Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Asia-Pacific association for study of liver guidelines on management of ascites in liver disease(Springer, 2023) Singh, V.; De, A.; Mehtani, R.; Angeli, P.; Maiwall, R.; Satapathy, S.; Singal, A.K.; Saraya, A.; Sharma, B.C.; Eapen, C.E.; Rao, P.N.; Shukla, A.; Shalimar; Choudhary, N.S.; Alcantara-Payawal, D.; Arora, V.; Aithal, G.; Kulkarni, A.; Roy, A.; Shrestha, A.; Mamun, A.M.; Niriella, M.A.; Siam, T.S.; Zhang, C.Q.; Huei, L.G.; Yu, M.L.; Roberts, S.K.; Peng, C.Y.; Chen, T.; George, J.; Wong, V.; Yilmaz, Y.; Treeprasertsuk, S.; Kurniawan, J.; Kim, S.U.; Younossi, Z.M.; Sarin, S.K.No abstract availableItem On the proposed definition of metabolic-associated fatty liver disease [Letter to the Editor](Elsevier, 2022) Niriella, M.A.; de Silva, A.P.; de Silva, H.J.No abstract available, Comment on Wai-Sun Wong V, et al, Clinical Gastroenterology and Hepatology. 2021;19(5):865-870. [Epub 2021 Jan 13.]Item Association of serum ferritin with diabetes and alcohol in patients with non-viral liver disease-related hepatocellular carcinoma(S. Karger, 2017) Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Ediriweera, D.; Gunetilleke, B.; Sivasundaram, T.; de Silva, H.J.INTRODUCTION: Non-alcoholic fatty liver disease is a leading cause for hepatocellular carcinoma (HCC) in Sri Lanka. Diabetes mellitus, alcohol abuse, and liver inflammation are known to increase the risk of HCC. The present study evaluates serum ferritin levels in a cohort of patients with non-viral HCC (nvHCC). METHODOLOGY: Consecutive patients with nvHCC presenting to the Colombo North Liver transplant Service, Ragama, from January 2012 to July 2013 were investigated. All were negative for hepatitis B and C. At registration, 5 mL of serum was separated into plain tubes, stored at -80°C and analysed for ferritin using an enzyme-linked immunosorbent assay. Correlation between the serum ferritin and patient risk factors, liver status, and tumour characteristics were analysed. RESULTS: There were 93 patients with nvHCC (median age 65 [12-82] years; 82 [88.2%] males). The median ferritin level was 246.2 μg/L, and 38 (40.86%) patients had elevated ferritin. Non-diabetics (median 363.5 mg/L, p = 0.003) and alcohol abusers (median 261.2 mg/L, p = 0.018) had higher ferritin levels. On multiple-variable analysis, being non-diabetic (p = 0.013) and alcoholic (p = 0.046) was significantly associated with high serum ferritin. No association was found with body mass index, tumour stage, size, macrovascular invasion, number of nodules, alpha-fetoprotein, bilirubin, international normalized ratio, and survival. CONCLUSION: In patients with nvHCC, serum ferritin levels are higher in non-diabetics and alcoholics.Item 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.Item Validation of Sinhala version of the Chronic Liver Disease Questionnaire (CLDQ) and evaluation of health related quality of fife among patients with cirrhosis in Sri Lanka(Sri Lanka Medical Association, 2013) Miththinda, J.K.N.D.; Ranawaka, C.K.; Pathmeswaran, A.; Dassanayake, A.S.; de Alwis, W.R.S.; Mufeena, M.N.F.; Senanayake, S.M.; Niriella, M.A.; de Silva, A.P.; de Silva, H.J.AIMS: Our aim was to validate a Sinhala version of the CLDQ (sCLDQ) and to test its correlation with the degree of liver dysfunction in a cohort of Sri Lankan cirrhotics. METHODS: A standard method was used to translate the CLDQ to Sinhala. Pilot testing was done and relevant cultural and language adaptations made. The final version was self-administered to stable chronic liver disease (CLD) patients, together with the WHO Quality of Life-BREF (WHOQOL-BREF) validated Sinhala version, for comparison. The sCLDQ was re-administered 4 weeks later to test internal consistency and reliability. The validation was assessed using Cronabach's alpha, intraclass correlation coefficient (ICC) and Pearson's correlation coefficient. ANOVA and Pearson's correlation were used to test correlation with the degree of liver dysfunction. RESULTS: Validation was done with 48 subjects, mean age 55.6 (SD 10) years; male 79%. Item total correlations of sCLDQ varied from 0.30-0.82. Overall Cronabach's alpha was 0.92. Re-administration of sCLDQ yielded an ICC of 0.54 (p=0.02). There was a