Browsing by Author "Dassanayake, A.S."

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Acute hearing loss due to scrub typhus: a forgotten complication of a reemerging disease
(Oxford University Press, 2006) Premaratna, R.; Chandrasena, T.G.A.N.; Dassanayake, A.S.; Loftis, A.D.; Dasch, G.A.; de Silva, H.J.
We describe 6 patients with scrub typhus who presented with acute hearing loss, a forgotten complication of this reemerging disease. They were admitted with fever of 10-14 days' duration and had clinical evidence of deafness and pneumonitis. Five patients had eschars, which prompted the diagnosis of typhus fever and led to early institution of treatment. Deafness has been described as a clue to the diagnosis of scrub typhus; awareness of this symptom facilitated early diagnosis in 4 of 5 patients who recovered. Acute hearing loss or hearing impairment in a febrile patient should arouse strong suspicion of scrub typhus.
Acute hearing loss in febrile patients: a predictor of scrub typhus
(Sri Lanka Medical Association, 2005) Premaratna, R.; Chandrasena, T.G.A.N.; Dassanayake, A.S.; Loftis, A.; Dasch, G.A.; de Silva, H.J.
INTRODUCTION: Rickettsial infections are re-emerging in Sri Lanka. Complications such as pneumonitis, myocarditis and encephalitis can occur late in the disease, and result in a high mortality. Early diagnosis reduces morbidity and mortality, but as laboratory facilities for definitive diagnosis are lacking, early diagnosis depends on clinical suspicion. Acute hearing loss which occurs in about 30% of patients has been recognised as a predictor of scrub typhus. METHODS: Six patients admitted to hospital with high fever and hearing impairment were further investigated. RESULTS: All were females with a mean age of 65 years (SD 2). The mean duration of fever at presentation was 12 days (SD 1), Hearing impairment was observe
Advancd hepatic fibrosis and cirrhosis due to nonalcoholic fatty liver disease in Sri lankan children: a preliminary report
(Springer International, 2008) Rajindrajith, S.; Dassanayake, A.S.; Hewavisenthi, J.; de Silva, H.J.
Nonalcoholic fatty liver disease (NAFLD) is one of the most common chronic liver diseases and may progress to advanced hepatic fibrosis and cirrhosis in some patients. Cirrhosis due to NAFLD is considered extremely rare in children in the Asia-Pacific region. We report the characteristics of 5 children with advanced hepatic fibrosis and cirrhosis due to NAFLD. Four of them were obese, and all of them had high alanine transaminase levels and ultrasonographic evidence of fatty liver. None had diabetes mellitus or hyperlipidemia. The calculated HOMA-IR was more than two in all five cases. Liver biopsy showed stage III fibrosis in 2 patients and stage IV fibrosis (cirrhosis) in 3.
Aetiology of cirrhosis in a tertiary referral centre in Sri Lanka
(Sri Lanka Medical Association, 2007) Dassanayake, A.S.; Munasinghe, C.S.; Mettananda, K.C.D.; de Silva, A.P.; de Silva, H.J.
