Browsing by Author "Perera, K.R.P."

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Effect of audio and visual distraction on patients undergoing colonoscopy: a randomized controlled study
(Stuttgart : Georg Thieme Verlag KG, 2016) de Silva, A.P.; Niriella, M.A.; Nandamuni, Y.; Nanayakkara, S.D.; Perera, K.R.P.; Kodisinghe, S.K.; Subasinghe, K.C.E.; Pathmeswaran, A.; de Silva, H.J.
BACKGROUND AND STUDY AIMS : Colonoscopy can cause anxiety and discomfort in patients. Sedation and analgesia as premedication can lead to complications in the elderly and those with comorbidities. This has led to an interest in the use of audio-visual distraction during the colonoscopy. We compared the effects of audio (AD) versus visual distraction (VD) in reducing discomfort and the need for sedation during colonoscopy. PATIENTS AND METHODS: Consecutive patients undergoing colonoscopy were randomized into three groups: one group was allowed to listen to the music of their choice (AD), the second group was allowed to watch a movie of their choice (VD), and the third group was not allowed either distraction during colonoscopy and acted as a control (C). Patient controlled analgesia and sedation were administered to all three groups. We used 25 mg of pethidine in 5-mg aliquots and 2.5 mg of midazolam in 0.5-mg aliquots. All patients were assessed for perceived pain and willingness to repeat the procedure. Number of "top-ups" of sedation and total dose of pethidine and midazolam were noted. Patient cooperation and ease of procedure were assessed by the colonoscopist. RESULTS: In total, 200 patients were recruited [AD, n = 66 (32 males, median age 57 years); VD, n = 67 (43 males, median age 58 years); C, n = 67 (35 males, median age 59 years)]. The AD group had significantly less pain (P = 0.001), better patient cooperation (P = 0.001) and willingness to undergo a repeat procedure (P = 0.024) compared with VD and C groups. CONCLUSIONS: AD reduces pain and discomfort, improves patient cooperation and willingness to undergo a repeat procedure, and seems a useful, simple adjunct to low dose sedation during colonoscopy.
Frequency, pattern and outcome of renal dysfunction in patients with cirrhosis: a prospective study using the proposed ADQI-IAC criteria
(Sri Lanka Medical Association, 2013) de Silva, S.T.; Perera, K.R.P.; Niriella, M.A.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Current criteria fail to detect milder degrees of renal dysfunction in cirrhosis, and exclude hepatorenal syndrome (HRS1 and 2) in patients who have structural kidney disease. Definitions addressing these issues have been proposed by a working party from the Acute Dialysis Quality Initiative and International Ascites Club (ADQI-IAC). METHODS: We studied the frequency, pattern and outcome of renal dysfunction in patients with cirrhosis using ADQI-IAC definitions. Consecutive patients attending outpatient clinics in Colombo North Teaching Hospital, Ragama, were prospectively recruited and followed up.RESULTS: Of 277 patients with cirrhosis and stable serum creatinine, 27 (9.7%) had serum creatinine >1.5mg/dl (current cut-off), and 23/27 (85%) fulfilled criteria for HRS2. 65/277 (23.5%) had eGFR<60ml/min [ADQI-IAC cut-off for chronic kidney disease (CKD)], but 42/65 (64.6%) did not fulfill criteria for HRS2. Compared to cirrhotics without CKD, the CKD group were older (61.4 vs 53.7 years; pO.OOOl), more likely to be female (50.8% vs 19.3%; p0.000l), had cryptogenic cirrhosis (67.7% vs 41%; pO.OOOl), and were Child-Pugh class B or C (95.4% vs 74%; p0.00l). As expected, they had higher MELD scores (16.6 vs 13.5; p<0.0001). 48/277 (17.3%) died during follow-up [mean 6.5 months (SD 2.2)]; an eGFR<60ml/min independently increased risk of death (HR 2.7; Nagelkerke R Square test). CONCLUSIONS: Compared to HRS criteria, the ADQI-IAC definition detects more than twice the number of cirrhoric patients with CKD. As CKD is associated with increased mortality, further study is needed to determine whether prognosis can be improved by treating acute deterioration of CKD with available treatments for HRS 1.
Frequency, pattern and short-term outcome of chronic renal dysfunction in patients with cirrhosis
(Wiley Blackwell Scientific Publications, 2013) Perera, K.R.P.; de Silva, S.T.; Niriella, M.A.; Pathmeswaran, A.; de Silva, H.J.
