Browsing by Author "Kumarasena, R.S."

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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
Comparison of outcomes of patients with alcoholic cirrhosis and non-alcoholic steatohepatitis (NASH) related cirrhosis
(Sri Lanka Medical Association, 2010) Senanayake, S.M.; Hewawasam, S.P.; Kumarasena, R.S.; Kasturiratne, A.; de Alwis, J.P.N.; Nandasiri, A.S.D.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.
OBJECTIVES: Most cases of cirrhosis in Sri Lanka are alcohol induced or cryptogenic. There is mounting evidence that a high proportion of cryptogenic cirrhosis is NASFI related. Although longterm outcome of NASH-cirrhosis is similar to Hepatitis C-cirrhosis, there has been no comparison with outcome of alcoholic cirrhosis. This study was done to compare long term outcomes of probable NASH-cirrhosis and alcoholic cirrhosis. METHODS: Patients with alcoholic cirrhosis and probable NASH-cirrhosis (cryptogenic cirrhosis with type-2 diabetes mellitus or obesity) whose clinical and follow-up details were available were identified from our cirrhosis database. Patients or their families were contacted to obtain the survival status and the date of death. The cause of death was obtained from death certificates and patient records. Outcomes of the two groups were compared using Kaplan-Meier survival curves. Results: Details of 185 patients (alcoholic cirrhosis 106, probable NASH-cirrhosis 79) were available for analysis. Mean survival times of alcoholic cirrhosis and NASH cirrhosis were 309.3 and 95.9 months respectively. There were 26 deaths (21 liver related) in the alcoholic cirrhosis group and 21 deaths (18 liver related) in the probable NASH cirrhosis group. Kaplan-Meier survival curves showed no significant difference in survival between the two groups (logrank test statistic 1.62, p = 0.2). Multivariate analysis using Cox proportional hazards model showed that the predictors of survival were Child-Pugh grade p<0.001) and age at diagnosis (p=0.005). CONCLUSION: The outcome of probable NASH-cirrhosis seems to be similar to that of alcoholic cirrhosis and deaths were mainly liver related.
Intravenous N-acetylcysteine in dengue-associated acute liver failure
(Springer International, 2010) Kumarasena, R.S.; Senanayake, S.M.; Sivaraman, K.; de Silva, A.P.; Dassanayake, A.S.; Premaratna, R.; Wijesiriwardena, B.; de Silva, H.J.
No Abstract Available
Liver dysfunction and its outcome in patients with dengue infection
(Sri Lanka Medical Association, 2010) Kumarasena, R.S.; de Silva, A.P.; Keragala, B.S.D.P.; Premaratna, B.A.H.R.; Premawardhena, A.P.; Jayamanna, S.F.; de Silva, H.J.; de Silva, S.T.
OBJECTIVES: To determine the frequency and severity of liver dysfunction due to dengue infection among hospitalised patients. METHOD: A retrospective, descriptive study was done at University Medical Unit, Colombo North Teaching Hospital. Records of all serologically confirmed dengue (IgM antibody positive) patients admitted from 1/1/09-31/1/10 were analysed. Results of blood tests, imaging and serology were noted. A diagnosis of acute liver failure was made in patients with an INR >1.5 together with hepatic encephalopathy. Patients on hepatotoxic drugs, alcohol abusers and patients with known chronic liver diseases (total 14 patients) were excluded from the analysis. RESULTS: Of 328 patients (58.5% female), aged 14-68 years (mean 38) with confirmed dengue, 169 (51.5%) had dengue fever, 147 (34.2%) dengue haemorrhagic fever (grade 1 and 2) and 47 (14.3%) dengue shock syndrome. 257 (78.4%) had elevated hepatic transaminases of whom 153 (46.6%) had minimal elevation (<3 times upper limit) and 38 (11.6%) had >1000 IU/1. Of those with elevated transaminases, 94% had AST: ALT >1. Thirteen (3.9%) with transaminases >1000 IU /I developed acute liver failure of whom 2 died. In 3 patients of whom 1 died, ischaemic liver injury (prolonged shock followed by rapid rise in ALT>AST) probably accounted for abnormal transaminases. Presence of nausea or vomiting at the time of AST/ALT>1000 was the only independent risk factor for development of acute liver failure (pO.OOl) on multivariate analysis. CONCLUSION: Abnormal liver function was common among hospitalised dengue patients. Liver failure was uncommon, and nausea or vomiting at the time of AST/ALT>1000 predicted its development.