INTRODUCTION: Alcoholic liver disease is believed to be the commonest cause of cirrhosis in Sri Lanka. However, with the rising prevalence of obesity and diabetes, non-alcoholic steatohepatitis (NASH) is increasingly being diagnosed. The prevalence of both Hepatitis B (<2%) and C (<1 %) is low in our population. OBJECTIVE: To study the aetiology of cirrhosis in a tertiary referral centre in Sri Lanka. DESIGN, SETTING AND METHODS: We analysed the database of outpatients with cirrhosis maintained since 2001, reviewing records with regard to aetiology. Diagnosis of cirrhosis was established on clinical, biochemical and radiological evidence, and confirmed histologically when required. A detailed alcohol and drug history was obtained. Hepatitis B and C serology, iron and copper studies, and an autoimmune screen were also performed. RESULTS: Records of 204 patients were analysed [male: female =160:44, mean age 51.2y (SD 12.2)]. The aetiology of cirrhosis was: alcohol in 116 (57.1%, male: female= 110:6); cryptogenic in 63 (31%, male:female 38:25), chronic Hepatitis B in 7 (male: female = 4:3), Wilson disease in 6 (male: female= 4:2), confirmed NASH in 6 (male: female= 2:4), autoimmune hepatitis in 4 (ai! females), chronic Hepatitis C in 1 (male) and haemochromatosis in 1 (male). Prevalence of diabetes was 44% among patients with cryptogenic cirrhosis and 24% among others. CONCLUSIONS: Alcohol remains the commonest cause of cirrhosis. Cryptogenic cirrhosis was the second commonest cause, and the leading cattse among females. The high prevalence of diabetes in cryptogenic cirrhosis suggests an aetiology of burned out NASH. Chronic viral hepatitis remains an uncommon cause for cirrhosis.
Aetiology of cirrhosis in a tertiary referral centre in Sri Lanka
(Wiley Blackwell Scientific Publications, 2005) Dassanayake, A.S.; Mettananda, K.C.D.; de Silva, A.P.; de Silva, H.J.
INTRODUCTION: Alcoholic liver disease is widely believed to be the commonest cause of cirrhosis in Sri Lanka. However, with the rising prevalence of obesity and diabetes, non-alcoholic steatohepatitis (NASH) is increasingly being diagnosed. Despite being situated in an intermediate to high transmission region, the prevalence of both hepatitis B (o2%) and C ( 1%) is low in our population. AIMS: To study the aetiology of cirrhosis in a tertiary referral centre in Sri Lanka. METHODS: We analysed the database of outpatients with cirrhosis maintained since 2001, reviewing records with regard to aetiology. A diagnosis of cirrhosis was established on clinical, biochemical and radiological evidence, and confirmed histologically when required. A detailed alcohol and drug history was obtained from all cirrhotic patients. Hepatitis B and C serology, iron and copper studies, and an autoimmune screen were also performed. RESULTS: Records of 101 patients were analysed (male:female 5 78:23, mean age 38.3 years (SD 17.5)). The aetiology of cirrhosis was as follows: alcohol 64 patients (63.4%, male:female 5 60:4), cryptogenic 24 (23.8%, male:female 5 12:12), chronic hepatitis B four (all males), autoimmune hepatitis four (all females), Wilson’s disease two (both females), previously diagnosed NASH two (one male, one female), and chronic hepatitis C one (male). The prevalence of diabetes was 45% among patients with cryptogenic cirrhosis compared to 27% among patients with other causes. CONCLUSIONS: Alcohol remains the commonest cause of cirrhosis in our patients. Cryptogenic cirrhosis was the second commonest cause overall, and the commonest among females. The high prevalence of diabetes among patients with cryptogenic cirrhosis suggests an aetiology of previously undetected NASH.
Alanine Transaminase (ALT) levels in normal adult Sri Lankans
(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2009) Niriella, M.A.; Dassanayake, A.S.; Kalubowila, K.; Kalubowila, U.; de Silva, A.P.; Wickremasinghe, A.R.; Kato, N.; Makaya, M.; de Silva, H.J.
