Browsing by Author "Wijewantha, H.S."

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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.
Development and validation of sinhala version of the Chronic Liver Disease Questionnaire (CLDQ) for assessment of quality of life among cirrhotics
(Sri Lanka Medical Association, 2012) Ranawaka, C.K.; Pathmeswaran, A.; de Alwis, W.R.S.; Mufeena, M.N.F.; Wijewantha, H.S.; Senanayake, S.M.; Niriella, M.A.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.
INTRODUCTION: Chronic liver disease (CLD) has a negative impact on patient quality of life (QOL). The Chronic Liver Disease Questionnaire (CLDQ) is a validated tool which measures the Health Related Quality of Life (HRQL) among cirrhotics. CLDQ is easy to administer, measures six domains of QOL; abdominal symptoms, fatigue, systemic symptoms, activity, emotional functions and worry. It shows good correlation with severity of CLD. Aims: To develop and validate a Sinhala version of the CLDQ (sCLDQ). METHODS: A standard method of forward and back-translation by bilingual translators was used to develop the sCLDQ. Pilot testing were done with relevant adaptations, considering differences in culture and language. The final version was self-administered to stable CLD patients without significant co-morbidities, together with the WHO BREF Sinhala version (validated for patients of any disease), for comparison. sCLDQ was re-administered 4 weeks later to study its internal consistency and reliability. The sCLDQ validation was assessed by Cronabach's alpha, intraclass correlation coefficient (ICC) and Pearson's correlation coefficient RESULTS: Forty eight patients participated in the validation process. The item total correlations of sCLDQ varied from 0.30 to 0.82 (except one item number 0.15). Overall Cronabach's alpha was 0.92. Re-administration of sCLDQ to 15 patients yielded an ICC of 0.54 (p = 0.02). There was a significant correlation (Pearson's r = 0.34; p = 0.03) between sCLDQ and WHO BREF. CONCLUSIONS: sCLDQ was reliable and valid and would be a useful tool to assess QOL of cirrhotic patients in Sri Lanka.
Profile of gastric varices among Sri Lankan cirrhotics
(Wiley Blackwell Scientific Publications, 2012) Ranawaka, C.K.; Mettananda, K.C.D.; de Alwis, R.; Miththinda, J.K.N.D.; Wijewantha, H.S.; Niriella, M.A.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.
BACKGROUND AND AIMS: Gastric varices (GV) can result in life threatening bleeding with a higher mortality than esophageal varices. There have been no studies on the characteristics of GV among Sri Lankan cirrhotics. Aim of this study was to perform a descriptive analysis of GV among a cohort of Sri Lankan cirrhotic population. METHODS: We analyzed medical records of all upper gastrointestinal endoscopies performed on cirrhotics, at the University Endoscopy Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka from 2006 to 2011. Characteristics of GV, demographics, indications and fi ndings at endoscopy were analyzed and they were compared among patients with Oesophageal varices (EV). RESULTS: Out of 641 cirrhotics screened, 628 had a complete data set for analysis. GV was detected in 70 (11%) patients; male:female 8.7:1.3; mean age 55 (SD = ± 10.7) years. From these 48/70 had EV (Gastro Oesophageal Varices GOV1 – 18/48, GOV2 – 30/48) in addition to GV. Only 22/70 had Isolated GV (IGV1–10, IGV2–12). Among patients with GV 38 (54%) had portal hypertensive gastropathy and 3 (4%) had gastric antral vascular ectasia. Nineteen (27%) of GV were detected on presentations with UGIB (6 with IGV, 13 with GOV), whereas 51 (73%) were detected on routine screening. EV was detected in 288 (46%) of cirrhotics (Isolated EV 240, GOV 48). Seventy seven (32%) of EV were detected on presentations with UGIB, whereas 163 (68%) were detected on routine screening. There was no statistically significant difference on presentation with UGIB between isolated EV (77/240) vs. IGV (6/22) patients (p = 0.64; χ2 = 0.2). CONCLUSION: The profi le of GV among our cirrhotics is comparable to previous reports from other centres. Findings suggest that in cirrhotic patients presenting with UGIB, a careful search for the presence of GV is as important as identifying EV, even among patients who have EV.