Predicting acute liver failure in dengue infection
(Sri Lanka Medical Association, 2016) Kumarasena, R.S.; Niriella, M.A.; Ranawaka, C.K.; Miththinda, J.K.N.D.; de Silva, A.P.; Dassanayake, A.S.; de Silva, H.J.
In a retrospective study involving 240 patients with dengue infection, we attempted to identify early predictors of acute liver failure (ALF). Sixteen out of 41 patients with serum AST more than 1000 IU/ml developed ALF compared to none with serum AST less than 1000 IU/ml. Among patients with serum AST more than 1000 IU/ml, presence of two of the three following phenomena, within the first 5 days of illness: elevated serum bilirubin, elevated alkaline phosphatise or persistent nausea and vomiting, predicted development of ALF (93.8% sensitivity, 98.7% specificity, 83.3% positive predictive and 99% negative predictive value). The presence of elevated serum bilirubin, alkaline phosphatase and persistent nausea and vomiting in patients with very high serum AST during the early phase of dengue infection should alert the physician of impending ALF.
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 population
Predicting acute liver failure in dengue infection
(Sri Lanka Medical Association, 2012) Ranawaka, C.K.; Kumarasena, R.S.; Niriella, M.A.; Miththinda, J.K.N.D.; Pathmeswaran, A.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.
INTRODUCTION: Dengue infections (Dl) 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 recognised. AIMS: To describe the spectrum of liver dysfunction and identify possible predictors of ALF in DI Methods: Serologically confirmed patients with Dl admitted to university medical unit, Ragama from January 2009 to March 2010 were included. Data were obtained from patient records. Results: Out of 240 patients (maleifemale 57.7%:42.5%; mean age 35.6 years[SD 15.4 years]], 49(20.4%) had severe dengue, 164(68.3%) had dengue with warning signs and 27(11.2%) had dengue without warning signs. Abdominal pain, persistent nausea and vomiting (PNV), skin or mucosal bleeding, hepatomegaly and ascites was present in 52.1%J 38.3%, 16.2%, 50% and 11.7% cases respectively. Deranged AST or ALT(ASTALT), serum bilirubin(SB), alkaline phosphatase(ALP), gamma glutamyl transpeptide(GGT), and 1NR were observed in 86.7%, 8.3%, 7.5%, 25% and 10% of patients respectively. Of the 240 patients 41(17.1%) had ASTALT>1000 IU and 199(82.9%) had ASTALT<1000 1U. Only 16/41 patients with ASTALT>1000 IU developed ALF while none from the ASTALT<1000 IU group developed ALF. Presence of 2 or more of elevated SB, elevated ALP or PNV predicted the development of ALF with 93.8% sensitivity, 98.7% specificity, 83.3% positive predictive value and 99% negative predictive value withp<0.001. CONCLUSIONS: ASTALT<1000 IU excluded patients at risk of ALF. Presence of 2 or more of PNV, elevated SB or ALP in patients with Dl may indicate impending ALF. This needs further validation in a larger population.
Predicting acute liver failure in dengue Infection
(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2013) Ranawaka, C.; Niriella, M.A.; Kumarasena, R.S.; Miththinda, J.K.N.D.; de Silva, A.P.; Premaratna, R.; de Silva, H.J.
