Browsing by Author "Senanayake, S.M."

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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.
Development and validation of Sinhala version of the chronic liver disease questionnaire (CLDQ)
(Wiley Blackwell Scientific Publications, 2013) Miththinda, J.K.N.D.; Ranawaka, C.; Pathmeswaran, A.; Dassanayake, A.S.; de Alwis, W.R.S.; Mufeena, M.N.F.; Senanayake, S.M.; Niriella, M.A.; de Silva, A.P.; de Silva, H.J.
OBJECTIVE: The Chronic Liver Disease Questionnaire (CLDQ) is a validated tool measuring the Health Related Quality of Life among cirrhotics. Aim of this study was to develop and validate a Sinhala version of the CLDQ (sCLDQ) and to test its correlation with the degree of liver dysfunction in a cohort of Sri Lankan patients with cirrhosis. METHODS: A standard translation method was used to develop the sCLDQ. Pilot testing was done with relevant cultural and language adaptations. The final version was self-administered to stable CLD patients, together with the WHO Quality of Life-BREF (WHOQOL-BREF) validated Sinhala version, for comparison. sCLDQ was re administered 4 weeks later to test internal consistency and reliability. The validation was assessed by Cronabach’s alpha, intraclass correlation coefficient (ICC) and Pearson’s correlation coefficient. ANOVA and Pearson’s correlation were used to test correlation with the degree of liver dysfunction. RESULTS: Validation was done with 214 subjects, mean age 55.6 (SD 10.4) years; male 77.6%. Overall Cronabach’s alpha was 0.926. Itra-class correlations varied from 0.431 to 0.912 and all were significant (p 0.000). Retesting was done on a sub-sample of 18 subjects. Test-retest correlation was 0.695 (p 0.008). WHO-BREF was applied on a sub-sample of 48 subjects. There was a significant correlation (Pearson’s r = 0.391; p = 0.004) between sCLDQ and WHOQOL BREF. sCLDQ was significantly associated with MELD (r = −0.13; p = 0.038), MELD Sodium (r = −0.223; p = 0.002), Bilirubin (r = −0.124; p = 0.036), Serum Sodium (r = 0.172; p = 0.009), Serum Albumin (r = 0.201; p = 0.003) and Child grade (f = 3.687; p = 0.027). CONCLUSION: sCLDQ is a reliable and valid tool to assess QoL of Sri Lankan cirrhotics and correlates well with known indices of disease severity.
Development and validation of sinhala version of the Chronic Liver Disease Questionnaire (CLDQ) for assessment of quality of life among cirrhotics
(Sri Lanka Medical Association, 2012) Ranawaka, C.K.; Pathmeswaran, A.; de Alwis, W.R.S.; Mufeena, M.N.F.; Wijewantha, H.S.; Senanayake, S.M.; Niriella, M.A.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.
INTRODUCTION: Chronic liver disease (CLD) has a negative impact on patient quality of life (QOL). The Chronic Liver Disease Questionnaire (CLDQ) is a validated tool which measures the Health Related Quality of Life (HRQL) among cirrhotics. CLDQ is easy to administer, measures six domains of QOL; abdominal symptoms, fatigue, systemic symptoms, activity, emotional functions and worry. It shows good correlation with severity of CLD. Aims: To develop and validate a Sinhala version of the CLDQ (sCLDQ). METHODS: A standard method of forward and back-translation by bilingual translators was used to develop the sCLDQ. Pilot testing were done with relevant adaptations, considering differences in culture and language. The final version was self-administered to stable CLD patients without significant co-morbidities, together with the WHO BREF Sinhala version (validated for patients of any disease), for comparison. sCLDQ was re-administered 4 weeks later to study its internal consistency and reliability. The sCLDQ validation was assessed by Cronabach's alpha, intraclass correlation coefficient (ICC) and Pearson's correlation coefficient RESULTS: Forty eight patients participated in the validation process. The item total correlations of sCLDQ varied from 0.30 to 0.82 (except one item number 0.15). Overall Cronabach's alpha was 0.92. Re-administration of sCLDQ to 15 patients yielded an ICC of 0.54 (p = 0.02). There was a significant correlation (Pearson's r = 0.34; p = 0.03) between sCLDQ and WHO BREF. CONCLUSIONS: sCLDQ was reliable and valid and would be a useful tool to assess QOL of cirrhotic patients in Sri Lanka.