OBJECTIVE: Current criteria fail to detect milder degrees of renal dysfunction in cirrhosis, and exclude hepatorenal syndrome (HRS1, HRS2) in patients with structural kidney disease. Definitions addressing this have been proposed by Working Party of the Acute Dialysis Quality Initiative and International Ascites Club (ADQI-IAC). We studied the frequency, pattern and outcome of renal dysfunction in patients with cirrhosis using ADQI-IAC definitions. METHODS: Consecutive patients attending outpatient clinics in Colombo North Teaching Hospital, Ragama, were prospectively recruited and followed up. RESULTS: Of 277 patients with cirrhosis and stable serum creatinine, 27 (9.7%) had serum creatinine >1.5 mg/dl (current cut-off), and 23/27 (85%) fulfilled criteria for HRS2. 65/277 (23.5%) had eGFR <60 ml/min [ADQI-IAC cut-off for chronic kidney disease (CKD)], but 42/65 (64.6%) did not fulfil criteria for HRS2. Compared to cirrhotics without CKD, the CKD group were older (61.4 vs 53.7 years; p < 0.0001), more likely to be female (50.8% vs 19.3%; p < 0.0001), more likely to have cryptogenic cirrhosis (67.7% vs 41%; p < 0.0001), and Child-Pugh class B or C (95.4% vs 74%; p < 0.001). As expected, they had higher MELD scores (16.6 vs 13.5; p < 0.0001). 58/277 (20.9%) died during follow-up [mean 9.8 months (SD 4.5)]. After adjusting for other variables, CKD independently increased risk of death 3.3-fold (Nagelkerke R Square test). CONCLUSION: Compared to HRS criteria, the ADQI-IAC definition detects more than twice the number of cirrhotic patients with CKD. As the presence of CKD is associated with increased mortality, further studies are needed to determine whether prognosis can be improved in such patients by treating acute deterioration of CKD with available treatments for HRS1.
Frequency, pattern and short-term outcome of chronic renal dysfunction in patients with cirrhosis: a prospective study employing HRS and ADOJ-IAC criteria
(Sri Lanka Medical Association, 2014) de Silva, S.T.; Perera, K.R.P.; Niriella, M.A.; Pathmeswaran, A.; de Silva, H.J.
INTRODUCTION AND OBJECTIVES: Diagnostic criteria of hepatorenal syndrome type 2 (HRS2) fail to detect milder degrees of chronic renal dysfunction (CRD) in cirrhosis, and exclude patients with pre-existing kidney disease. Definitions addressing this have been proposed by Working Party of the Acute Dialysis Quality Initiative and International Ascites Club (ADOJ-IAC), we studied the frequency, pattern and short-term outcome of CRD in patients with cirrhosis, using both HRS2 and ADQJ-IAC criteria. METHODS: Consecutive patients with cirrhosis and stable serum creatinine (SCr) for 3 months or more attending outpatient clinics in Colombo North Teaching Hospital, Ragama, were prospectivefy recruited and followed up. RESULTS: Of 277 patients with cirrhosis and stable SCr, 23 (8.3%) fulfilled criteria for HRS2. 65/277 (23.5%) had eGFR<60ml/min/1.73m2 [ADOJ-IAC definition of chronic kidney disease (CKD)]. This included the 23 patients with HRS2, and an additional 42/65 (64.6%) who did not fulfil diagnostic criteria for HRS2 (non-HRS2 CKD). 58/277 (20.9%) died during follow-up [mean 9.8 months (SD 4.5)]. This included 12/23 (52.2%) with HRS2 and 14/42 (33.3%} with Non-HRS2 CKD. Based on a multiple regression model Child-Turcotte:Pugh (CTP) class and CRD were significantly associated with death. After correcting for CTP class, both HRS2 (OR 4.56, 95%CI 1.79-11.53) and Non-HRS2 CKD (OR 2.19, 95%CI 1.02-4.68) were independently associated with death. CONCLUSIONS: Compared to HRS2 criteria, eGFR<60mI/min/1.73m2 detected almost twice the number of cirrhotics with CRD. Patients with eGFR<60ml/min/1.73m2 who did not fulfil criteria for HRS2 also had significant short-term mortality. ADQI-IAC criteria thus appear to be a more useful definition of CRD in cirrhotics.
Renal dysfuction in patients with cirrhosis - a prospective analysis
(Sri Lanka Medical Assosiation, 2012) Perera, K.R.P.; de Silva, S.T.; de Silva, H.J.
INTRODUCTION: Renal dysfunction in cirrhosis has been shown to increase the risk of death seven-fold. Current definitions fail to detect milder degrees of renal dysfunction and exclude hepatorenal syndrome types 1 and 2 (HRS 1 and 2) in patients who have structural kidney diseases. Both have therapeutic implications; delayed diagnosis leading to a worse prognosis and withholding of treatments with potential benefit (eg. TIPPS, vasoconstrictors). Definitions that address these issues have been proposed [cirrhosis with acute kidney injury (AKI), chronic kidney disease (CKD) and acute-on-chronic kidney disease (ACKD)]. AIMS: To study frequency and pattern of renal dysfunction in cirrhotic patients using the newly proposed definitions METHODS: Consecutive patients with cirrhosis attending outpatient clinics were prospectively recruited from 01/08/2011 to 15/03/2012. Clinical data were obtained and renal functions were tested. Results: Of 166 patients with cirrhosis 17(10.2%) had serum creatinine >1.5 mg/dL (current cut-off), and 13/17(76.5%) fulfilled criteria of HRS 2. However, 49/166(29.5%) had eGFR <60 mg/dl (proposed cut-off), but 36/49(73.4%) did not fulfill criteria for HRS. 27/36(75%) had type II diabetes mellitus, 12/36(33.3%) had hypertension and 7/36(19.4%) had no co-morbidities. During the study period, 36/166 patients required admission; 12/36(33.3%) due to acute renal dysfunction (a rise of serum creatinine >0.3mg/dl within 48 hours). 6/12(50%) fulfilled criteria for HRS 1. Of the others, 4/6 had normal renal function and 2/6 had non-HRS CKD prior to admission. CONCLUSIONS: Our results suggest that current definitions fail to detect many cirrhotic patients with renal dysfunction. The proposed criteria seem more inclusive.