significant correlation between sCLDQ and WHOQOL-BREF (r=0.34; p=0.03). Validated sCLDQ xvas administered to a different cohort of 202 cirrhotics with mean age of 55.3 years (SD 10,5); male 77%; mean duration of cirrhosis 2.7 years (SD 2.9) years. Higher Child class (F=0.000; p-0.017) and hyponatraemia (r=0.2I3; p=0.005) were associated with worse sCLDQ scores. There was no significant association between sCLDQ score and MELD (r=-0.128, p=0.072). CONCLUSIONS: The sCLDQ is a reliable and valid tool to assess QOL of Sri Lankan cirrhotics and it correlates with known indices of disease severity.Item 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.Item Predicting acute liver failure in dengue infection(Wiley Blackwell Scientific Publications, 2012) Ranawaka, C.K.; Kumarasena, R.S.; Niriella, M.A.; Miththinda, J.K.N.D.; Pathmeswaran, A.; Dassanayake, A.S.; de Silva, A.P.; Premaratna, R.; de Silva, H.J.BACKGROUND AND AIM: Dengue infections (DI) have a diverse clinical spectrum ranging from asymptomatic illness to severe dengue. Unusual manifestations such as encephalitis, myocarditis, and acute liver failure (ALF) are increasingly recognized. Though ALF is less common has a poor prognosis. Aim of this study was to identify possible predictors of ALF in DI. METHOD: Serologically confirmed patients with DI, admitted to university medical unit, Ragama, Sri Lanka from January 2009 to March 2010 were included. Patients were consisted of direct admission as well as referrals with deranged liver functions. Data was obtained from patient records. RESULTS AND DISCUSSION: Out of 240 patients (male : female 57.7%:42.5%; mean age 35.6 years [SD 15.4 years]), 164 had dengue with warning signs, 27 had dengue without warning signs and 49 had severe dengue. 15/49 severe dengue patients had profound shock. Abdominal pain, persistent vomiting (PV), bleeding, hepatomegaly and ascites were present in 125, 92, 39,129 and 28 cases respectively. Elevated AST/ALT, serum bilirubin (SB), alkaline phosphatase (ALP) and gamma glutamyl transpeptide (GGT) were observed in 208, 20, 18 and 60 patients respectively. Of the 240 patients 41 had AST/ALT > 1000 IU/ml and 199 had AST/ALT < 1000 IU/ml. Only 16/41 patients with AST/ALT > 1000 IU/ml developed ALF while none from the AST/ALT < 1000 IU/ml group. Only 4/15 of profound shock had ALF. Patients with AST/ALT > 1000 IU/ml, presence of 2 or 3 of; elevated SB, elevated ALP or PV predicted the development of ALF with 93.8% sensitivity, 98.7% specificity, 83.3% positive predictive value (PPV) and 99% negative predictive value (NPV) with p < 0.001. CONCLUSIONS: Dengue patients who’s AST/ALT < 1000 IU/ml, excluded patients at risk of ALF. Presence of 2 or 3 of: PV, elevated SB or elevated ALP in a patient with AST/ALT > 1000 IU/ml may indicate impending ALF. This needs further validation in a larger populationItem Development and validation of sinhala version of the chronic liver disease questionnaire (CLDQ) for assessment of quality of life among cirrhotics(Wiley Blackwell Scientific Publications, 2012) Ranawaka, C.K.; Pathmeswaran, A.; Senanayake, S.M.; de Alwis, R.; Mufeena, M.N.F.; Niriella, M.A.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.BACKGROUND AND AIM: 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 and measures six domains of QOL; abdominal symptoms, fatigue, systemic symptoms, activity, emotional functions and worry. It shows good correlation with severity of CLD. No tool had been developed previously to asses QOL among CLD patients in Sri Lanka. Aim of this study was to develop and validate a Sinhala version of the CLDQ (sCLDQ). METHODS: A standard method of forward and back-translation by bilingual translators was employed to develop the sCLDQ. Pilot testing was done with relevant linguistic and cultural adaptations. The final version was self-administered to stable CLD patients without significant comorbidities, together with the WHO BREF Sinhala version (a validated QOL assessment tool for 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 coeffi cient (ICC) and Pearson’s correlation coeffi cient. RESULTS AND DISCUSSION: Forty eight patients participated in the validation process. The item total correlations of sCLDQ varied from 0.30 to 0.82 (except one item, 