BACKGROUND : Alanine transaminase (ALT) levels are widely used in screening for liver disease.The upper limit of normal (ULN) of ALT (males 30 IU/l, females 19 IU/l) have been definedfor western populations. Normal levels have not been established for Asian populations. OBJECTIVES: To establish levels of ALT for a normal, adult Sri Lankan population METHODS: This study was part of a community based investigation - Ragama Health Study (RHS). The study population consisted of 35-64 year old adults, selected using stratified random sampling. Consenting adults were screened by a structured interview, liver ultrasound and collection of 10 ml venous blood. The “normal” population was defined as those not using potentially hepatotoxic drugs, safe alcohol consumption (14 units/week for males, 7 units/week for females), absence of fatty liver, and being HBsAg and anti-HCVab negative. ALT levels were estimated by a kit using the Bergmeyer method. The 95th percentile of the ALT levels was taken as the ULN. RESULTS: 3012 subjects participated in the study. The ALT level (U/l) among 831 normal males (mean 36, median 30, SD 20, ULN 68) was significantly higher than that of the 885 normal females (mean 29, median 25, SD 13, ULN 53) (p<0.001,Student's t-test ). CONCLUSION: The ULN for ALT levels of a “normal” Sri Lankan population was higher than observed in western populations. The levels were higher in males. ULN for ALT may need to be redefined for different population groups.
Alcohol use and alcoholic fatty liver disease: a prospective, communitybased study among adults in an urban community in Sri Lanka
(The Sri Lanka Medical Association, 2022) Niriella, M.A.; Kasturiratne, A.; Beddage, T.; de Silva, S.T.; Dassanayake, A.S.; Pathmeswaran, A.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.
Background: Data on alcoholic fatty liver (AFL) is limited. Therefore, we investigated alcohol use and AFL in a cohort of adults in an urban community in Sri Lanka. Methods: The study population (selected by age-stratified random sampling) was screened in 2007 (35-64 years) and re-evaluated in 2014. They were assessed by structured interviews, anthropometric measurements, liver-ultrasound, and biochemical and serological tests. AFL was diagnosed on ultrasound criteria, ‘unsafe’ alcohol consumption (Asian standards: males>14 units, females >7 units per week) and absence of hepatitis B/C markers. Controls were unsafe alcohol consumers who had no fatty liver on ultrasound. Results: 2985/3012 (99%) had complete data for analysis. 272/2985 (9.1%) were unsafe-drinkers in 2007 [males-270; mean-age-51.9, SD-8.0 years]. 86/272 (31.6%) had AFL [males-85; mean-age-50.2, SD-8.6 years]. Male gender [p<0.001], increased waist circumference (WC) [OR 4.9, p<0.01], BMI>23kg/m2 [OR 3.5, p<0.01] and raised alanine aminotransferase (ALT) [OR 2.8, p<0.01] were independently associated with AFL. 173/272 (63.6%) unsafe alcohol consumers from 2007 were re-evaluated in 2014. 134/173 had either had AFL or had changed to ‘safe’ or no alcohol consumption. 21/39 (53.8%) [males-21 (100%), meanage- 57.9, SD-7.9 years] who remained ‘unsafe’ alcohol users who had no fatty liver in 2007 developed AFL after 7-years (annual incidence 7.7%). On bivariate analysis, only male gender was associated with new-onset AFL. Of the 42 who had AFL at baseline but changed their drinking status from unsafe to safe or no alcohol, 6 had resolution of fatty liver in 2014. Conclusion: In this community-based study among adults from an urban community, unsafe alcohol use was found in 9.1%. Among unsafe alcohol users, the prevalence of AFL was 31.6% and the annual incidence of AFL was 7.7%. New-onset AFL was independently associated with male gender.
