Browsing by Author "Moratuwagama, D."

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An audit of patients' compliance with the standards for warfarin therapy
(Sri Lanka Medical Association, 2018) Fernando, C. H. K. A.; Costa, Y. J.; Williams, H. S. A.; Moratuwagama, D.
INTRODUCTION AND OBJECTIVES: Warfarin is an oral anticoagulant with complex pharmacokinetics and pharmacodynamics. Therefore close monitoring is essential. Strict adherence to therapy depends on the patient's knowledge regarding anticoagulation. The objective was to assess patients' essential knowledge on warfarin with regard to anticoagulation therapy. METHODS: An audit was conducted over 6 months at Colombo North Teaching Hospital. 50 consecutive patients, of both genders, who had been on warfarin for at least 1 month were recruited. Their knowledge of warfarin therapy was evaluated using a 10 item questionnaire. Results were analyzed and compared against standards. RESULTS: Male:female ratio was 4:6 and mean age was 59.7 years. 46 % of patients had completed education up to Ordinary Level, 6% had never attended school. Indications for warfarin included: VTE 46 %, atrial fibrillation 28%, chronic cardiac dysfunction 22%, prosthetic heart valves 2%, and pulmonary hypertension 2%. 62% knew their current dose of warfarin, 4% were aware of their therapeutic INR, 68% knew what remedial action should be taken in the event of a haemorrhage, 48% were aware of effects of over anticoagulation, 22% were aware of effects of subtherapeutic anticoagulation, 86% were aware of interference of green leaves with therapy, 40% were aware ofNSAID affect anticoagulation, 70% were aware of alcohol effect on anticoagulation. CONCLUSION: As results did not meet standards, we suggest there should be better patient education regarding warfarin therapy. Patient information leaflets as well as information of this audit be made aware to teams concerned for better care of patients.
Percentage of small platelets on peripheral blood smear and Child-Turcott-Pugh class can predict the presence of oesophageal varices in newly diagnosed patients with cirrhosis: development of a prediction model for resource limited settings
(BioMed Central, 2019) Perera, K.; Kodisinghe, S.K.; Ediriweera, D.S.; Moratuwagama, D.; Williams, S.; Pathmeswaran, A.; Niriella, M.A.; de Silva, H.J.
BACKGROUND:In cirrhosis upper-gastrointestinal-endoscopy (UGIE) identifies oesophageal varices (OV). UGIE is unavailable in most resource-limited settings. Therefore, we assessed prediction of presence of OV using hematological parameters (HP) and Child-Turcott-Pugh (CTP) class.METHODS:A prospective study was carried out on consecutive, consenting, newly-diagnosed patients with cirrhosis, in the University Medical Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka from April 2014-April 2016. All patients had UGIE to evaluate presence and degree of OV, prior to appropriate therapy. HP (full blood count with indices using automated analyzer and peripheral blood smear using Leishmann stain) and CTP class were assessed on admission. Linear logistic regression model was developed to predict OV using HP and CTP class.RESULTS:54-patients with cirrhosis were included [14(26%), 24(44%) and 16(30%) belonged to CTP class A, B and C respectively]. 37 had varices [CTP-A 4/14(26.6%), CTP-B 19/24(79.2%), CTP-C 14/16(87.5%)] on UGIE. Generalized linear model fitting showed decreasing percentage of small platelets (%SP) (P = 0.002), CTP-B (P = 0.003) and CTP-C (P = 0.003) compared to CTP-A had higher probability of having OV. The model predicts the log odds for having OV = - 0.189 - (0.046*%SP) + 2.9 [if CTP-B] + 3.7 [if CTP-C]. Based on receiver operating characteristic (ROC) analysis, a model value > - 0.19 was selected as the cutoff point to predict OV with 89%-sensitivity, 76%-specificity, 89%-positive predictive value and 76%-negative predictive value.CONCLUSIONS:We constructed a model using %SP on peripheral blood smear and CTP class. This model may be used to predict the presence of OV, in newly diagnosed patients with cirrhosis, with acceptable sensitivity and specificity, to prioritize the patients who deserve early UGIE in limited resource settings
Splenic Syndrome in a young man at high altitude with undetected Sickle Cell Trait
(Sage, 2018) Fernando, C.H.K.A.; Mendis, S.; Upasena, A.P.; Costa, Y.J.; Williams, H.S.A.; Moratuwagama, D.
INTRODUCTION: Splenic syndrome is a rare presentation of sickle cell disease. It is important to rule out this possibility when an ethnically vulnerable patient presents with an acute abdominal symptoms in a background of precipitating events. CASE REPORT: A 26-year-old man who developed a severe abdominal pain at high altitude, found to have a tender splenomegaly. However, further inquiry revealed he is from an area where sickle cell disease is prevalent. Screening for sickle cell disease was positive. Radiological investigations confirmed a massive splenic infarction keeping with a diagnosis of splenic syndrome. Patient was managed conservatively. CONCLUSION: Sickle cell trait is considered a benign carrier state. However, rarely they can present with life-threatening conditions. Therefore, a high degree of clinical suspicion is required for early diagnosis of these specific entities to avoid increased morbidity and mortality of these patients.