Browsing by Author "Waraketiya, P.R."

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Clostridium difficile infection in inflammatory bowel disease patients in Sri Lanka
(Sri Lanka Medical Association, 2012) Waraketiya, P.R.; de Silva, A.P.; Wijesinghe, N.T.; Waraketiya, P.R.; Wijewantha, H.S.; Chandrasena, L.G.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION: Over the last decade an increase in Clostridium difficile associated diarrhoea (CDAD) has been observed among Caucasians (1%). The frequency of CDAD is very high in Caucasian IBD patients; 8.7% in one study of IBD patients in remission. This has led to guidelines recommending routine screening for CDAD in IBD. Clinical impressions are that CDAD is rare among Sri Lankans. AIMS: This study was conducted to determine the frequency of CDAD in a cohort of Sri Lankan IBD patients and healthy controls. METHODS: Cases [n=154] were histologically confirmed IBD patients, in clinical remission. The controls [n=100) were non-IBD patients who presented to medical clinics without diarrhoea and with no exposure to antibiotics for up to 8 weeks prior to recruitment. Immunoassays for Clostridium difficile toxins A and B were performed on stool samples obtained from both groups. RESULTS: The frequency of CDAD was 0.7% (n=l) and 0% (n=0) in IBD patients and controls respectively. CONCLUSIONS: Compared to Caucasians, CDAD was very rare in this cohort of Sri Lankans, including those with IBD. Routine screening for CDAD does not seem necessary in our setting.
Developing a severity index on day 4 to predict severe dengue infection in adults
(Sri Lanka Medical Association, 2012) Wijewantha, H.S.; Premaratna, R.; Nishad, A.A.N.; Mabharana, I.D.M.; de Silva, A.P.; Waraketiya, P.R.; Niriella, M.A.; de Silva, H.J.
INTRODUCTION: Dengue causes high morbidity and mortality among adults in Sri Lanka. Early prediction of severe illness would help to reduce morbidity and mortality. Studies to identify predictors of severe dengue in adults are sparse. AIMS: To identify predictors of severe dengue infection by the fourth day of illness. Methods: Symptoms, signs and investigation results on the 4th day of illness were compared between two groups of patients with serologically confirmed dengue over 6 months from 1st of March 2011; Group A (severe illness: evidence of fluid leakage, compensated shock, profound shock). Group B (non-severe illness). RESULTS: Of 117 adults 9meanage 32 yrs (SD= 13.3) and 95 males) 27 fell into Group A and 90 into group B. On day 4 of illness serum aminotransferases (AST and ALT) were significantly higher in Group A than group B [AST: 260 iu/1 (SD=168.8] vs 145 iu/l(SD 135.11), p=0.005; ALT: 247 iu/1 (SD= 161.5) vs 105 iu/1 (SD= 91.5), p=0.002]. Overall AST (r=0.3, p=0.038) and ALT (r=0.3, p=0.045) had a positive correlation with haematocrit (PCV). An index was developed using stepwi-se multivariate discriminant function analysis to predict severe infection by the 4th day. A severity Index, [(0.082 x PCVD4) + (0.02 x PlateIetD4) + (-0.006 x ASTD4) -3.677] of <-0.258 predicted severe infection with 73.7 % specificity, 73.8% sensitivity, 56% positive predictive value and 86% negative predictive value. CONCLUSIONS: A severity index <-0.258 calculated on the 4th day of illness may predict severe infection among adult dengue patients. This must now be validated prospectively.
Incidence of inflammatory bowel disease in Gampaha district: details of the Sri Lankan component of the Asia-Pacific Crohn's and Colitis Epidemiology Study
(Sri Lanka Medical Association, 2014) Kasturiratne, A.; Mufeena, M.N.; Mettananda, K.C.D.; Fernandopulle, N.; Rajindrajith, S.; Waraketiya, P.R.; Weerasinghe, S.K.; Ranaweera, A.; Hewavisenthi, S.J.de S.; de Silva, A.P.; de Silva, H.J.
The aim of this report is to provide details of the methodology and results of the Sri Lankan component of the Asia-Pacific Crohn's and Colitis. Epidemiology Study. Fourteen state and private hospitals with specialist services in the Gampaha and Colombo districts were kept under surveillance over a 12 month period to recruit patients with newly diagnosed Inflammatory Bowel Disease (IBD) who were permanent residents of the Gampaha district. Thirty five cases (ulcerative colitis-21, Crohn's disease-13, IBD-undetermined-1) were detected, giving a crude annual IBD incidence of 1.59 per 100,000 population.
Prevalence of eosinophilic oesophagitis among adult Sri Lankan patients with refractory upper gastrointestinal symptoms: a prospective study
(Wiley Blackwell Scientific Publications, 2012) Ranawaka, C.K.; de Silva, A.P.; de Alwis, R.; Waraketiya, P.R.; Jayathilake, T.M.A.H.; Niriella, M.A.; Dassanayake, A.S.; Hewavisenthi, S.J.de S.; de Silva, H.J.
BACKGROUND AND AIM: Eosinophilic oesophagitis (EoE) is increasing in the West (community prevalence 0.02–1%). It is especially prevalent among patients with refractory upper gastrointestinal (UGI) symptoms (8.8–48%). Diagnosis is important as the treatment is with corticosteroids and other immunomodulators rather than acid suppression and prokinetics. EOE has been poorly studied in Asian populations. Our aim of this study was to evaluate the prevalence of EoE among adult Sri Lankan patients with refractory UGI symptoms. METHODS: The study was carried out in the University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka. Over a period of one year from March 2011, consecutive, consenting patients (aged 18–70) referred for gastroduodenoscopy (OGD); with persistent UGI symptoms despite standard therapy for at least two months were recruited. Patients without significant abnormalities other than features of EoE on OGD underwent two biopsies each from the distal and mid oesophagus. Biopsies were obtained from duodenum and stomach at the same time to rule out possible eosonophilic gastroenteritis. A diagnosis of EoE was made when there were 15 or more intra-epithelial eosinophils per high-power field, according to the international guidelines. RESULTS AND DISCUSSION: Common refractory symptoms were dyspepsia, gastro-oesophageal refl ux and dysphagia in 74, 64, 27 respectively. Only 106 patients (M: F = 42:64 mean age 48 yrs (SD 13.3) who fulfill the criteria underwent oesophageal biopsies. Endoscopy was macroscopically normal in 98 patients and suggestive of EoE in 8; concentric mucosal rings in 2 and white exudates in 6 patients. Only 2 (1.9%) patients had histological evidence of EoE, both had symptoms of refractory dyphagia and one had compatible macroscopic endoscopic features of EoE (concentric mucosal rings). CONCLUSION: The prevalence of EoE in this Sri Lankan cohort of adult patients with refractory UGI symptoms was much lower than reported in Western series