Anthropometric correlates of total body fat, visceral adiposity and cardio-metabolic health risk: a community cohort study of urban, adult Sri Lankans
(Sri Lanka Medical Association, 2016) Niriella, M.A.; de Silva, S.T.; Kasturiratne, A.; Kottachchi, D.; Ranawaka, U.K.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION: Anthropometric measurements (AM) are used as proxies for more direct measurements of body fat (BF) and its distribution. Several studies have examined the association between AM, BF and health outcomes such as cardiovascular risk (CVR). However, correlation of such simple AM and advanced measures of BF and the ability of these to predict CVR has not been studied in community follow up studies. OBJECTIVES: To examine the relationship between simple and advanced anthropometric measurements and their ability to predict cardiovascular risk factors in an urban adult Sri Lankan population. METHOD: The data was collected from a community cohort of adults (aged 42-71 years) selected by age-stratified random sampling from electoral lists of the Medical Officer of Health area, Ragama. Individual simple measurements [body weight, height, waist circumference (WC), hip circumference (HC)], advanced measurements [total body fat (TBF), visceral fat percentage (VFP) by Omron® body fat monitor] and cardiovascular risk factors [blood pressure, HbA1c, triglycerides, low-density (LDL-C), high-density-lipoprotein cholesterol (HDL-C) level, cardio-metabloic risk (CMR) (2 or more risk factors)] were assessed and their relationships were examined. RESULTS: 2155 individuals [1244 (57.7%) women, mean age 59.2 years (SD, 7.7)] participated. Complete data were available for 2000 (92.8%) [1147 (57.4%) women, mean age 59.2 years (SD, 7.7)]. Mean (SD) for anthropometric measurements were: males WC-85.9 (10.8) cm, HC-93.4 (8.0) cm, WHpR (waist-to-hip ratio) -0.92 (0.06), WhtR (waist-to-height ratio) -0.52 (0.06), BMI (body mass index) -23.5 (3.8) kg/m2, TBF -27.0 (5.7)%, VFP -10.7 (5.2)%; females WC -84.8 (10.7) cm, HC-97.2 (9.5) cm, WHpR-0.87(0.08), WhtR-0.52 (0.07), BMI -25.4 (4.4) kg/m2, TBF -38.2 (4.2)%, VFP-9.6 (4.9)%. BMI and WC correlated well with VFP (Pearson’s r for males: 0.94 and 0.85, females: 0.96 and 0.78, respectively). In both sexes, increasing BMI, WC, WHtR, TBF and VFP, were significantly associated with higher risks of hypertension, diabetes, dyslipidemia and combined CMR (ROC area under the curve>0.6). CONCLUSIONS: In this cohort of urban, adult Sri Lanka, simple anthropometric measurements correlated strongly with VFP, and were equally good in predicting cardiovascular risk factors.
Are alanine transaminase (ALT) levels useful to screen for Non-alcoholic Fatty Liver Disease (NAFLD) in the community?
(Sri Lanka Medical Association, 2009) Niriella, M.A.; Dassanayake, A.S.; Kalubowila, K.V.U.; Rajindrajith, S.; de Silva, A.P.; Wickremasinghe, A.R.; Kato, N.; Makaya, M.; de Silva, H.J.
BACKGROUND: The value of ALT in screening for NAFLD is controversial. Furthermore, the upper limit of normal (ULN) ALT is defined for western populations but not Asian populations. Objectives: To establish ULN ALT for an urban adult Sri Lankan population, and assess its value in screening for NAFLD in that community. METHODS: This was part of a community based study on non-communicable diseases - the Ragama Health Study. 35-64y adults were selected using stratified random sampling. They were screened by structured interview and liver ultrasound, and 10ml venous blood .was obtained. "Normal" adults were defined as those not using potentially hepatotoxic drugs, drinking alcohol within safe limits, HBsAg and anti-HCV negative, and no fatty liver on ultrasound. NAFLD was diagnosed on established ultrasound criteria, .safe alcohol consumption and being HBsAg and anti-HCV negative. The 95th percentile of ALT was taken as the ULN for this population. RESULTS: 3012 subjects participated in the study. Those with NAFLD (n=930) and "normals" (n=1716) were matched for age and sex. ULN ALT (U/l) was significantly higher in normal males than females (68 vs. 53; p<0.001, Student's t-test). ALT was significantly higher in NAFLD than normals (p<0.001). However, ALT>ULN had a sensitivity [positive predictive value (PPV)] of only 14.5% (58%) for males and 11.5% (60%) for females with NAFLD. When ULN ALT cut offs for western populations (males 30 IU/1, females 19 IU/1) were used, although sensitivity considerably increased, the PPV to detect NAFLD decreased.further [sensitivity (PPV): males 79.4% (42%); females 94.6% (41%)]. CONCLUSIONS: Although ALT was significantly higher in NAFLD than in normal adults, it does not seem a useful test to screen for NAFLD in the community.