Development and validation of sinhala version of the chronic liver disease questionnaire (CLDQ) for assessment of quality of life among cirrhotics
(Wiley Blackwell Scientific Publications, 2012) Ranawaka, C.K.; Pathmeswaran, A.; Senanayake, S.M.; de Alwis, R.; Mufeena, M.N.F.; Niriella, M.A.; Dassanayake, A.S.; de Silva, A.P.; de Silva, H.J.
BACKGROUND AND AIM: Chronic liver disease (CLD) has a negative impact on patient quality of life (QOL). The Chronic Liver Disease Questionnaire (CLDQ) is a validated tool which measures the Health Related Quality of Life (HRQL) among cirrhotics. CLDQ is easy to administer and measures six domains of QOL; abdominal symptoms, fatigue, systemic symptoms, activity, emotional functions and worry. It shows good correlation with severity of CLD. No tool had been developed previously to asses QOL among CLD patients in Sri Lanka. Aim of this study was to develop and validate a Sinhala version of the CLDQ (sCLDQ). METHODS: A standard method of forward and back-translation by bilingual translators was employed to develop the sCLDQ. Pilot testing was done with relevant linguistic and cultural adaptations. The final version was self-administered to stable CLD patients without significant comorbidities, together with the WHO BREF Sinhala version (a validated QOL assessment tool for any disease), for comparison. sCLDQ was re-administered 4 weeks later to study its internal consistency and reliability. The sCLDQ validation was assessed by Cronabach’s alpha, intraclass correlation coeffi cient (ICC) and Pearson’s correlation coeffi cient. RESULTS AND DISCUSSION: Forty eight patients participated in the validation process. The item total correlations of sCLDQ varied from 0.30 to 0.82 (except one item, 0.15). Overall Cronabach’s alpha was 0.92. Re-administration of sCLDQ to 15 patients yielded an ICC of 0.54 (p = 0.02). There was a signifi cant correlation (Pearson’s r = 0.34; p = 0.03) between sCLDQ and WHO BREF. Conclusion: sCLDQ was reliable and valid and would be a useful tool to assess QOL among cirrhotic patients in Sri Lanka.
Intravenous N-acetylcysteine in acute liver failure associated with dengue infection
(Sri Lanka Medical Association, 2010) Rumarasena, R.S.; Senanayake, S.M.; de Silva, A.P.; Biyanwila, C.; Dassanayake, A.S.; Premaratna, R.; V/ijesiriwardena, B.; de Silva, H.J.
BACKGROUND: Acute liver failure is rare in dengue but has a poor outcome. N-acetylcysteine (HAC) improves survival in early stage non-acetaminophen acute liver failure. However, its usefulness has not been established in dengue associated acute liver failure. OBJECTIVES: To determine the benefit of intravenous NAC in acute liver failure due to dengue. Methods; Outcome of consecutive adult patients with serologically confirmed dengue infection associated acute liver failure (INR>1.5 with encephalopathy) was retrospectively analysed. They received NAC by intravenous infusion for 72 hours in addition to supportive management. None had taken paracetamol above the therapeutic dose, used hepatotoxic drugs or abused alcohol. Serology for Hepatitis A, B, C, leptospira, and rickettsiae was negative. All patients had negative computerized tomography of the brain. RESULTS: There were 18 patients, (10 females) aged 22-68 years. 11 had dengue hemorrhagic fever (grade 1 and 2), 7 had dengue shock syndrome, 12 had pleural effusions and 8 had ascites. 15 patients had acute liver failure and 3 acute on chronic liver failure (previously diagnosed cirrhotics). 14 patients had early stage hepatic encephalopathy (coma grades I-II), and 4 had advanced encephalopathy (coma grades III-IV). All patients with coma grades l-II recovered completely, while 3 with coma grades III-IV died. None had adverse effects attributable to NAC. CONCLUSION: These preliminary observations suggest that using intravenous NAC in the early stages of dengue associated liver failure is safe and may benefit patients.
