Lipoprotein (HDL), Total Cholesterol (TC), HbA1c%] at baseline and follow-up were compared. RESULTS: Of the 2985 original study participants, 2148 (71.9%) attended follow-up after 7 years. This included 705 who had NAFLD in 2007 and 834 who did not have NAFLD in 2007. Out of 705 who had NAFLD in 2007, 11(1.6%) changed their NAFLD status due to excess alcohol consumption. After controlling for baseline values, NAFLD patients showed significant reduction in BMI, weight, WHR, HDL and TC levels and increase in HbA1c levels compared to non-NAFLD people. Despite this, none of them had complete resolution of NAFLD. CONCLUSION: We did not find resolution of NAFLD in this general population cohort. The observed improvements in anthropometric, clinical and biochemical measurements were inadequate for resolution of NAFLD.nal Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, Japan.
Patterns of alcohol use and occurrence of alcoholic fatty liver disease: a prospective, community cohort, 7-year follow-up study
(Sri Lanka Medical Association, 2017) Niriella, M.A.; de Silva, S.T.; Kasturiratne, A.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Piyaratna, T.A.C.L.; Vithiya, K.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.
INTRODUCTION & OBJECTIVES: Data is limited on alcoholic fatty liver disease (AFLD). We investigated patterns of alcohol use and AFLD, among urban, adult, Sri Lankans. METHODS: Study population (selected by age-stratified random sampling from Ragama MOH-area) was screened initially in 2007 (35-64 years) and re-evaluated in 2014. On both occasions they were assessed by structured-interview, anthropometric measurements, liver ultrasound, biochemical and serological tests. AFLD was diagnosed on ultrasound criteria, unsafe alcohol consumption (Asian standards: males>14units, females>7units per week) and absence of hepatitis B/C markers. Controls were individuals with unsafe alcohol consumption, but had no ultrasound criteria of AFLD. Case-control genetic-association for PNPLA3 (rs738409) polymorphism for AFLD was performed. RESULTS: A total of 2983/3012 (99%) had complete data. 272/2983(9.1%) were unsafe-drinkers [males- 70; mean-age 51.9 (SD-8.0) years]. 86/2983 (2.9%) of the cohort and 86/272 (31.6%) of unsafe-drinkers had AFLD [males-85; mean-age 50.2 (SD-8.6) years]. Males [p<0.001], increased waist circumference (WC) [p=0.001], BMI>23kg/m2 [p<0.001], raised triglycerides (TG) [p<0.001], low education level (LEL-not completed secondary-education) [p<0.01] and low monthly household-income (23kg/m2 [p<0.001], raised TG [p<0.001] and LEL [p<0.05] independently predicted incident-AFLD. The genetic association study [133-cases (combined 2007-2014), 97-controls] showed no association with AFLD at PNPLA3 (rs738409). CONCLUSION: The prevalence of AFLD was 2.9% in 2007 and annual incidence among heavy drinkers, after 7-year follow-up was 5.7%. Incident-AFLD was associated with males, obesity, raised TG and LEL.
Prevalence and risk factors for metabolic syndrome among aging adults in an urban Sri Lankan population
(Sri Lanka Medical Association, 2015) Kasturiratne, K.T.A.A.; Niriella, M.A.; de Silva, S.T.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Piyaratna, T.A.C.L.; Vithiya, K.; Kottachchi, D.; Ranawaka, U.K.; Jayasinghe, C.; Rajindrajith, S.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Metabolic syndrome (MetS) is assumed to be of high prevalence in the Asian region. However, its community prevalence and risk factors in South Asia is poorly studied. We determined the prevalence and risk factors for MetS among adults in an urban Sri Lankan population. METHOD: The study population consisted of 42-71 year old adults, selected by stratified random sampling from the Ragama Medical Officer of Health area. MetS was defined by the International Diabetic Federation criteria with ethnic specific cutoffs. Anthropometric measurements, blood pressure (BP) and body fat distribution estimates were made. Glycosylated hemoglobin, fasting serum lipids, serum alanine aminotransferase (ALT) and serum creatinine (SCr) with estimated glomerular filtration rate (eGFR) were determined. CKD was defined as GFR<60ml/min/1.72m2 (KDIGO/KDOQI classification), USS abdomen was performed to detect fatty liver and non-alcoholic fatty liver disease (NAFLD) was diagnosed on safe alcohol consumption (< 14 units/week for men, < 7 units/week for females) and absence of hepatitis B and C markers. RESULTS: 2155 (1244 [57.7%] women, mean age 59.2 years [SD, 7.7]) participated. 1014 (47.1%) [mean age 59.2 years (SD, 7.7), 256 (28.1%) men; 758 (60.9%) women] had MetS. On multivariate analysis female gender, abnormal total body fat and abnormal visceral fat level (>10%) and presence of NAFLD were independently associated with MetS. Age 65 or more, raised ALT and CKD were not associated with MetS. CONCLUSION: The prevalence of MetS among adults in this aging urban Sri Lankan community was high and is independently associated with female gender, abnormal body fat distribution and presence NAFLD.