Assessment and comparison of knowledge, attitudes and practices on usage of paracetamol among people (both males and females) within 20-30 years and 50-60 years attending Outpatient Department at Divisional Hospital, Wellawa
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2021) Galhenage, T.S.; Gangoda, E.W.W.M.M.B.; Hewawasam, H.H.A.U.; Hiran, J.K.H.; lllangasinghe, H.M.M.P.K.; Dassanayake, A.S.
Introduction: Paracetamol possesses analgesic and antipyretic properties and is considered as one of the most commonly used over the counter medications worldwide. Despite its favourable safety profile, intentional and unintentional acute overdose of paracetamol attributes to potentially fatal organ damage. Objectives: To assess and compare knowledge, attitudes and practices on paracetamol usage and associated factors among young (20-30yrs) and older adults (50-60yrs) attending the Outpatient Department (OPD) at Divisional Hospital (DH), Wellawa. Methods: A Descriptive cross-sectional study was conducted using an interviewer administered questionnaire among 424 patients who attended the OPD at DH, Wellawa. These categorical data were described using percentages and significant associations were determined using T test. The analysis was processed through SPSS software. Results: Participants in the 20-30 years and 50-60-year age groups had 98.6% and 91.8% above average knowledge respectively, 89.2% and 94.3% above average attitudes respectively, 59.2% and 49.5% above average practices respectively on paracetamol usage. There was no statistically significant association between knowledge, attitude and practices with gender. However, according to the T test, only practices were found to have a statistically significant association with age. Conclusions: A majority of the participants from both age groups had an above average knowledge and attitudes on paracetamol usage. Although a majority from 20-30-year age group had an above average practices, only a minority from 50-60-year age group had above average practices on paracetamol usage. Furthermore, there was a statistically significant association only between practices and age.
Association between road accidents and low-grade hepatic encephalopathy among Sri Lankan drivers with cirrhosis: a prospective case control study
(Biomed Central, 2016) Subasinghe, S.K.C.E.; Nandimuni, Y.; Ranasinghe, S.; Niriella, M.A.; Miththinda, J.K.N.D.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.
BACKGROUND: Low-grade hepatic encephalopathy (LGHE) comprises minimal hepatic encephalopathy (MHE) and grade 1 hepatic encephalopathy. LGHE has no or minimal recognizable symptoms but has mild cognitive and psychomotor deficits. Studies in Western countries have demonstrated increased road accidents (RA) among patients with MHE. Our objective was to investigate the association between Sri Lankan LGHE phenotype and RA. STUDY DESIGN AND METHODS: A prospective, case–control study was conducted in the University Medical Unit, North Colombo Teaching Hospital, Ragama Sri Lanka. Patients with cirrhosis of any aetiology, without OHE, who had been driving during previous 1 month were included. A similar number of age matched, healthy control drivers were also enrolled. Both groups were subjected to five pencil-paper based psychometric tests used to detect LGHE in cirrhotics. Self-reported RA during the previous 1 month were recorded: categorized as ‘major’ when resulted in hospitalization of the involved, ‘minor’ when there were injuries, but not serious enough for hospitalization of the involved and ‘other’ when limited to damages to vehicle or environment without injuries. RESULTS: Among 55 drivers with cirrhosis and LGHE [males, median age 53 years (range 30–60)], 7 (12.7 %) reported RA compared to 6 (10.9 %) among 55 controls [males; median age 51 years (range 30–60)]. There were no ‘major’ accidents in either group. 2/55 (3.6 %) cases and 2/55 (3.6 %) controls reported ‘minor’ accidents. CONCLUSION: There was no increased frequency of RA among Sri Lankan drivers with LGHE compared to healthy controls. This is with the limitation of the study based only on self reported RA.