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
The Long-term outcomes of a cohort of Sri Lankan patients with ulcerative colitis: a retrospective study at two national referral centers and review of literature
(Dove Medical Press, 2013) Senanayake, S.M.; Fernandopulle, A.N.; Niriella, M.A.; Wijesinghe, N.T.; Ranaweera, A.; Mufeena, M.N.; Pathmeswaran, A.; Navarathne, N.M.; de Silva, A.P.; de Silva, H.J.
BACKGROUND: Inflammatory bowel disease, especially ulcerative colitis, is increasing in many "non-Western" countries, including Sri Lanka. The aim was to evaluate long-term outcomes of ulcerative colitis in a Sri Lankan population. METHODS: A retrospective cohort study was conducted at the gastroenterology clinics of the Colombo North Teaching Hospital, Ragama and the National Hospital of Sri Lanka, Colombo; the two major referral centers for ulcerative colitis. All cases had histological confirmation of ulcerative colitis. Three outcomes: colectomy, development of colorectal carcinoma, and death were assessed. Patients not attending the clinic during the previous 4 weeks, or their families, were contacted to obtain clinical details and survival status. In those who had died, the cause of death was confirmed from clinical records and death certificates. RESULTS: Details of 348/425 (81.9%) patients with ulcerative colitis (mean age 45.6 [standard deviation {SD} 14.3] years, male/female ratio = 1.00:1.03) were available. The mean follow-up was 6.8 (SD 6.5) years. The cumulative colectomy rates at 1, 5, 10, and 15 years were 1.5%, 4.0%, 5.5%, and 9.3% respectively. The cumulative probability of colorectal cancer in this cohort after 10 and 15 years was 0.47% and 2.36% respectively. The cumulative survival rate after 1, 5, 10, and 15 years was 99.7%, 98.9%, 98.1%, and 94.5% respectively. Patients with pancolitis were more likely to have disease-related death (P = 0.05). Multivariate analysis (Cox proportional hazards model) showed that an older age at diagnosis was associated with long-term mortality (hazard ratio, 1.11; P = 0.001). CONCLUSION: In this cohort, colectomy, colorectal carcinoma, and death rates were low, suggesting a relatively benign disease course for ulcerative colitis.
Survival of patients with alcoholic and cryptogenic cirrhosis without liver transplantation: a single center retrospective study
(Biomed Central, 2012) Senanayake, S.M.; Niriella, M.A.; Weerasinghe, S.K.; Kasturiratne, A.; de Alwis, J.P.N.; de Silva, A.P.; Dassanayake, A.S.; de Silva, H.J.
BACKGROUND: There is no recent data addressing the long term survival of cirrhosis patients without transplantation, but with the availability of optimal pharmacological and endoscopic therapies. We compared the long term transplant free survival of alcoholic (AC) and cryptogenic (CC) cirrhosis patients in a setting where liver transplantation was, until very recently, not available. AC and CC patient details were extracted from our database, maintained since 1995. For those who had not attended clinics within the past 4 weeks, the patient or families were contacted to obtain survival status. If deceased, cause of death was ascertained from death certificates and patient records. Survival was compared using Kaplan-Meier curves. RESULTS: Complete details were available in 549/651 (84.3%) patients (AC 306, CC 243). Mean follow up duration (SD) (months) was 29.9 (32.6). 82/96 deaths (85.4%) among AC and 80/94 deaths (85.1%) among CC were liver related. Multivariate analysis showed age at diagnosis and Child's class predicted overall survival among all groups. The median survival in Child's class B and C were 53.5 and 25.3 months respectively. Survival was similar among AC and CC. Among AC survival was improved by abstinence [HR = 0.63 (95% CI: 0.40-1.00)] and was worse with diabetes [HR=1.59 (95% CI: 1.02- 2.48)] irrespective of alcohol status. CONCLUSIONS: The overall survival of AC was similar to CC. Death in both groups were predominantly liver related, and was predicated by age at diagnosis and Child class. Among AC, presence of diabetes and non-abstinence from alcohol were independent predictors for poor survival.
Validation of Sinhala version of the Chronic Liver Disease Questionnaire (CLDQ) and evaluation of health related quality of fife among patients with cirrhosis in Sri Lanka
(Sri Lanka Medical Association, 2013) Miththinda, J.K.N.D.; Ranawaka, C.K.; Pathmeswaran, A.; Dassanayake, A.S.; de Alwis, W.R.S.; Mufeena, M.N.F.; Senanayake, S.M.; Niriella, M.A.; de Silva, A.P.; de Silva, H.J.