Usefulness of ileoscopy during Colonoscopy
(Sri Lanka Medical Association, 2011) Wijewantha, H.S.; de Silva, A.P.; Wijesinghe, N.T.; Kumarasena, R.S.; Hewavisenthi, J.; Dassanayake, A.S.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: To investigate utility of ileoscopy during colonoscopy in a cohort of Sri Lankan patients. METHODS: We performed a retrospective analysis of all patients who underwent colonoscopy from January 2007 to September 2010. We compared diagnostic utility of ileoscopy in patients who were considered to have specific clinical indications for ileoscopy (group A) with those who did not (group B). RESULTS: 789 colonoscopies were performed and the terminal ileum was successfully intubated in 638 (80.9%). Overall, 108/638 (16.9%) patients had macroscopic or microscopic abnormalities of the ileum. 51/638 (8%) of these were considered to be significant ileal pathology: Crohn's disease (34), tuberculosis (5), ileitis - resolving infection (8) or drug induced (4). The others of doubtful clinical importance were backwash ileitis in ulcerative colitis (12) and non-specific ileitis (37). 35 patients with ileal abnormalities (Crohn's disease 6, non-specific ileitis 29) had no abnormalities in the colon. 66 patients with a macroscopicalfy normal terminal ileum had abnormal microscopy: Crohn's desease (21), ileitis - resolving infection (3) or drug induced (2), backwash ileitis (4), non-specific ileitis (36). In group A [n=511; mean (SD) age 47.7 (16) years; 53.4% males] 47/511 (9.2%) had significant ileal pathology compared to 4/127 (3.15%) in group B [n=127; mean (SD) age 53.2 (16) years; 50.4% males] (x2 = 4.270, df=l , p=0.03S). CONCLUSIONS: Ileoscopy and biopsy during colonoscopy is a useful investigation which detects significant pathology, even in situations where the rest of the colon is normal and the ileum appears macroscopically normal. The procedure should be recommended.
Usefulness of routine terminal ileoscopy and biopsy during colonoscopy in a tropical setting: a retrospective record-based study
(Hindawi Publishing Corporation, 2014) Wijewantha, H.S.; de Silva, A.P.; Niriella, M.A.; Wijesinghe, N.; Waraketiya, P.; Kumarasena, R.S.; Dassanayake, A.S.; Hewavisenthi, S.J.de S.; de Silva, H.J.
Introduction. Available evidence for routine terminal ileoscopy during colonoscopy is equivocal. We investigated the place of routine terminal ileoscopy and biopsy during colonoscopy, in a tropical setting. Materials and Methods. All consenting adults undergoing colonoscopy had routine TI and biopsy. Patients with right iliac fossa (RIF) pain, diarrhoea, anaemia, suspected inflammatory bowel disease (IBD), and raised inflammatory markers were defined as Group A and all others undergoing colonoscopy as Group B. Results. Caecal intubation and TI were achieved in 988/1096 (90.15%) and 832/1096 (75.9%) cases, respectively. 764/832(91.8%) patients were included in final analysis. 81/764 (10.6%) patients had either macroscopic (34/81) or microscopic (47/81) abnormalities of terminal ileum; 20/81 had both. These were CD (28/47), tuberculosis (TB) (6/47), ileitis due to resolving infection (8/47), and drug-induced ileitis (5/47). 27/81 with macroscopically normal ileum had CD (18/27), ileitis due to resolving infection (5/27) and drug-induced ileitis (4/27) on histology. 12/764 (1.57%) patients with macroscopically normal colon had ileal CD (8/12), drug-induced ileitis (2/12), and resolving ileal infection (2/12) on histology. 47/764 (6.15%) patients had ileal pathology that influenced subsequent management. These were significantly higher in Group A (43/555 (8%)) than in Group B (4/209 (1.9%)) (P = 0.0048, χ (2) = 7.968). Conclusion. TI and biopsy improve diagnostic yield of colonoscopy in patients with RIF pain, diarrhoea, anaemia, suspected IBD, and raised inflammatory markers.