BACKGROUND: Dengue infections (DI) can range from being asymptomatic to severe illness. Unusual manifestations such as encephalitis, myocarditis, and acute liver failure (ALF) have been recognized. ALF is uncommon, but has a poor prognosis. The aim of this study was to identify predictors of ALF in DI. METHODS: Serologically confirmed patients with DI who were admitted to hospital from January 2009 to March 2010 were included. Patients consisted of direct admissions as well as referrals, some with deranged liver functions. Data was obtained from patient records. Clinical details and serum biochemistry was evaluated for up to five days from onset of illness. ALF in DI was defined as evidence of coagulation abnormality [International normalised ratio (INR) ≥ 1.5], and any degree of mental alteration (encephalopathy) in a patient without pre-existing cirrhosis. RESULTS: Out of 240 patients [57.7% male, 42.3% female; 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 nausea and vomiting (PNV), bleeding, hepatomegaly and ascites were present in 125, 92, 39, 129 and 28 cases respectively. Elevated aspartate aminotransferase (AST), 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 .1000 IU/ml (this included 4/ 15 with profound shock). 16/41 patients with AST .1000 IU/ml, including 4 with profound shock, developed ALF while none with AST ,1000 IU/ml developed ALF. In patients with AST .1000 IU/ml, presence of 2 or 3 of elevated SB, elevated ALP or PNV predicted the development of ALF with 93.8% sensitivity, 98.7% specificity, 83.3% positive predictive value and 99% negative predictive value (Fisher's exact test). CONCLUSIONS: Dengue patients with AST,1000 IU/ml are not at risk of developing ALF. Patients with AST .1000 (regardless of presence or absence of profound shock), with 2 or 3 of elevated SB, elevated ALP or PNV seem to be at risk of developing ALF. These findings need to be validated in a larger cohort of patients.
The prone 12 o'clock position reduces Heal intubation time during colonoscopy compared to the left lateral 6 o'clock (standard) position
(Sri Lanka Medical Association, 2010) de Silva, A.P.; Kumarasena, R.S.; Keragala, B.S.D.P.; Kalubowila, K.V.U.; Niriella, M.A.; Dassanayake, A.S.; Pathmeswaran, A.; de Silva, H.J.
OBJECTIVES: Ileal intubation is the gold standard for evidence of a complete colonoscopy. However, despite evidence of clinical benefit, ileoscopy is not always attempted due to perceived technical difficulty. The aim of this study was to compare time taken for ileal intubation using a new position - the prone 12 o'clock position (PP) - with the standard method (left lateral 6 o'clock position-LLP).METHODS: We first performed a pilot study using fluoroscopy to determine the best patient position for the most direct (end-on) approach to the ileo-caecal valve. The prone 12 o'clock position appeared to be the best position. We then randomized consecutive patients having colonoscopy, aged 18-80 years and who were not pregnant, to undergo ileoscopy in the standard position or the prone 12 o'clock position. RESULTS: Colonoscopy was performed on 150 patients [82 females, mean (SD) age 53 (16) years]. 75 patients were randomized for ileal intubation in the PP and 75 patients in the LLP. Overall, the ileum was successfully intubated in 145 (96%) patients [74 (98.7%) in the PP and 71 (94.7%) in the LLP]. The mean (SD) ileal intubation time was 26.4 (63) seconds in the PP and 96.9 (112) seconds in the LLP (p0.000l; Student t-test). The ileum was abnormal in 11 (7.5%) patients: 6 in the PP group and 5 in toe LLP group. CONCLUSIONS: During colonoscopy, the prone 12 o'clock position gives a more direct approach to the ileo-caecal valve and reduces ileal intubation time when compared to the standard left lateral 6 o'clock position.