Association of genetic variants with non-alcoholic fatty liver disease in an urban Sri Lankan community
(Wiley-Blackwell, 2015) Kasturiratne, A.; Akiyama, K.; Niriella, M.A.; Takeuchi, F.; Isono, M.; Dassanayake, A.S.; de Silva, A.P.; Wickremasinghe, A.R.; Kato, N.; de Silva, H.J.
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.
Bleeding from oesophageal ulceration induced by endoscopic variceal ligation for primary prophylaxis
(British Medical Assosiation, 2010) Kumarasena, R.S.; Niriella, M.A.; Kalubowila, U.; de Silva, A.P.; Dassanayake, A.S.; de Silva, H.J.
Comment on : García-Pagán JC et al Spanish Variceal Bleeding Study Group.(Gut. 2009; 58(8):1144-50.) No Abstract Available
A Case of persistent portal hypertension following ligation of a large porto - systemic shunt during cadaveric donor liver transplantation
(Sri Lanka Medical Association., 2020) Siriwardana, R.C.; Shanthanayagam, N.; Gunetilleke, M.B.; Weerasuriya, A.P.; Niriella, M.A.; Dassanayake, A.S.; Dissanayake, R.
No abstract available
Challenges for liver transplantation during recovery from the COVID-19 pandemic: Insights and recommendations
(New York Stratton., 2020) Niriella, M.A.; Siriwardana, R.C.; Perera, M.T.P.R.; Narasimhan, G.; Chan, S.C.; Dassanayake, A.S.
ABSTRACT: The coronavirus disease 2019 (COVID-19) pandemic is placing an increasing burden on liver transplant (LT) services worldwide. At the peak of the pandemic, many LT services worldwide reduced or halted their activities. With the gradual easing of lockdowns, LT teams face new challenges when restarting activities. The numbers of LTs are likely to drop in the immediate post-COVID era. Prolonged and intermittent lockdowns are likely to lead to a shortage of supplies, especially in poor resource settings. Special attention is needed to avoid nosocomial COVID-19 infection among cirrhotic patients awaiting transplant, post-transplant patients, and members of transplant teams. LT programs may have to revise existing strategies in selecting donors and recipients for transplants. Redesigning service provision, restructuring outpatient care, carefully screening and selecting donors and recipients, and performing LT with limited resources will have to be initiated in the post-COVID era if long-term recovery of LT services is to be expected. Costs involved with LT are likely to increase, considering the change in protocols of testing, quarantining, and interstate traveling. This paper discusses the different elements affecting and the widespread impact of the COVID-19 pandemic on LT and strategies to minimize the impact of these factors and to adapt so LT services can meet the health care needs during this pandemic and beyond.
Changing phenotype of IBD in Sri Lanka
(Sri Lanka Medical Association, 2016) Niriella, M.A.; Kodisinghe, S.K.; Dinamithra, N.P.; Rajapakshe, N.; Nanayakkara, S.D.; Luke, H.P.D.P.; Silva, K.T.M.; Dassanayake, A.S.; de Silva, A.P.; Navarathne, N.M.M.; de Silva, H.J.