Prevalence and risk factors for Non-Alcoholic Fatty Liver Disease among an urban aging adult Sri Lankan population – Ragama Health Study 7-year follow up
(Sri Lanka Medical Association, 2015) Niriella, M.A.; Kasturiratne, A.; de Silva, S.T.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Priyantha, T.A.C.L.; Vithiya, K.; Kottachchi, D.; Ranawaka, U.K.; Jayasinghe, Y.C.; Rajindrajith, S.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: A previous community based study reported a prevalence of 33% for non-alcoholic fatty liver disease (NAFLD) among and urban adult Sri Lankan population. In this follow up study of the same population after 7 years, e reassessed the prevalence and risk factors for NAFLD. METHODS: The study population consisted of 42-71 year old adults, originally 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. Anthropometric measurements, blood pressure (BP) and body fat distribution estimates were made. HbA1c, fasting serum lipids, serum alanine aminotransferase (ALT) and serum creatinine (SCr) with estimated glomerular filtration rate (eGFR) were determined. CKD was defined as eGFR<60ml/min/1.72m2 (KDIGO/KDOQI classification). RESULTS: of the 2985 original study participants, 2155(72.2%) (1244[57.7%] women, mean age 59.2 years [SD, 7.7]) participated in the present study. 1322 [mean age 58.9 years (SD, 7.6), 483(53.0%) men and 839(67.4%) women] had NAFLD. On multivariate analysis, obesity, abnormal body fat distribution, elevated systolic BP, raised plasma triglycerides, and low HDL were independently associated wth NAFLD. Raised diastolic BP, raised HbA1c, raised ALT and presence of CKD were not associated with NAFLD. CONCLUSION: The prevalence of NAFLD among adults in this aging urban Sri Lankan community has increased over 7 years and is independently associated with constituent features of the metabolic syndrome.
Prevalence of non-alcoholic fatty liver disease and its risk factors in an urban adolescent cohort in Sri Lanka
(Sri Lanka Medical Association, 2015) Jayasinghe, Y.C.; Rajindrajith, S.; Kasturiratne, A.; de Silva, S.T.; Niriella, M.A.; Perera, K.R.; Subasinghe, S.K.C.E.; Kodisinghe, S.K.; Priyantha, T.A.C.L.; Vithiya, K.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: High prevalence of non-alcoholic fatty liver disease (NAFLD) is reported among adults in Sri Lanka. Although limited data on childhood obesity is available, community prevalence of NAFLD and its risk factors among adolescents is unknown. We investigated the prevalence and risk factors for NAFLD in an urban adolescent birth cohort in Sri Lanka. METHODS: The study population consisted 14 year-olds, belonging to the birth cohort born in 2000, residing in the Ragama Medical Officer of Health area. NAFLD was diagnosed based on established ultrasound criteria. Anthropometric measurements, blood pressure (BP) and total body fat distribution (TBF) estimates were made. Fasting blood sugar, serum insulin, fasting serum lipid and serum alanine aminotransferase (ALT) levels were measured. Independent predictors of NAFLD were determined by multivariate analysis. RESULTS: 508 adolescents [263 (51.8%) girls] participated in the study. Overall 44 (8.7%) had NAFLD [22 (8.4%) girls]. 46 (18.8%) boys and 54 (20.5%) girls had a BMI above the equivalent of 23 kgm2in adults. 44 (17.1%) boys and 77 (29.3%) girls had elevated TBF. On multivariate analysis, having an elevated BMI [OR=10.1 (95% confidence interval: 3.9-29.2) and elevated TBF [OR=4.4 (95% confidence interval: 1.5-12.8)] were independently associated with NAFLD. CONCLUSION: The prevalence of NAFLD among adolescents in this urban Sri Lankan community is high, and is strongly associated with obesity and abnormal TBF. Despite elevated TBF being commoner in girls, we found no gender differences in prevalence of NAFLD among adolescents in this urban Sri Lankan community is strongly associated with obesity and abnormal TBF. Our findings emphasize the needs to access these risk factors through preventive and screening programs.
Psychological distress and factors associated with psychological distress among preventive health care workers involved in COVID-19 prevention work in selected districts of Sri Lanka
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Dissanayake, D.M.S.Y.; Rathnayaka, R.M.S.M.; Perera, K.R.; Gamage, D.H.P.; Fernando, W.A.R.S.; Nazeer, I.; Palihawadana, V.