The Prone 12 o'clock position reduces iIleal intubation time during colonoscopy compared to the left lateral 6 o'clock (standard) position
(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2010) de Silva, A.P.; Kumarasena, R.S.; Keragala, S.P.; Udayapushpa, K.V.; Niriella, M.A.; Dassanayake, A.S.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION Ileal intubation is the gold standard for evidence of a complete colonoscopy. However, despite evidence of clinical benefit, ileoscopy is not always attempted due to perceived technical difficulty. Although several studies have previously reported on the time taken for ileal intubation, such timings have not been standardized. Aim To compare time taken for ileal intubation using a new position - the prone 12 o’clock position (PP) - with the standard method (left lateral 6 o’clock position-LLP). METHODS We first performed a pilot study using fluoroscopy to determine the best patient position for the most direct (end-on) approach to the ileo-caecal valve. The prone 12 o’clock position appeared to be the best position. We then randomized consecutive patients having colonoscopy, aged 18-80 years and who were not pregnant, to undergo ileoscopy in the standard position or the prone 12 o’clock position. After the ileo-caecal valve was identified during colonoscopy, ileal intubation time was standardized and defined as the time taken for the tip of the colonoscope to be maneuvered from the mid-point of the caecum to entering the terminal ileum. RESULTS Colonoscopy was performed on 150 patients [82 females, mean (SD) age 53 (16) years]. 75 patients were randomized for ileal intubation in the PP and 75 patients in the LLP. Overall, the ileum was successfully intubated in 145 (96%) patients [74 (98.7%) in the PP and71 (94.7%) in the LLP]. The mean (SD) ileal intubation time was 26.4 (63) seconds in the PP and 96.9 (112) seconds in the LLP (p0.0001; Student t-test). The ileum was abnormal in 11 (7.5%) patients: 6 in the PP group and 5 in the LLP group. CONCLUSIONS During colonoscopy, the prone 12 o’clock position gives a more direct approach to the ileo-caecal valve and significantly reduces ileal intubation time when compared to the standard left lateral 6 o’clock position
The Prone 12 o'clock position reduces ileal intubation time during colonoscopy compared to the left lateral 6 o'clock (standard) position
(BioMed Central, 2011) de Silva, A.P.; Kumarasena, R.S.; Keragala, S.D.P.; Kalubowila, U.; Niriella, M.A.; Dassanayake, A.S.; Pathmeswaran, A.; de Silva, H.J.
BACKGROUND: Ileal intubation is the gold standard for a complete colonoscopy. However, despite evidence of clinical benefit ileoscopy is not always attempted due to perceived technical difficulty. Our aim was to compare time taken for ileal intubation using a new position-the prone 12 o'clock position (PP) with the standard method (left lateral 6 o'clock position-LLP). METHODS: We performed a pilot study using fluoroscopy to determine the best patient position for ileal intubation. This was the prone 12 o'clock position. Patients were colonoscoped in the left lateral position and then randomized to ileal intubation in the 6 o'clock position(LL) or the 12 o'clock (PP) position. RESULTS: 202 consecutive patients were referred for colonoscopy. Colonoscopy was performed on 150 patients [82 females, mean (SD) age 53 (16) years]. 75 patients were randomized for ileal intubation in the PP and 75 patients in the LLP. Overall, the ileum was successfully intubated in 145 (96%) patients [74 (98.7%) in the PP and 71 (94.7%) in the LLP]. The median (Interquartile Range) ileal intubation time was 12 (10) seconds in the PP and 87 (82) seconds in the LLP (p < 0.0001; Mann-Whitney U test). The ileum was abnormal in 11 (7.5%) patients. CONCLUSIONS: During colonoscopy, the prone 12 o'clock position gives a more direct approach to the ileo-caecal valve and significantly reduces ileal intubation time. TRIAL REGISTRATION: Trial registry: Sri Lanka Clinical Trial Registry Clinical trial registry number: SLCTR/2009/002
Usefulness of Ileoscopy during Colonoscopy
(American Gastroenterological Association(AGA) Institute, Published by Elsevier Inc., 2011) Wijewantha, H.; de Silva, A.P.; Wijesinghe, N.T.; Kumarasena, R.S.; Dassanayake, A.S.; Hewavisenthi, S.J.; de Silva, H.J.