INTRODUCTION: Inflammatory bowel disease (IBD) is increasing in Asia Pacific, with recent changes in phenotype reported from some countries. METHOD: Patients with histologically proven IBD [ulcerative colitis(UC), Crohn’s disease(CD), unclassified(U)], diagnosed between January 2006-December 2010 (Group 1) and January 2011-December 2015 (Group 2), who had regular follow up, were included from Colombo North Teaching Hospital and National Hospital of Sri Lanka (two main referral centers). The two groups were compared with regard to phenotype of IBD (subgroups, severity, age at diagnosis, duration of symptoms, extra-intestinal manifestations (EIM) at diagnosis, cigarette smoking, family history, and highest therapy during follow up). RESULTS: 304 patients were included [Group 1: UC-72(74.2%), CD-25(25.8%); Group 2: UC-113(54.6%), CD-90(43.5%), U-4(1.9%)]. There were more females in Group 2 for UC and CD. Median age at diagnosis was similar for UC but higher for CD in Group 2 compared to Group 1.The median duration of symptoms to diagnosis was not different for UC and CD in the two groups. In both groups, left sided colitis (E2) predominated for UC and Ileo-colonic disease (L3) and non-stricturing, non-penetrating (B1) disease predominated for CD. There was no difference in degree of severity, rate of complications, pattern of EIM, smoking history at presentation, family history or highest therapy during follow up for either disease in the two groups (Table 1). CONCLUSIONS: During the 10 years, there seems to be a recent increase in the proportion of CD among IBD patients. However, there were no major changes in disease phenotype for UC or CD.
Clinical characteristics and outcome of hepatocellular carcinoma in alcohol related and cryptogenic cirrhosis:a prospective study
(Elsevier, 2015) Siriwardana, R.C.; Niriella, M.A.; Dassanayake, A.S.; Liyanage, C.; Gunetilleke, B.; Jayathunge, S.; de Silva, H.J.
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is becoming a leading cause of chronic liver disease. Hepatocellular carcinoma (HCC) is one of its complications. Although the pathophysiology is unclear, it is reasonable to expect that cryptogenic cirrhosis related HCC (cryptogenic HCC) behaves differently to other types of HCC. This study prospectively compared patients with cryptogenic HCC and those with HCC related to alcoholic cirrhosis. METHODS: A total of 150 consecutive patients with HCC (89 cryptogenic HCC and 61 alcohol related HCC) referred to our unit over a 23-month period were studied. Their demographic data, liver function, tumor characteristics and outcomes were compared. RESULTS: Alcohol related HCC was seen only in males. Compared with cryptogenic HCC, alcohol related HCC had significantly higher aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio (1.7 vs 1.4, P=0.002), model for end-stage liver disease score (13 vs 11, P=0.018) and Child's score (7 vs 6, P=0.037). No significant difference was seen in platelet counts, serum sodium and AST to platelet ratio index. Single nodular tumors were more common in cryptogenic HCC, while diffuse type tumors and macroscopic vascular invasion were common in alcohol related HCC. In patients who could not be offered any treatment because of advanced tumors or poor liver function, alcohol related HCC had a significantly lower median survival (5.3 months) compared with cryptogenic HCC (9.3 months, P=0.034). CONCLUSIONS: Compared with cryptogenic HCC, alcohol related HCC had worse liver function and aggressive tumor morphology at presentation, and a higher proportion was untreatable. In patients who could not be treated, median survival was lower in patients with alcohol related HCC than in those with cryptogenic HCC.
Clinical characteristics and outcomes of hepatocellular carcinoma: results from prospective study, from a tertiary referral center in Sri Lanka
(Sri Lanka Medical Association, 2018) Bulathsinhala, B.K.S.; Siriwardana, R.C.; Gunetilleke, M.B.; Niriella, M.A.; Dassanayake, A.S.