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 signifi cant correlation (Pearson’s r = 0.34; p = 0.03) between sCLDQ and WHO BREF. Conclusion: sCLDQ was reliable and valid and would be a useful tool to assess QOL among cirrhotic patients in Sri Lanka.Item Association between road accidents and minimal hepatic encephalopathy in a cohort of Sri Lankan cirrhotic drivers(Wiley Blackwell Scientific Publications, 2014) Subasinghe, S.K.C.E.; Nandamuni, Y.; Ranasinghe, S.; Kodisinghe, K.; Niriella, M.A.; de Silva, A.P.; de Silva, H.J.OBJECTIVE: Minimal hepatic encephalopathy (MHE) has no recognizable clinical symptoms of hepatic encephalopathy (HE) but has mild cognitive and psychomotor deficits which can interfere with executive decision making and psychomotor speed. It affects driving ability and previous studies in Western countries have demonstrated an association between MHE and increased road accidents. Our objective was to investigate this association in a cohort of Sri Lankan cirrhotic drivers. METHODS: A prospective, case controlled study ongoing study has been conducted in the Gastroenterology Clinic, University Medical Unit, North Colombo Teaching Hospital, Ragama, from August 2013. Patients with cirrhosis of any aetiology, without overt HE, who had been driving any vehicle during the past one month were subjected to 5 standard pencil-paper based psychometric tests used to detect MHE. Road accidents were recorded for both cirrhotic drivers with MHE and controls. Accidents were categorized as major when they resulted in hospitalization of the involved person/s, and minor when there were no serious injuries. RESULTS: Among 55 cirrhotic drivers with MHE [males, median age 53 years (range 30-60)], 7 (12.7%) reported any type of accident compared to 6 (10.9%) among 55 controls [males; median age 51 years (range 30-60)]. 2/55 (3.6%) cases and 2/55 (3.6%) controls reported minor accidents. There were no major accidents in either group. CONCLUSION: Preliminary results of this ongoing study do not indicate an increased frequency of road accidents in a cohort of Sri Lankan cirrhotic drivers with MHEItem Development and validation of Sinhala version of the chronic liver disease questionnaire (CLDQ)(Wiley Blackwell Scientific Publications, 2013) Miththinda, J.K.N.D.; Ranawaka, C.; Pathmeswaran, A.; Dassanayake, A.S.; de Alwis, W.R.S.; Mufeena, M.N.F.; Senanayake, S.M.; Niriella, M.A.; de Silva, A.P.; de Silva, H.J.OBJECTIVE: The Chronic Liver Disease Questionnaire (CLDQ) is a validated tool measuring the Health Related Quality of Life among cirrhotics. Aim of this study was to develop and validate a Sinhala version of the CLDQ (sCLDQ) and to test its correlation with the degree of liver dysfunction in a cohort of Sri Lankan patients with cirrhosis. METHODS: A standard translation method was used to develop the sCLDQ. Pilot testing was done with relevant cultural and language adaptations. The final version was self-administered to stable CLD patients, together with the WHO Quality of Life-BREF (WHOQOL-BREF) validated Sinhala version, for comparison. sCLDQ was re administered 4 weeks later to test internal consistency and reliability. The validation was assessed by Cronabach’s alpha, intraclass correlation coefficient (ICC) and Pearson’s correlation coefficient. ANOVA and Pearson’s correlation were used to test correlation with the degree of liver dysfunction. RESULTS: Validation was done with 214 subjects, mean age 55.6 (SD 10.4) years; male 77.6%. Overall Cronabach’s alpha was 0.926. Itra-class correlations varied from 0.431 to 0.912 and all were significant (p 0.000). Retesting was done on a sub-sample of 18 subjects. Test-retest correlation was 0.695 (p 0.008). WHO-BREF was applied on a sub-sample of 48 subjects. There was a significant correlation (Pearson’s r = 0.391; p = 0.004) between sCLDQ and WHOQOL BREF. sCLDQ was significantly associated with MELD (r = −0.13; p = 0.038), MELD Sodium (r = −0.223; p = 0.002), Bilirubin (r = −0.124; p = 0.036), Serum Sodium (r = 0.172; p = 0.009), Serum Albumin (r = 0.201; p = 0.003) and Child grade (f = 3.687; p = 0.027). CONCLUSION: sCLDQ is a reliable and valid tool to assess QoL of Sri Lankan cirrhotics and correlates well with known indices of disease severity.