INTRODUCTION: Ileoscopy during colonoscopy adds only three minutes to total procedure time and has no added complications. However, available evidence for recommending the procedure is contradictory. There are few studies adressing this issue in South Asian populations. Aims: To investigate the usefulness of terminal ileoscopy during colonoscopy in a cohort of Sri Lankan patients attending a tertiary care centre. METHODOLOGY: From January 2007, our unit policy was to perform ileoscopy in all patients undergoing colonoscopy. A retrospective analysis of all patients who underwent colonoscopy in the unit from January 2007 to September 2010 was performed. Data were obtained from endoscopy unit and patient records. We compared usefulness of ileoscopy in patients considered to have specific clinical indications for ileoscopy - right iliac fossa pain, diarrhea, anemia, inflammatory bowel disease and raised inflammatory markers (group A) with those that did not (group B). RESULTS: 789 colonoscopies were performed during the study period, and the terminal ileum was successfully intubated in 638 (80.9%). Reasons for not intubating the ileum were technical difficulty and/or severe patient discomfort. 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 other abnormalities, of doubtful clinical importance and which did not alter management, 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 macroscopically normal terminal ileum had abnormal microscopy: Crohn’s disease (21), ileitis - resolving infection (3) or drug induced (2), backwash ileitis in ulcerative colitis (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=1, p=0.038). CONCLUSION: Ileoscopy and biopsy during colonoscopy is a useful investigation which detects significant pathology, in some instances where the rest of the colon is normal and sometimes even when the ileum appears macroscopically normal. The procedure should be recommended, especially for patients with right iliac fossa pain, diarrhea, anemia, inflammatory bowel disease and raised inflammatory markers.
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.
The Utility of the ALT: AST ratio as an early screening test for dengue fever
(Sri Lanka Medical Association, 2010) de Silva, A.P.; Keragala, B.S.D.P.; Kasturiratne, A.; Kumarasena, R.S.; Dassanayake, A.S.; Premaratna, R.; Dassanayake, K.M.M.P.; de Silva, H.J.
OBJECTIVES: Early diagnosis of dengue infection is important to reduce morbidity and mortality. The widely used antibody test becomes positive only after the fifth day of fever, and viral diagnosis by PCR is expensive and not widely available. Liver transaminases are commonly elevated in dengue, and the aspartate aminotransferase: alanine aminotransferase (AST: ALT) ratio is >1. This study was done to determine the utility of the AST/ALT ratio >1 as a test to detect dengue infection early. Methods: We recruited all patients aged 18 to 65 years who were not pregnant, with fever less than three days admitted to hospital from September 2009 to January 2010 during the current dengue epidemic. In addition to routine invetigations and management, all patients had liver transaminases (AST and ALT) measured on day 3, and dengue IgM antibody on day five of the illness. Statistical analysis was performed using SPSS 16. RESULTS: 117 patients [65 males; mean age 32 years (SD =14.7)] were recruited. 83/117 (70.9%) were confirmed as dengue infection. AST: ALT >1 was significantly more common in dengue compared to other short duration fevers (75/83 vs 13/34, pO.OOl; Chi squared test). AST: ALT ratio >1 on day 3 had a sensitivity of 90.4% and specificity of 61.8% to detect dengue. The positive predictive value and negative predictive value of the ratio were 85.2% and 72.4% respectively. CONCLUSIONS: AST/ALT ratio seems a useful test to differentiate dengue fever from other short duration febrile illnesses in an epidemic setting.
Worsening cholestasis and possible cefuroxime-induced liver injury following "successful" therapeutic endoscopic retrograde cholangiopancreatography for a distal common bile duct stone: a case report
(BioMed Central, 2016) Niriella, M.A.; Kumarasena, R.S.; Dassanayake, A.S.; Pathirana, A.; de Silva, H.J.
BACKGROUND: Cefuroxime very rarely causes drug-induced liver injury. We present a case of a patient with paradoxical worsening of jaundice caused by cefuroxime-induced cholestasis following therapeutic endoscopic retrograde cholangiopancreatography for a distal common bile duct stone. CASE PRESENTATION: A 51-year-old, previously healthy Sri Lankan man presented to our hospital with obstructive jaundice caused by a distal common bile duct stone. Endoscopic retrograde cholangiopancreatography with stone extraction, common bile duct clearance, and stenting failed to improve the cholestasis, with paradoxical worsening of his jaundice. A liver biopsy revealed features of drug-induced intrahepatic cholestasis. Although his case was complicated by an episode of cholangitis, the patient made a complete recovery in 4 months with supportive treatment and withdrawal of the offending drug. CONCLUSIONS: This case highlights a very rare drug-induced liver injury caused by cefuroxime as well as our approach to treating a patient with paradoxical worsening of jaundice after therapeutic endoscopic retrograde cholangiopancreatography.