Introduction: The COVID-19 pandemic has gravely affected the mental health of preventive healthcare workers (HCW) in Sri Lanka. Objectives: The study aimed to describe psychological distress, its associated factors and coping mechanisms among preventive HCW involved in COVID-19 prevention in Sri Lanka. Methods: A descriptive cross-sectional study was conducted among 158 preventive HCW [Medical Officers of Health (MOH), Assistant MOH, Public Health Inspector (PHI) and Supervising PHI] at MOH offices in Colombo, Gampaha, Kalutara, Matara and Badulla districts from November 2020 to March 2021. Data collection utilized convenience sampling. Psychological distress level was determined by Kessler’s Psychological Distress Scale 10. Results: Among the respondents 57.6% were psychologically distressed. The significant associations were, age above 40 years (p=0.019), having pregnant women at home (p=0.032), work experience less than 15 years (p = 0.007), unavailability of sufficient PPE (p=0.024), stressful work environment (p=0.013), dissatisfaction on control and prevention strategies (p = 0.029). Distress between PHIs (Mean= 22.0) and Medical Officers (Mean= 21.2) was not significant (t=0.580, p=0.563). Commonest coping mechanism of distress was maintaining a positive attitude (77.7%). Negative coping mechanisms included resorting to alcohol (8.2%), smoking (5.1%) and drugs (0.6%). Conclusions: Over half of the participants were psychologically distressed. Participant’s age, presence of children and pregnant women at home, work experience, unavailability of sufficient PPE, dissatisfaction on current prevention and control strategies and stress at workstation were reported to have a significant association with psychological stress. Commonest positive coping strategy of stress was maintaining a positive attitude towards the pandemic.
A Randomized control study of audio versus visual distraction to reduce patient discomfort during colonoscopy
(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2015) de Silva, A.P.; Nandamuni, Y.; Nanayakkara, S.; Perera, K.R.; Kodisinghe, S.K.; Subasinghe, S.K.C.; Niriella, M.A.; Dassanayake, A.S.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION : Colonoscopy can cause anxiety and discomfort in patients who undergo this procedure. Heavy sedation and analgesia as premedication can lead to complications in the elderly and those with co-morbidities. This has led to an interest in use of audio-visual distraction during the colonoscopy as an adjunct. Our aim was to compare effects of audio (AD) versus visual distraction (VD) in reducing discomfort and need for sedation during colonoscopy. METHODS : Consecutive consenting patients who were undergoing colonoscopy were randomized into three groups: one group was allowed to listen to the music of their choice (AD), the second group was allowed to watch a film of their choice (VD) (using SONY head mounted display:HMZ-T3W-H) and the third group with neither during colonoscopy acted as a control (C). Patient controlled sedation (PCS) was administered to all three groups. We used 25 mg pethidine in 5 mg aliquots and 2.5 mg midazolam in 0.5 mg aliquots. All patients were assessed for pain, number of ‘top-ups’ of sedation, total dose of pethidine and midazolam, patient cooperation and willingness to repeat the procedure. RESULTS :There were 77 patients [AD, n=25 (16 males, median age 57 years); VD, n=26, (18 males, median age 58 years); C, n=26 (10 males, median age 59 years)]. The AD group had significantly less pain (p=0.048), number of ‘top-ups’ of sedation (p=0.03), total doses of pethidine (p=0.03) and midazolam (p=0.032), and better patient cooperation (p=0.001) compared with controls. There was no difference between the AD (72%) and VD (73%) groups in willingness to undergo a repeat procedure. Conclusions AD reduces pain and discomfort and the requirement for sedation and seems a useful and simple adjunct to low dose sedation use during colonoscopy.
A randomized control study of audio versus visual distraction to reduce patient discomfort during colonoscopy
(Sri lanka Medical Association, 2015) de Silva, A.P.; Nandamuni, Y.; Rajapakshe, N.N.; Nanayakkara, S.; Perera, K.R.; Kodisinghe, S.K.; Subasinghe, S.K.C.; Niriella, M.A.; Dassanayake, A.S.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Colonoscopy can cause discomfort and anxiety in patients. Heavy sedation as premedication can lead to complications in elderly and those with co-morbidities. This has led to possible use of audio-visual distraction during the procedure. We compared effects of audio versus visual distraction in reducing discomfort during colonoscopy. METHOD: 131 consecutive patients who underwent colonoscopy were randomized into three groups: allowed to listen to music of their choice during colonoscopy (AD), allowed to watch a film of their choice (VD) and neither as control (C). Patient controlled sedation (PCS) was administered to all three groups; 25 mg pethidine in 5 mg aliquots and 2.5 mg midazolam in 0.5 mg aliquots. All patients were assessed for pain, number of 'top-ups' of sedation, total dose of pethidine and midazolam and patient cooperation and willingness for a repeat procedure. RESULTS: There were 131 patients (AD=43; VD=44; O44). The AD group had significantly less pain and discomfort (p=0.033) compared to VD and Cgroups. There was no significant difference in number of 'top-ups' of sedation, total doses of pethidine and midazolam among the groups. Better patient cooperation (p=0.002) was evident in ADgroup compared with VD and C groups. There was nt> difference between the AD and VD groups in willingness to undergo a repeat procedure. CONCLUSION: Listening to music of your choice during colonoscopy seems to reduce pain and discomfort and increase the patients' cooperation. This may be a useful and simple tool in screening colonoscopy.