INTRODUCTION:Hepatocellular carcinoma is increasing globally. Compared to global patterns, hepatitis B and C are rare in Sri Lanka whilst non-alcoholic fatty liver disease (NAFLD) and alcohol are the commonest causes of hepatocellular carcinoma.OBJECTIVE:To determine the characteristics of a cohort of Sri Lankan patients with hepatocellular carcinoma of non-viral aetiology.METHODS:Details of 550 consecutive patients with hepatocellular carcinoma referred from 2012 to 2017 were collected prospectively. Demographic data, clinical and biochemical details, aetiology, comorbidities, tumor characteristics and type of treatment offered were retrospectively analyzed.RESULTS:Median age was 62.9 years (range 12 - 88) with male preponderance (n = 473; 86%). Overall median BMI was 35.8 kgm-2. Majority (n=309; 56 %) had NAFLD induced cirrhosis, second commonest cause was alcohol (n=203;36.9 %). Tumour was single nodular 233(42.4%) and diffusely infiltrating 92(16.7%). Diagnostic rise in serum alpha-fetoprotein (over 200 micrograms) was seen in 30.2%. Venous invasion was present in 28.5% [portal vein 136 (24.7%), hepatic vein 9 (1.6%) and cava 12(2.2%)]. Extra hepatic tumor spread was seen in 6.9% [lungs 20(3.6%), bones 4(0.7%), peritoneal 6 (1.1%) and metastases at other sites 8 (1.45%)]. Curative surgery was offered in 78(14.2%). Tumour embolization was done in 192(34.9%), radio frequency ablation 34(6.2%), alcohol injection 42(7.6%) and 204(37.1%) patients were offered palliative care. Overall median survival was 20.6 months.CONCLUSION:In a large Sri Lankan cohort, most hepatocellular carcinomas were due to cryptogenic cirrhosis and it was aggressive at presentation. Screening of high-risk NAFLD patients needs to be considered and further palliative care needs to be improved.
Clinical predictors of poor outcomes in hepatocellular carcinoma of nonviral aetiology
(Sri Lanka Medical Association, 2017) Siriwardana, H.D.R.C.; Niriella, M.A.; Dassanayake, A.S.; de Silva, A.P.; Gunetilleke, B.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION & OBJECTIVES: Clinical predictors for prognosis of NASH and alcohol related (non-viral) hepatocellular carcinoma (nvHCC) is poorly described. METHODS: Patients with nvHCC, from a tertiary referral hepatobiliary clinic were prospectively screened. Clinical evaluation, liver biochemistry, pre-treatment AFP (pt-AFP) and contrast enhanced CT abdomen were performed. HCC was diagnosed using American Association for the Study of Liver Disease guidelines, and TNM staged. nvHCC was diagnosed in HCC negative for HBsAg, anti-HCVantibody, autoimmune and metabolic screening. Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) scores were calculated. Cox regression analysis was used to identify the factors associated with mortality. RESULTS: A total of 472 patients with nvHCC [age-64 (12-88) years; males-417 (88.3%)] were screened [261 (61.1%) had diabetes; 212 (48.8%) were regular, 85 (19.6%) social, 137 (31.6%) nonconsumers of alcohol]. 358 (83.4%) had cirrhosis [Child A (58.3%), B (32.8%), C (8.9%); median CTP 6 (1-14), MELD 11 (5-40)]. 170 (42.2%) HCCs were TNM stage 3, with median diameter 6cm (0.9-26.5). 239 (71.6%) had no vascular or visceral invasion. Median pt-AFP was 26.6ng/ml (1.16-100,000) [pt-AFP>200ng/ml: n=90 (31.4%) pt-AFP>400ng/ml: n=68 (23.8%)]. Gender, alcohol use (consumer/not), diabetes (present/absent), cirrhosis (present/absent), Child-class (A or B/C), total diameter (<5cm or ≥5cm), nodularity (single/multiple), vascular invasion (present/absent), TNM stage (early/late) and pt-AFP level (<200 or ≥200ng/ml) were assessed as predictors of mortality. On bivariate analysis, Child B/C class (p<0.05), vascular invasion (p<0.001), TNM stage 3 and 4 (p<0.05) and pt- AFP≥200ng/ml (<0.05) were predictive of death. On multivariate analysis, TNM stage ¾ (p<0.05, HR=2.07 and 4.07 respectively) and pt-AFP level≥200ng/ml (p<0.05, HR=1.71) remained independently predictive of death. CONCLUSION: Among patients with nvHCC, TNM stage 3/4 and pt-AFP≥200ng/ml independently predicts death.