AIMS: Our aim was to validate a Sinhala version of the CLDQ (sCLDQ) and to test its correlation with the degree of liver dysfunction in a cohort of Sri Lankan cirrhotics. METHODS: A standard method was used to translate the CLDQ to Sinhala. Pilot testing was done and relevant cultural and language adaptations made. The final version was self-administered to stable chronic liver disease (CLD) patients, together with the WHO Quality of Life-BREF (WHOQOL-BREF) validated Sinhala version, for comparison. The sCLDQ was re-administered 4 weeks later to test internal consistency and reliability. The validation was assessed using Cronabach's alpha, intraclass correlation coefficient (ICC) and Pearson's correlation coefficient. ANOVA and Pearson's correlation were used to test correlation with the degree of liver dysfunction. RESULTS: Validation was done with 48 subjects, mean age 55.6 (SD 10) years; male 79%. Item total correlations of sCLDQ varied from 0.30-0.82. Overall Cronabach's alpha was 0.92. Re-administration of sCLDQ yielded an ICC of 0.54 (p=0.02). There was a significant correlation between sCLDQ and WHOQOL-BREF (r=0.34; p=0.03). Validated sCLDQ xvas administered to a different cohort of 202 cirrhotics with mean age of 55.3 years (SD 10,5); male 77%; mean duration of cirrhosis 2.7 years (SD 2.9) years. Higher Child class (F=0.000; p-0.017) and hyponatraemia (r=0.2I3; p=0.005) were associated with worse sCLDQ scores. There was no significant association between sCLDQ score and MELD (r=-0.128, p=0.072). CONCLUSIONS: The sCLDQ is a reliable and valid tool to assess QOL of Sri Lankan cirrhotics and it correlates with known indices of disease severity.
Validation of the Sinhala version of the Chronic Liver Disease Questionnaire(CLDQ) for assessment of health related quality of life among Sri Lankan cirrhotics
(Sri Lanka Medical Association, 2013) Ranawaka, C.K.; Miththinda, J.K.N.D.; Senanayake, S.M.; de Alwis, W.R.S.; Mufeena, M.N.F.; Niriella, M.A.; Dassanayake, A.S.; de Silva, A.P.; Pathmeswaran, A.; de Silva, H.J.
OBJECTIVES: The Chronic Liver Disease Questionnaire (CLDQ) is a validated tool measuring Health Related Quality of Life among patients with cirrhosis. The aim of this study was to validate a Sinhala version of the CLDQ (sCLDQ) and to test its correlation with the degree of liverdysfunction in a cohort of Sri Lankan patients with cirrhosis. METHODS: A standard translation method was used. Pilot testing was done with relevant cultural and language adaptations. The final version and the WHO Quality of Life-BREF (WHOQOL-BREF) validated Sinhala version were administered to patients with chronic lever disease(CLD). sCLDQ was re-administered 4 weeks later to test internal consistency and reliability. The validaty and reliability were assessed by Cronabach's alpha, intraclass correlation coefficient (ICC) and Pearson's correlation coefficient. ANOVA and Pearson's correlation were used to assess correlation with the degree of liver dysfunction. RESULTS: Validation was done with 214 participants [mean age 55.6 years (SD 10.4) male 77.6%]. Cronabach's alpha was 0.926. Intra-class correlations varied from 0.431 to 0.912 and all were significant (p< 0.001). Retesting was done on a sub-sample of 18 participants. Test-retest correlation was 0.695 (p = 0.008). WHO-BREF was administered to a sub-sample of 48 subjects. There was a significant correlation (Pearson's r=0.391; p=0.004) between sCLDQ and WHOQOL BREF. sCLDQ was significantly associated with MELD (r=-0.13; p=0.038), MELD sodium (r=-0.223; p=0.002), serum bilirubin (r=-0.124; p=0.036), serum sodium (r=0.172; p=0.009), serum albumin (r=0.201; p=0.003) and Child grade (f=3.687; p=0.027). CONCLUSIONS: CLDQ is a reliable and valid tool to assess quality of life of Sri Lankan patients with cirrhosis and correlates well with known indices of disease severity