Browsing by Author "Nandasiri, A.S.D."

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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.
Do thalassaemic patients, their parents and caregivers support termination of pregnancy as a method for thalassaemia prevention?
(Sri Lanka Medical Association, 2011) Nandasiri, A.S.D.; Dissakaruna, A.M.D.D.; Silva, D.P.S.I.; Nishad, A.A.N.; Premawardhena, A.P.
INTRODUCTION AND OBJECTIVES: The only proven way to prevent thalassaemia, the commonest monogenic disease in Sri Lanka, is premarital and ante natal counselling followed by pre-natal diagnosis (PND) and termination of affected fetuses. Termination of pregnancy (TOP) of a thalassaemic fetus is illegal in Sri Lanka. This study assesses the attitudes towards termination of thalassaemic fetuses among the patients themselves, their immediate family members and hospital staff. METHODS: A single operator administered a pre-formed questionnaire to test the knowledge and attitudes towards TOP among patients, parents, immediate family members and hospital staff associated with the thalassaemia unit; over a two month period from Is' of March 2010, at the Thalassaemia Unit, NCTH, Ragama. RESULTS: A total of 24 adult patients with thalassaemia major (TM) and 15 with thalassaemia intermedia (TIM) 39 parents and 25 hospital staff were interviewed. 39.1% of TMs, 60% TIMs, 60% hospital staff, 54.5% parents were aware of PND. 78.8% of TMs, 87% TIMs, 60% hospital staff, 85.3% parents knew that abortion of a thalassaemic fetus was illegal. Only 39.1% of TM supported TOP, if thalassaemia was diagnosed antenatally whilst 73.3% TIMs, 80% hospital staff and 88.57% parents were supportive (pO.OQl). 78.2% of TMs, 100% in all other groups support premarital screening and making partner screening compulsory. CONCLUSIONS: Though there is strong support for TOP from parents and hospital staff, this is not so with patients with TM. However partner selection prior to marriage seems to have more uniform support.
Pulmonary arterial hypertension in thalassaemia patients- does splenectomy and disease severity increase the risk?
(Sri Lanka Medical Association, 2011) Premawardana, N.P.; Nandasiri, A.S.D.; Ranaweera, A.G.R.M.A.; Nishad, A.A.N.; Silva, D.P.S.I.; Premawardhena, A.P.
INTRODUCTION AND OBJECTIVES: Pulmonary arterial hypertension (PAH) has been described in patients with thalassaemia. A causative association with splenectomy has been postulated. Our previous observations differed from this. We aimed to study these factors in our patients. METHODS: Pulmonary artery pressure (PAP) and other data of thaiassaemics attending the Thalassaemia Unit, Ragarna were studied using clinic records. PAP was measured using trans-thoracic 2D echocardiography. Four categories were separately analysed: thalassaemia major (TM) with splenectomy (A) and without (B), thalassaemia intermedia (TI) with splenectomy (C) and without (D). PAH was defined as PAP over 25 mm Hg. RESULTS: A total of 74 patients were studied, 60 (81%) with TM and 14 (19%) with TI. 25 of TMs (41%) and 10 of TIs (71%) had splenectomy (p <0.05). Mean ages (SD) of TM and TI were 20.71(8.4) and 32.6 (13.3) years respectively. Those of categories ABCD were 20.9 (7.4), 20.7 (9.1), 27 (9.6) and 46 (12.3) years. A total of 16 (21.6%) of all patients had PAH (95% CI13.8-32.3). This included 13 (21.7%) TM patients and three (21.4%) with TI (p-0.98). The prevalence of PAH was 17.1% (95 CI 8.4-33.5) in splenectomised thalassaemia patients and 25.6% (95% CI 16.5-43.8) in non splenectomised patients (p= 0.37), and in categories A,B,C,D were 16%, 23%, 20% and 25% respectively. Mean of PAP of splenectomised with PAH is 39 mmHg (SD=4.5) and in non splenectomised with PAH was 34.9 mmHg (SD=5.3) (p=0.8). CONCLUSIONS: PAH is a significant complication in patients with thalassaemia. However the severity of disease nor the splenectomy status were found to be causatively linked in our study.